Monthly Archives: July 2017

What I Wish I’d Known About My Knees


Serious questions are now being raised about the benefits of the arthroscopic procedures that millions of people endure in hopes of delaying, if not avoiding, total knee replacements.

The latest challenge, published in May in BMJ by an expert panel that systematically reviewed 12 well-designed trials and 13 observational studies, concluded that arthroscopic surgery for degenerative knee arthritis and meniscal tears resulted in no lasting pain relief or improved function.

Three months after the procedure, fewer than 15 percent of patients experienced at best “a small or very small improvement in pain and function,” effects that disappeared completely within a year.

As with all invasive procedures, the surgery is not without risks, infection being the most common, though not the only, complication.

Furthermore, the panel added, “Most patients will experience an important improvement in pain and function without arthroscopy.”

That, in fact, was the experience of a friend who, at about age 70 and an avid tennis player, consulted the same surgeon who had operated on my knee years earlier. My friend was told he had a torn meniscus that could be repaired arthroscopically, but he chose not to have the procedure. Instead, after several weeks of physical therapy, the pain had subsided, he returned to the court and has been playing without a recurrence for at least eight years.

“Arthroscopic surgery has a role, but not for arthritis and meniscal tears,” Dr. Reed A.C. Siemieniuk, a methodologist at McMaster University in Hamilton, Ontario, and chairman of the panel, said in an interview. “It became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn’t work.”

Arthroscopic surgery can sometimes be useful, he said, citing as examples people with traumatic injuries and young athletes with sports injuries. My son Erik is a case in point. When he was 23, Erik was playing basketball when he sustained a rupture of the anterior cruciate ligament in one knee that was successfully repaired arthroscopically. He’s been playing tennis and basketball on that knee without pain for the last 24 years.

The panel noted that about one-quarter of people older than 50 experience knee pain from degenerative knee disease, a percentage that rises with age. Arthroscopic procedures for this condition “cost more than $3 billion per year in the United States alone,” the report stated, suggesting that it was a near-complete waste of money.

Other common interventions include steroid injections into the knee. These can reduce painful inflammation, but if used repeatedly, steroids can speed the development of arthritis in the joint. A study published in May in JAMA by researchers at Tufts Medical Center found that the injection of a corticosteroid every three months over two years resulted in greater loss of knee cartilage and no significant difference in knee pain compared to patients who received a placebo injection.

The value of the other procedure I had, injections of hyaluronic acid (Synvisc and Monovisc are common brands), has somewhat better research support for patients with knee pain. One large study, published last year in PLOS One, included more than 50,000 patients treated with one or more courses of these injections and compared them to more than 131,000 patients who had no injections.

For those who underwent five or more courses, the injections delayed the average time to a total knee replacement by 3.6 years, whereas those who had only one course averaged 1.4 years until knee replacement, and those who had no injections had their knees replaced after an average of 114 days.

Dr. Siemieniuk conceded that treatment for degenerative knee arthritis can be “frustrating for both doctors and patients” because there is no clear answer as to what will help which patients.

Until there is better evidence, he suggested the following approaches that are known to help keep many patients out of the operating room.

• If you are overweight, lose weight. The more you weigh, the more pressure on your knees with every step and the more they are likely to hurt when walking or climbing stairs.

• Pay attention to the activities that aggravate knee pain and try to avoid those that are not essential, like squatting or sitting too long in one place.

• If the pain is bad enough, take an over-the-counter pain reliever like acetaminophen (Tylenol and others) or an NSAID (nonsteroidal anti-inflammatory drug) like ibuprofen or naproxen.

• Probably most helpful of all, undergo one or more cycles of physical therapy administered by a licensed therapist, perhaps one who specializes in knee pain. Be sure to do the recommended exercises at home and continue to do them indefinitely lest their benefits dissipate.

• Consider consulting an occupational therapist who can teach you how to modify your activities to minimize knee discomfort.


5 Signs of Hidden Depression You Should Never Ignore and 5 Ways to Help

By Kat Gal 

Your friend seems fine.

She is social and appears to be cheerful all the time. Her life is in order. She rarely even complains.

There is no way she’s depressed.

The truth is, though… depression shows up differently for everyone.

Not everyone dealing with depression shows it in public. Not everyone struggling sits in the corner, cries all the time or acts withdrawn either.

There are people who have hidden depression and because they hide it so well, it can sometimes be very difficult to support them in getting better and finding happiness again.

But support is crucial and I want to show you how to spot a friend or loved one who may need you during this time… even if they aren’t openly asking for it.

