Saturday, September 9, 2017

The Second Edition of Saving My Knees Is Out!

Here it is, with a new cover, new preface and five additional short chapters. Putting it together was more of an effort than I expected. Pardon me while I take a victory lap!

The first time, I formatted the book myself. It’s definitely doable, but tedious. I wrote out the steps last time, and on reviewing the process, I thought, “Eh, I’d rather skip this if I can find someone to do it for a good price.”

Did I ever. One of my luckier moments this summer was finding Allen of eB Format. He was responsive, intelligent, reasonably priced (less than $100) and did a nice job. He improved a few things without my asking. I said I’d mention his fine work on the blog, and his website’s here if anyone’s interested.

Now on to the book:

In the second edition, at the end I tried to answer a few criticisms that have surfaced – not that I’m really thin-skinned or anything, but for instance, when someone reads your book and likes it but can’t tell what you did to heal – well, that’s probably a failure of the writing or organization. By the way, if it’s unclear to anyone reading right now, I healed with high-repetition, low-load exercise, which for me was a very structured program of walking.

No fancy stretches, no miracle shoes, etc. Walking your way to health sounds simple, but there was a lot more to my story than that, which is what led to an entire book. I wanted to tell a story: of what happened to my knees, and how I got through it.

Which brings me to a second criticism: It would be a fine book, some readers have opined, if you could skip over the non-knee bits here and there, such as when, during my summer devoted to recovery, everything started going wrong, including my discovery of mold on my camera lenses. I completely understand this. Most people with knee pain just want answers. What do I do, what works, what doesn’t?

I conceived of this book as something different though: a story, with a central character (me) and a progression through the stages of knee pain, the experiments with things that didn’t work, and then the discoveries that led to healing.

Also, I thought it was useful to give readers an idea of what kind of person I am (competitive, type A, active, with a relatively injury-free history). That does figure into how I got into such a mess, and was related to the challenges of getting out. And the camera lens mold turned out to be part of a larger crapfest of a summer, and that turned out to be important too, because you will go through times like that when you have knee pain – every little bad thing that happens will seem like more grief dumped on you, and you’ll think that nothing will ever get better.

So there you have it. I also did the update because I wanted to include a chapter on Scott Dye and his “envelope of function” framework. I knew a little about Dye while writing the original book, but there was much, much more I only found out about later. I wish he could’ve been part of the first edition.

For first-time visitors wondering whether it’s worth their time and money: check out the blog. Poke around some. All the content here is free. If you like what you find, and want to find out the full story – well, Saving My Knees is it.


Update: I want to be clear that, if you bought the first edition, I'm not trying to suggest you buy the second too! That seems absurd. What's in the additional chapters (which are generally short) can be found around the blog (just do a search for "Scott Dye" for example; I talk about him in one of the add-on chapters). I will ask Amazon if people who bought the first can be automatically upgraded to the second, but I'm not optimistic Amazon will be able to do this.

Saturday, August 26, 2017

Can You Guess the Top Five Posts on This Blog?

I was hoping today I could announce the second edition of Saving My Knees was out. But alas, while I was downloading it to Amazon's Kindle publishing center, with the new cover and five additional short chapters, Kindle burped up an unfriendly message.

Namely it had found 11 spelling errors.

Now, nine weren’t really spelling errors, but two were legitimate typos, which made me cringe. So I am going to see if my ebook formatter will correct these two, then we’ll be off to the races – for real this time.

Meanwhile, I thought it would be fun, especially for relatively new visitors, to show you the five most popular blog posts I have done. You see, I have access to the dashboard behind this blog, which shows all sorts of nifty details, such as where visitors are coming from and how many views each post has gotten.

The winner, by a long shot, is “If You’re Overweight and Have Knee Pain, You Need to Read This” – 37,363 views so far. Nice!

The others rounding out the top five:

2. Here Are My "Radical" Beliefs About Healing Bad Knees (17,422)

3. "What Should I Do If I Have 'Weak' Knees?" (14,155)

4. Comment Corner: Sleeping Position, Signals From Bad Knees (10,417)

5. Why I think Cycling May Be the Best Activity for Rehabbing Bad Knees (9,220)

One thing I noticed while doing this little roundup: all these posts are from 2011. So maybe, gulp, I’m running out of things to say?

After the second edition comes out, I’ll probably write fewer posts, and just invite people to chat among themselves. It’s always interesting to hear from people out there who are struggling with knee pain, and listen as others try to help them. Thankfully I’m no longer struggling (which is perhaps why I’ve become a bit boring ... ah well).

Saturday, August 12, 2017

Low Dose Naltrexone for Damping Inflammation?

Sometime visitor “Racer R-X” (that’s his full handle, if I recall correctly) occasionally drops a comment below one of my posts.

I’ve maintained for a while that I get the smart readers in the world of knee pain – thoughtful, analytical people who are in full-on search mode for ways to get better. Every time I hear from Racer R-X, I’m reminded of this.

