There Are Plenty of Options...

Yesterday I had my MRI review meeting with my orthopedic surgeon, Dr. Andrew Parker. I brought in the MRI, and we went over the radiologist's interpretations before Dr. Parker showed me the actual MRI images of my right knee.

There are multiple issues at play: (1) bits of cartilage have broken off and are floating around (but they're quite small at the moment); (2) I'm losing cartilage, esp. behind the kneecap; (3) I'm developing osteoarthritis; (4) I have a lot of fluid build-up all around the patella; and (5) I have scar tissue buildup from my previous 1,984 other knee surgeries (slight exaggeration on the number), in addition to some calcification of tissue around the kneecap. 

Dr. Parker suggests that this means: my knee is an utter and absolute mess. But I have options. They are: (1) knee replacement (not quite yet--like "killing an ant with a bazooka"); (2) arthroscopic surgery to clean out debris, calcification, and some of the scar tissue (but this won't guarantee lessening of swelling and/or pain); (3) injections of OrthoVisc, a "joint fluid treatment" that treats osteoartritis for months at a time; and (4) taking Glucosamine Condroitin and Aleve (for inflammation). 

As you can see with the above list, I've organized it in order or horrendousness (worst first). But the good news is that I start with (4), move to (3) in a few months, and keep repeating (3) for the next few years. I have been told I can continue to run. But, alas, I cannot run "a lot": maybe 20 miles a week, or 25. But I'll never marathon or ultramarathon, the real hope I had when I started blogging on this topic. 

It's funny: in the last ten years I've had no problems with my knees whatsoever. I knew I had these surgeries and I have the scars to prove it. But I had bounced back, and I felt a bit bionic. I laughed when my mother cringed as she asked me, "how many miles did you run today?" As if it was all a dream, the previous injuries. But at my age (38) it was just a matter of time. Those injuries would eventually come back. I think this is akin to hearing my grandfather-in-law, at 93, just this week was diagnosed with lung cancer. He quit smoking in the 1950s, but it eventually caught up with him.

In my research I've found plenty of articles on overuse injuries for ultraendurance athletes. Consider the article by O'Toole et al.: Overuse Injuries in Ultraendurance Triathietes from the American Journal of Sports Medicine. The injuries to the athletes were common and random (not all athletes had the same injuries). The bad news is that I am not an Ironman competitor: my last actual elite sports competition was in 1994. 

The good news is that these athletes, who do dangerous and outrageous sports feats, keep doing it. So I might have to get injections with a horse needle into my knee every couple of months to keep running. And I will.

All the Excuses in the World...

All the excuses in the world won't get a runner ready to be an ultrarunner. Excuses of mine so far: injuries. Time. Dissertation. Family. But there are plenty of runners out there with families and jobs and injuries who become world-class (or even just consistent) ultrarunners. For me, injury has been the key interrupter in my training.

Roy Stevenson, an exercise physiologist and writer for ultraRUNNING online, says of DOMS (Delayed Onset Muscle Soreness), "It is very common for out-of-condition or beginning runners to experience DOMS. Its severity depends on how much and how intensely we exercise, and whether we have performed that exercise before. But it’s not just beginning runners who are susceptible to DOMS – even well-conditioned runners who’ve been training consistently for several years can experience DOMS after a race or vigorous training session, especially a lengthy downhill-running workout."

I can attest to having suffered DOMS. And Stevenson is right that those of us who think we're conditioned but are not. I was only running 25 miles a week when I pulled my right calf muscle, and that's not nearly enough mileage to consider a marathon, let alone an ultrarunning event. 

One of the most important things I can learn from Stevenson is that the actual damage done to muscles is real. Stevenson says, "Traumatized muscle is a war zone! Your leg muscles are under siege after repeated eccentric contractions and the descriptions of the damage sound horrifying. Here are some of the main protagonists: disruption to the muscle sarcomere; breaching of cell membranes; swollen muscle fibers; wear and tear on connective tissues (ligaments and tendons); calcium spillage from muscle tubules; cell inflammation and increased production of superoxide free radicals..." The pain we feel has a cause and can be medically identified; and so my month off, while it might not be the length of time required for full rest, was one of the smartest things I've done for my ultrarunning dreams.

Stevenson finishes by suggesting that "Apart from using the modalities recommended above as preventative methods (warm-up, ice, compression, some antioxidants, and post-training carbohydrate/protein mixtures), stimulating DOMS to a minor degree in training will prepare the runner better for DOMS muscle trauma." And this makes sense: runners, like all athletes, need to be fully prepared for the difficulties of DOMS during training and events. Knowing how muscle soreness feels and how to mitigate the damage will help me keep running even when DOMS flares up.

International Herald Tribune Blog about China and Censorship

Check out this article by Mark McDonald.

The Waiting Game

Some good news on the medical front: my injury to my knee is not major; so minor, in fact, that I've run twice this week. But the good news isn't great for one reason: I still have a scheduled MRI on Thursday. What the orthopedic surgeon saw on X-Rays and through mobility of my right knee is that it could be a small amount of scar tissue that makes me feel the "pop" behind my right knee when I climb stairs. That would be great news. The tissue will dissolve eventually and won't harm me in the long run.

But the potential bad news: it could be loose cartilage, in which case a minor surgery would be needed to remove any cartilage that's hanging out in there but not in place. As cartilage is the "cushion" for the knees and absorbs the impact of contact sports and the stresses of running, I need all I can get. So for many reasons I'm crossing my fingers for scar tissue. When in the world will I ever say that again?

There is also hope for me in that while I was informed that, at 38, I have arthritis in my right knee due to all the trauma of previous injuries/surgeries, that arthritis will not limit my running. "They're not incompatible," says Dr. Parker. And, if you think about it, running and staying healthy will help my joints by limiting weight gain (a real bear on the joints), creating endorphin rushes to help with mood, and work on my cardiovascular system, which supports overall health. 

The most amazing thing I learned at my appointment last week was that there is a new treatment for runners (NFL players, basket ballers, basically anyone who is super active and tough on their knee joints) called Synvisc. Synvisc is a joint lubricant that an athlete can get (injected into the knees, yes) once or twice a year to work in sync with the cartilage and to work as a "shock absorber"; it also does wonders for pain relief.

Now, the question is, to research Synvisc and runners; who uses it? What have been their results with it? Also, will my insurance cover the costs?

Health care is expensive; but I think it would be more expensive, in the long run, not to run...

References Cited

Parker, D. Andrew. Interview: March 9, 2012. http://commonwealthorthocenters.com/