It’s that time of December again, when we take stock of the year that was and start to dream of the possibilities of the year ahead.
I’d like to take a moment to thank the readers of this blog (and the book). My plans, at least for now, are to keep blogging at least semi-frequently until the book sales taper off. I think it’s nice for people who read Saving My Knees to find me online and active.
The book arose from frustration: doctors, I think, are unduly pessimistic about the ability of bad knees to heal, when given time and the proper treatment. I showed it was possible with my own knees (“proof of concept” to validate a hypothesis). My knees are normal today.
The book also arose from anger: after extensive research, I became upset at what physical therapists thought was the “proper treatment” for my knees, and disappointed in my doctors – who I felt should have known better – that they condoned this protocol.
Anyway, I’m not trying to hog the spotlight today. I really wanted to make this an appreciation of you readers, especially those people who share comments and insight on this site. I didn't write the best-selling knee book, but I think I’ve got the smartest readers. ;)
I’ll take that.
Saturday, December 30, 2017
Saturday, December 16, 2017
Why I’m So Optimistic About Cartilage Healing
I figured I’d tackle this one straight-on today.
First things first: No, the holes in your cartilage don’t have to heal for your knees to feel better. This is absolutely not a prerequisite. There are many people walking about with cartilage defects and no knee pain. That’s not a bad club to be part of. After all, you just want to be rid of knee pain, right? Who cares if your cartilage is as smooth as a baby’s bum?
Second thing: I am occasionally asked if I have a follow-up MRI in my possession to prove that my cartilage did, indeed, heal. See my post here about why, no, I haven’t done this and why I don’t think it matters much anyway.
Another reason it doesn’t matter much: there appears to be much stronger evidence out there than a single MRI from yours truly. That takes us back to the original point: Why do I think cartilage can heal?
Take a good hard look at the table below. I copied it from a study, “Factors Affecting Progression of Knee Cartilage Defects in Normal Subjects Over Two Years.” The 86 people who participated had MRIs done of their knees at the start of the study, then two years later. (Yes, these were “healthy subjects,” but I’ve seen another study that includes knee pain sufferers that came to similar conclusions.)
The condition of each subject’s cartilage was graded for five different knee compartments. The scoring again goes like this:
Grade 0 = normal
Grade 1 = focal blistering
Grade 2 = irregular surface and loss of thickness of less than 50%
Grade 3 = deep ulceration with loss of thickness of more than 50%
Grade 4 = full-thickness wear of cartilage with bone exposed
Now look at that table. I’ve color-coded it in a way that I hope enhances readability. Let’s consider the the 14 defects that started out as Grade 3. If cartilage simply wears away, and that’s the end of story, you would expect their follow-up grade to be either 3 or 4.
But what actually happens? Yes, three of them stay at Grade 3, and five worsen to Grade 4. Yet four improve to Grade 2, and two of them – one in seven – improve all the way to Grade 1.
Yes, the sample sizes are small. Still, the pattern is repeated elsewhere (the extremes, at Grade 4 and Grade 0, suffer from the floor and ceiling effect, of course). Look at the 88 defects that started out as Grade 2. A full 31 percent of them, or almost a third, improve to Grade 1.
Yes, there are valid questions to raise. What is the nature of this new cartilage? Is it weaker fibrocartilage (actually, another researcher has found that though new cartilage starts out that way, over time it begins looking more like regular hyaline). Also, could there be misreading of results? (My take: yes, probably some, but I doubt on this extensive a scale.)
To me, this constitutes very interesting, and compelling, evidence that cartilage changes are a two-way street. Cartilage doesn’t just get worse. It’s always getting worse and getting better. And if it can get better, then why not try to enhance that ability? (Note: this was a “natural” study, meaning that some subjects saw positive changes in the tissue, and they weren't even on a special regimen!)
First things first: No, the holes in your cartilage don’t have to heal for your knees to feel better. This is absolutely not a prerequisite. There are many people walking about with cartilage defects and no knee pain. That’s not a bad club to be part of. After all, you just want to be rid of knee pain, right? Who cares if your cartilage is as smooth as a baby’s bum?
Second thing: I am occasionally asked if I have a follow-up MRI in my possession to prove that my cartilage did, indeed, heal. See my post here about why, no, I haven’t done this and why I don’t think it matters much anyway.
Another reason it doesn’t matter much: there appears to be much stronger evidence out there than a single MRI from yours truly. That takes us back to the original point: Why do I think cartilage can heal?
Take a good hard look at the table below. I copied it from a study, “Factors Affecting Progression of Knee Cartilage Defects in Normal Subjects Over Two Years.” The 86 people who participated had MRIs done of their knees at the start of the study, then two years later. (Yes, these were “healthy subjects,” but I’ve seen another study that includes knee pain sufferers that came to similar conclusions.)
The condition of each subject’s cartilage was graded for five different knee compartments. The scoring again goes like this:
Grade 0 = normal
Grade 1 = focal blistering
Grade 2 = irregular surface and loss of thickness of less than 50%
Grade 3 = deep ulceration with loss of thickness of more than 50%
Grade 4 = full-thickness wear of cartilage with bone exposed
But what actually happens? Yes, three of them stay at Grade 3, and five worsen to Grade 4. Yet four improve to Grade 2, and two of them – one in seven – improve all the way to Grade 1.
Yes, the sample sizes are small. Still, the pattern is repeated elsewhere (the extremes, at Grade 4 and Grade 0, suffer from the floor and ceiling effect, of course). Look at the 88 defects that started out as Grade 2. A full 31 percent of them, or almost a third, improve to Grade 1.
