Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (14 page)

In the end, only my writing remained. I parceled this activity out in small two-hour daily chunks. When typing hurt too much, I tried writing in longhand. When writing in longhand hurt too much, I tried grasping the pen lightly and making soft, whispery strokes. I repeatedly asked my physical therapist whether it was okay to continue writing. She assured me it was, as long as I used proper form. I wish I hadn’t listened to her. My right forearm kept getting worse while my left began to improve a little.

In August, Congyu and I got married in a quiet civil ceremony in Shenzhen. She looked absolutely beautiful, wearing a lovely white dress and strappy shoes with high heels. As for me, I looked fine but wasn’t.

The next day, while lounging around Cong’s apartment, I drew a picture of a ceramic owl that sat next to her TV set. I used her charcoal artist’s pencil and applied hardly any pressure while sketching. The image was small and simple. Yet the tendon near my right elbow became inflamed and pained me for several days afterwards. When I told her what happened, her eyes widened with surprise. She knew I was having trouble with my arms, but never realized how severe it was.

Even while the problems with my back and forearms made my life unpleasant, I vowed not to be distracted from my main goal that summer: saving my knees. I had a detailed plan of action that I began executing immediately after leaving Bloomberg.

At my request, my mother mailed a large box containing twenty pounds of protein powder; she shipped it over because the supplement costs one-third as much in the United States as in Hong Kong. Many diets lack sufficient protein, an organic compound that supplies the building blocks for the repair of damaged tissues. Every day, I consumed a high-protein drink, along with one and a half liters of water to stay properly hydrated.

My mother also sent me a wind-up timer, again at my request. She never questioned what it was for or why I needed it; moms are wonderfully and unconditionally supportive. Had she asked, I would have told her that the timer was to keep me on a schedule of “dosed motion.” I like that phrase; it suggests that movement can be administered with the precision of a pharmaceutical.

Here’s how my “dosed motion” worked: In addition to my short daily walks, I periodically moved around my apartment. Every fifteen minutes, the timer rang and I got up and walked. The distance covered was only sixty or seventy steps at a time: from the kitchen to the bedroom, back and forth. I was trying to copy the success I had with the simple pool walkarounds. The lesson I had learned before: bad knees need to move frequently, but not too much at once.

To an onlooker, my first month out of work would have seemed pretty dull. I spent a lot of time sitting on the floor with my legs out straight or lying on my back with my knees propped up on the couch cushions, all the while waiting for a cheap department store timer to jingle. My objective was simple at that stage: to reduce the frequent burning sensations in my knee joints. I made good progress.

Then even that small victory was snatched away, shortly after record-breaking rains doused Hong Kong in June. The city turned unbelievably soggy and sodden. Almost every day dawned gray and depressing. Weeping rain, sheets of rain, typhoon rain, we had it all. The monthly total was almost four and a half feet of water. That easily shattered a hundred-year-old record.

In the subtropics, rain and heat and humidity combine to spawn outbreaks of mold and mildew. Six years in South Florida, another hot, moist climate, never prepared me for the infestation I faced in Hong Kong. White mold sprouted in a clothing cabinet. Green mold coated the backside of my bookcase and bearded both my pairs of Oxford dress shoes. Mildew ran riot in a large clothing closet. And black fungus spread widely over the ceiling throughout my apartment.

The more dark corners I explored, the more fungus I found flourishing. That led to an eradication attempt that spanned a few weeks. I washed, rewashed, and thoroughly dried loads upon loads of clothes. I spent a few days climbing up and down a chair, painting the ceiling with antifungal chemicals. Then, when that failed to control the mold, I would occasionally get back up on the chair to spray spots on the ceiling with a bleach solution.

All the stepping up and down, and the cleaning and scrubbing and kneeling, took its toll on my weak knees. They slipped backwards. They began to bother me more.