He’s pretty much beaten his knee pain and is back on his bike, powering up mountains. It took him a while to reach that point, he learned a lot, and I’d love for him to tell his complete story here at some point. (There are bits and pieces in the comments he’s left, scattered over a number of posts.)

Anyway, he dropped in a link to an article, "The use of low-dose naltrexone as a novel anti-inflammatory treatment for chronic pain."

First, people with stubborn knee pain usually suffer from the bad kind of inflammation: chronic inflammation that has a harmful effect on their joints. Getting inflammation under control is important to getting better.

This article suggests that low doses of naltrexone may be helpful for certain people:
Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn’s disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells.
Yes, no overt mention of knees, but complex regional pain syndrome may be a factor in some cases of knee pain, according to one reader of this blog who has researched this extensively.

Naltrexone apparently is used mainly to treat dependence on alcohol or opioids. It’s sold under the trade names Revia and Vivitrol, for example. If you’re having trouble with subduing inflammation, I encourage you to take a look.

Advantages of taking naltrexone include its moderate price (less than a dollar a day) and infrequent side effects.

Disadvantages are worth pointing out too: It’s unclear how to determine the best dose for particular individuals, and the default dose commonly used (4.5 mg) isn’t a size that tablets are now created in. Also the authors note: “Even though naltrexone has a long history of safe use with a wide range of large dosages, we know very little about the long-term safety of the drug when used chronically in low dosages.”

As usual, my standard disclaimer applies: This is not in any way my endorsement of this drug. I’ve never tried it myself; I don’t know anyone who has either. But when I was dealing with knee pain all the time, I eagerly read about anything and everything that might help me. So consider the above link in that spirit.

Saturday, July 29, 2017

The Latest Reason to Skip That Steroid Shot for Knee Pain

If you’re trying to fight inflammation in a bad knee by using drugs, opt for the milder, non-steroidal stuff.

That’s the takeaway from a study published this year in JAMA.

There were 140 subjects, average age 58. They had pain and inflammation because of knee osteoarthritis. For every three months over two years, the subjects received knee injections that consisted of either the corticosteroid triamcinolone or a placebo.

What researchers then found was rather surprising.

Knee pain declined slightly in both groups, but by about the same amount – so the steroid didn’t even outperform a saline placebo. However, those who got the corticosteroid injections had “significantly greater cartilage volume loss.”

The researchers’ conclusion doesn’t mince words: These findings do not support this treatment for patients with symptomatic knee osteoarthritis.

Controlling inflammation is good, but it’s probably a good idea to take a pass on steroids.

Saturday, July 15, 2017

What Jane Brody Wishes She Had Known About Her Knees

Check out “What I Wish I’d Known About My Knees” by Jane Brody of the New York Times. It’s a very good article, and you can feel her weary skepticism shining through. Jane Brody has been through a lot trying to get rid of knee pain. For instance, in the 1990s, she wrote a flattering column about the potential of glucosamine. But alas, in the end the supplements didn’t work. She tried a lot of other things that didn’t work too before finally undergoing a double knee replacement.
Many of the procedures people undergo to counter chronic knee pain in the hopes of avoiding a knee replacement have limited or no evidence to support them. Some enrich the pockets of medical practitioners while rarely benefiting patients for more than a few months. 
I wish I had known that before I had succumbed to wishful thinking and tried them all.
She tried arthroscopic surgery for a shredded meniscus. She mentions a systematic review of 12 trials and 13 observational studies that determined that arthroscopic surgery to improve knee arthritis and tears in the meniscus offered no lasting relief or improvement in function.

She also tried hyaluronic acid when she was told her knee arthritis was bone on bone. But, she reports:
The painful, costly injections were said to relieve knee pain in two-thirds of patients. Alas, I was in the third that didn’t benefit.
One of the best parts of the article wasn't even in the article. I fished it out of the comment section. Note the underlined sentences. This commenter, presumably an orthopedic surgeon, is fully aware of the profit motive at work behind all those needless arthroscopic procedures:
I started my orthopedic residency in 1995. We had a monthly journal club where we met at a fairly expensive restaurant (paid for by pharmaceutical or joint replacement companies!) to discuss the articles in the latest orthopedic journals. 
The article that generated the most buzz was a double blind study of patients with meniscal tears. Half the patients got the actual arthroscopic repair, the other half underwent the same general anesthesia and had the same surgical incisions but no actual arthroscopy. Double blind means neither the patients or the surgeons knew which patients were in which group. No difference was seen in the two groups. Some protested that the study was unethical by subjecting the placebo group to the risks of general anesthesia and infection. In retrospect the same could have justifiably been said about those getting the actual procedure. 
Two decades plus, nothing has changed. Arthroscopy is the bread and butter for orthopedic surgeons. A general orthopedist might do a handful of knee replacements in a week while they do twenty scopes. The latter can be scheduled like a factory line, each scope taking less than half an hour to perform. Doesn't pay like a knee replacement but it's far less grueling on the surgeon (and the patient!). Far less likelihood of complications. 
Nothing's changed in 2+ decades, don't hold your breath waiting for the ortho docs to give up their bread and butter!
Something to keep in mind if a surgeon suggests going into your joint to "clean it up a little"!

