Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (11 page)

I also broadly tracked temperature. Was the day warm, cool, cold? This eventually turned up an interesting tidbit: my knees preferred cold days to warm. (My wife’s bad knee, on the other hand, liked warm days better.) That knowledge became important when I almost hurt myself by pushing too hard one January. After that, I tried to guard against over-exercising in cold weather because my knees would send signals that they felt stronger than they really were.

Early on, I realized the journal needed one more feature. While I did include daily observations about my knees, that alone wouldn’t allow me to easily identify trends over time. If my joints were “sort of achy” one week and “achy” the next, how much worse was that? Using words as measuring sticks seemed sloppy and imprecise. Instead I created what I call a knee score.

This was my attempt to give quantitative weight to the qualitative evaluation of how the joints felt. The scale ran from one to twenty. “One” was the worst and indicated that my knees were burning or aching constantly and bothering me a lot. At “eight” the discomfort was moderate. “Thirteen” signified some symptoms, but manageable. Anytime I reached “seventeen,” I was fine for periods of an hour or two. “Twenty” I would reserve only for times when my knees felt great for the entire day.

After settling on this system, I still had to figure out when to determine the score. This wasn’t a trivial issue. Most mornings, it was like I woke up with a brand-new set of knees that wore out at some point: by early evening, late afternoon, or even sometimes mid-morning. It wouldn’t be fair to compare a knee score from Tuesday at 7 a.m. to one at Wednesday at 4 p.m.

My solution was to sample two points daily: one at about 7:30 at night, the other half an hour after waking. I chose to wait half an hour because of my morning routine, where I always poured a bowl of cereal then sat at my computer to eat and surf the Internet. Because my knees didn’t like sitting, this activity served as a mini “stress test.” It gave me good insight into how weak my joints were that day.

The morning score turned out to be particularly useful for another reason. It often served as a delayed verdict on the previous day’s activities. Realizing this was an epiphany of the first order. I could do damage to my knees and not know it until a day later!

The experience of delayed symptoms wasn’t my imagination. After returning from Tibet, whenever I did weightlifting sessions, my knees would suffer the next day. They also hurt on mornings after Tim had me do one-legged dips to examine my leg strength and alignment. My limbs were strong enough to do the weight room exercises and the dips, but my injured joints couldn’t handle the load and always complained later.

With the journal for my knees, a scoring system for how they felt, and my trusty pedometer, I was ready. My plan for getting better would involve gentle movement, and a lot of it. Ideally, I would also avoid long sessions of sitting, a prime irritant for my weak knees. That forced me to grapple with a hard truth: working at a desk ten hours each day was a roadblock to recovery.

I had to get some time off from work. There was no way around it. I put together a case to present to my bosses in the news department. They had so far impressed me with their sympathy for my situation. When I talked to them, they nodded in understanding, but said they couldn’t make the final decision on my request.

That responsibility rested with the human resources department. That didn’t worry me at first; everyone I knew in human resources seemed reasonable and concerned about my welfare. So I arranged a sit-down meeting with a pleasantly earnest HR representative. Indeed, the company did want to help, she assured me. But getting that help wouldn’t be so simple.

Before hurting my knees, I’d never had much to do with human resources people. I knew they were involved in the hiring paperwork when you first joined a company, then sort of faded into the background. They resurfaced occasionally to lead sessions that alerted employees to such things as the career perils of sexual harassment. At one place I worked, they redesigned the yearly evaluations: a several-page form grew to about ten pages, requiring numbers and comments for a seemingly endless series of little boxes.

Now that I needed them to approve my plan to heal, I was eager to open a dialogue. I wanted to share what I had discovered about bad knees that my doctors apparently didn’t know yet. Their unflagging smiles were inscrutable though. It was impossible to figure out what they really thought about anything because their point of view seemed to have become one with the corporate hive mind. Their expressed “thoughts” sounded like iterations of policies.

To capture the essence of my frustration with human resources, in an inspired moment I thought up the parable of Grog and Nog:

During prehistoric times, Grog and Nog worked for Painted Rocks ‘R Us. They painted small decorative boulders that they carried to caves and arranged in the interior to maximum aesthetic effect. The company they belonged to was small but growing fast.

One weekend Grog hurt his foot in the woolly mammoth hunt. He went to work, limping noticeably. His job required lugging heavy rocks all day long, and he couldn’t do it comfortably. Finally he went to the company owner, Borg, and pleaded for a month off so his injury could heal.

“I like you,” Borg said, clapping him on the back. “You’re a really good worker. Take a month off. See you in September.” A month later, refreshed and healed, Grog returned to Painted Rocks ‘R Us.

Meanwhile, the company’s explosive growth continued. Large colored rocks became the must-have cave accessory for the troglodyte with taste. Revenue and profits spiked higher. More workers were added to keep pace with demand. Eventually a new company executive drew Borg aside.