With my health increasingly fragile, I then had a run of incredibly bad luck with the physical world around me. First, my computer broke down, in the most annoying way: in stages. To begin with, the hard drive crashed. After it was replaced, the motherboard died. After a new motherboard was installed, the monitor stopped working.

Without a PC, which was my chief source of entertainment (I had no TV), I turned to my photography hobby to fill the long, empty days. I considered organizing my own photo-taking expeditions to nearby islands. While testing out my camera, a digital Canon 20D, I snapped a few photos at night and noticed something bizarre on the long-exposure images. Spidery threads radiated in one corner, like a branching network of nerves.

One by one, I held my expensive lenses up to the light. On most, the tiny threads traced over the glass. A Canon repair center in Tsim Sha Tsui confirmed what I suspected: my camera body and several lenses were riddled with the fungus that had overrun my apartment. They would have to be carefully cleaned. That took several weeks and cost more than $700.

Casting about for a new diversion, I turned to books. Mass-market English paperbacks in Hong Kong cost $15 apiece, so I got a library card. A bookmobile rolled into Discovery Bay every Tuesday. Of course something was bound to go wrong. Sure enough, the bookmobile missed a week because of a typhoon. After that it failed to show up a few times because of unspecified maintenance issues.

Failures and frustrations kept piling higher and higher. In mid-summer, I had reluctantly given up almost all typing and writing longhand to let my sore tendons heal. Then I realized that voice-recognition software might be a good way to work around my infirmity. So I went to a computer shop to buy a program called Dragon NaturallySpeaking.

Of course the computer shop I visited didn’t happen to have any copies on hand. A day-long intensive search of the city revealed that neither did anyone else. In fact, it turned out the U.S. makers of the software were between versions—what were the odds? It wouldn’t be in stock for a week, a clerk told me. That week turned into a month.

I hated my life that summer. The weather was uncomfortable. My body felt like it was falling apart. My confidence evaporated in my ability to heal from anything. Everything big that could go wrong did: the problems with my computer and camera, the unavailable software that I needed to get my life back on track. My anger constantly simmered just below the surface.

During that summer, I began to seriously meditate for the first time ever. It was an attempt to relax and control the pain and dissipate some of the pessimistic funk I had fallen into. I was an intensely negative ball of energy. My mother sent me a sort of idiot’s guide to meditation that I read, but didn’t follow too closely. The standard cross-legged posture would have caused my knees to complain and didn’t seem important anyway. I also never focused on a word or sound or scene.

The way I practiced meditation was simple. I tried to unknot my muscles, as much as possible, while letting my mind go blank. I sought to unburden myself of all kinds of tension, whether physical or mental. It surprised me how feverishly active my mind was. At the beginning of a meditation session, it seemed like I was trying to restore order to the trading floor of the New York Stock Exchange going full tilt. That was the background cacophony I lived with.

Sometimes, after a period of focused silence and relaxation, I slipped into a trance-like state. The physical pain would go away. A pleasant sensation would spread through my mind like the bloom of firecrackers lighting up the night sky. It’s hard to describe this state; I recall experiencing a sort of warm tingling on reaching an interior space where everything was peaceful and simple and clear.

Coming from an ardent rationalist, I realize all this sounds rather warm and mushy. But when healing is hard, you need to marshal all available resources. You need your mind to be working with, not against you. You need to be able to shed the anxiety and bitterness and negativity weighing you down. These things levy a very real physical tax that impairs your ability to get better.

Meditation turned out to be a good strategy for surviving a bad time. I was grateful when the summer of 2008 began to recede in the rearview mirror. At the end of September I took stock of my gains over my first five months away from Bloomberg.

My progress looked scant. My knees tolerated better my daily walk of a couple of miles, but that still wasn’t far. I could sit normally at a desk without problems, but only for a few hours at a time. My knee joints seemed stronger, but only a little.

It seemed like a good time to make an aggressive push forward. Winter was fast approaching. That meant cool, dry days and lots of sunshine. The weather would be perfect for hiking.

