Kneed to Know: Redux

Having a functional knee had become commonplace and I did not pay much attention to minor problems; occasional pain for no obvious reason and “crunching” when I climbed stairs or squat to work in the garden. Anyone with chronic knee problems has some familiarity with that sound of bone-on-bone that is like dragging something heavy over a gravelly surface. These things sneak up on you and become part of the daily normal and you forget that all the negative signs are significant of the on-going deterioration.

Part of my partially conscious reticence was the impending reapplication of a corticosteroid to the join in July. The appointment has come and gone and the result is much as it was in February; full functionality, or as fully functional as an “unhappy knee” as one of the Matt termed what he saw on the x-ray image.

The team of three (doctor, nurse and x-ray technician) were still in a leaning mode since the return from vacation by Matt the highly skilled nurse who’d done the procedure painlessly the first time. The doctor, much younger than the recently retired one from the first procedure. The doctor was going to do the deed this time under Matt’s careful gaze. The lidocaine injection hurt, not badly, but enough to elicit an involuntary “Ouch! That hurt” from me. Thereafter it was painless with the only sensation being a subtle pressure as the corticosteroid was distributed in the joint. Below is an image of the knee and the target.


Now, five days later, my knee does not crunch and I am ascending and decending stairs easily. I am scheduled for another injection in six months and I will not hesitate to call if I notice problems recurring; not gonna become complacent. For anyone facing compromised mobility such as this, not trying a steroid in the knee is probably a mistake and until I can no longer get relief or can not handle pain I’ll continue to have the procedure.

Kneed to Know: Week Twelve

As I entered my tenth week of having minimal knee pain I fell. Hard. Both knees. Forgot about that last step. Not good.

I should have put ice on the bad knee, but didn’t, maybe because I wanted to punish my carelessness; not a good reason, but also a likely one. Mostly, I complained silently and limped when I moved around. There’s no reason to offer a daily description of how I fared. It’s adequate to say that the bruises faded, the abrasions where I scraped the deadbolt key before breaking it off healed and I reached a new normal (post-injection normal). I had more discomfort if I spent too much time walking unbraced, but working around the house where I walked, bent and knelt seemed unimpaired.

Obviously, the injection gave me a level of physical renewal by reducing local inflammation. Now, it is all about being responsible, careful and avoiding extremes . . . like falling.

Kneed to Know: Almost Two Months

I’ve debated making a final entry because after seven weeks I am able to function better than I had for many years. Yes, it’s a hassle to use the brace, but the result has been pain-freedom. Seems obvious that my real problem in the not-so-distant past was inflammation. With the inflammation gone and a reduction in joint movement and hyper-extension, bone-on-bone contact is creepy but not pain inducing. I’m long past the days of pick-up basketball games in McClatchey Park in Atlanta, but well able to tend to our ever-expanding garden and regular home maintenance. It’s not as exciting, but still very satisfying.

I’ll keep updating intermittently. Okay?

Kneed to Know: Week Four

Last week I received a call from my favorite orthopedic doc. She said that as long as steroid injections reduce my knee pain it’s the treatment of choice. Unless I want to discuss surgery I have no reason to see her and I can visit the people with the long needle when needed. She said that I have severe arthritis and that it’s good that I have chosen to remain active.

I torque my knee after speaking to her and had some frustrating pain for a couple of days, but used naproxen and inactivity to deal with it. Because the steroid acted on the severe inflammation in my knee, using an anti-inflammatory and minimizing activities that can exacerbate the joint problem is logical. After a day of limited activity I have gotten back to my new normal and am once again pain free.

It’s always going to be a matter of how much pain is too much to bear. Thus, it is imperative that I be aware of what causes problems; over use, over-weight and failure to use my brace. The other important thing to do is rebuild the musculature around the knee which helps keep it more stable. To that end, I am back on the bike and working at building a mileage base.

A Kneed to Know: Still Working

I'm well into my third week of mostly pain-free activity. I say nearly because too much torque on the joint sends painful reminders to be careful. I wear the brace for any physically demanding, weight-bearing activities, but do not need it for riding. Occasionally, I feel hints of distress waiting to happen so that even for something like walking to the mailbox (maybe 50 yeards) I strap on the brace.

