Friday, August 8, 2008

cortisone shots in my knees: a love story

I finally did it!

I blogged in a previous post that I have bad knees. Over the past 8 years, I've been to 3 different doctors. The first doctor told me I had chondromalacia (wearing away of the kneecap), and that I should stop walking the 4 miles I was doing for exercise everyday. I cut back on the daily walking and picked up yoga.

The knee pain subsided but came back. I saw another doctor who took x-rays and proudly declared that I was an "anatomical freak" with *the* most pronounced angles of thigh bones and femur bones going into my knees that he had ever seen. Whoa. This doctor was an older guy and the head of Orthopedic Surgery. I trusted his opinion when he told me I had osteoarthritis. Then I almost passed out in his office as he gleefully went on to discuss various operations he could do, including a controversial surgery he used to do 'back in the 70's" in which he went sliced into the hip and turned out the hip bones out, to mitigate the angle in which they went into the knee.

I was in a bit of shock after all this. I cut down my walking even more and continued with yoga, and got into rock climbing. These both have less impact on the knees.

The last few months I really started to notice that the knee pain was slowing me down and keeping me from doing things I wanted to do. I love to hike, and I live in the city and don't have a car, so I still end up walking quite a bit. (In many ways I am a bad patient?!) I was also able to predict chilly and rainy weather by my aching knees first thing in the morning, before I even opened the blinds.

So I went for another opinion with a 3rd doctor, Dr. Akizuki. Thanks to the fabulous reviews on www.yelp.com, I felt like I was in good hands. Dr. Akizuki is the official doctor of the SF Giants. He is professional, knowledgeable, has a great sense of humor. But best of all, I love his positive attitude. He had me do an MRI of my knees and nixed the osteoarthritis theory, giving me back the previous diagnosis of chondromalacia. Osteoarthritis is the wearing away of the whole knee, whereas chondromalacia is the wearing away just of the knee cap. It is more common in women than in men because our hips put more pressure on the knees. I am also very bowlegged, which puts added pressure on my knees. And of course, my years of running and walking on the pavement didn't help.

Dr. Akizuki clearly spelled out my options---first start with physical therapy to strengthen the hips, then try a cortisone shot, then try fluid shots if it still hurts, then having arthroscopic surgery so he could see what was going on in my knee. At some point, I will probably need knee replacements, but I'll try less invasive procedures first.

I've been doing physical therapy for the last 6 weeks or so. I feel like my thigh muscles are getting stronger, thereby causing the knees to do less work, but I still have pain that holds me back from doing things. So I decided to go for the cortisone shot. This will hopefully decrease inflammation and decrease pain, although it's not a cure. Chondromalacia is a degenerative process that unfortunately will only continue to wear down my knees.

I got a shot in each knee. The needle was *BIG*, but the shot was quick (15 seconds) and completely painless, thanks to some pain-numbing stuff injected with the shot, and Dr. Akizuki's hilarious dialogue and constant checking in with me. For the next 6 hours or so, I tried to keep off my legs. My knees felt numb but I could still walk around. I ended up walking 6 blocks to my office and felt ok. But by evening, my knees had stiffened up considerably. My left knee had some pain, but my right knee was just tight. I ended up limping to bed.

Today they feel much better and looser. I'm keeping off them again, the doctor said the first couple of days this was to be expected due to the massive blast of cortisone. I can't wait to see how I feel tomorrow! Although there is no guarantee that this will work for pain, most people get relief for 3-6 months, some up to a year!

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