5 Things To Look For With Hidden Depression

1. They may be irritated or angry a lot.

Anger and irritation are two common signs of depression. When you think of depression, you usually think of sadness, helplessness, apathy and melancholia. When someone is angry or irritated, you may mistake it for a bad mood or bad temper. However, anger and irritation are often a way to express depression, especially in men.

2. They may withdraw.

When someone is dealing with depression, it’s common for them to lose all interest in anything, especially in the activities they once loved doing. They may become more withdrawn, sleep in late and call into work more often, etc. Becoming withdrawn can be one of the biggest signs that someone is suffering.

3. They may become flakey and unreliable.

People dealing with depression may make plans with you when they feel up to it or feel pressure to do so, but then they may not follow through with it, cancel or not show up at all. You may consider this rude. If they do this several times in a row, you may even consider cutting ties with them. But be aware, someone who suddenly begins flaking out on you could be secretly depressed.

4. They may be exhausted, have trouble sleeping or sleep too much.

Dealing with depression is difficult and tiring. Everything becomes way too hard, even sleeping and/or staying awake. People with depression may have trouble falling asleep, staying asleep or may be tired even when they’ve slept all day long. They may be coping with depression by sleeping far too much. Sleep problems and unusual sleep patterns can often be a warning sign of deeper issues.

5. They may suddenly gain or lose a noticeable amount of weight.

There can be many reasons for weight loss and weight gain. People often lose weight because they’ve started eating better and exercising. They may gain weight because of indulging during the holidays, having less time to exercise or having a few too many brownies. A variety of illnesses and health conditions can also cause weight loss or weight gain.

Be careful trying to associate someone’s weight loss or weight gain with depression (or eating disorders) right away. Just keep in mind that not eating enough or eating too much can be a coping mechanism as well. Look for other signs of depression along with the weight fluctuation. If there is no other explanation – an improved diet, more or less exercise, or a medical condition, etc. – it may be a sign of depression.

What Can You Do If Someone You Know May Be Dealing With Hidden Depression?

  • Talk to them. Don’t interrogate them, but be there for them. Genuinely express interest in their lives and well-being.
  • Offer support. Do so by listening and trying to understand, without judgement. Also offer non-emotional support, like cooking a healthy meal or helping them around the house or with their pets of children.
  • Be patient. Depression is difficult. Healing is a difficult journey too. It takes time and may be full of ups and downs.
  • Believe in them. Don’t give up on them, even if they seem to have given up on themselves. Tell them you believe in them and that you believe they can heal.
  • Love them. Tell them that you love them unconditionally. Love them through words and actions.
  • Become vulnerable. You don’t have to do this alone; you are not alone. Just sharing your story can be liberating. This is a great way to begin healing and allowing those that love and care for you to help.
  • Eat better. When you are dealing with depression, sometimes the last thing you want to do is to eat healthy (or eat at all). But an unhealthy diet can lead to further depression. Focus on organic, plant-based whole foods: vegetables, fruits, nuts, seeds, legumes and whole grains. Your gut influences your brain, so take care of your gut flora and consider adding in a quality probiotic.
  • Move your body. Stretch, walk, do yoga, run, dance or anything you’d like. You don’t have to do too much, but try to move at least a few minutes – preferably 20-30 minutes each day.
  • Be in nature. Connecting with nature is healing. Walk barefoot in the grass. Hug a tree. Watch the sunset. Go for a hike. Swim in a lake. Play with animals.
  • Journal. Journaling is an excellent way to express your emotions, recognize patterns, let go of limiting beliefs and just ‘let it all out.’
  • Do some art. Art is another way to express your emotions, deal with negative feelings and create happiness. You don’t have to be an artist and you don’t have to show your work to anyone. Draw, paint, take photos, make some sculptures, knit, crochet, do some craft work, make a picture album, or color in an adult coloring book.
  • Do something that makes you happy. For now, it doesn’t have to be profound. If watching your favorite show puts a smile on your face, do that. It is important to start somewhere and that looks different for everyone.
  • Start practicing self-love. Do some mirror-work by looking into your own eyes in the mirror and talking positively to yourself. Practice affirmations. Practice smiling.
  • Get professional help. There is no shame in seeking professional support. A psychologist, therapist, counselor or a life coach can help you find answers and find happiness in life.

Always remember that there is HOPE. Help, love and guidance is out there, even when it doesn’t feel like it is. Don’t give up on yourself and most importantly, don’t give up on those you love.

We’re all in this together – no matter what.