Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain (3 page)

But bruises didn’t bother me. They would heal. I always healed well.

I didn’t know the day would soon come when that confidence would be thoroughly shattered.

My problems all started because of a change of scenery.

In January of 2006, to quell an itch for new adventures, I quit my job at the
Sun-Sentinel
in Fort Lauderdale to join Bloomberg News as a finance editor in Hong Kong. The two locales had virtually nothing in common, except for being at roughly the same steamy latitude on the map.

Little did I suspect, my life would change completely during three years in the former British colony. For one, I would get married, to a smart Chinese woman with a good heart and a beautiful smile. I would also suffer through what physically was my worst time ever. My knees were about to break down, leaving me confused and deeply scared.

Deciding to move to Asia wasn’t easy. I liked the
Sun-Sentinel
, my cycling buddies, and my bandmates from a group we named Bone. The three of us, all in our forties, did a few small gigs for kicks and even cut a CD. The trouble was, rock guitarist was a hobby and my real career path appeared uncertain. The newspaper industry looked shaky. All across the United States, circulation kept eroding as advertising dollars dried up. Profit margins shrank.

It seemed to me that newspaper companies were paying the price for being asleep at the switch during the great migration into cyberspace. They squandered a huge opportunity to leverage their main resource—bright, creative people who develop high-value content—into control over profitable swaths of the Internet. And my employer, Tribune, seemed too bureaucratic and hidebound to adapt anytime soon to the revolution.

Bloomberg struck me as a company with much stronger prospects. Michael Bloomberg, now the mayor of New York, built a globe-spanning organization around an information-rich electronic terminal. The “Bloomberg” (the man and machine have become synonymous) sliced and diced financial data. It was a real-time window on markets as they moved: stocks, bonds, credit-default swaps, currencies, you name it. Having that information at their fingertips made Wall Street’s traders and investment bankers smarter—and richer.

Unlike the hapless newspaper chains, Bloomberg had found a way to mine gold in the knowledge industry. It didn’t take long for me to accept an offer to join Bloomberg’s worldwide team of top journalists. I would specialize in China affairs, helping to shape stories on everything from public stock sales to mergers and acquisitions. My salary shot up by half, barely eclipsing six figures. It was a career achievement in a profession known for its low pay.

The year 2006 was a thrilling time to be a business journalist covering China. The sleeping giant had fully awoken after its decades-long spell under the cult of Mao. The government was unshackling more pieces of the once state-controlled economy. A new generation of entrepreneurs and wealthy capitalists was on the rise.

And China, a behemoth of 1.3 billion people, began to roar. Its economy was exploding, growing more than ten percent a year. The country’s statisticians could barely keep up. They ended up revising the 2004 growth figures upwards by seventeen percent. That was like misplacing an economy the size of Denmark’s.

For a Westerner, so many things about China were fascinating: The newspaper photo of a seven-year-old boy, exhaling a thick cloud of cigarette smoke, above a caption that said China has 350 million smokers—more than the U.S. has people. The pre-Olympic campaign in Beijing to clean up embarrassing translations of English, such as the local restaurant menus that featured “Pock-faced Lady’s Tofu” and “Fry the Cow River.” The homogeneity of China’s leadership: a New York Times photo showed nine old men, each with a full head of hair dyed black, wearing dark blue suits and white shirts and red neckties (except for one maverick in a blue one). The sobering food scares, such as when a factory manager sold edible lard made from swill, sewage, and recycled industrial oil. The rampant intellectual piracy (fake Harry Potter books included
Harry Potter and the Chinese Porcelain Doll
).

Hong Kong had its own distinct image as a hive of international commerce and finance. That changed little even after the British returned the city to China in 1997. Hulking container ships constantly plied the waters around the main island, where the skyline near the waterfront stands out against an escarpment draped in verdant green.

This bustling Asian hub possessed a surprising amount of natural beauty. Miles of fairly remote, high-quality hiking trails threaded through mountains and parks. The city hosted Chinese banyans dripping with ropy roots, a dizzying number of dragonflies, and a nightmarish lineup of snakes, from muscular pythons to swaying cobras and highly poisonous banded kraits.

