"Has anyone talked to you about your ACLs?"

So there I am, lying on my back on the table, and this very nice doctor has a death grip on my leg and is wobbling my knee. Then she says "Has anyone ever talked to you about your ACLs?"

And I laugh. Kind of a hollow laugh. Yes, that's not a new discussion.Suddenly, the knee catches, and then lets go again with a crack. Remember those boring days in class when you used to quietly crack your knuckles, and one of them would insist on going off with a sound that could be heard three classrooms away? Yeah, that sound. She jumped. I twitched a bit.

It's been about five years since I stepped in that gopher hole and sprained my knee, except it wasn't a sprain and it didn't get better. It gave me a matched set: torn meniscus in both knees (the other dating back to high school days, back before arthroscopic surgery existed), and, as I found out that day, arthritis. And my stretchy, loose ACLs and MCLs. Since then I've been taking 1000mg of Relafin a day, and for the most part it's done pretty well. With something like this, you have good days and bad days and sometimes you have to be rational and give it a rest. The thing I'd noticed is that -- as expected at some point -- there were more rest days and fewer go days, so it was time to see where things stood.Arthritis is progressive, it doesn't get better, the only question is how fast or slow it gets worse. At the far end of this tunnel are brand new titanium knees and a note from my doctor to the TSA. ("Dear sir. no explosives, just hunks of metal where his kneecaps used to be. Sincerely, his doctor").

 So I scheduled myself to radiology for pictures, and now I'm on a table scaring the crap out of my doctor as my knees simulate a semi-automatic rifle. Fortunately, no shrapnel. So we talked over where I was feeling what, and she moved things around and clucked her tongue a bit and asked me about my ACLs, and then we looked at the pretty pictures.It's about what I expected. The right knee is close to bone on bone (hint: not fun). But overall, it's progressing on the slow side. This is good, because we all want to delay knee replacement as long as possible, if only because artificial knees only last for a couple of decades, and the longer we stick with the original equipment, the less chance we'll need to swap in a second set down the road.

Although if I live to see my ultimate goal on how to die ("in bed at the hands of a jealous husband. at age 90) maybe I should be rooting for needing three sets of replacements… I suggest we boost the dosage of the Relafin. She suggests there are better ways to destroy your liver. She pops over to the desk and comes back with the needles. The look a foot long, but really, only about 3". It's time for my first cortisone shots! lucky me. She's good. I almost don't feel the left. The right is a tighter gap and she slides off the inside of the kneecap a bit -- you feel it, but I can't say it hurts. Just a funny feeling -- and then that's done. I was warned I'd probably want to haunt the couch with ice bags the first night (they were right), and then we'd see how well the knees reacted. Cortisone is a steroid. It's a massive anti-inflammatory. It'll knock down the irritation and swelling for weeks if things go well. I'm eligible for cortisone every three months as long as it does the job. When it no longer does, that's when we have to start considering "other options" (so to speak). 

And so far? they feel better than they have for a year. I tried cutting the Relafin completely to see if we could do without it (and give my liver a rest), but decided that wasn't quite right. I'm back on half the dose of Relafin I'd been taking, which means I have some leeway for ramping it up again if I need it. I'm moving better, more or less pain free, and subjectively, the joints seem a lot more stable, loose ACLs not withstanding. Cortisone isn't risk free. Use it too often, it can cause degeneration in the joints -- make things worse, not better. That's something to remember when if you follow sports and you hear about all of these athletes taking cortisone shots to get ready for games. Something to remember next time you hear someone babbling about overpaid athletes; a number of them are making a conscious decision that'll likely lead to orthopedic problems for the rest of their lives, just to be there for that game.

Stop and think about the number of retired athletes in their 40's and 50's having knees replaced now. They're making sacrifices most of us can't conceive of, and will end up with physical challenges they'll live with the rest of their lives long after the money stops coming in. But for me, a more conservative approach. And the early results mean I'm now a lot more mobile than I have been recently, and I'm trying to take advantage of that. I don't want to be that guy driving through Yosemite with a scooter hooked to the back of the car. Of course, if that's what it comes to, it's better than some of the alternatives, no? What really matters is not letting stuff like this stop you… It may slow you down, but use that as an opportunity to enjoy the view, not an excuse to miss it completely…