To Cut or Not To Cut

Discussion in 'Health & Fitness' started by Cindysphinx, Nov 27, 2009.

  1. Cindysphinx

    Cindysphinx G.O.A.T.

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    OK, it's time to decide what to do about this knee.

    Long story short. The MRI says incomplete lateral meniscus tear and arthritis. Physical exam says medial meniscus tear. Xrays say no arthritis. Several weeks of PT didn't resolve things. OS says he can't do anything more short of surgery. OS says it makes sense to do an exploratory arthroscopy: Go in, look around, clean it up. OS says I would be out 4-6 weeks.

    As things stand, there is definitely something wrong with the knee. It doesn't hurt when I play doubles, but I am extremely slow. When I run, it starts hurting after about 5 minutes. No matter how much or how little I play (or ice or Advil), my knee is sore, especially after I've been sitting a while. I spend a lot of time trying to manage swelling.

    I am really on the fence about this.

    I had arthroscopic surgery on the other knee in 2005, but that decision was easy because that knee was so bad. Still, it took a year before the knee (and my fitness) was 100%. It's hard to believe the promises of 4-6 weeks this time around given what happened last time.

    Still, if I go ahead and have the surgery now, then I could put my energies into rehab rather than putting my effort into (unsuccessful) attempts to manage things. I have heard that living with a bad meniscus raises your risk of arthritis. I am very worried that I have lost some strength in this leg, and that could set me up for a more serious injury (I already got a stress fracture and bone bruise, which I doubt would have happened on a healthy knee). I could miss Dec. and Jan., but I'd perhaps be ready to play in February. Then again, every surgery has risks, and I would hate myself if the surgery went bad and created more problems than it solved.

    Or I could just soldier on and schedule the surgery after the 2010 adult season in June, so I'd have the entire summer to recover. And maybe by then the knee would have gotten better on its own. But if I wait that long, I will be a pile of wriggling Jello in terms of loss of overall fitness and strength, and that will take a long time to recover, assuming I can recover my fitness at all at my age.

    Anybody got any bright ideas? Should I do this now (like, this week) or wait?
     
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  2. Ripper014

    Ripper014 Hall of Fame

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    No bright ideas but you can take this for what it is worth... tennis is winding down... with Christmas coming up... and 4-6 weeks will have you up and running by the new year.

    What I find about injuries is that instinctively you will stress other parts of your body to take the pressure of the injured area. In the long run... you are at risk if injuring something else.

    Though I hate the thought of surgery and have never had to go through it yet... I recommend getting things fixed before something seriously goes wrong.

    Tennis is just tennis it is not life changing... losing your health is.
     
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  3. ollinger

    ollinger Legend

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    Problem here is that it's not clear whether arthritis, meniscus tear or both are causing the pain. 15-20% of meniscus surgeries produce no improvement in symptoms. Depending on what part of the meniscus is involved, it can either be sutured or just "cleaned up," the latter producing frequently less satisfying outcomes. You may want to find out exactly what the orthopod expects to be able to do.
     
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  4. Cindysphinx

    Cindysphinx G.O.A.T.

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    He doesn't know what he will find when he gets in there. And he can't say until he knows what exactly is going on.

    That's also kind of scary. This guy is a good surgeon. He operated on my daughter's knee earlier this year. In her case, no one could figure out what was wrong, and a different doc thought meniscus tear. He went in and found no tear, so he did nothing and closed her up. Problems persisted for another 18 months, despite a consultation with yet another OS.

    So I took her to this new guy, and he decided it was a tracking problem and did a lateral release. When he came out of the operating room, he said he was certain he had fixed the problem. Six months later and she is pain-free and running.

    I trust this guy's judgment, and his judgment is all I have to go on, unfortunately.
     
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  5. LeeD

    LeeD Bionic Poster

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    Sorry to hear about your knees.
    I tore my lateral meniscus like late July this year, and I stopped playing for easily 2 months, first days back tentative and scared.
    I'm a gardener, and had to BACK down all the stairs I needed to negotiate, could never walk facing down the steps until +3 weeks after injury.
    Of course, I windsurfed 5 days a week, 2 hours a day, but that's a walk in the park for me (I often sail in 20+ mph winds keeping dry for 3 hours).
    It healed, but not my sprained left ankle from Sept '08 or the back of my wrists, from 5 years ago.
    Always get a third opinion. Fortunately for me, I know at least 5 orthopedic surgeons and a couple of sports medicine docs. Comes with the territory from surfing, motocross, waterski jumping, windsurfing, and tennis.
     