“This operation is much, much too informal,” the executive said, shaking his head. “You let people take off a month or two when they hurt their feet, you’ve got no written guidelines for sickness or pregnancy or the accrual of vacation time, and that’s just for starters.”

“If someone doesn’t feel good, I just tell him to stay home until he feels better,” Borg said, blinking in puzzlement.

“Well, that’s all wrong. Some of your workers take one day, others a week or two. How can you be sure someone isn’t taking advantage of you? Besides, you’re not treating everyone fairly. You need rules, policies, and procedures.”

Chastened, Borg said, “Okay.” And so, over the next few months, a special team spent many hours discussing and debating and then writing down pages of rules, policies, and procedures.

Soon afterwards, Nog was out late one weekend vigorously flinging spears at a pterodactyl. He showed up at work Monday, moaning. Whenever he tried to move a rock, pain shot through his elbow. So he went to Borg and said, “Can I get a month off, like Grog did, so my elbow can heal?”

Borg replied, “You’ve got to see HR.”

“Huh?” Nog replied, scratching his head. “HR? What’s that?”

“They’re in charge of medical leave.”

So Nog trudged off to visit the newly formed HR department, where a smiling woman explained the company couldn’t do anything yet. He must see a doctor first.

Unfortunately, in prehistoric times the medical thinking on sore elbows wasn’t very advanced. After examining Nog, the doctor said: “This thingamajiggy in your elbow hurts when you move rocks, and that’s your job, and you’ve got to be able to do your job, so let me prescribe this pill here,” he said, reaching for a small, flat stone. “Your health plan will pay for it.”

“A stone?” Nog said.

“Yes, whenever you feel pain, just pound the pill ten times against your forehead.”

Nog returned to work, immediately felt pain on doing some lifting, and whacked himself in the head repeatedly with the stone. That made him dizzy. He noticed that when he felt dizzy, his elbow didn’t hurt as much. But once his head cleared, his elbow hurt even more. After several weeks he returned to the doctor, frustrated.

“Doc, I don’t think it’s healing.”

The doctor shrugged. There wasn’t much optimism in the prehistoric medical community about the ability of chronically sore elbows to heal. So he advised, “Keep using the pill for a few more weeks. If that doesn’t work, we’ve only got one more option. But it’s guaranteed to take care of your arm for good.”

“Great,” Nog said, excited. “What’s that?”

“Amputate.”

The point of this story really isn’t that HR departments are bad or bureaucratic. They do serve a valuable purpose, especially in an age of litigation. We do need codes of behavior, standards to evaluate performance, policies to govern absences for health reasons. For critical judgments on medical leave, it does make sense to go outside the company and seek an expert opinion. Naturally that means a qualified physician.

But what happens when the prevailing knowledge in the medical community about a certain condition turns out to be faulty? What happens when it’s more valuable for a human resources person to be able to think outside the box than follow rigid policies to the letter?

Because, the fact is, medical beliefs
do
change. Doctors once used bloodletting to treat everything from acne to asthma. Two centuries ago, if I had pneumonia and my human resources department ordered me to see a physician, he might have treated me by draining a few pints of my blood into a bowl.

On its face, that seems like a ridiculous parallel. Medical science today is far beyond that level of ignorance, busily plumbing the secrets of the human genome. Yet the inner workings of human cartilage remain somewhat mysterious.

Not so long ago, doctors believed the tissue had no capacity to heal. That has been proven false, leading to a more nuanced appraisal: “Cartilage has a
limited
capacity to heal.” In another decade, the thinking may evolve further, to something like, “Cartilage has a good capacity to heal, very slowly, under the right conditions.” That’s what I believed.

So I wanted to try an experiment: working half-time for three months to cut back on the extended periods of sitting. My ideal workday would consist of a morning and afternoon shift at my desk, with five hours of light exercise sandwiched in between.

Of course human resources wouldn’t approve my plan without a doctor’s consent. On this point they wouldn’t budge. I thought about which orthopedist to try to recruit, then settled on Dr. Song. Even though he seemed rather curt and unfriendly before, he might be an open thinker. He had agreed to my having an MRI.

On a fall day in 2007, I found myself back in his office. The appointment began with me talking in a fervent blue streak for the better part of ten minutes: sitting at work bothered my knees a lot, I had tried a million things without success, and on and on and on. He gave me his sideways look of suspicion, as if I were trying to sell him a beachfront lot on some island he’d never heard of.

Finally he said, still eyeing me warily, “What do you want me to do?”

“I know I can get better,” I insisted, “if I’m given a chance.”

Then I outlined my idea to work half-time. During the five hours in the middle of the day, I would immerse myself in motion that didn’t put much strain on my knees, such as moving about in a pool or walking slowly around the city. As the weeks passed, the weak joints would get stronger and allow me to exercise more vigorously. I promised to work with a physical therapist during the three months, though to be honest, I didn’t expect much help from Tim. He was a muscle-first guy; I needed a joint-first guy.

