Rats. He's on to me!
Is there a 12-step program for addicted runners??
You gotta love a doctor with a good sense of humor. That's probably
easier if the medical practitioner is an orthopedist than an oncologist, but
the fact remains (for me, at least) that a little humor can help keep serious
issues in perspective.
Laughter is the best medicine, and all that.
This entry is related to the last one because once I stopped masking all
sorts of osteoarthritic aches and pains by giving up ibuprofen about six weeks ago, it
was quite obvious that it was time to do something about my cranky knees.
< big sigh >
Two summers ago I injured my left knee after climbing several
14ers in Colorado. I was a little concerned about muscloskeletal
damage but had no clue how seriously the diagnosis would affect
It was an awesome run/hike on Mts. Belford
and Oxford on 8-13-07 when I hurt my knee!
When we got back to Roanoke a few weeks later I made an
appointment with one of the physicians at Roanoke Orthopaedics, a
large practice with about ten orthopedists who are very
specialized. Jim and I both had already had surgery with one of
the foot specialists there and liked him. However, for my new
knee problem I was
referred to another doctor, Brent Johnson, who is very
experienced in both knee and shoulder surgery AND is a sports
It's been a good doctor-patient fit. That's important to me.
X-rays and an MRI in 2007 showed only a slight meniscus tear
(relatively good news) but plenty of cartilage loss (bad, bad
news) in my knee.
At that point I was clearly on notice that my cartilage was
rapidly deteriorating -- probably in the other knee, too
-- and I'd better modify my running. In addition to
athletic alternatives, we talked about
long-term treatments like physical therapy,
Dr. Johnson was surprised that I wasn't in much pain back then except for
the recent strain. What neither of us realized was
just how effectively the ibuprofen was masking the arthritic pain.
That treatment was fine until the ibuprofen began (possibly) causing the
problems I talked about in the
last entry and I decided it was
in my best interest to get off the magic pills.
You mean this isn't normal??!!
Dr. Johnson essentially said to come back when
the pain got so bad that it was limiting my ability to
comfortably do normal physical activities (he doesn't consider
running ultras "normal," of course) and strongly advised me
to run less and do more cross-training that puts less impact on my
I CAN SEE CLEARLY NOW
Now I'm pretty stubborn and thoroughly addicted to running, but not totally
stupid! I could see the writing on the wall.
I modified my fitness program. For the past two years I've been
running and hiking less hilly, mountainous terrain,
incorporating more and more walking into my training to where
I'm doing very little running, and covering fewer
miles each month. I've learned to (mostly) enjoy flatter
surfaces, shorter and fixed-time races, and more cross-training --
preferably aerobic activities that I can do outside, on trails, that produce
I try to be grateful for what I'm still able to do and not whine
too much about it.
I've been in some denial, however, as evidenced by the
mountainous 50Ks I ran/walked this past summer and the mountains
I continued hiking in the Rockies:
Tahoe Rim Trail 50K in July
Turns out, that was kind of my "swan song" for ultra running.
As time has marched on, both knees have become more noticeably sore
going down hills (even walking) and especially down steps and
stairs. Even before returning to Roanoke in September or getting
off ibuprofen, I made an appointment to see Dr. Johnson again so
I could determine if it was time for knee injections.
Within a few days of getting off ibuprofen, the answer was
obvious: it was time!
BONE ON BONE
The reality of my situation hit with full force when Jim and I consulted
with Dr. Johnson at the end of September. He didn't order any MRIs
this time; inexpensive
X-rays clearly show the problem in BOTH knees:
Sue's knees (September 2009)
I am now officially "bone-on-bone" on the inside of both knees.
You can see them rubbing together in the photo above, at or
maybe even past the stage where injections might help.
But Dr. Johnson tried to "inject" some humor into the situation
by comparing my knees with various car parts that need a
periodic lube job or retread -- and my running-addicted
brain to a computer that still needs some reprogramming! I'll
delve into the "reprogramming" part in the next entry.
Here are some graphics of healthy versus arthritic knees from the
Ouch! That third picture looks worse than my knees feel, even without the
use of ibuprofen!
