Adventures in PRP Therapy

Well, after 5 months or so, having plateaued in my recovery, I decided to revert to my default behavior..casting about for some non-surgical treatment that sounded vaguely like it might have a scientific basis, and would be unlikely to make anything worse.  What I came up with was Platelet Rich Plasma Injection Therapy, aka, PRP.  The theory is that you centrifuge the person’s blood to produce a plasma that has a high concentration of platelets, and therefore various growth factors ..in other words..all the good stuff that promotes healing..you can then inject into the joint and it might initiate tissue repair.  It seemed to make sense, and since it was nothing but my own blood being injected, with a little tiny needle, I figured there wasn’t a lot that could go wrong.   The doctor suggested he should, at the same time, aspirate the popliteal cyst in the back of my knee, which apparently either never resolved at all, or has recurred as I’ve increased my activity level.  I hadn’t noticed it lately, but that seemed like a good idea.

So, here’s how it went.  The nurses/assistants (or whatever they were..no one ever tells you these things..) drew a bunch of blood really fast by using an anticoagulant and went off to spin it down.  Then, two doctors, a med student, and a nurse-type person assistant came in and, after numbing the area and visualizing the cyst on ultrasound, and planning their attack, stuck a needle in and aspirated the fluid, while pushing on the cyst to get it properly positioned.  The doctor told me it was dumbell-shaped and wrapped around the gastroc, but that this is not unusual.  This part produced a sudden  and very unusual-feeling pain that ran down the back of my calf,  which apparently was unexpected, but the whole thing wasn’t bad.

After that I got to flip on my back,while they injected the PRP, and I was able to watch the ultrasound.  It was interesting having a 5-person team all gathered around..it was like an episode of ‘House’.  Except that if it had been an episode of ‘House’, I would have had a seizure and the camera would have zoomed into my body to reveal that procedure accidentally released a giantic hookworm that had been living in the cyst in my knee and was now swimming directly to my heart..or brain..or both..and then they would have had to take time to randomly speculate on possible diagnoses for an hour..and well..I would have been there all day, so yeah..good thing it wasn’t House.  Anyway, the main doc warned me that it would hurt when the platelets went in, but it didn’t at all.  According to him, I am the only patient he’s had who didn’t say “Ow” at that point.   After that, they had me wait around to make sure I wouldn’t faint, and then I went home feeling fine, but with a scrip for 10 Vicodin, because doctors like to give you Vicodin for some reason.  It seemed like too much trouble to fill the prescription and go sell them on the street so I didn’t fill it.

So, the rest of the day my knee felt mildly unstable while walking, but I attribute that either to the anaesthetic or to fact that all that fluid they aspirated was exerting a stabilizing effect on my knee.  In any case, that sensation wore off  and I had no pain until today, which is 4 days post-procedure, and all I have is  soreness  below the joint line in the back and medially.        Somehow it seems sort of unrelated to the other things.  Oh well.  Anyway, I have a follow-up in roughly 3 weeks.

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How to Recover

OK, so I’m 16 weeks post-injury.  I still have pain and effusion in my knee, and I’ve crossed off the spring races from my calendar but for the most part I’ve stopped whining and limping and feeling sorry for myself.  And today I had one of my mini-epiphanies..the kind where I suddenly have an exciting revelation about something that should have been obvious long ago…I think I’m going about this all wrong!  Basically, the problem is that I have no idea how to come back from this injury.  I did PT, I had a cortisone shot, I had ART/Graston therapy, and I saw a doctor about getting PRP injections (I haven’ t decided yet).  In other words, I’m trying things at random, hoping something will work, and expecting that eventually I’ll find the magic bullet and I’ll all of a sudden get better and be able to start running 30-35 miles a week again.  And I think this is wrong.  I need to be more methodical.  I need to train.  I need a plan.