Up until then, I did all my walking on level ground. The problem was, I couldn’t work up a sweat and get my heart pumping. The hills and mountains of Hong Kong held out the promise of a grueling workout. I decided to accept the challenge. It was time to do some climbing.

On my quest to save my knees, the theme of adaptation often preoccupied me. I strongly believe that our bodies, when subject to the proper stresses, have an amazing ability to change to meet the new demands put on them.

For months I had done easy walks along the Discovery Bay beach and around a nearby cove where small, creaky ferries picked up passengers bound for Mui Wo and the island of Peng Chau. As the end of the year approached, I was looking for opportunities to push my joints harder, little by little. 

In October, I tried light cycling again. After two ten-minute sessions on my indoor trainer,  days apart, with a careful monitoring of symptoms in between, I had to accept that my knees just weren’t ready. Biking would have to wait.

That left hiking on hilly trails, a program I had resolved to begin as summer waned and the fierce heat abated. Doctors often advise patients with bad knees to avoid steep terrain. That didn’t make sense to me. If you always avoid it, how can your knees ever adapt to it?

At the same time, I knew enough not to start dashing recklessly up and down mountains. Hiking sensibly was important. When walking in the cold, I took care to keep my knees covered and warm. Also I went down slopes and stairs carefully.

Going downhill seemed to pose a much bigger risk to my damaged cartilage than going uphill. Gravity acts as a brake of sorts when you climb higher, slowing you down. But it has the opposite effect when you descend, hurrying you along and causing your weight to slam down with more force than normal. So when the terrain sloped lower, I made a conscious effort to take softer, more controlled steps, pushing back against gravity.

In November, I started hitting the hiking trails. They led me away from the dull safety of Discovery Bay toward a raw, natural part of Lantau Island. One route in particular was a favorite. Rambling down it was like passing through a portal into an earlier, rural Chinese society. On a lazy summer day, you could hear the loud thrum of crickets and the slow scrape of hoes in small gardens.

The path begins by taking you south, away from Discovery Bay’s modern apartment towers and sidewalks of pastel-colored brick. It hugs the shoreline and wends through small scatterings of squatter huts, even crossing through the middle of one. The crude huts are cobbled together from scrap sheet metal and discarded wood. Bricks anchor tarps that cover rusted tin roofs. One squatter sold vegetables from a garden that sprawled over a steep hillside.

After three-quarters of a mile of relatively easy walking, the trail angles upwards. It rises past an abandoned shell of an old British jeep in the middle of nowhere, a Land Rover open to the elements with dried vines curling around a windshield post. A little farther on, a narrow paved road leads to the tree-sheltered Trappist Haven Monastery, where the chapel bell tolls at five minutes before the hour.

Then you make your way farther inland, away from the sea. A footbridge spans a small stream shrouded in shadows. As the path becomes quieter and more remote, you can’t tell what you’ll stumble upon. A half dozen wandering feral cattle sometimes take up a spot alongside the trail to graze for a while. Red-necked keelback snakes slide through the grass.

Soon the climbing begins in earnest again. The trail tilts up and winds back and forth as the tree cover thins. Finally, a long set of stairs ascends to a small pagoda with concrete benches for the weary. From this perch, on a clear day you can glimpse the main island of Hong Kong some six miles away.

It took me a while to reach the highest point, the pagoda rest station. I tried to pace myself. Every week or two I hiked a little farther on the trail until on December 13, I reached the summit. It was a terrific feeling. Sweat rolled down my brow and my heart drummed hard and strong in my chest.

Breaking the sweat barrier was so important for me in getting better. It’s hard to overstate how much it mattered. For so long my knees protested at any exercise hard enough to produce a sweat. Then, one day, I was striding up that trail to the monastery, feeling my body perspiring because it was
really
working, and I never wanted to stop moving.

The “sweat effect” went deep. Certainly sweating during vigorous exercise did me good psychologically. It represented a tangible milestone of progress and revealed as well how much I missed that happy, tired feeling after a good workout. But beyond that, something magical seemed to happen in my knee joints. Immediately afterwards, they felt much better.