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  6. Cindysphinx

    Cindysphinx G.O.A.T.

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    I dunno. I don't see the point of a third opinion, or a second opinion. The test results are what they are. The physical exam is what it is (and contradicts the MRI completely).

    There aren't many more tools left in the box. The only things we have left are an injection (pointless) and surgery.

    Lee, how do you know you had a torn meniscus?
     
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  7. LeeD

    LeeD Bionic Poster

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    Oh, just two of my sports medicine docs looked me over, and one of the ortho's. OTOH, my buddy who's an Eroom doc also looked it over, and he said "REST thos"..... my other Eroom doc buddie said to have it looked at and monitored.
    Having lived thru 4 collarbone breaks, 2 tib/fibs, 1 fib, over 17 ribs, 5 fingers, and over 7 dislocates and separated shoulders, I'd think I have an idea how to recoup from physical injuries.
    Oh, I've raced over 40 road races (motorcycles) and over 300 motocross races.
     
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  8. Topaz

    Topaz Legend

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    I would echo pretty much everything Ripper said...this is actually a pretty good time to have it...would you rather miss mixed or ladies doubles/singles/multiple leagues that start later on.

    A woman in my clinic had knee surgery last year the day after Christmas. She was back on the court in February.

    If you trust this guy (and it sounds like you do, with good reason) I would say let him go in and look around.

    And, on a totally different note, I was doing some reading about nettle tea (looking for alternative remedies for my chronic inflammatory sinus problems), and it seems it is widely recommended for many things, among them arthritis. Here's some info, take out of it what you wish:

    http://herbalmedicine.suite101.com/article.cfm/stinging_nettles

    http://www.teabenefits.com/herbal-tea-benefits/nettle-tea-benefits.html

    http://www.herbsorganic.co.za/pages/working on/Nettle/Nettle info.htm
     
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  9. Fedace

    Fedace Banned

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    I say STOP listening to people in the forum and listen to the advice that the best possible Orthopedic surgeon can give you. Find the one that specializes in Sports medicine as sub-specialty. I am sure you have good insurance. from what i can gather, you are middle class or above.....
     
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  10. Jim A

    Jim A Professional

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    Recovery is so quick nowadays on it, and better to avoid the arthritis.

    I'm 39 and have no cartilage in one knee and tears in the other, I waited too long to get the first done and they wound up shaving down the kneecap and drilling holes in it to improve blood flow and stave off arthritis about 3 years ago. Regardless I was back on the ice in just 4 weeks or so...our captain got 'scoped a month before districts and while not 100% wasn't far off his game, he logged about 500 miles on the bike though to get ready

    I'm waiting to find out on the other one but likely will get it done sooner than later as well in order to have a couple months to prep before the season starts in April/May, 10 sets over the past few days have pretty much sealed that conclusion.
     
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  11. Ripper014

    Ripper014 Hall of Fame

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    Topaz... have you ever tried doing nasal flushes (sinus rinse) for your nasal problem? I occasionally have to deal with bad allergies over the spring and fall... but find if I do regular sinus rinses it seems to help a lot. Disgusting I know... but its not too bad once you have gone through it once... and know what to expect.
     
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  12. Ken Honecker

    Ken Honecker Rookie

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    I'm a hardcore, rub some dirt on it sort of a guy. For example when I strained a calf this fall I kept playing until the other guy called it a night realizing I wasn't going to let him win. I've always waited until after season to have stuff worked on. That said I'd try and get a concencess of whether waiting was very likely to lead to problems down the road. If the answer was yes I think I'd get it worked on right away and then rehab the crap out of it. You want to be able to get another 20-30 years out of that knee right?
     
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  13. Topaz

    Topaz Legend

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    Yup, I do them regularly...started about 2 years ago with the recommendation of my doc. I think they've helped tremendously, but I still seem to get a sinus infection every year during the same time...and they are getting worse. This last one was probably the most painful one I've ever had. She (my doc) hasn't felt the need to send me to a specialist yet, so I was just researching some other possibilities. I also read that chronic sinusitis can be caused by a food allergy! I already keep a daily food log, so I'm going to look at that as well. Headed out to Whole Foods today to see if I can find some nettle tea. Even if it doesn't work the benefits seem very complete for lots of other things, too.