The injection of the corticosteroid into my knee joint has been relatively successful, meaning it worked, but the reality of bone-on-bone remains. As long as I can function this well I see no compelling reason to consider anything more drastic like replacement surgery.

A Kneed to Know: One Week

A week has passed since I had my knee shot-up and I have been able to move about like a real person as long as I wear my spiffy Bledsoe Z13 ACL Knee Brace. I have occasional minor discomfort if I apply too much lateral or twisting motion. My guess is that the steroid did what it’s supposed to do by reducing swelling and other similar irritation. Nothing else has changed. I still feel the same grinding, bone-on-bone sensation. I can live with that since it’s been there for a decade or more. I’m hoping that awareness and care will prolong any additional positive effects of the corticosteroid.

A Kneed To Know; Preamble

My arthritic left knee hasn’t worked well for years, but until recently pain was intermittent and always associated with doing too much or doing something that might have been made less taxing if I had worn the brace the VA provided. For more than two months I frequently had difficulty rising from sitting because pain exceeded my tolerable threshold. Then, for no definable reason that problem disappeared to be replaced by near constant pain of variable levels.

Getting my primary care physicians to refer me to someone specializing in joints took time, but I won’t belabor the point or whine about my frustration. Recently, like three days ago (as I write this), I met with joint people.

There are four common approaches to knee pain of the arthritic sort, which mine is; replacement (partial or complete), living within ones pain tolerance and threshold, injection of hyaluronic acid (a joint lubricant) and injection of a corticosteroid. Wear and tear on the knee joint, whether ordinary or extreme, is part of aging and arthritis simply adds to the problem.

Replacement works if you can tolerate the rehabilitation period AND are wiling to work at range of movement and strength during thew rehab. I am still not ready to consider replacement because of the down-time during rehab. I don’t wanna be even more limited than I already am for even three weeks. Adding to that is the dramatic nature of replacement. I guess I see it like the difference between an engine rebuild when your MG-B’s engine sound a little out-of-sorts and adding a bottle of Motor Honey. Maybe the Motor Honey gains a few weeks or months. Just sayin’ how I reason it.

My pain tolerance for joint issues is pretty high, but when it gets to a point where you can’t do things while tolerating it, decisions have to be made. Lemme add here, that with my bum knee, in 2015 I piloted a tandem bike from Pittsburgh to DC, then north into central PA, covering 500+ miles. I like to do, but pain compromised my ability to do lots of things and not riding was the finale.

My primary care doc recommended that I get the knee lube (hyaluronic acid) because it had few potential issues. There’s some dispute about the efficacy of it. Sometimes it works and sometimes it doesn’t and how long if it does work is indefinite. The indefinite thing is true of a corticosteroid, too. Where there is a significant difference, it seems, is a corticosteroid’s potential to combat some of the physical issues in a bum knee, specifically swelling. If I was going to do anything, doing a corticosteroid seemed like a better first step.

I’ve never been a fan of needles of any size, but having one shoved into my knee joint carries a more dire mental image. I felt more “pain” meaning barely anything when I got the lidocaine than I did when the actual injection was done; painless and quick. Maybe it’s related in part to the number of knees they have injected; “some days we do 16 knees.” There are lots of old, bum knees wandering the halls of VA facilities.

I walked out of the facility without pain. I relaxed for the remainder of the day after getting home. The following day I helped a friend to install some edging and mulch. Later, I planted field peas and lima beans on my hands and knees and hauled a small cart load of mulch to the garden. If I’d had pain I could not have done a quarter of what I did. Did I overdo it? Not in my opinion. Part of me wants to get in as much as possible before that indefinite period becomes finite. I’ve ridden a mile and a half each day as a start toward regaining lung and heart.

I wear my brace for all but the least strenuous tasks around the house and carry it in a pannier when riding. I stay aware of hyper-extension, my knee’s mechanical issue. I cross my fingers.

So, here’s the point; I think the injection has been very helpful and what happens between now and when I see the orthopedist will be useful to us when we discuss what comes next. I’ll keep you posted.