Wondering what was going on, I looked into how exercise affects synovial fluid. This normally thick fluid is vitally important, helping to protect knee cartilage. In a badly diseased joint, it becomes thin and watery.

A Japanese study from 2003 supplied some insight. For three months, patients with osteoarthritic knees did “isometric” quadriceps exercises; the term refers to a type of exercise where muscles are tensed without movement. The results were quite impressive: the viscosity, or thickness, of the patients’ joint fluid jumped by almost a third.

Not only my joints, but my whole body started improving noticeably that winter. Aerobically, I felt more fit. Also the up-and-down hiking caused my leg muscles to get sore, then stronger. Soon I noticed that, when puttering around the apartment, my knees were simply more functional. I no longer avoided bending them when I had to reach down for something. They flexed easily and I could even hold a crouched position for a few seconds with no discomfort.

Amid all these changes came an even bigger life change. On January 7, almost a week before my forty-seventh birthday, Congyu called in the morning. I was at my desk, absorbed in a bit of writing, but quickly perked up on hearing her voice. It had a strange, subdued quality. I thought of her elderly father, whose remaining kidney was bad; a surgeon removed the first because of cancer. Had his health taken an abrupt turn for the worse?

Then she spoke in a small voice full of wonder: “I’m going to have a baby.” That news surprised me. Before marrying we talked about having children, and time was running short—she was thirty-seven, I was forty-six. But I assumed it would take a few years of trying, not four months. We were both over thirty-five, and in my mid-twenties, I was rejected as a sperm donor because of low fertility. We talked for a while; I remember being at a loss for words and saying “wow” a lot. A great new adventure lay before us.

When we traced backwards to figure out the date of conception, I realized with a smile that it was early December. That seemed appropriate. Late November and early December marked a turning point for me. About then, my walking on the monastery trail started paying big dividends. For the first time in many months, I felt very hopeful and optimistic.

The prospect of becoming a father certainly lent a new urgency to my program to heal. I vowed to push myself even harder and almost blundered into a trap. December and January were such good months that I wrongly assumed that my knee issues were almost behind me. What I didn’t account for was the cold weather effect. The chilly temperatures that my knees preferred were masking some problems.

The joints became crunchier than before, even though my muscles felt good. When Hong Kong had a few agreeably mild days, my knee scores dipped a little. Then I got some unpleasant feedback on a hike: tingling under my left kneecap. The message hit me loud and clear. I was doing too much by walking at least three miles up and down, nearly every day.

I realized then that my Type A tendencies sometimes cloud my better judgment. My nature is to exercise hard and always perform my best. That kind of thinking can be destructive in trying to recover from an injury that mends slowly and poorly. So I made adjustments. I began to build in regular off days of easier, shorter walks over flat ground. Also, during the months of February through April, I decided not to keep increasing my step counts. Instead I worked on improving my form while walking, especially downhill, and letting my knees grow into my new regimen.

As they continued to recover well, I took aim at another trouble spot: the forearm tendons that attached to my inner elbows. My arms as a whole had become terribly weak. Congyu had taken photos of me during Christmas, opening gifts from my mother. It shocked me to see how thin and flabby my upper arms were. The muscles had wasted away.

By the end of 2008, I had become resigned to the idea of having surgery. The damaged tendons weren’t getting better after more than half a year. My last visit with Patty, she grimly observed that patients with chronic tendon pain regain only about seventy percent of their original strength. At first that discouraged me. Later I wondered if that figure was just the equivalent of an old wives’ tale.

Certainly I did struggle to heal. Patty suggested exercises that I did daily, but without success. Periodically, I stopped doing them for a week or two, thinking the problem could be that the muscles and tendons were being overtaxed. But taking a break didn’t seem to do much good either. During December and January, I felt despondent about my bad forearms. They even got sore after continuously curling 3.3 pounds (about the same weight as a few cans of soup) for three or four minutes. I needed help.