    I found a *lot* of info on alternative remedies for arthritis as I was looking...very interesting (at least to me!).
     
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  14. chess9

    chess9 Hall of Fame

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    I'd go with my instincts on this one too.

    One of the guys at our club had his meniscus trimmed and was hitting balls against the ball machine three days later. I saw him hitting balls for an hour in a pick-up doubles match today. He wasn't running hard, but he was moving! It's about two weeks out now. I'm told trimming the meniscus is a minor bit of knee work. I haven't had mine done though. ;)

    Also, as young as you are, you'll heal quickly. ;)

    -Robert
     
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  15. crystal_clear

    crystal_clear Professional

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    Agreed~ body is like a car. A small fix would save a big fix in the future. A car needs a regular oil change and maintenance to keep smooth running condition.

    What about body? How many people take care of their bodies like taking care of their cars?
     
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  16. Cindysphinx

    Cindysphinx G.O.A.T.

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    I played a match tonight. The knee did what it always does: It behaved beautifully during the match. No pain, no problems. Three Advil.

    And now I'm up in the middle of the night with my knee aching. And I know when I get up from my desk, it will take some time to straighten my leg because of Theatre Sign.

    I still can't decide whether to just keep playing on it and let nature run its course, or intervene. I was poking around the internet, and research shows that a stable meniscus tear can be left alone. It seems so weird to get surgery for a bit of aching and swelling. But this has been going on since August and it is getting old. . . .
     
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  17. jrod

    jrod Hall of Fame

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    Problem is Cindy, you don't know exactly what is going on in there. Secondly, regardless as to whether or not you get cut you will likely have to stay off it for a decent spell to let it heal.

    My sense is to have the Doc take a look and get a proper diagnosis. Given decent information I'm pretty sure you can make an intelligent decision. As it stands now, you are speculating along with everyone else.

    Just my $0.02.
     
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  18. Cindysphinx

    Cindysphinx G.O.A.T.

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    OK, I put in a call to the scheduler for this doctor.

    I just got back from my exercise class. One hour of lower body work (15-minute run, lunges, squats, sprints, backwards hills). Felt the occasional twinge and couldn't do the side-walking lunges, but I could do everything else perfectly. Whoever heard of getting surgery when you can do pretty much everything you want to do? This is so weird.
     
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  19. mike53

    mike53 Professional

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    Not saying yours is, but most elective cosmetic surgery would fall into this category. Everyone I know is getting everything they can get covered fixed right now because of their uncertainly over the pending legislation.
     
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  20. charliefedererer

    charliefedererer Legend

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    Good luck with the arthroscopic surgery.
    Providing everything heals well, are you making plans to modify your multiple knee pounding activities to prevent future knee problems?
     
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  21. Cindysphinx

    Cindysphinx G.O.A.T.

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    No. I need to play tennis. I need to run. I'll keep doing it until I can't do it anymore.

    No more singles, though. Both times I hurt a knee, it was in an effort to become a singles player.

    I reached a decision today. I called and talked to the scheduler for this practice. She said I would need an EKG, blood work and complete physical. Getting this done would push me back well into December. Which means I'd miss a lot of the winter season.

    Hearing that also reminded me that I had some issues under general anesthesia last time -- it's not good when your heart rate falls and they have to give you two doses of epi, is it?

    So I'll live with it as long as I can. Gotta just suck it up, I figure.
     
    Last edited: Nov 30, 2009
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  22. Ripper014

    Ripper014 Hall of Fame

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    Your body is a incredible machine with warning mechanisms in place... if you feel pain there is a reason for it... it is your body telling you something is wrong.

    It is your choice to manage the threshold of pain you are willing to deal with... but I would rather sacrifice a short term loss for a long term gain, especially if it is something I will eventually have to deal with anyway.
     
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  23. jazzyfunkybluesy

    jazzyfunkybluesy Banned

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    Why ask strangers ask your doctor Jesus.
     
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  24. Ripper014

    Ripper014 Hall of Fame

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    My biggest concern would be the possibility of doing any additional damage, plus I find it frustrating to be playing competitively at less than my best.
     
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  25. crystal_clear

    crystal_clear Professional

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    Agreed~ Long term tennis is more important than the temporary one.
     