I loved much about my new home, but hated the pollution. The Associated Press said the makers of
The Dark Knight
scotched plans to film Batman dropping into Hong Kong’s harbor after a water test turned up tuberculosis and salmonella. Household trash bearded the waterlines of small beaches.

At least you could avoid contact with the water, unlike the air. The skies are almost three times as filthy as New York City’s. Winters were the worst. The north wind blew smokestack emissions from China’s heavily industrialized Guangdong province overhead, creating a gray miasma. The first time I visited The Peak, a famous tourist lookout, I was horrified to see the sharp separation between blue sky and the brownish-gray haze that shrouded the city.

Sometimes the air had a smoky, chemical smell, but usually the pollution didn’t bother me when I resumed my cycling abroad. I lived on sparsely populated Lantau Island (the largest of Hong Kong’s scattered islands) in an isolated community called Discovery Bay. The development lay sandwiched between a wall of hills and the South China Sea. A 25-minute ride on a giant catamaran ferry connected us to the central island.

Discovery Bay was a little cramped for cycling: the main drag stretched only two miles end to end. Still, the pavement was smooth and the traffic light. (Private cars were basically prohibited, so golf carts, costing more than $100,000 each, were everywhere.) While exploring on my bike, I noticed that hardly any vehicles found their way onto a 1.9-mile-long hill road that ascended to a reservoir, then higher still to a golf course on a plateau.

The long climb presented the kind of challenge that stirred my competitive nature. In pancake-flat South Florida, I had never developed any ability as a climber. There, cyclists did their hill training at a local park, on the sides of a paved-over landfill. In Hong Kong, that hill to the golf course became my obsession. The first mile angled upwards as harshly as the Tour de France’s legendary Mount Ventoux. During my two-hour Saturday morning rides, I would fight my way to the top three times. Then Sunday morning I’d do it all over again.

On a long climb up a steep hill, you don’t move fast enough to generate any cooling wind. The intense summer sun would bore into the small of my back and make me feel like an ant trapped under a magnifying glass. By then the day’s ride would be almost over, and the bladder of my Camelbak hydration pack empty. Without water, it was a hot, painful slog to the top.

At first I struggled to reach six miles an hour on the ascent. As time passed, I lost a little weight and continued to stubbornly throw myself back onto the slopes. At the end of my first year in Discovery Bay, on a cool, windless day, I flew up the road to the reservoir, averaging better than 8.3 miles an hour. My grit must have showed as I muscled my way higher, all alone. A man out for a stroll watched me for a few moments. Then he called out with wry amusement, “I think you won.”

My intense weekend workouts left me completely drained. I welcomed that feeling of utter fatigue, believing that my suffering would only make me stronger. Actually I was sowing the seeds for disaster.

On each climb, the cartilage lining my kneecaps had to withstand tremendous pressure. For starters, my Florida bicycle lacked easy gears for climbing and it took months for me to fix that. To make matters worse, I foolishly marked out my own “sprint zone.” Every time up, I made a short, furious uphill push over one stretch of road. The effort left me gasping—and, considering the high forces generated, probably began to damage my knee cartilage. Then there was the fact that all my climbing came at the end of long rides, when my body was tired and dehydrated.

Sometimes I even went cycling while recovering from a recent illness, and getting sick turned out to be a frequent problem. My terrific immune system seemed to be missing in action. I came down with a nasty case of food poisoning in Beijing that laid me flat and shivering and nauseated. I battled a flu in Tokyo during my Bloomberg News training. A head cold in Xi’an. And there was more: another flu, several more colds, and a few severe stomach upsets.

In early 2007, while pedaling up the twisting road to the golf course, I noticed an uncomfortable feeling in my right knee. The sensation was more annoying than painful—a slight fullness or soreness. I eased up a little and tried to push harder with my left leg to compensate. A minute later the knee seemed better.

