Saturday, January 9, 2010

Bees Knees

It seems for me, the odd years (2007, 2009 for example) have been the years that I've had various medical issues, found out that I have various things wrong with me, in 07 I had a couple minor/major surgeries, in 09 I found out among other things that I have MS. I also found out that I had nodules on my Thyroid (found during MRI scans that were for the diagnosis of the MS), I still no nothing for sure about the nodes, other than I get to go back in 9 months for another ultra-sound and that my dr wants to take the wait and see approach.

I also found out in 09 that my "good" knee actually is more bone on bone with Osteoarthritis than my "bad" knee. I still think of it as my good knee since it is still the stronger and more dependable one. What sucks is that since it's got arthritis behind the kneecap it is the one that aches the most at the moment, the other knee is manageable with periodic synvisc shots (at least pain-wise, it still threatens to just "go-out" on my for no apparent reason when I first stand up).

My bad knee has caused me to do my impression of a drunk at a local bar on more than one occasion. I don't know why bar/restaurants have the tables with the high stool seats? I sit for very long on those, and when I stand, I never know if my knee will work with me or not. Just recently, right before the holiday's we had gone out with M's sister and her partner for wings and I went to stand to go to the restroom and I felt the knee go, so I just rolled with it and landed on my back looking up at a couple that were waiting to be seated. The guy was very helpful and concerned and help me regain my feet.

Having lived with the "bad" left knee for the last 8-9 years or so, I was very unhappy to learn last year that my "good" right knee was actually in worse shape. My osteo doc says that xray's and tests are deceiving, that what matters is how they feel. True. And that would be fine if the right knee continued to feel ok and not bother me. But that arthritis behind the knee cap is annoying. It makes it hard to drive for long distances, I want to shift my leg around and find a position that doesn't ache and I can't. My doc calls it "movie theatre knee" because people that have it can't sit through a movie. I also can't sit still through lunch and pity my lunch companions that are unlucky enough to sit across from me. They know when it is worse than normal, guess the kicks in the shins are a good clue. It also wakes me up, and keeps me up at night. Which I'm finding with the MS, interferring with getting enough sleep is harder to overcome than it used to be.

I'm used to dealing with pain, working through pain, but this kneecap thing is something different. I am sure it is not the worst pain I've ever had. It is just the most annoying.  And it is getting worse. The shots don't help like they did on the other knee.  I saw the ortho doc and he says there is little else to do at this point.  As he said, we have talked about the fact that what I need ultimately will be to replace both knees (initially 8 yrs ago it was just the 1, now it is both).  And that what we need to do know is to do what ever we can to put off when we will do that.  You may ask why? I know lots of my friends did. Well, in order to do the surgery to replace a knee, they have to trim the ligaments and tendons and use them to attach to the artifical knee.  Unfortunately the ligaments and tendons are something that the body will not grow longer, so apparently it is only possible to do 2 replacements of that knee due to the length of these.  Replacement parts are improving, and the titanium they use for the knee itself is very good and lasts a long time.  Unfortunately the plastic they have to use to simulate the cartiledge is not so good and only has a life span of 10-15 yrs. They are finding new techniques and plastics so that might change but they haven't been in use long enough to really know.  So the long and short of it is that they don't like to do knee replacements on anyone until they are at least in their mid- to late 50's.  I'm in my 40's. 

When I saw my dr this past week, I pointed out that I was now in my late 40's - 47 to be exact.  But he said he would really rather it be at least 6 yrs from now if not closer to when I'm 55.  I can see the point - worst case (have to look at worst cases, because I've found in my life and in my family they often come true - prepare for the worst and hope for the best), I could have a replacement today at 47, have it only last 10 yr, and get my 2nd at 57 and now if it lasts even 15yrs, that will put me at 72 and unable to walk.  Not bad maybe.  However, my dad was 79 and would have continued on if it weren't for getting GBS (Gilliam Barre Syndrom) at 76 and never completely recovering from it.  My mom is still going and is 83.  Course if that 2nd knee only made it 10 yrs, I'd be 67 and unable to walk.  Not good.  I explained this to an acquantance and her response was, well, then at that point why not cut your leg off and get a full leg prosthesis.  Hmmmm. Yeah, why wait, do it now?

