Reaching Out

In my current quest to regenerate my knee, I first reached out to a long-time friend, who went through arthroscopic surgery last year for similar issues. Here’s what I said:

Since the first of the year, my R knee has been swelling to a greater or lesser extent, so I went to see a Sports MD, and got an MRI.

The key paragraph in the report:

Lateral meniscus degeneration is present. The lateral meniscus 
demonstrates a posterior horn, faint, inner one third, horizontal, 5 
mm in length meniscal tear. Extension identified to the inferior 
articular surface. The lateral compartment cartilage demonstrates 
mild grade 1/2 chondromalacia. The lateral collateral ligamentous 
complex as well as the posterior, lateral corner stabilizers of the 
knee remain intact.”

So, a small (1/4”) tear in the meniscus, which is fraying; and pretty bad degeneration of the cartilage on the outside and under the patella.

Is this anything like what you have/had? And if so, exactly what did they do, if anything, to the cartilage? Did you consider platelet or stem cell injections?

My discussion with the SportsMD guy left things pretty much in my hands. I’m going to keep biking and swimming full bore. I’ll run what I can, but give up speed, volume and frequency and (for now at least) going up or down hills. I’ll see an orthopedist when I get back from Spain end of April/May, but I’d rather not consider any surgery unless I can’t run at all AND that would give me a chance to keep shuffling for another year or two, until I turn 72 or so.

And, down the road, if it ever comes to not being able to ski, I’d consider a new knee, as that would probably let me keep sliding around.

I’m looking for thoughts, ideas, not sympathy…

And he replied:

I would defer any decisions until you get a good orthopedic opinion.

I’m surprised you characterize the results as “pretty bad degeneration”.  The fraying or tear is pretty common for our age ( see my MRI).

Stem cell or platelets injections have never been seriously peer-reviewed and in my research pretty much BS.  Certainly not evidence based standard of care.

I would not dismiss the value of PT if so recommended by orthopedist.  I had chondromalacia findings a long time ago, and PT made a huge difference.

Knee replacement, I would guess, is a very long way off.

Cutting back a little in light of the swelling makes sense for now.  But I would avoid any major compromise in your training until after an orthopods opinion comes in, unless the swelling or pain becomes problematic

And my reaction:

Two things in this note…

First, thanks for your measured and dispassionate to my current gnarly knee. When I was in medical school, the one part of the body I never wanted to see during pro-sections was the knee… it looked and felt so complex and important, that I developed a variant of medical student’s syndrome about it, having a fear and worry that I would somehow damage it. I’ve carried that all my life, so this current episode feeds on that adolescent emotion.

Everything you say is consistent with what I’ve seen while obsessively googling things. Back to this after the second item I want to share with you:

I hope you are reading this week’s New Yorker, the one with the eye on the cover, analyzing the brain on a couch (on my iPad, the eye rotates). Among the three mind-centric articles (I don’t count the one about Scott Pruitt, which I am assiduously avoiding), be sure to read the one by Larissa MacFarquhar on a philosopher named Andy Clark.

Remember my enthusiasm about the U of WA neuroscientist who combined musings on the origin of our brain/mind development with his trips down the Grand Canyon? He felt that the need to throw accurately to kill megafauna required immense brain power and neuronal coordination, selecting for larger and larger brains. The brain thus grew bigger, and since we weren’t continuously throwing spears at saber tooth tigers, we had a lot of free time to think up stuff like wheels, cooking, and the theories of evolution and relativity, etc.

So Dr. Clark has taken a journey over the past 30 years about artificial intelligence, robots, the purpose of the brain and its role in the world. The whole article is fascinating, but two steps along the way particularly interested me. First,   after watching how difficult it was for robots and artificial intelligence to be easily functional and plastic, he realised that “the line between action and thought was more blurry than it seemed. A creature didn’t think in order to move; it just moved, and by moving it discovered the world that then formed the contents of its thoughts.” Hmm:  I move, therefore I think?

The second idea which struck me: “Each step…took him further away from the idea of cognition as a disembodied language and toward thinking of it as fundamentally shaped by the particular structure of its animal body, with its arms and its legs and its neuronal brain.”

I’ve long resonated with both those ideas, that our mind is not separate from the body, but ultimately arises from the totality of the organism (Clark has some interesting ideas concerning just where the boundary is between mind and the world around it…) You can see how this loops back to my reaction to finding damage of any sort in any part of me – how is it going to change not just my anatomy, not just what I am able to do, but ultimately, who I am.

But you’ve probably noticed that a lot in this second phase of our friendship. Luckily, I have several traits which serve me well: I’m pretty good at assessing and analyzing; I’m basically optimistic; and I am obsessively goal-driven. Right now, I’m using the first two traits to get me towards the third.

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