Yes, there are valid questions to raise. What is the nature of this new cartilage? Is it weaker fibrocartilage (actually, another researcher has found that though new cartilage starts out that way, over time it begins looking more like regular hyaline). Also, could there be misreading of results? (My take: yes, probably some, but I doubt on this extensive a scale.)
To me, this constitutes very interesting, and compelling, evidence that cartilage changes are a two-way street. Cartilage doesn’t just get worse. It’s always getting worse and getting better. And if it can get better, then why not try to enhance that ability? (Note: this was a “natural” study, meaning that some subjects saw positive changes in the tissue, and they weren't even on a special regimen!)
Saturday, December 2, 2017
Taking the Big Leap: It’s Not an Easy Call
Every so often I like to mix into this blog something both personal and current. How’s this: At the end of September, I got laid off in a restructuring.
It happens. If you’re a little older and experienced, it happens more often.
But, as readers of my book may realize, I take a perverse pleasure in proving wrong the people who underestimate me. Orthopedic doctors in Hong Kong didn’t think my knees would get better. After extensive (and obsessive) research, I found what I thought was lots of evidence that they were dead wrong.
It took me many months, with much detailed record-keeping and experimenting and patience, but in the end, I healed. My knees returned to normal. This became the greatest achievement of my life, and nothing else is really even close.
Today I wanted to revisit a hard decision I made, now that I find myself among the ranks of the unemployed again. Early in 2008, I made up my mind to quit my job in order to try to heal my knees. Sitting at work with bent legs was impeding my effort to heal, because my knees were constantly inflamed.
First, let me make something clear: I could never advise another knee pain sufferer to quit his or her job. That’s a very individual decision. It’s also a calculated gamble. Had I never managed to heal, I would have found myself unemployed, and maybe even unemployable.
But if you’ve got chronic knee pain, it may be worth considering. If you do, here are some questions worth asking yourself:
• How much do activities that I must perform at work worsen my knee pain? Those “activities” can even be non-activities, such as sitting. Or maybe you’re roaming a warehouse eight hours a day, fulfilling Internet orders. Or maybe you’re dealing with a crushing amount of stress.
• Do I have any evidence that my knees will improve if I devote myself to healing them? Do you have a good feel for what your knees like and don’t like, and what kind of program will provide the kind of nourshing motion that will enable them to get better?
• If I leave my job, what support do I have? Financial support could be savings (and you’ll want to calculate how long it will last). Emotional support could be friends and family.
• How hard will it be for me to rejoin the workforce in six months, or even a year? Clearly, some of this depends on factors beyond your control, such as the job market, but certain high-demand professionals may find it easier to transition back into full employment.
• What are my goals, in terms of healing, before I rejoin the workforce? And, if things don’t go well, when do I give up and either live with the pain or turn to pain medication or surgery? It’s good to have goals before you set out on what could be a challenging journey.
• Is there a way for me to keep working, but only part-time? If you recall, in Saving My Knees, I proposed an experiment, with my doctor's support, to try to rehabilitate my damaged knees. My employer agreed, but unfortunately, the experiment was too short. Still, it did prove to me that I was on the right track with my thinking.
Again, it’s a difficult, courageous leap to take, and not for the faint of heart. It may be worth it for you, or it may not be. I can’t decide that for you. Only you can.
It happens. If you’re a little older and experienced, it happens more often.
But, as readers of my book may realize, I take a perverse pleasure in proving wrong the people who underestimate me. Orthopedic doctors in Hong Kong didn’t think my knees would get better. After extensive (and obsessive) research, I found what I thought was lots of evidence that they were dead wrong.
It took me many months, with much detailed record-keeping and experimenting and patience, but in the end, I healed. My knees returned to normal. This became the greatest achievement of my life, and nothing else is really even close.
Today I wanted to revisit a hard decision I made, now that I find myself among the ranks of the unemployed again. Early in 2008, I made up my mind to quit my job in order to try to heal my knees. Sitting at work with bent legs was impeding my effort to heal, because my knees were constantly inflamed.
First, let me make something clear: I could never advise another knee pain sufferer to quit his or her job. That’s a very individual decision. It’s also a calculated gamble. Had I never managed to heal, I would have found myself unemployed, and maybe even unemployable.
But if you’ve got chronic knee pain, it may be worth considering. If you do, here are some questions worth asking yourself:
• How much do activities that I must perform at work worsen my knee pain? Those “activities” can even be non-activities, such as sitting. Or maybe you’re roaming a warehouse eight hours a day, fulfilling Internet orders. Or maybe you’re dealing with a crushing amount of stress.
• Do I have any evidence that my knees will improve if I devote myself to healing them? Do you have a good feel for what your knees like and don’t like, and what kind of program will provide the kind of nourshing motion that will enable them to get better?
• If I leave my job, what support do I have? Financial support could be savings (and you’ll want to calculate how long it will last). Emotional support could be friends and family.
• How hard will it be for me to rejoin the workforce in six months, or even a year? Clearly, some of this depends on factors beyond your control, such as the job market, but certain high-demand professionals may find it easier to transition back into full employment.
• What are my goals, in terms of healing, before I rejoin the workforce? And, if things don’t go well, when do I give up and either live with the pain or turn to pain medication or surgery? It’s good to have goals before you set out on what could be a challenging journey.
• Is there a way for me to keep working, but only part-time? If you recall, in Saving My Knees, I proposed an experiment, with my doctor's support, to try to rehabilitate my damaged knees. My employer agreed, but unfortunately, the experiment was too short. Still, it did prove to me that I was on the right track with my thinking.
Again, it’s a difficult, courageous leap to take, and not for the faint of heart. It may be worth it for you, or it may not be. I can’t decide that for you. Only you can.
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