So my doc offered that our other option at the moment for the pain-in-ass kneecap was to do orthoscopic surgery on it, go in with a camera and clean out any irritants, loose cartiledge, and smooth any rough spots and arthritis.  This could help and is less invasive and easier recovery than a knee replacement.  The knee would be sore for a while, and I would be on crutches for a bit.  Since I work as a network engineer and sit at a desk behind a computer most of the time, I would only miss 3-4 days of work.  Risk is that it might not really help all that much. Or it might not last that long.

So, I spoke with my big brother, who is a cardiologist, 11 yrs older than me, and who I trust when it comes to medical delima's and asked for his thoughts.  His take was that this wasn't his field, but based on what his friends (in the field) say, my doc is right, we need to wait on the knee replacement.  B says knee replacements are still in their infancy.  Hips and other things (shoulders?) are well established.  Knees are different, partly because of the need for the plastic which we haven't discovered something that holds up well or long enough, because of the only being able to do the replacement 2x in a person, etc.  He said his guys say that I would be best to wait until I'm at least "HIS" age - as in 58, before thinking about a replacement.  His suggestion was that if the knee was giving me fits, he thought the orthoscopy would help, and anything to delay the replacement was worth doing. 

So everything seems to lean toward doing the orthoscopy.  I'm afraid though.  That's my "good" knee.  The dependable, stable one.  It may hurt but I can count on it.  The other one isn't in pain at the moment - it will in about 6 months or so, start aching and then it will be time to think about another round of shots.  But even though the left doesn't hurt, I can't count on it.  It might fold.  So contemplating having surgery on the good one, and having to depend more on the bad one is a bit scary.  I mean I depend so much on that right leg.  It stablizes me when I first stand up, until I can feel that my left will carry my weight.  That's the knee I kneel on if I have to kneel down (I don't recommend it with knees like mine), and I even kneel on it on the bed each night to climb in. So many things currently depend on that knee - old dependable.  "Old" being very fitting in that my osteo says while I might be 47, unfortunately I have the knees of a 67 yr old.  I'd like to find her and swap back...

This morning, my knee is really bugging me.  I'm having a hard time sitting to write this.  I stretch it out and prop it up and that's ok for a while (like 5 min) then i have to move it.  I get up and walk around.  I sit down to work again.  For another 5-10 min.  That is like my typical morning or afternoon at work. when the knee flares up, I can't find a "happy" position.  Excersise doesn't even help either.  My left when it starts flaring is helped when i get on the bike and ride for a while (either the excersise or real doesn't matter).  I try that but doesn't help with the kneecap.  In fact it stays irritated when I'm riding.  So I try to ignore it.  I did ride the excercise bike this morning about 15 minutes then i gave up.  I also did 15 minutes on the wii fit.  I'm trying to get in better shape (one of my "non-resolution" intentions for 2010).

If the knee keeps up I guess I will proceed with orthoscopy.  If that works, then I'll still be able to depend on my stable knee and it won't drive me nuts.  So if I look at it that way it could be a win situation.  Least enough to buy a little more time.


Diane J Standiford said...

My brother has had several knee surgeries and as I understand it they have come a long way in knee surgery techniques. I hope you're careful on your bike ride.

MS Day Dreamer said...

Diane - Thanks for the good words. I know my brother also was saying they have come a long way in knee surgery, he was just also suggesting that the total knee replacment is still in its infancy compared to hips and other replacements. He was playing the part of big-brother and wanting to make sure I didn't jump into something. Even my ortho suggests that I wait a few more years before looking at the replacement options. So at this point I am just trying to decide if I go for the orthoscopic clean/scrape-it and see if that helps for a while or just continue to grin and bear it. However it is getting less and less grin and bearable. So I'm thinking I will call and have them see whether my insurance wants to grant their seal of approval and get this scheduled and proceed.