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  26. jrod

    jrod Hall of Fame

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    Sorry but your estimates are a little exaggerated. Blood work takes 20 minutes tops (18 minutes of waiting and 2 minutes to draw blood). It takes less than a couple of days to run the labs.

    The EKG takes a a few minutes and a complete physical takes about an hour. I did both of these things yesterday and my total time invested was 90 minutes (including drive time), NOT a whole season.

    Sure does smell like denial. I sure hope your knee problem resolves itself on its own.
     
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  27. Cindysphinx

    Cindysphinx G.O.A.T.

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    My doc is scheduling physicals for January. I suppose I could try to find a new doc, but my health plan is very short on internists who will accept a new patient. I dithered too long.

    JazzyFunkyblues:

    My doctor's name is not Jesus.

    Anyway, it is helpful to knock a decision around with other people sometimes. The people here have a different take on this than my doctor. His bottom line is "Yeah, sure, go play tennis if you want. You aren't going to hurt anything. Come back when you get tired of dealing with it." That may be medically correct, but it doesn't grapple at all with the philosophical and lifestyle and risk assessment questions.

    That's why I have you people! :)
     
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  28. jrod

    jrod Hall of Fame

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    ^^^ I agree with your doc's advice. He is essentially defering to you for final judgement on the matter. You are the only person who knows when something isn't right. Hopefully you are honest with yourself and don't risk further injuring yourself Cindy.

    Years ago, when I was a runner, my knees started to tell me "enough". I intially ignored the signs but after another 6 months the pain while running became unbearable. A colleague of mine who I ran with also suffered identical symptoms. We both stopped running and sought medical advice at the same time (late 40's for me, early 50's for him).

    My doctor outlined the possibilities and suggested remedies. His approach was one of extreme caution, with surgery being the very last remedy. I started with physical therapy. The guy I got was very good (tri-athelete ) and started me on a number of strengthening exercises. Before long I started to play tennis for the first time in years.

    My colleague got different medical advice, even though our symptoms were similar. His doctor recommended surgery for what he thought was a tear in his miniscus. He had the surgery and took 6 months to recover. His knee is fine today yet he does not run any more.

    The thing is, both of us knew when it was time to stop. We both knew when it was time to seek medical advice. Even though our symptoms were identical, the root causes were not. We both had successful outcomes and are both very active now.

    Hoepfully you'll know when it is time and get sound medical advice. At the end of the day though, you are the best judge as to which course of action makes the most sense.
     
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  29. charliefedererer

    charliefedererer Legend

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    Clearly this is an area with no absolutes with regard to the best combinations of future activity. We want to be fit AND healthy, and enjoy the activities we have already come to enjoy.

    I had some knee pain at the end of the tennis season/running season in November about 10 years ago. With cold weather approaching I took a couple of weeks off around Thanksgiving.
    The knee felt great. I flew to a meeting in Houston, and couldn't resist going on about a 6 mile run on roads. The knee was achy again for about a week. So I swore off running on roads, and switched to running on soft playing fields, and doing more of the aerobic work on stair steppers/Nordic Track/bike/rowing. It kills me, but I decided I play too much on hard courts to do anything but occasional road running. It still feels like a great hardship to give up on the road running, but I'm lucky enough to live next door to a fabulous series of playing fields kept soft with sprinklers all summer. And now I love cross country skiing, which definitely has less pounding than running, but only do if the courts are covered with snow, and that's probably only a few weekends a year. And I swore off using NSAIDS (ibuprofen, naproxen)the way I used to use them for every ache and pain. The multiple pathways of the inflammatory system are way too powerful to suppress it with anything other than high dose prednisone. The suppression of the cyclooxygenase/prostaglandin pathway does occur, but it seemed to me that the micro-tears in tendons/ligaments/cartilage would elicit more than enough of an antiinflammatory response by all the other pathways so eventually collagen could be laid down to heal these small tears. But high doses of NSAIDS are a very effective pain reliever, and I began to worry that hiding the discomfort would numb my all-too-easily-numbible brain into thinking I was fine since I felt fine (I never know when to stop). I decided I wanted to be more like my Dad who played competitively until he was 79, and not need a knee replacement like my Mom (who played 5 times a week in her 60's) until her knee replacement at only 69.