That discomfort in my right knee occasionally returned while cycling uphill. One day after riding and showering, I crouched to pick up something and heard a rippling crunch from inside both knees. It sounded sort of like someone sitting on a bag of potato chips. However, there was no pain. Knees pop and crack a lot anyway, so I wasn’t alarmed.

What did worry me were the problems I was having at work, sitting with legs bent. As an editor, I had a classic desk job. Moreover, Bloomberg demanded ten-hour days, eight a.m. to six p.m. At first my knees would be fine up until midweek, then a general burning sensation would settle in around the kneecaps and persist through Friday. As time passed, the burning feeling began arriving earlier in the workweek. Soon I was coming in Monday, sitting down, and waiting with dread for it to begin.

Questions raced through my mind: What was wrong? Where did it start? When would it go away?

What causes an injury usually isn’t a mystery. A vast miles-long network of nerves tells you with all the subtlety of a foghorn. You jump for that basketball rebound, then come down on a twisted ankle and let out a pained gasp. Or you sling in that softball from center field and feel a twinge in your shoulder and rub it, wincing.

Unfortunately, early damage to knee cartilage usually doesn’t announce itself. That made it challenging for me to sleuth out the origins of my injury. But as I learned more about my condition, I was able to construct a pretty good narrative of what probably occurred:

Almost two months after I arrrived in Hong Kong, so did my titanium Litespeed road bike, aboard a freighter. I wasted no time in unpacking the bicycle and, in late March of 2006, began riding up the hills of Discovery Bay.

Every weekend, without fail (unless the rain was too hard), I struggled up that weaving road to the golf course a total of six times. My knees felt fine. I suspect though that the cartilage was already beginning to deteriorate under the strain from my spirited climbing.

By January I felt pretty strong. Eager to test myself in competition, I made a blunder that pushed my knees over the tipping point: I decided to start training for the Mount Washington Hill Climb in August. I planned to fly home and be among the six hundred cyclists that ascend to the New Hampshire mountain’s peak, a grueling 7.6 miles. Some exhausted competitors even topple over on the final steep rise, only yards from the finish line.

The hill leading to Discovery Bay’s golf course wasn’t tough enough or long enough to train well for such an arduous event. The other end of Lantau Island featured a harder climb that ended at a tourist attraction, a towering bronze Buddha.

So one day in mid-February I found myself on the remote, forested hill, on a brand-new Cannondale with a lightweight aluminum frame. As I grunted and drove the bicycle forward, my front tire lifted off the pavement a few times. My gears weren’t adequate for a climb that steep; my front chainrings were too large. Near the top, my speed sank to 4.5 miles an hour. I felt a twinge of discomfort in my right knee.

The knockout blow for my knees came two days later, on February 19, during an attempt at cross-training. I went for a marathon hike along the spine of the island. A small ramshackle ferry deposited me at sea level at the village of Mui Wo, then I began climbing. I later estimated that I walked straight up more than 4,500 feet, or close to a mile.

Low clouds enveloped the mountain peaks and high plateaus, making the scene sort of surreal. Despite the cool weather, I walked for long stretches in denim shorts with bare knees. The last stretch of the hike was a long descent. The outline of the 100-foot-high Buddha loomed in the distance. I was exhausted. My legs slammed down, again and again.

The next morning, my thigh and calf muscles felt like ground hamburger. They were accustomed to cycling, but not hiking. They recovered slowly over the next two weeks. Once they did, a new problem attracted my attention. Something seemed to be amiss in both knees. The joints had stopped giving me gentle hints that trouble was brewing. Now the red warning light was flashing hard. I had burning discomfort around my kneecaps while sitting for long periods.

That symptom puzzled me initially. I knew virtually nothing about knees. It seemed that resting should help them heal. And what better way to rest than to sit quietly at a desk? Strangely though, the symptoms abated when I walked about. I began trying to figure out what was going on by poking about online.

It didn’t take long to make a match: chondromalacia patella. The term is just a fancy way of saying the cartilage lining the kneecap is going bad. The condition sometimes afflicts cyclists who do a lot of hill work. Eventually doctors diagnosed me with patellofemoral pain syndrome, also known as runner’s knee. Not all my symptoms lined up. I didn’t really have trouble climbing or descending stairs, but my knees did hate sitting.

