Saturday, October 7, 2017

Karen’s Success Story: Cycling with a Twist

I recently fished a recovering-by-bicycle story out of the comment section. I love it because it shows how a little ingenuity can take you a long way, and Karen’s attitude is definitely that of a winner. Here it is below, with light editing:

"About two years ago I began experiencing pain in my knees going up and down stairs after workouts. It gradually got worse until I decided to see a doctor. I received X-rays, two cortisone shots and the knowledge that I don’t have arthritis. (I used to work out regularly three to four days a week.)

"I pouted around, got depressed, gained 20 pounds and about one year and a half later finally started seeing a trainer to help me get back in shape. It was very, very slow progress, but after about six months I was able to go up and down stairs without pain. However, the workouts began to get increasingly frustrating because the strength-training exercises pretty much all hurt. Squats were terrible. My trainer was really positive and kept trying to motivate me, but it seemed like everything he tried hurt.

"So I quit and started reading up on knees and ran across your blog.

"Last fall, my husband and I first saw pedal-assist electrical bikes all over Europe. I tried riding a bike when my knees were at their worst and couldn’t. But I tried a stationary bike again and this time had NO problem whatsoever! So my husband and I walked into the bike store and I walked out with a Trek Lift.

"Without sounding corny, it has changed my life. I ride my bike every day I can. I feel normal again. I feel like I’ve actually worked out. My husband and I used to ride together, but stopped due to my knees. Now I leave him in the dust! He loves it because I push him to ride harder and he sometimes even drafts off me. LOL!

"I’ve found that I use the motor the most on very steep hills, when I need to push off at a stop sign, or cross the road quickly. The bike feels best for me in the “ECO” mode in a middle gear. It has the smoothness of a stationary bike and I'm still working to pedal. Plus all the fun of riding outdoors. The best part is that my knees feel better than ever! (My knee problems stem mostly from pressure on the knees, for example: hopping up and down on my toes. But luckily, I’ve never had any problem walking.)

"I wanted to share my cycling SUCCESS story and maybe it will inspire someone else to give a pedal-assist bike a try. Thank you for sharing your success stories too!"

Thank you, Karen! Anyone else want to share a success story? Just drop it in the comment section. Success stories are always in vogue!

Saturday, September 23, 2017

The Great Lie in the U.S. Health Care Debate

I want to talk about something a little different today. If you're an American with bad knees, yes, it affects you – but it also touches the lives of many millions more than than that.

I want to talk about the great lie in the debate about U.S. health care.

First, this isn’t about Democrats, Republicans, Democans, Republicrats, whatever. Personally, I’m an Independent. I think both parties have become corrupted by money, but that’s a subject for another day, and another blog.

The great risible lie is this: U.S. health care is a free market that people choose or choose not to be part of, and like other free markets, the solution to our current woes – millions of uninsured, soaring drug prices, unaffordable insurance, etc. – can be found simply by unshackling market forces.

This is ludicrous.

Look, if I walk into a Honda dealership, and demand an Accord for free, the salesman (if he’s not laughing too hard) will point me to the door and tell me to get lost.

Sales of autos operate well within the free market model. There are competing dealerships; comparison-shopping isn’t hard to do; a Honda Accord buyer who doesn’t find the deal he wants can substitute a like product (a secondhand Accord, or another model from a different carmaker) to satisfy his need for private transportation. Also, we all agree no one has a “right” to a car.

But if I walk into a hospital emergency room, staggering and vomiting blood and without a penny to my name, the nurse on duty won’t point me to the door and tell me to get lost. That hospital has a legal obligation under the Emergency Medical and Treatment Labor Act (passed by Congress in 1986) to care for me. If I don’t have insurance, it doesn’t matter. What’s more, the law doesn’t let doctors half-treat me or dump me on another hospital for failure to pay.