Saturday, July 1, 2017

Housekeeping Stuff: Second Edition of SMK, Spam Comments

I’m hoping to get a second edition of Saving My Knees out by the end of the summer, or early fall. The major reason for a new edition is to update a few things, such as how my knees have been since I wrote it (they generally feel great) and what I’ve learned since then (such as the envelope of function framework for understanding knee pain).

But not to worry: I’m not backing away from what’s contained in the heart of the book. I still think the program I followed made the most sense. I may have focused a bit too much on this idea of restoring my cartilage, but I will say: my cartilage was very crunchy before, and it isn’t any longer. So something apparently improved.

Now, on to the subject of what have become increasingly sophisticated spam comments:

I expect that the people who really need to read this won’t, because they don’t really read this blog. Rather, they’re like those people you see briefly in a neighborhood, stapling advertising fliers to a telephone pole, then moving on.

I realize there are ways of escalating against spam comments, such as (most severe) putting comments in a pen until a moderator (that would be me) can approve them. Then nothing that’s spammy gets in the comment section.

But honestly, I don’t think that’s good for people who want live back-and-forth discussions here, plus it’s not great for me either, having to constantly moderate. I’d rather jump in on my usual occasional basis and clean up the comments. So far it seems to be working.

What is a spam comment? This is a good question. As some of you may know, when my book first came out, I was accused of promoting it on the KneeGuru website and thrown out of their online community. In that case though, I was actively participating in the boards. I went on there and told my story and answered questions. Honestly, I strongly believed that I had a message that needed to be spread that I wasn't seeing anywhere else.

So back to the question: What constitutes a spam comment? What gets a comment deleted? Here are a few things I look for:

* Someone I’ve never seen on the site before, who posts once with a link, and that’s it. That's often a red flag.

* A comment that’s blandly approving (“This is a great post”) or that speaks in generalities but doesn’t really address the post above. Believe me, after a while, it gets easy to spot the spam comments where a person probably making $2.15 an hour in some Third World country is trying to engage superficially with the blog, all the time thinking, “Gotta get this link in.”

* A short comment that has a link, either embedded or at the end, to something like “orthopedic supplies.”

Basically, I apply the smell test to a lot of stuff. I hope I haven’t inadvertently deleted any legit comments. But I strongly suspect that if I have, the ratio is something like one good deleted for every 300 bad.

Anyway, that’s the end of the housekeeping stuff. A Happy Fourth to all!

Saturday, June 17, 2017

Fake News, Medical Edition

There is something that’s not quite fake news, but possibly more dangerous, in the world of medicine.

First, what would you think if you had chronic knee pain and came across this intriguing item?
High quality (pharmaceutical grade) chondroitin sulfate is as good as a widely prescribed non-steroidal anti-inflammatory drug (celecoxib) for the treatment of painful knee osteoarthritis, according to a British study published in the Annals of Rheumatic Diseases.
Your reaction might be something along the lines of “Sign me up for that!” Especially when, upon doing a little investigating, you discover that chondroitin sulfate is an over-the-counter supplement – much cheaper and easier to obtain than celecoxib. What’s more, it’s naturally found in cartilage.

The problem is, high-quality studies have found it’s basically useless, just like glucosamine.

So what’s going on with this new study? I was curious and tracked down the full write-up here. But I wasn’t looking for details such as the number of people who took part, the methodology, confidence intervals for the results, etc.

This time, I was looking for something different: a certain taint that is increasingly a problem with published clinical studies. It took me a lot of – I mean, a LOT of – scrolling to find it. But at the end, neatly dropped in like an insignificant afterthought, there it was:
The study was sponsored by IBSA Institut Biochimique SA, Pambio-Noranco, Switzerland, a pharmaceutical company marketing Chondroitin Sulfate. The manuscript was entirely written by the first Author (JYR) who received an editorial assistance from IBSA. However, IBSA has no influence on the content of the manuscript. The editorial assistance was limited to the final editing of the manuscript and the submission process through the ARD website.
Which raises a host of questions: (1) If the study happened to find that chondroitin sulfate was useless, or even worse, harmful in some way, would the results have just been quietly quashed? (2) How exactly was this study “sponsored”? How much money did the principal researchers receive? Are we to believe that the knowledge of who is writing their paychecks really has no influence on how this study is conducted and reported? (3) What exactly was the nature of this “editorial assistance” that was provided?

Upton Sinclair once wrote wisely: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

This study is not quite that kind of situation. But it’s a cousin to that kind of situation.