    It had occurred to me as I was splitting wood that there is two ways to do it. One is to get a very heavy sledge hammer and hit the wedge with one great blow. The other is to use a more manageble hammer and hit it repeatedly until the log was completely split in two. Just like there are two ways to split a meniscus, either with one great blow, or many smaller ones. I worry that the large avascular central area of the meniscus might never properly heal, even if perfectly surgically aligned, unlike the lateral well vascularized meniscus tears that almost always heal.
     
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  30. drak

    drak Professional

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    Cindy I can only relate my 3 scope experiences (the past 13 years - I am 54 now) for relatively minor medial meniscus tears. In all 3 I recovered fully in 4-6 weeks, I was in good shape prior to surgery and did a solid rehab schedule. Even after my last scope surgery 2 yrs ago at age 52 I was playing hard and normal singles at 4.5 level in 5-6 weeks. Maybe your damage is worse, but my "scope" experiences have been very positive.

    Drak
     
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  31. drak

    drak Professional

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    all 3 of my cuts were by my choice because it was irritating but did not really effect my play. The doc said some non athletes might do nothing and be fine, I like to go full out and not have to deal with the after pain all the time, so I got cut all 3 times and they were minor tears, felt much better afterward so for me they worked. Only YOU can decide what you are willing to accept and risk.

    Drak
     
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  32. drak

    drak Professional

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    Just get an epidural, I did that for 2 of my knees and watched both on the monitor above, it was cool - like a PBS special!

    Drak
     
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  33. Cindysphinx

    Cindysphinx G.O.A.T.

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    OK, you lost me there at the end.

    I hear you on the issues of longevity. I haven't changed my running surface -- uneven surfaces make me very nervous -- but I've changed the distances and the way I run. An hour is my max. Most common is 30 minutes. I try to do a lot of hills and sprints when I do run, and I am likely to walk on the downhills.

    See, I just don't find myself very effective on a tennis court if I don't supplement tennis with runs. I haven't run since August, and I am starting to look like Tim Conway from the old Carol Burnett show -- no extension, slow first step. Lobs get over me, I can't run them down. It is now easy to beat me with a middling drop shot. This is embarrassing.

    I don't think swimming, cycling or eliptical is going to help me with what I need for tennis. Only hills and sprints do that.

    And I hate hate hate gyms and everything in them. When I did PT, I absolutely dreaded the 5-minute warm-up on the bike. Where did I get this horrible aversion to bikes?
     
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  34. drak

    drak Professional

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    I don't get that, I had no physicals or blood drawn for any of my knee scopes done by 3 different Docs, and even for my much bigger shoulder surgery last December I had none of this - weird if you ask me.
     
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  35. Cindysphinx

    Cindysphinx G.O.A.T.

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    Yeah, it is weird. I kind of expected to call and pick a date and have that be it.

    Last time (2005), the doc wanted a full cardio work-up. At the time, I had a cheap health insurance plan, so *my portion* of the cost of that work-up was over $500. I have a freak-of-nature vascular issue and some benign valve thing lots of middle-aged women get, so that (coupled with my absurdly low pulse rate) weirded him out.

    Since it is now 2009, I'll bet the internist is going to want to do the cardio work-up again. Do they think I'm made of money?
     
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  36. sureshs

    sureshs Bionic Poster

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    Ollinger is a medical guy and gives good advice.
     
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  37. Ripper014

    Ripper014 Hall of Fame

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    Time to move to Canada... have you looked at P90x ... it is a in home work out regiment that I really enjoy. It is as hard as you want to make it... and it is a total body workout that varies everyday. I have always hated home based workout schemes but this one actually has me doing it with enthusiasm.
     
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  38. drak

    drak Professional

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    well it sounds like you have a few health "issues" so a better safe than sorry approach is prudent. Do consider an epidural from waist down as opposed to being knocked out thru anesthesia.
     
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  39. Cindysphinx

    Cindysphinx G.O.A.T.

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    That's interesting that your doc was willing to do an epidural. My first doc who did my surgery was adamantly against doing it that way. He says epidurals can be incomplete and patients can still move. If they move while the instruments are in there, there can be some bad outcomes. He had to talk me into the general, though, as I had really hoped to do the epidural.

    I've had three epidurals for childbirth, and they totally rock!
     
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  40. Topaz

    Topaz Legend

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    Vascular regions have a good blood supply and regenerate/heal well and quickly.

    Avascular regions do not have a good blood supply, and therefore, not so great on the healing.

