This is my first non-political diary in 3+ years as an active Kossack.
I have little doubt that Ted Kennedy's passing was the trigger to this reflection on knees, aging, happiness, and redemption
I'm 52 and my entire life has been filled with daily physical activity ...
Downhill skiing, XC-skiing, Soccer, Baselball/softball, Hiking, Swimming, Mountain biking, Climbing, Running, Yoga
... and plenty of hours at the gym lifting weights and doing organized aerobics.
Along the way I've had more than my fair share of injuries requiring hospitalization and/or surgery.
A partial list only would include; fractured wrist (bone graft), blown ACL (ACL replacement), fractured radius, elbow tendonitis (calcium deposit scraping), bone spur (surgical removal), meniscal tear (arthroscopic surgery), and various contusions, cuts, and gashes requiring suturing and bandaging.
This level of activity and variety of injury has, over the years, taken a cumulative toll on my body.
Even so, I'd managed to sucessfully heal and/or modify athletic pursuits to match my current state of physical well being without having to surrender an active life.
That is until recently ...
... when the cumulative wear and tear to my knees (osteoarthritis aka OA) became so debilitating it rendered me an invalid almost without the ability to go up and down a single flight of stairs.
Within several months I went from riding my bicycle 150+ miles/week to sitting on my ass day after day wondering if I would ever hike or ski or bike again.
The fall from activity (and grace) was swift.
In addition to a variety of daily aches and pains (sharp, dull, localized, regional, persistent, variable, throbbing, swirling, pounding, tearing) the generalized swelling and stiffness was so acute I could only bend my knees <> 50% normal range and then only slowly and under very controlled conditions.
I began to move in a shuffle, like the TV image of a very old and debilitated man. I even began to see myself in this way and imagined that others saw me that way too.
As an added punch in the gut, my forced inactivity lead to noticeable weight gain which when I attempted to move about put even greater stress and strain on my knees. This, combined with persistent stiffness and swelling, made it harder and harder to pursue any daily physical activities at all. I was trapped in my own vicious cycle of hellish inactivity.
Each day I became more depressed at my future prospects for recovery.
Although I pursued medical solutions my investigations hit a series of dead ends. Eventually I latched onto the idea that I needed both knees replaced and set about looking for orthopaedic surgeons in my area with established reputations and practices that focused on knee replacement surgery.
Thank goodness I have health insurance (COBRA from a previous job) and was able to find a "specialist" who did 300+ knee replacements a year and took UHC. I scheduled an appointment (3 weeks out which was great as some others would not see me for 6+ months) and waited with great anticipation to see Dr. XXXX.
Before looking at my film Dr. XXXX did a clincal evaluation. We then talked for a bit and he reviwed the x-rays.
Based on my age and level of cartilage deterioration (according to the x-rays what is called level I only) he determined that knee replacement was not indicated. I was heartbroken. I thought this was my only hope for once again living a normal life and here I was being told that I'd have to live without the ability to do basic daily activities.
This was the bottom.
However, at this point the Dr. brought up the possiblity of an alternative treatement. He suggested we try a new procedure whereby 6ml of Hyaluronan was injected directly into my knee joint (in the space behind the patella).
A variant of this procedure has been used in Europe since the early 90's and in the US since the early 00's. In the past the procedure required a series (5, 4 or 3) on injections spaced a week apart. The new procedure allowed for a single 6ml injection in each knee.
The results have ranged from very little improvement to almost total improvement (no pain, no stiffness). There have been no or very little reported side effects and most people seem to tolerate the injections well. The catch, there is always a catch, is that the improvement is not permanent. If the patient responds positively to the treatment they will need to have it repeated every 6 months or so.
I was in.
The proedure for ordering the medication (it's treated like a prescription) was somewhat onerous and it took almost 3 weeks until the meds were received by the Dr. and I was scheduled for my shots.
There was one other complication (they sent the 3 shot series instead of the single shot) that the Dr. said would not be a problem as he would just inject the site once and snap on each of the 2ml cartridges and inject the formulation in series during the one visit.
I arrived at the office and after thoroughly cleaning the area he first injected my knees with novocaine and then with the Synvisc which is made by Genzyme from rooster combs (the source of the hyaluronic acid). The procedure itself took less than 5 minutes. I walked out of the office with my fingers crossed.
The novocaine made my kness numb and therefore in no pain. I was sure that when it wore off I would return to the same old stiffness and pain.
By that night when the novocaine had finally worn off and the pain had not returned I was cautiously hopeful. Some other indications that things might be going well included reduced noise (the clicking and snapping that had charaterized my knees when they were bent seemed to be gone) and less stiffness.
So here I am now 3 weeks out from the treatment and my kness have improved every day. Right now I would say the "improvment" which includes reduced pain, increased range of motion, reduced swelling and stiffness, and increased strength is in the 90% range. I am back to walking, hiking, bike riding, and swimming (weight lifting and other activities will follow if I continue to improve).
That me say that my experience is not definitive. Others have had both better and worse responses to Synvisc (and the other variants). However, if you are suffering with OA (knees) I would highly recommend looking into this treatment option.
It has literally given me my life back.
UPDATE: Please rec this up so others can read about the possible help they can get. Seems like a few commenters have learned about the procedure from this diary. Thanks.