“Patellofemoral pain syndrome” is quite a mouthful. It sounds impressive. Months later, when I became weary of shuttling between doctors and physical therapists, I asked an orthopedist straight out, “What does that mean?” He bristled at my impudence, sidestepped the question, and our session soon came to an awkward end. I had come in complaining of knee pain. As I left, he pointed to the diagnosis section on his patient form and said, without apparent irony, “I’m going to write down that you have knee pain.”

Well, what
does
the term mean? “Patellofemoral” simply refers to the joint area where the kneecap (patella) and thighbone (femur) meet. The “pain” part is kind of obvious—that’s why you’re sitting in the doctor’s office. Then you have the magical word “syndrome.” During my research about this condition, I came across an online wag who opined that when they say you have a syndrome, you know you’re screwed.

As best I can tell, this medical term is sort of lawyerly and self-referential. It boils down to something like this: patellofemoral pain syndrome is the condition of having the constellation of symptoms that constitute patellofemoral pain syndrome. The definition begs the obvious question: “What’s causing the symptoms?” It may be bad cartilage, true. Or it may be a really tiny green man in your knee tapping on the nerves with a really tiny pickaxe.

So if your knee pain is caused by a really tiny green man—or something other than bad cartilage—you can’t complain about being misdiagnosed. The doctor who examined you can in good conscience lift his hands and protest, “I just said you have
patellofemoral pain syndrome
.” In reality, defective cartilage is often somehow to blame. The terms “patellofemoral pain syndrome” and “chondromalacia patella” are frequently, if mistakenly, used interchangeably.

At this point, a knee pain sufferer may be wondering why all this matters. The last few paragraphs may seem like an odd semantic digression, or an amusing exercise in picking nits. Except there’s a critical point buried in there.

During my long struggle to recover, I learned a lot of things. Foremost was this, my first axiom of healing if you will:
Before devising a plan to heal, you need to know what’s wrong and what’s causing it to be wrong
. “Patellofemoral pain syndrome” simply says you have knee pain with certain characteristics. It feels like a copout, a halfway diagnosis that doesn’t try hard enough to pinpoint exactly “what’s wrong.” You have to know what’s wrong to figure out how to fix it.

Whatever the proper name for my condition, one thing became clear during the spring of 2007, as I tried to sort out the problems myself: my knees were getting worse. Cycling began to bother them more and more. On May 20, I stepped off my bicycle and vowed not to get back on until I felt better. With a heavy heart, I abandoned the Mount Washington Hill Climb. All my energy had to be devoted to healing.

Still, I couldn’t halt the downward slide. At first my knees tolerated walking very well. Each workday morning, the Discovery Bay ferry dropped me off at Pier 3. I then clopped in my dress shoes about three-quarters of a mile to the business district, passing through the glitzy IFC Mall, then over an elevated pedestrian walkway, and finally reaching the Cheung Kong Center, where Bloomberg’s offices were.

Eventually I began to experience discomfort during that walk. After that came problems standing in one spot. The packed elevators at day’s end were the worst. Bloomberg occupied the top floor for our elevator bank, so the trip down usually made several stops. The company on the twenty-third floor seemed to employ a small city’s worth of workers. As they wedged themselves onto the full elevator, I would stand still and grimace. My knees would heat up as if a cigarette lighter flame was flickering inside the joint.

I avoided lines in fast-food restaurants or stores. Whenever stuck in one, I would bounce back and forth, alternately shifting my weight from one leg to the other. I wanted to keep moving to prevent my knees from lighting up. At night my final pre-bedtime ritual was brushing my teeth. It took only several minutes, but I couldn’t stand in one place that long. The awful burning would set in, and I’d have to do my back-and-forth shuffle again.

My social life outside of work dried up. I declined invitations to go out for drinks or for group dinners with the finance team. The prospect of having to sit for another hour or two was too daunting. My knees were too weak.