    Also, RE workouts...at home weight workouts that will kick you in the rear = Cathe Friedrich and Jari Love.
     
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  41. Cindysphinx

    Cindysphinx G.O.A.T.

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    Yes, but what has that got to do with my meniscus, given that I don't know whether it is torn or where it is torn? I mean, is this an argument for waiting to see if I am lucky and tore a vascular region?
     
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  42. drak

    drak Professional

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    I've had two for knee surgeries and my docs said nothing about any movement risk.

    Drak
     
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  43. jmjmkim

    jmjmkim Semi-Pro

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    Surgery should always be last choice
     
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  44. equinox

    equinox Hall of Fame

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    Umm manage the injury better? Cut down on tennis sessions and give more yourself recovery time.
     
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  45. Cindysphinx

    Cindysphinx G.O.A.T.

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    Yeah, I'm doing that. I try not to play on consecutive days, and I've stopped doing my Wednesday long run.

    It doesn't really help, though. I guess it might help prevent things from getting worse in the short term . . . .
     
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  46. charliefedererer

    charliefedererer Legend

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    You may be interested in the following as a background as to what is going on at the microscpic level at you knee:
    Cartilage, like most tissues, does not have a potential for regenerating once there is an injury. The little micro tears are filled in by scar tissue. More serious through and through meniscal tears do have the potential to heal together without surgery if in close opposition and treated by extensive rest, but suturing them together should speed the recovery as there is no gap to be bridged by fibrous scar tissue, and the sutures limit movement. But it still takes 6-8 weeks for the fibrous scar to strengthen to the point of resisting meaningful force. As the fibrous scar tissue that binds the collagen fragments is laid down it resembles a spider's web (also made of protein). Pound for pound, a spider's web is stronger than steel. But as we all know, if we want to disrupt a spider's web, all we have to do is wiggle our finger to break it up. So too, early fibrous scar tissue's individual strands are strong, yet so thin they are easily disrupted by movement. But over time they they are continued to be laid down in the inflammatory process by fibrocytes that have migrated to the site of inflammation from out tiniest blood vessels, the capillaries. The fibrin fibers create a weave that is ever tighter and increasingly cross linked at the molecular level so that they are not just individual fibers but a healed three dimentional tissue that plugs the gap left by injured tissue that died, and adheres tightly to adjacent cartilage tissue.
    But all this is predicated on there being a blood supply to nourish the fibrocytes as they lay down the fibrin strands.
    In our menisci, there are lots of tiny capillaries that can supply the needed blood containing oxygen and nutrients to sustain the healing process. But these capillary beds exists almost exclusively at the periphery of the menisci. The large central area of menisci have very few capillaries, i.e. have a poor blood supply, or are "avascular". Thus, this central area does not have a good potential for healing, with or without surgery.

    "The MRI says incomplete lateral meniscus tear and arthritis."
    What this means is that you had a former meniscal tear there that has healed back together by the above process of scar formation by the laying down of fibrin in between the crack in your meniscus. This looks like it is solidly held together, but the scar in this filled in crack is not cartilage. Hence the use of the term "arthritis", or inflammation of the cartilage, even though in this case the inflammation has actually probably ceased, and a fairly stable scar tissue filler is in place. Your orthopedic surgeon does not think this is the current source of your pain as there is no tenderness when he puts pressure on this area.

    "Physical exam says medial meniscus tear."
    Apparently there is no defect on the usually sensative MRI, so thankfully at least it's unlikely that there is a large tear. But this is the area of tenderness on physical exam, so there may be a small tear there. Or maybe its an area of "bruise" with mutliple micro tears that won't be visible even on arthroscopy at the surface of the cartilage.

    "Xrays say no arthritis."
    Xrays are far less sensitive to say anything about the menisci. Indeed on plain x-rays the mensici are essentially "invisible". If an area of meniscus separates off, or dies from repeated trauma (known as "osteoarthritis" or
    "degenerative joint disease") then the femur bone above directly contacts the tibia below, and the lack of joint space is a representation on xray that this has happened. The other evidence of arthritis on plain xray would have been deposits of calciium withing the cartilage areas, as calcium crystals sometimes abnormally deposits there as the scar tissue is formed in the healing of cartilage.

