A Dr. Visit

Before you read this post there are two disclaimers. 1.) You may just want to skip this post if you are only interested in the trail adventure. This is about my stubborn knee. 2.) This is a fictionalized account. Dr Heiden did not say everything I quoted him as saying, nor did I for that matter. Jennifer thinks I should tell you what parts, but that wouldn't be any fun. I think you can determine it on your own.

I was looking forward to seeing the doctor about solutions for my knee. I am not old enough to sit the bench for the duration. I still want to be active, so what can we do to help my knee recover. 9:30 AM was the time, the Orthopedic Specialty Clinic was the place. It was 9:10 when I arrived. 9:10! I am never this early, I must be excited.

It is a good thing I was there 20 minutes early. I sat in the waiting room reading the book I brought along until 10:35. The fact that I had an appointment scheduled at 11:00 to share my own doctoral wisdom with another didn’t seem to faze them. I sat with both feet on the floor because crossing either leg over the other eventually makes the old knee hurt.

Finally I get called to the examining room where, as usually happens, you have to tell the whole story to the nurse as a warm up for telling the whole story to the Doctor. I kind of wish they would both listen the first time so I can be sure I get the story correct.

My Orthopedic Dr. is Eric Heiden of Olympic speed skating fame. He has a very good bedside manner and was very agreeable. We had a good conversation. He began with the Dr approved manner of poking, pulling, twisting, and pushing trying to find the painful part of the knee. He was able to find a few tender spots that none of the other health care professionals were able to find.

“Does it hurt when you sit like this?” demonstrating the way I had been sitting for over an hour in his waiting room. Now I knew why I had to sit there that long.

“How long has this been hurting?” he asked me as he pulled and twisted.

“Well, I hurt it on April 4 when we were long distance hiking. For 250 miles I hiked along, one step after another, and all of a sudden I took a step that hurt.”

“Do you like hiking?” was his next question.

“Well,” I replied, “I really do like my wife and she really likes hiking.”

“So she drags you all over the country to hike?”

“Pretty much.”

“Hmmmm, Lets look at the MRI.”

He read the MRI report and went over it sentence by sentence, telling me what each sentence meant. Then he sent me for some x-rays. The x-ray tech was all business so after a couple of attempts at conversation I went through the x-ray motions silently. When I returned to the room, the information I was waiting for, the answer to 2 months of waiting and wondering, here was the answer to my question, “what can I do to get back in action?”

He pulled up the x-rays on the computer. He then proceeded to show me each and every problem and where the lack of cartilage was affecting me.

“Here is a little bit of arthritis right here and here, but it is nothing unusual nor should it be giving you any problems.” Then he switched views to a side by side of both knees. “Ahh,” he said. Don’t you hate it when the Dr. says that. You don’t know if he is saying “Ahh, we are going to have to amputate the leg,” or “Ahh, now we know the problem.”

In this case thankfully it was neither. He pointed to the unevenness of the bones and said, “do you see this gap here in relation to this gap here?”

“Yes, it is pretty obvious”

“Well this is where you have used up the cartilage and this bone is causing the pain. The unevenness is like you have been living for 50 years with your front end out of alignment.”

“Oh,” I said. “Is that why I could never run very fast or jump very high?”

He looked at me, grimaced and said, “No that is because you are white!”

“Well as long as I have a reason. So basically you are saying that I was hiking along and after being out of alignment for 58 years, (I corrected his estimate of my age) and 264 miles on the trail, all of a sudden, my knee got old.”

“That’s about it.”

“So what do we do about it. I am not ready for a rocking chair.”

“You can consider several things. I could scope the knee and try to clean it up, but I really don’t think that is your problem. We could give you a cortisone shot and that will keep the pain out for a few months, but that isn’t a long term solution. We could give you something made out of the protein in a Rooster’s Comb. That will lubricate the knee and help what cartilage is left and that will last for 6-9 months. It works well for some people, not so good for others. You could get some orthotics made for your regular shoes and your hiking shoes that will bring your knee into alignment. That has about a 50% chance of doing some good. And finally you can consider changes in lifestyle.”

“Uh oh,” I thought. So I asked, “what does that mean?”

“Well,” he began, with the mantra that all of us big people are used to. You need to watch your weight and exercise the muscles around the knee. Knee bends, squats, ham string curls, etc.”

Then came the hard to hear part. “And you need to quit hiking down hill with a 40 pound pack on your back. When you are going downhill you are multiplying the force on your knees 11 times.”

“But Doc,” I protested. “We want to finish hiking the AT.”

“How far do you have to go?”

“Well,” I fudged. “Over a 1000 miles.” Yeah I know, It is more like 1594.7 but whose counting that closely? I mean if we were really counting it is only 1593.2. Of course from where we will have to restart it is the larger figure. He didn’t give me a straight answer.

“Ok,” I asked. What do I do for cardio exercise?”

“The best thing you can do is speed skate.”

“Uh, I have ice skated twice in my life, although the first time was on racing skates, about 41 years ago on a frozen pond at the local park.”

“The next best thing you can do is swim.”

“Do you think I could swim?”

“Sure.”

“Great, I have never been able to swim before. I am looking forward to getting to the pool.”

“Oh,” things don’t get by Dr. Heiden. “Maybe you better get a bicycle and ride a bike, or use a stationery bike.”

“How about the elliptical trainer.”

“That is better than the treadmill, you need to be careful. And hiking is ok, just don’t go up and down, hike on the level.”

So now we know my activity for awhile. I didn’t ask him about golf because his answer didn’t matter. I didn’t ask him about basketball because the answer is pretty obvious. I should have asked him about mowing the lawn though. He might have told me I needed to let Jennifer do it.

“OK, I decided. Lets do the chicken treatment I guess. That will eliminate the pain while I work to build up the muscles so I can maybe continue our hike next spring.” I didn’t say the last part out loud.

“We need to check your insurance, we may have to get a pre authorization.”

A few minutes later the first person I told my story to came in and told me the insurance said no dice. I can’t get chicken until I have the cortisone treatment. That is the same thing they told me when I asked Dr. Hill for one of the new medicines they treat psoriasis with. “Nope, can’t have the medicine that works until you try the medicine you have been using for 25 years that doesn’t work.” To be fair, they don’t know I did the cortisone for psoriasis years ago when we had different insurance.

Now I have a knee full of cortisone. I am ready to hit the gym. Then one more restriction before I go. “Give the cortisone a week to start working before you start the training.”

Now after only 8 hours, my knee feels worse than ever. Hopefully that is the cortisone at work. That is what Nancy nurse told me to expect. Hurt knee Hurt!