So first I asked the Internet for a plan, but it was frustratingly silent.  The Internet has plenty of rehabilitation protocols for post meniscus surgery, and all sorts of PT protocols for knee injury that assume by 12 weeks you are all better and back to normal activities.  But nothing to tell me how to get from where I am now, able to run 5 miles, with pain but not too much, to running 14.5 miles, which was where I was before the injury.  So I’ve decided that I will use one of the half marathon training plans out there, and train myself back to running.

This will be a first for me, since I’ve never been one to train for a race, preferring instead to just run whatever I feel like and on race day just show up  and run the race. (Yes, I know, that could conceivably be contributing to my many injuries, but I can’t help it..training is annoying and takes the fun out of everything! )  So, anyway, I am leaning toward the 8-week Hal Higdon half marathon program, with an extra mile tacked on at the very end.  That will have me back to pre-injury long-run distance by the beginning of May if I have no major setbacks.  Knock wood.

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Cortisone shots are awesome..for a little while

So. It’s now been 8 weeks since the injury.  The sharp, stabbing lateral knee pain caused by the meniscal tear is diminished but not gone.  But, as I sit here on the couch with my right leg tucked under me, my right knee is starting to do this weird  pain thing..and in another second I’ll have to straighten out my leg and massage my knee until the pain subsides.  This particular injury is turning out to be a real pain to deal with.  Not only has it stopped me from running, but i when I drive or occasionally when I am just sitting with a flexed knee, I get a really  intense pain that radiates down my calf. The doctor wasn’t sure why, but she gave me a cortisone shot and Whee!..completely pain-free within 20 minutes.  Until it wore off, after 48 short but very happy hours.  So now I wonder if I can score some cortisone on the street somewhere? But back to the radiating flexed-knee  pain.   I have developed a hypothesis, because, hey, it’s my knee and not having a hypothesis bugs me.  When I first got the MRI, after being off the knee resting for several days, the radiologist noted that along with the radial tear to the meniscus, and moderate effusion in the joint  there was a Baker’s (popliteal) cyst at the back of the knee that was “leaking” down into the calf.  The BC is thought to be a result of the meniscal injury, and apparently it’s the result of joint fluid sort of flowing into a bursa in the back of the knee through a narrow channel.  So, when one ruptures or leaks, as in my case,  synovial fluid is very irritating and can cause a lot of pain.    But when I exercise, I still get the ‘fat knee’ feeling, caused by effusion building up in the knee.  So, back to the weird part. The worst  instances have been when driving home from PT or from the gym.  Within a couple of minutes of driving I get this incredibly intense  pain and have to pull over, extend my knee, grit my teeth and and massage as hard as I can before I can drive again.  So, I’m thinking that when I flex my knee, the effustion in the knee space is injected into the Baker’s cyst and/or, the sitting position causes the leak to open up and inject fluid down into my calf.  Either that or something about the sitting position in a car causes the BC to press on nerves or blood vessels.  The car seat is definitely deeper than a normla chair, so the back of my knee is pressing in the edge of the seat in a way that likely doesn’t happen with my kitchen chairs, for example.  In any case, I feel like a good portion of the pain is from the Baker’s cyst and not the torn meniscus per se.   If true, it means that it’s all about reducing the effusion in my knee.  Now, if only  could figure out how to do that..  Sigh.

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House of Cards

Well, I’ve had yet another demonstration of how my running is a delicately balanced house of cards, and all it takes is one itty bitty butterfly flapping its wings of chaos to knock it over.  In this case the butterfly was a mysterious illness, which sidelined me from running for a couple of days,  and as a result my running schedule got out of whack..prompting me to make the fateful decision to work out at the gym just to get in some exercise.  I avoided the dread-mill, since I hate it so much, but I did use those other evil machines of destruction, two different versions of some elliptical-stair-simulator-thingy.   This did something bad to my hips.   Then, as if that weren’t enough, yesterday I had to cut my Thursday run short because of work, so I got on my stationary bike that I haven’t ridden since Joe Biden was a junior senator (really) and rode it for an hour late last night.    Then today, I did a 7 mile lunch-hour run and both my knees were all hurty.  Sigh.

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