And, at some point, most everyone will wind up in an emergency room. It happens, even to people who eat their kale every day and exercise vigorously and do a hundred other things right. We’re all going to need a health care “product” at some point – and we’ll need it for much more than emergency room visits -- whether we can pay or not. If we can’t pay, everyone else gets to pay for us that day when we land in the ER (see Note #6 below).

The alternative is stark: All those people without insurance, and without a means to pay, we let die.

Who wants that? Who thinks that even makes sense in the richest nation on earth, which spends so much on health care?

I know there are a lot of ideas on fixing the U.S. health care system: offering insurance across state lines (which will do very little), tort reform (which will do a little, but not nearly enough). But the first thing we have to face: every American is in this system together. We need a proposal that starts with that as the first principle. Everyone gets covered. Maybe that leads to single payer. Maybe that leads to Medicare for all. Or maybe there’s a different way.

But let’s be honest about who’s in the U.S. health care system.

We all are.

Some additional notes:

1. The U.S. pays two to three times as much per person as most other industrialized countries on health care. Despite this, the quality of our health care is ranked only 28th worldwide, below Slovenia’s. The U.K., which is ranked fifth, spends less than half what we do per capita. So it’s like we order filet mignon at Le Cirque, and in return get a turdburger in a styrofoam clamshell. Why isn’t everyone incensed about this? This isn’t a Republican issue, or a Democrat issue. It’s a people-opposed-to-stupid-spending issue.

2. On free-market “comparison shopping” for medical services: It’s practically impossible. Don’t believe me? Read this. The author says he should have been the perfect shopper for medical care: (1) he lives in Massachusetts, a state that passed price transparency laws to help patients shop for care (2) he’s a physician (3) the surgery at issue was minor and not urgent, giving him plenty of time to shop around (4) his research focuses on consumerism and price transparency. So it’s like the author of the Kelley Blue Book shopping for a used car. And how did the process go? Terribly. How’s this an efficient free market when price discovery is a nightmare?

3. Did you hear the story about Fin Mox? It’s an antibiotic for fish. But people were buying it for their loved ones – er, loved “fish” – because they couldn’t afford regular antibiotics. I’d link you to the Amazon page, with the hilarious comments from people whose “fish” didn’t have health insurance, and for whom Fin Mox was a blessing – but Amazon took the page down. The richest country in the world has poor people buying antibiotics for fish to get the medicine they need? That’s a disgrace.

4. Read this from emergency room physician Farzon Nahvi. He treated people – including a man with a brain bleed, whose life he saved – who later said, “Thanks, but I wish you hadn’t done that.” Because they didn’t have the money to pay the staggering emergency-room bills. Nahvi quotes Paul Ryan on health care: “You get it if you want it. That’s freedom.” Nahvi observes “Being given services without your consent, and then getting saddled with the cost, is nothing like freedom.” No, and let me complete the thought: it becomes closer to indentured servitude – or actually slavery, since indentured servants at least have to sign a contract.

5. One thing that puzzles me: if you believe in a free market in labor, you should definitely hate the current health care system. A full 56 percent of Americans get their health care through their employer. Many people are shackled to jobs at large companies, resistant to changing, because they don’t want to lose that precious insurance benefit. So think of all the people who could be innovators, or who could switch to a more productive job at a smaller company, benefiting the economy, but don’t because they need their gold-plated health insurance plan. So we squander the potential in our labor force. Why aren’t more conservatives upset about this?

6. A report last year showed one of five Americans visit the emergency room at least once a year. Separately, a study showed that a whopping 71 percent of these visits were either unnecessary or avoidable. Emergency room care is very expensive treatment, so this indicates a lot of waste. People lacking health insurance sometimes wind up in an emergency room because they can’t afford regular doctors.

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.

Second Update: I reached out to Amazon. I was told that readers who bought the first edition could contact Kindle customer care, and someone there could help them download the latest version. A reader below in the comment section reports that this did work. Here are the url's Amazon gave me:

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"!