ORTHOVISC: MY NEW FRIEND
Dr. Johnson's preferred type of injection is
viscosupplement made of natural hyaluronan, which is found in
healthy joint fluid. Injected into the knee, it helps to
lubricate and cushion the joint so folks like me with serious
osteoarthritis can continue or resume normal
activities ("normal" -- there's that word again!). There are seven or eight different
injections on the market now. Dr. Johnson prefers this one for
several reasons, including its efficacy, cost, and ease of
Orthovisc is injected 2cc at a time*** into the affected knee (in
my case, both of 'em) over three consecutive weeks for a total
of 6cc in each knee. There is a short animation
here that shows how it oozes in
and settles into what Dr. Johnson calls a "balloon" inside the
joint. Although the fluid apparently absorbs into the body
fairly soon, the beneficial effects last an average of six
There isn't a limit
medically to the number of times you can get injections;
Dr. Johnson has one patient who has received the series eight
times. That guy's either well-heeled or has great insurance!
It's not a cheap fix.
Nor does viscosupplementation work for everyone. Dr. Johnson gave
50-50 odds that it would be effective in my case. Even if my
insurance hadn't covered it, I would have paid for the treatment
out of pocket to see if it would help. Injections sure beat knee
replacements if they'll work for several years!
And I keep hoping researchers will come up with something even
better before I need knee replacements. With so many older folks
now needing the surgery -- and millions more Baby
Boomers like me waiting in the wings -- I'm surprised science
hasn't produced a more permanent cushioning substance yet.
Graphic of a total knee
*** Over the summer a friend told us about a new Synvisc
injection that is given in only one injection. Dave was
considering it so he wouldn't have to get the other type of Synvisc, which is administered in five injections.
He figured it'd be easier and cheaper with only one dose. When I asked
Dr. Johnson about it, he said he won't use Synvisc One because
it's just too much lubricant to go in all at once and would be
too painful. He knows whereof he speaks -- he gets
viscosupplementation in one of his own knees! As soon as
I learned about my doc's very personal experience with this stuff, I
trusted him even more.
AT LEAST MY REFLEXES ARE GOOD
I had to return to Dr. Johnson's office three more times to get
the injections because they have to be specially ordered
Jim went with me for the first injection so he could see
the procedure and cart me home if I was too sore to drive
The whole process was much simpler than we expected.
Well, except for that little incident when Dr. Johnson hit a
nerve the very first time he stuck the needle into one of my knees
and I involuntarily jerked. Oops! The needle went flying and had
to be replaced but fortunately the
expensive Orthovisc was intact in the glass. Surprised all three
of us! My leg went flying up just like he'd hit my "funny bone."
On his second
try, I held my knee with my hands and didn't feel either the needle
or the fluid going in. I
did feel what the orthopedist describes as "pressure" when he
injected the other
knee (carefully!) but it didn't hurt.
Although one or both of my knees were a little sore right after
each injection, they felt fine after a few hours. I wasn't
allowed to do anything very strenuous for 48 hours, then I could
resume all normal activities including walking, cycling,
gardening, etc. When I realized how simple it was, I went in by
myself for the second and third injections.
Dr. Johnson has a good sense of humor and likes analogies, I seriously considered
purchasing a can of Great Stuff™ to take in the
second time and
ask, "Wouldn't this be a whole lot less expensive??"
If you're not familiar with
Great Stuff, there are several
variations of the expanding foam that you can spray into
different types of cracks and joints in your house to fill,
seal, and insulate them -- kinda like Orthovisc does for
knees, I thought!
I decided it wasn't worth the time to buy a can and then return
it, so I just took in a picture and Dr. Johnson got a laugh out of it.
Hey, if you can't joke about things like this . . .
I got my third and last set of Orthovisc injections three weeks
ago. I can already tell a difference. That's very good!
Dr. Johnson said I'd know within six weeks if the lubricant
works for me. Most folks who get relief from viscosupplements
feel the best after 8-12 weeks; that's when the effect tends to
peak. I'll try to remember to report how my knees feel at that
point in my treatment.
I'm optimistic so far, but I realize that there could possibly
be some placebo effect
because I really want to put off knee replacement surgery as long as
possible. Placebos aren't all bad, but considering how pricey
Orthovisc is, I hope the device itself is really working. (Oddly
to me, these lubricants are not classified as drugs but as
"medical devices." Go figure.)
Despite what seems to me to be a high price for viscosupplements,
they are considerably cheaper than the estimated $20,000+ each knee
replacement would cost in the Roanoke area if I
needed surgery at today's prices! No wonder my insurance company OK'd the
Next entry: what little to no knee cartilage means to me
in the long run (pun intended)
"Runtrails & Company" - Sue Norwood, Jim O'Neil,
and Cody the Ultra Lab
© 2009 Sue Norwood and Jim O'Neil