As I struggled with my physical limitations, my personality changed. At work, I was increasingly unpleasant. I became the kind of boss I would never want to work for. I lost my temper once in the newsroom, subjecting a reporter to a loud and profane outburst that many co-workers overheard. The incident left me deeply embarrassed and ashamed. This wasn’t the kind of manager I wanted to be.

At times I broke down, all alone in a small inner room in my apartment, the door shut tightly so no one else would hear. My knees hurt so often: sitting, standing, walking. Was this agony going to define the rest of my life? In my darkest moments, I thought about ways to kill myself. My suicide plans grew more vivid and detailed. Then I would think of my mother and fiancee, and how devastated they would be, and realize I couldn’t give up.

This sounds so dramatic now, as I look back. After all, there are quadriplegics helpless within their own skin, their bodies a useless shell, their minds still keen—a cruel fate. But chronic pain is a terrible burden. It saps your will to live. It’s easy for healthy, well-meaning sympathizers to pat you on the shoulder and smile and say, “Everything will be okay.” I don’t trust them. For them, chronic pain is theoretical, not real.

Seeking relief, I desperately tried many things. I think that’s a common response to recurring knee pain, especially among fallen athletes. You’re terrified about losing the health and well-being you’ve gained through an active lifestyle.

I popped aspirin and over-the-counter painkillers to quiet the inflammation. They lost their effectiveness after a while. Also, after swallowing six aspirin one day, I spent the night waking up burping. The aspirin was chewing up my stomach. It didn’t matter. Becoming dependent on painkillers and anti-inflammatories was taking the wrong path anyway; they weren’t treating the underlying problem.

Before giving up cycling, I tried swapping out my pedals for a pair that allowed my feet and ankles to rotate more freely and naturally. I experimented with pedaling differently, to take pressure off my knees. I switched to gentler gears that quickened my rate of spin when climbing uphill. Those solutions came too late to do any good, however.

I used ice on my knees. Heating pads. I rubbed them. Gently moved the kneecaps before exercise. I bought a child’s kick ball with Superman’s image on the front and squeezed it between my legs while sitting. That provided relief for one online sufferer; his chondromalacia was caused by mistracking kneecaps, he wrote on a message board. It didn’t work for me. Knee injuries, I discovered, were sort of like snowflakes: they came in many different varieties.

Then there were the $250 MBT shoes that came with their own CD. They were black with freakishly fat soles. The engineers took their inspiration from an East African, barefoot tribe that supposedly had great posture and few joint and back problems. The design tried to reproduce the natural instability of walking barefoot over soft ground. The strange-looking and tippy shoes proved tricky to walk in, but the makers claimed they reduced stress on knee joints by nineteen percent. I gamely set out in my MBT shoes and half an hour later was back in my room, moaning over my painful knees.

After trying so many things, when relief still didn’t come, I adopted coping strategies. These can be very dangerous, I would learn later, but at the time my thinking was simple: I needed some way to reduce the pain enough to get through the workday. My knees couldn’t tolerate long periods of sitting in a normal position.

Elevating my legs and keeping them straight usually made the burning sensation go away. So I brought in a pair of gray trousers from home and crawled under my desk. A sturdy wire basket bolted to the underside held a rat’s nest of electrical and communications cables. I knotted the trousers to the basket, making a sling, and secured the setup with plastic cable ties. I managed to slice my thumb open with a pair of scissors, but otherwise, the operation was a success. I could slip off my shoes and thrust my stocking feet into the sling to keep my legs extended.

Coping strategies are probably common among people with nagging injuries. Later I realized what I disliked about them: you avoid facing and dealing with the problem. When you’re sleeping with a light shining in your eyes, do you get up to turn it off or roll over? Pretending the problem isn’t there doesn’t get rid of it. I couldn’t sit normally. That was a problem, a big one. I couldn’t spend the rest of my life with my legs propped up on boxes or makeshift slings.

Clearly I was in trouble and needed help. I began to seek out orthopedic doctors, looking for answers and options. It would turn out to be a frustrating and demoralizing experience.