    "Several weeks of PT didn't resolve things."
    There are no specific PT activities, or activities of any kind, that can speed the rate of cartilage healing. Whoever finds one surely will win the Nobel Prize (hence the dubious claims from nutritional supplements, ultrasound, accupuncture, etc. If a way of doing so ever is discovered, it will really be the true "fountain of youth" freeing the world from most from joint and back problems, and it will not be kept a secret as the process will be worth trillions to the discoverer/manufacturer). The purpose of the PT was for you to keep the joint active, but without pressure, so your own body could heal while you otherwise kept off the knee. (And truth be told, it's not at all clear you, individually, actually needed this PT.)
    The only way to speed up the healing of cartilage problems, short of suturing two areas of separation together or removing protruding fragments, is through time. The wondrous process of the inflammatory reaction that starts at site of injury with the initial movement of white blood cells into an area, with those white blood cells emitting chemical mediators that attact the accumulation of fibrocytes that lay down the fibrin strands and then for the crosslinking to occur takes a good month to have even 20% of the final tensile strength. As the crosslinking continues, the final strength of the scar tissue and its attatchments continues to increase, reaching 40% at two months and up to over 60% in six moths, with final strength increases actually going on for a year. Of course many things could ****** this "healing" process, including poor local blood supply and excessive movement/repeated trauma. And for micro and smaller tears the process moves along faster as the three dimentional space that has to be filled in is smaller.

    "The OS says he can't do anything more short of surgery. OS says it makes sense to do an exploratory arthroscopy: Go in, look around, clean it up. OS says I would be out 4-6 weeks."
    There may indeed be a small fragment of protruding cartilage, a small piece of "floating" cartilage in the joint space, or less likely, an actual small tear that needs suturing. I'm not an orthopedic surgeon, and I would have to rely on his experience to what the likelihood of finding something to fix would be.
    The exploration itself is a worthy process as it is the most sensitive way to find out what's at the surface of the joint space or floating within it, even though the MRI was the most sensitive to actually evaluate the three dimentional aspect of the meniscus (although even the MRI gives a poor view of the multi microscopic injuries that might be present).
    Certainly the 4-6 weeks would be the best chance for small and micro injuries in your cartilage to heal, even if they would have done so without the arthroscopy. And by eliminating the repeated small blows to the knee menisci, you would be decreasing the chance that a fault line would emerge connenecting the dots of the micro/small injuries that finally results in a large tear.
     
    #46
  47. charliefedererer

    charliefedererer Legend

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    Double post. Sorry.
     
    Last edited: Dec 2, 2009
    #47
  48. Cindysphinx

    Cindysphinx G.O.A.T.

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    Wow. Thank you, Charlie!

    If I'm understanding this passage correctly -- and I may not be on account of all of those huge words -- a period of rest of 4-6 weeks (which I did beginning in September) should have helped. But if I continue resting, things might get better, but I'd have to rest for six months?

    My current plan is to keep playing and running at reduced levels, essentially trying to take it easy. If things haven't improved by June, then I would probably do the surgery.

    Does that sound consistent with the information you provided? Or should I think about resting from Dec. to Mid-January also?

    Sorry to be so dense about this, but I don't do well with things involving science or math, and sometimes the only thing I hear in my head is a blank buzzing.
     
    #48
  49. LeeD

    LeeD Bionic Poster

    Joined:
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    Wait a minute here....
    You think you have a meniscus tear and you're RUNNING?
    I couldn't even walk down steps facing forwards!
    I needed the bannister to get up steps.
    And for easily 2 weeks.
    How can you say you have an injury when you can still run?
    I can't run ONE mile with my 15 month old sprained left ankle.
     
    #49
  50. Cindysphinx

    Cindysphinx G.O.A.T.

    Joined:
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    That was the situation in 2005 with my other knee. Limped, couldn't straighten, had trouble with stairs and uneven terrain, couldn't run or play tennis (or walk very well). Turned out to be a complex tear, and he removed 15% of the meniscus and did a plica ressection.

    The reason I think I have an injury now in the other knee is that the MRI said an incomplete lateral meniscus tear. I also have pain at the joint line on the medial side, which suggests a tear in the medial meniscus, although this might just be a teensy thing. That's why I think something is injured.

    The problem I am having is precisely what you suggest: If the situation is grave enough to require surgery, then how come I can play tennis and run?

    It manifests itself in theatre sign (pain upon straightening after I've been sitting a while) and twinges when I do certain leg exercises that require lateral movement. I can do standard lunges and squats all day long.
     
    #50

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