74. 5kg=30kg, 10kg=70kg etc

I started writing this post before Christmas hoping to get it done before Christmas Day to upload but it didn’t happen.  Most people would be super busy anyway to read it so I guess the right time for it to be done is today.  

Dr Szomor appointment on Friday 15th.  He is a hip and knee orthopaedic surgeon that my GP referred me to for a consult about my MRI results.  It was in the afternoon and near St George Hospital so I parked in the main car park and utilised my 3 hrs of free parking with my oncology patient card.  I walked through the hospital complex and out onto Kensington St and up to his office. The lift in the building did that juddering type feeling and the 3 of us passengers in the lift silently glanced at each other with the same look of speculation and slight trepidation.  Isn’t it funny how so often people in lifts just don’t talk and even people who had been talking stop their conversation while in the lift. A sacred zone of concentration to make sure the lift makes it to your floor without incident perhaps.

I was about half an hour early as I wasn’t sure of traffic or finding the place. It was a good thing though as there was forms to fill out and that took a good 20 minutes. One was a history which included medical history but also injuries. The other form was a knee pain scale. Options were how much your knee (both knees actually) made it difficult to do every day things, like going up or down stairs, getting dressed, showering and all manner of questions that took up two pages. 

He was about 10 mins late and then once I was shown into his office by the receptionist he was another 10 mins. I found his chairs quite uncomfortable. They were old style brown leather chairs,  antique with wooden arms, metal fastenings. They were quite low to the ground which I found amusing due to the amount of people that would be coming to his office with hip and knee issues.  I know I have long legs so generally chairs are lower down for me than other people but these were extra low to the ground. Reminded me of how the toilets in the USA are so much lower than the toilets here.  That was an issue for me when I had meniscus tears on the left knee in 2015 when I was in the USA for three months.  Getting on and off the toilet was quite difficult with a sore knee that locks up at the most annoying times.  

When he finally did come into his office he apologised for being late and then went through the pictures on the MRI.  He started a commentary “This is where your medical meniscus should be and this is where it is.  These bright white parts are inflammation and/or fluid build up.  These bits here that look like little teeth are bone spurs. This happens when you have cartilage loss and the bones start to grind on each other.  These sections here, (he motioned to the outside of my knee) show that you have bone on bone in this section.  Behind you knee cap is quite advanced osteoarthritis too.  See these bones here where they are a bit lighter in colour, this is bruised bone.  Hmmm, usually these two bones never touch, in what position was your leg when you had your fall?”  I told him that my leg was fully bent behind me and I’d landed on it and my heal was up near my spine above my bum.  “Yes, that would certainly mean these two bones had ground together. Do you get pain there?”  Sure do!  He ran through some more of the pictures and then said “Hmmm, what’s going on here? It’s behind your knee.  Maybe I should read the report.”  He hums softly to himself as he reads through the report and then says “Ah yes, the soft tissue and all that conjoining parts behind the knee have been injured, are inflamed, stretched and a little bit torn.”  He runs through the pictures again a bit slower, obviously looking at things that the report had pointed out.  He taps his fingers on the desk a few times.  

“Ok, can you stand up and walk up and down the room a few times?”  I heave myself out of the chair, grateful for all the arm exercises that Lewis gets me to do so I can keep most of my weight off my sore knee.  I walk up and down the room, I have a bit of a limp and am favouring my left knee.  “May I check your hips?”  I give consent and he finds my hip bones on the sides of my body and says “Your pelvis is out, the left side is a good 2-3cms higher than the right side.  Can you keep your left foot flat and lift your right heal off the floor?  Good, does that help with your hip and pelvis pain?”  Sure does, about 50% of the pain is relieved.  He says massage, targeted exercises and stretches and a chiropractor will help that that.  I have had a tendency to have hips that are out of alignment most of my life but I’m guessing my fall down the stairs didn’t help that either.  I need to find a good chiropractor and my favourite one Chris moved to Tumut in 2021.  I’ve asked a few people for recommendations, especially ones that have knowledge of osteoarthritis and cancer treatment issues.  

After the walking around and pelvis poking Dr Szomor asks me to lie on the skinny beg in his room, on my back.  I can’t quite straighten my left leg out as it hurts.  He says that’s because of the trauma to the back of my knee mostly.  He pokes different areas around my knee and leg, some of the times it is excruciatingly painful, other times it hurts and other times it doesn’t hurt.  He yanks my leg in different directions while holding or poking my knee.  He asks me to press against his arm, or hand and other times to pull against his hand while he is holding my foot or my knee.  He tests the pulse in my foot “Good pulse here” he muses under his breath.  Throughout the whole process he sometimes emits a low “hmmmmm”.  He repeats most of what he has done with my right side.  Then I’m allowed to get off the bed and back into the very low leather chairs.

“At this point your don’t need surgery.  (Good!). You have bone on bone sections and a lot of inflammation and fluid pockets which are impeding movement in some areas.  The meniscus is not where it should be but I would only consider surgery if it is really flapping about or is caught somewhere and seriously impeding mobility.  The bone spurs, some are attached and some have been broken off due to the injury.  We don’t get in and clean out knees and joints anymore.  That also gets rid of good bone and cartilage and can create more problems.” He reads the pages of the history that I’d filled out.  “What type of chemotherapy did you have?  Was it paclitaxel?”  Yes I say, and also two other types.   “Paclitaxel won’t give your osteoarthritis but if you have some it can speed up the degeneration”.  Great, that’s probably why I had such bad bone pain which was confusing Dr Michael.  “The hormone therapy you are on can also cause some ligament and tendons to be more susceptible to injury…what is abemaciclib?  I haven’t heard of that medication before.”  I fill him in on how new it is and what it does.  He said he’d look it up.  

Next he talks about treatment options.  “One of the best things you are do it eat a low inflammation diet, do exercises like stationary bike, rowing machine, low impact type things”.  I tell him about being paleo and what I do with Lewis.  He was very happy to hear that I was already going the things he would recommend.  I mentioned tomatoes giving me a pain spike in the half hour after eating them and agreed that nightshades can affect some people in a negative way.  “Listen to your body with what you eat and adjust as needed.  If you have to take some pain killers, take the ones that also have anti-inflammatory in them.  If the medications don’t help much within 5-7 days then you might need to consider a cortisone injection that can give some relief for up to 3-4 months.  That is something your GP can monitor.  How is your weight management going?”  I tell him that I have been slowly losing weight since 2018 and since eating paleo I have lost almost 6kg or so since Nov 1st.  He was happy with that and said “For every 5kg you lose that is 30kg in weight impact on your knee joints.  So 10kg is 70kg and so on.  Being a healthy weight and exercising regularly is one of the best things you can do.”  Noted, I’ll continue on with those things for sure.  “You possibly will need some surgery, partial or full reconstruction in the future but baring any more escalations or injury it would be 10 years but probably closer to 15-20 years”.  

He doesn’t need to see me again unless things escalate or I injure it again (Nope!  Not doing that again!!) so I pay and take the lift down. No juddering around this time, it’s just me in the lift this time.  I walk back to my car and then headed home.  Driving is ok unless I”m stopped at a red light and have to hold the clutch in, then my knee starts complaining.  It doesn’t complain just putting the clutch in and out but holding it in isn’t fun.  So, I have been putting the car in neutral when at a red light and that has been helping.