Who needs their knees, anyway?

I hadn’t written a blog post about my knee injury because I wasn’t sure whether it was related to cancer, but now I know how they are connected. The short version is that my knee swelled up so badly that I couldn’t walk on the night of May 6th/morning of May 7th. Because I am on blood thinners, the knee joint kept filling up with blood, a condition that I learned is called hemarthrosis. I’ve spent the past 4+ weeks meeting with a bazillion doctors (GP, orthopedic doctor, orthopedic oncologist, orthopedic surgeon, hematologist), going to the ER (twice), having my knee drained (3 times), and mostly lying on the sofa for 2 of those weeks, trying to get the swelling to come down. I still have a bit of swelling, but I’ve been able to walk 10-20+ minutes the past week without making it worse. I’m still wearing a compression sleeve, which is a step up from the brace and crutches I was using before.

Now for the longer version. There was no particular event that caused the injury. The day after I did front squats at the gym (last week of April), I noticed that my left knee was a bit swollen. There was no pain, so I didn’t think much of it. Five days later (May 6), I played volleyball in the backyard with Lily. No pain, no twisting, no problems. By the next morning, my knee was so swollen and painful that I couldn’t walk. I had about a 10-degree angle where I didn’t have pain. Getting into and out of the car was horrible – it’s nearly impossible to keep your leg at a slightly-less-than straight angle.

The MRI revealed that I have no cartilage between the thigh and shin bones and tendinosis (worn tendon) on all sides. I.e., old age, osteoarthritis. I didn’t even know I had arthritis!

Over the next 2 weeks, my knee was in a vicious cycle of filling up with blood after being drained. The ER doctor (May 17) was the first one to point out that the blood thinner was causing the swelling (he drained nearly 1/3 c. of blood, only to have it swell up again within an hour or so, after we left the ER). It was so painful at one point that I didn’t know how I was going to make it 48 hours until my doctor’s appointment to get it drained for the 3rd time. In consultation with my hematologist, I went off Lovenox for a while so that the swelling could subside. Not gonna lie, I didn’t miss doing 2 painful shots a day!

This past Monday morning, we met with an orthopedic oncologist at Geisinger-Danville who was amazed that I've been as active as I have, given the extent of the osteoarthritis. He said the only way to stop the bleeding or to prevent this from happening again is to quit blood thinners. But he acknowledged the conundrum: I have to take blood thinners because lung cancer puts me at a high risk for blood clots, and I’ve already had 3 life-threatening pulmonary emboli (July to Sept. 2022). So, I have to thread the needle and find a dosage that both avoids hemarthrosis and blood clots/PE!

I feel like I am in a scene from Raiders of the Lost Ark where peril awaits on all sides and there is only one narrow path toward safety, but I won’t know if I’ve chosen well or poorly until it’s too late and I’ve been swallowed by eels, attacked by a ghouls, fallen into the abyss, or met some other terrible fate.

There are no easy solutions. Neither the orthopedic oncologist nor the orthopedic surgeon I saw today thinks that a steroid/cortisone shot would help because it treats pain and I don’t have any pain (when my knee isn't swollen from hemarthrosis). They also don’t think arthroscopic surgery is advised. There is nothing in my knee that can really be repaired.

After talking with my hematologist (Dr. Woytowitz) earlier this week, I felt a bit more reassured that we might be able to find that sweet spot. My usual Lovenox dose (based on body weight) is .8 mL twice/day. I’m currently on .4 mL and will work up to .5 mL. When we return from a trip to see family in the Midwest in mid-June, I will get my blood checked to determine if I stay at .5 or go up to .6 mL. My risk of PE is now much lower now because my cancer is under control and it’s been nearly 2.75 years since I’ve had a PE. I really appreciate Dr. Woytowitz. He called and spent 20 minutes on the phone with me, thinking through various options. He thinks very much like a scientist and practical problem solver, and even wandered into social construction of science territory – something to the effect of, “At some point, someone had to just decide, the formula is x mL per kilo of body weight; it’s not an exact science.” And all this was with no appointment and therefore no charge.

After all these appointments, we have some answers about what happened and why: an arthritis flare-up caused the initial bleeding and swelling. The blood thinner caused a vicious bleeding cycle. There is no cure or solution other than letting it heal and reducing my Lovenox dosage.

Although all the doctors think it will be fine for me to travel, I now have a lingering fear that I'll do something to tweak my knee again and be back at square one. For instance, I don’t know that I can ever risk peppering (playing 1:1 volleyball) with Lily again, which makes me really sad. I’m also hyper-vigilant again about looking for signs of blood clots. “Does my ankle look swollen? Why is my heart rate 95 even though I’m just sitting here?” I don’t know how long it’ll be before I can do lower-body strength training or ride my bike again. I’m supposed to wait until the swelling is completely gone, which could take weeks.

Although I was disappointed in the first ER doctor (Why didn’t he drain my knee to alleviate the pain???) and the orthopedic doctor (her diagnosis and recommendations were less complete and informative than those of the other doctors), some of my other doctors and professionals have gone above and beyond: my GP who thinks holistically and can always get us in for same-day appointments, my PT who responds to emails and sends advice at no charge, my trainers/gym owners who are in my corner and ready to create customized workouts tailored to my physical needs and limitations (now I’m doing upper-body and core only), and my hematologist, who I’ve never even met in person, but always returns calls the same day and never seems hurried.

One upside of not being able to go to the gym and exercise is that I’ve been sleeping in until about 7:30 nearly every day. And with the better weather, I’ve been able to enjoy our back patio. I’ve also caught up on a bunch of little tasks like posting months-old pictures on Facebook, as those of you on Facebook have surely noticed!

Finally, I would be remiss not to mention Leland’s excellent husbandry. He’s been doing all the cooking, chores, and kid transport since this ordeal started (save for a short period when I thought I was getting better) and has accompanied me to my countless appointments.

As if we needed One More Thing, we hit a deer on I-80 on Monday as we were driving our EV to my doctor’s appointment (an 80-minute drive). Thanks to Leland’s quick reflexes, only the front right of the car was damaged, and we could still drive it, but it is in the shop with $5000 worth of damage (all but a little bit covered by insurance). The last thing we needed was serious injuries, a totaled car, and missing an impossible-to-schedule doctor’s appointment.

We heard Bruce Cockburn live for the first time in Pittsburgh on May 16. I’ve always loved these lyrics from two of his songs, particularly when I’m feeling down or contemplative. They’ve been especially on my mind in the past several weeks:

Sometimes the best map will not guide you
You can’t see what’s ‘round the bend
Sometimes the road leads through dark places
Sometimes the darkness is your friend (Pacing the Cage)

****

Sometimes a wind comes out of nowhere
And knocks you off your feet
And look—see my tears—
They fill the whole night sky
The whole night sky (The Whole Night Sky)

I would say that I’m now feeling a bit more optimistic. A friend commented that she associates “I Get Knocked Down” with me. That tracks.

I get knocked down
But I get up again
You're never gonna keep me down

the sunrise, not long before we hit the deer