Dr. Song never offered a specific critique of my plan. He would support it, he did say, and anyone at Bloomberg who had questions about his decision could telephone him. I was elated. The experiment would soon begin.

I was quickly proved wrong. The news department’s liaison in human resources, after listening to my account of the doctor’s visit, informed me, “We need to have something in writing.” I shrugged, thinking that wouldn’t be a problem, and confidently returned to see Dr. Song.

Inexplicably, he balked at this new request. He seemed uneasy. He told me rather brusquely that he didn’t have time to put anything in writing. I was silent but stunned. How long could that take? Five, ten minutes?

Arguing with him would be futile; I didn’t have much leverage. The path of least resistance became clear: I would write up something myself that sounded reasonable, then ask Dr. Song to sign it.

The wording would be tricky. There had to be some details about my rehabilitation activities, but including too many would risk having Dr. Song say, “I don’t agree with this and won’t sign.” It also would be dishonest, as well as flirting with his rejection, to use the phrase “I recommend that . . .” He had recommended nothing, but supported my proposal. One final landmine: Dr. Song might belong to the Church of the Almighty Quadriceps too. That meant I had to tread lightly when it came to this idea of improving my joints. So I made a few subtle shifts in phrasing to emphasize the benefits for my leg muscles.

I presented him with the following statement:

Richard Bedard has chondromalacia in both knees, a condition that benefits from regular exercise to strengthen leg muscles around the knee. He has expressed concern that he is unable to exercise as vigorously as he needs to because the cartilage in the knee joints remains weak.

I support a plan under which he would take two to three months to try to improve the health of the cartilage through frequent motion (such as light walking and moving his legs in the swimming pool), then attempt to strengthen the leg muscles. Under this plan, he would work a half-day shift, with a break in the middle to focus on movement and exercise.

He reviewed, then signed it, adding his official stamp for good measure. I then submitted the document to Bloomberg’s HR department and held my breath. Would they wonder why it wasn’t on office stationery? Was there enough detail? Had they asked me any questions, I was prepared to tell them the full story, crazy as it might seem. I had nothing to hide.

But no questions came, or requests for further paperwork.

I remember that giddy moment when I realized there were no more obstacles. I was actually going to do this. I had spent hours dissecting the Tibet vacation in my mind, trying to figure out what exactly helped my knees start to heal. It seemed to be motion, motion, motion. Instead of being stuck behind a desk, I was strolling through outdoor markets and wandering the grounds of Tibetan monasteries with Congyu.

My first day working half time, I took the subway to Kowloon and bought a neoprene wetsuit top at a hole-in-the-wall specialty shop for thirty-six dollars. I envisioned myself splashing in the health club pool for hours on end. It was late October, and the insulated top would help keep me warm in the water.

By then, the club’s pool was already a familiar part of my therapy. For a few months I had been swimming there. It wasn’t pretty. I was a lousy swimmer, never having learned to coordinate my breathing properly. At Phillips Andover Academy I passed the high school swim test, a requirement to graduate, by doing a determined dog paddle.

In Hong Kong, I solved the breathing problem. Namely, while swimming in the water, I didn’t breathe. I filled my lungs with air and did a face-down overhead crawl, surfacing with a gasp on touching the other end. That worked fine, except my knees didn’t like the kicking motion associated with the stroke. I fixed that by buying a pair of inflatable armbands for young children and rolling them over my feet onto my ankles. The armbands kept my legs effortlessly afloat. Overall I looked a bit ridiculous making my way through the water, so I just stayed in the slow lane and tried to avoid busy times.

On the first day of my experiment in healing through motion, I lowered myself into the pool, feeling excited. The bright-blue wetsuit top was zipped all the way up to my neck. I was hopeful about what could be achieved through water exercise. The fluid provides a unique, buoyant environment that can be ideal for rehabilitating bad joints. Your body moves against constant, gentle resistance.

It didn’t take long for the flaws in my plan to become evident. The neoprene didn’t insulate very well. That turned out to be a big problem; I have low body fat and the water felt chilly. Once I warmed up things improved somewhat, though a different issue emerged: it’s really boring to kick your legs back and forth again and again, especially when you don’t feel too comfortable.

After an hour of swimming and easy underwater kicking, I gave up for the day and got dressed. It was time to walk. And walk I did: around a small park outside the Citigroup Tower, through the upscale Pacific Place mall, down into the hubbub of the Wanchai district. I took slow, shuffling steps to try to protect my joints. Periodically I sat and rested for a few minutes. That first week, I drowned my knees in movement.

The result: The burning and pain in my knees didn’t get better. It got worse. That mystified and irritated me. I felt like a fraud, having fought so hard for this half-time work schedule. And for what? My thoughts turned again to the Tibet vacation, and this time, I forced myself to recollect in more detail what Congyu and I did. I even wrote down notes, trying to reconstruct the events of each day. And I discovered something surprising. We weren’t moving all the time at all.