Cortisone Day

Monday was Cortisone day. It is a day I both look forward to and dread. Off to visit the Orthopedist, wearing sweats that I can pull up over the knees easily.

Back in 2007, I was out for a walk, and doing some birding. Trying to get a better look at a bird, I stepped backward, into a gopher hole. The lower part of my right leg twisted and rotated, the upper part didn't.

The knee is not a pivot joint. Many of us find this out the hard way. The knee didn't heal. The swelling went down, but every time I started using it, it got wonky. Unstable, and it'd lock up on me. Every so often I'd take a step and it wouldn't carry my weight. So, off to the surgeon to get the meniscus I'd torn in the gopher hole fixed. Except the surgeon took one look at the x-rays and told me they weren't operable.That wasn't what I'd expected to hear. The knees were arthritic. Which, I guess shouldn't have been a surprise to middle-aged me, but it was. We had two options: drugs or knee replacement. Knee replacement is -- routine -- but has all sorts of challenges. Not the least of which is that they only last for a couple of decades (or less) and then you need to replace them again. If we could delay needing the first replacement, we'd increase the chances I'd never need a second. Not to mention to replace both knees is about four or five months of fun (and physical therapy).

So we started simple. Relafen, an NSAID (Non-Steroidal Anti-Inflammatory). Close relative to Motrin, one of the family of different things you probably generically call aspirin. Fortunately, I tolerated it well, and the knees reacted to it. The pain went away, the knee stabilized, and I could walk again. We started at 500mg (the Motrin you can buy at the store are 200mg). That held the fort for about 18 months, then we boosted it to 1000mg a day. That was good for another couple of years.Arthritis is a progressive disease. It never gets better, the best you can do is fight it to a draw. So ultimately the Relafen wasn't enough any more. My doctor didn't want to raise the dosage (you can go to 2000mg a day, but you can also eat your liver doing so), so he suggested Cortisone.

In walks my doctor, syringes in hand. We talk over how the knees are getting along, they poke at the knees and mark the injection points, and they carefully cover the areas with iodine and then a local anesthetic. I joke about getting the injection points tattooed to save him time. He picks up the first needle, which seems like it's a foot long, and I close my eyes.I'm not a fan of needles, but I tolerate them okay, as long as I don't look. For some reason, the needle hurts a lot more if I see it go in, so I close my eyes.

The iodine is cold. The local stings the skin, just a bit. The needle goes in, finds its way under the kneecap. It's not so much pain as pressure as the liquid flows in and redistributes. Still, it's not what I'd call pleasant. The needle leaves, the hole is covered with a bandage, we compare notes on how it felt and when to chat next, and I'm gone.

Over the next few hours, a miracle occurs. My knees transform from sore, achy, old people knees into younger knees that actually move without creaks and snaps. The transition itself isn't painless -- sometimes a little, sometimes a lot, but once it settles down, things work a lot better for a while. This time, the right knee gives up mostly without a fight and within 12 hours felt great. The left knee, which has a lot less damage to it, swelled up a bit and got sore and took about 36 hours before it felt better.

One thing getting cortisone shots has done is give me a new appreciation for what professional athletes go through to entertain us. My doctors don't want to give me shots more often than every three months because of the risk of doing damage to your connective tissue: it can turn your tendons and ligaments to jello if you hit them with it too often. Yet you hear about pro athletes injecting an injured joint routinely, sometimes before every game. A lot of these guys are taking risks of lifeline orthopedic problems to win -- for our enjoyment (and the money and fame). Something to remember next time someone starts up the "athletes are paid too much" rant.

Cortisone doesn't heal. Cortisone is a quality of life drug. It reduces pain and improves mobility, but it's temporary. If you use it too often too close together it can make things worse. The big challenge in my life right now is that I'm too sedentary, but moving around more is great in theory, not so great when moving hurts. Cortisone spackles over that gap, at least for a while.I know that ultimately, I'm going to lose this fight and need to go through knee replacement.  If I can put it off another five years I'll be thrilled. Right now, that looks practical, but time will tell. And in my long term goal to not be that old guy in the scooter, I'll take any advantage I can get.So that's why I'll keep taking the cortisone, even though it means dealing with those needles....