Once again it came from Doug Kelsey, half a world away. On his blog he described how to fix a bad Achilles tendon on the back of the heel. At the same time, he made a common-sense observation that contained a profound truth: a tendon is a tendon, no matter where it is. The tissue fulfills the same function, has the same characteristics, and needs the same approach to repair.

His treatment for the damaged Achilles tendon consisted of a thrice-weekly workout that combined low-repetition “eccentric” exercises (in which a contracting muscle is forcibly lengthened) with high-repetition movements (to stoke the injured tissue’s metabolism). The objective: push the tendon hard enough to make it sore the next day, coaxing it to rebuild itself.

I designed my own version of this program for my forearms, using dumbbell weights. The small 3.3-pound plates fit into my palm and were light enough to do 150 quick repetitions. For the low-repetition exercises, I started doing bicep curls with an eleven-pound weight (that showed how weak I was; in Florida I regularly did thirty-five-pound curls without a problem).

To make the exercise eccentric, I simply shifted the emphasis. Normal curls are about lifting; mine were about lowering. I would bring the dumbbell up to my shoulder, then focus on slowly controlling the descent to the start position.

My first session, in late January, I had poor form. On each curl with the eleven-pound dumbbell, the weight dropped rather quickly. My skinny arms and weak tendons couldn’t provide any push-back resistance. The dumbbell felt as heavy as a burlap sack filled with rocks. I grunted and grit my teeth. The next day I achieved one desired effect: my tendons were sore.

Over the following weeks, the damaged tendons repeatedly endured the same cycle: get sore, get a little stronger. Gradually I added more plates to the bars, at last reaching twenty-two pounds. My form improved too. I went from doing twenty awkward repetitions with eleven pounds to doing thirty, nice and slow, with twice the weight.

In early April I was happily surprised to find I could type for a few minutes at a time, no symptoms. Near the end of April, three months after beginning the exercise regimen, I was typing almost normally.

At long last, everything was coming together. My knees were better. My arms were better. My back had even begun to improve, through special exercises to strengthen muscles around the spine.

At that point, my time in Hong Kong was nearing an end, but I had one more goal to achieve. It had been kicking around in the back of my mind for months. Before flying back to America on April 30, I wanted to walk to Mui Wo along the familiar monastery trail. Until then, I always stopped at the pagoda on the hill, roughly the halfway point, then turned around. Going all the way, at least once, felt right as a symbolic act of completion.

I set out on a late April day under cool, dreary, low-hanging skies. A whisper of wind rustled the foliage. Through the stillness, I heard the trilling of birds and the calls of other hikers on the trail. First I climbed up to the pagoda way station. Once there, I rested and gazed out toward Hong Kong Island. All I could see was thick mist shrouding a small island in the near distance.

After a ten-minute break, I began a slow descent to Mui Wo. The drone of a ferry engine drifted over the green hills as my feet crunched over loose soil. I tried to listen hard and see hard too, to freeze in my memory these last impressions of Hong Kong. I had gone through the worst period of my life here. But along the way I discovered a stirring message underneath all the despair: that things do get better, when you believe in yourself and have a rational plan for progress and don’t give up.

In the end, I became convinced that we always have to keep in mind our natural resilience, instead of becoming obsessed with what seem like the inevitable breakdowns that come with the aging process. Our bodies do change with time; that’s an undeniable fact. We grow a little slower, a little more fragile. But that’s not the whole story.

Even into old age, our bodies are remarkable in what they can do. It’s important to appreciate that. Over the course of our long lives, they respond to millions of physical insults and find a way to heal. They don’t suddenly forget how to do that when a certain page on the calendar flips over. 

I quit my job to prove that my bad knees could get better. After twelve months, my journey wasn’t over, but I had accomplished a lot. My knees were stronger and more mobile. They rarely ached or pained me. And I was convinced that even better days lay ahead.