The Knee Odyssey

Hi all. This is going to be long. I want advice. Some of this is embarrassing to tell you but I will anyhow.

When I was 19 years old I tore my right ACL while dancing to "Like a Prayer" in a friend's dorm room. But because I wasn't an athlete, at the time I didn't know that's what I did and the university health center didn't even mention that possibility when I went to see them. I also think I tore cartilage in that knee at the same time. For years, that knee was unstable and I kept re-injuring it because it was unstable. But I never went to an orthopedist because I was in my 20's and didn't know any better. Also around age 20 I injured my left knee while hiking. I am accident prone and active and take risks with my body. So it goes. By the time I was 23 my right knee was fucked up in a way that I did go to an orthopedist and was told I needed meniscus surgery. Either my ACL wasn't totally torn then or they missed it on the MRI or something. Long story short: between ages 23 and 25 I had both right and left knee meniscus surgery.

Fast forward to 2001 when I was 30 years old and my right knee had been unstable still for years, and finally I was diagnosed with R knee torn ACL and more torn meniscus and had ACL reconstruction surgery and more meniscus fix in my right knee. In case you don't know, when they do meniscus surgery, I think they pretty much just clean out the torn part, so I think you end up with less cartilage in your knee. Cartilage is there for a reason.

So picture this: age 30, less cartilage than normal in both knees (and an impaired right hamstring because that's what they used to reconstruct my right ACL -- I didn't want a cadaver ACL, which is what I would do if I could do it over again), plus reconstructed right ACL. During this time I was on boats a lot doing research for my PhD and I may or may not have had some more knee stuff. (A lot of the knee issues I was experiencing during these years were from spending time on boats but also just living.) During this time in grad school I also -- I had always been chubby -- gained a lot of weight, a fact that will become relevant below. So while I always loved activity and did cycling, yoga, and swimming, because of the injuries in my 20's I avoided activity that required twisting or turning knees (tennis, for example) and I didn't run for exercise.

I have always loved walking a lot and have always walked. I didn't ever want to stop walking a lot.

When I finished my PhD at age 32, I set about losing a lot of weight because I was bigger than I wanted to be. From about 2003 until 2020 I was always in various stages of weight loss or regain, but mostly loss. I eventually went from weighing 213 lbs in 2003 to about 165 in 2005 or 2006. Then, when I moved to New Orleans from NYC in 2007, I gained the "New Orleans 25." So I was going up and down about 20 lbs every couple of years. Which was OK. Around 2009 my elderly mother in law began a decline that started with chronic back pain and back surgery, and I got scared about the idea of growing older and being inactive and immobile. So, I started going to the gym and working with trainers. Starting in 2010 I have transformed myself into a weightlifter who also has done a ton of swimming, walking, cycling. All throughout this time my knees were always a problem but I modify things at the gym. I had a couple of re-injuries. At one point in the 20-teens, I had gone back to orthopedists and was going to get meniscus surgery on my left knee again but then my acupuncturist cured my knee for the time being, which was also miraculous.

In 2015 my car was t-boned by a woman who ran a stop sign and my knees hit the dashboard hard (plus I got whiplash and a concussion but that is not relevant to knees). I got another MRI and was told that my right ACL was somehow torn again and my left ACL was also somehow torn. I was also told at the time that my knee cartilage was largely nonexistent. Sometimes during those years, I would take a long walk and my knee would swell up. By this time, I was in my 40's and had decided I never wanted to have knee surgery again. I decided to try to live with fucked up knees and make my legs as strong as possible. Which is what I have done. By 2015 I had also lost so much weight I was down to 135 lbs.

Just for some more background and context, from 2015 to 2020 I also went through the worst major depressive episode I have ever experienced, even though I'd been on a very successful antidepressant for 10 years that had kept my clinical depression managed well. In 2019 my father died while I was in the major depression which also really sucked in a million ways.

I had an inexplicable break of this terrible depression for 8 months in 2018 and gained some weight again during those months because I was happy and enjoying life and food and drink. My knees really started bothering me again at that time, and I went to the orthopedist again and was told I had some options: I could try an injection that sort of acts like lubricant/fake cartilage. I could eventually have knee replacements. I could do nothing. I was told that losing weight would take pressure off my knees but the doctor was good about this and didn't make a huge issue of my weight. Then I got depressed again in 2018 late and lost a ton of weight again. I kept active during this whole time and was strong, skinny, and very very very clinically depressed. I tried numerous antidepressants that either didn't work or had side effects I could not tolerate.

Finally In March 2020 I started Effexor, an antidepressant I had never wanted to take because of the reported side effects. Within 48 hours after titrating up to 150 mg, my depression vanished and I felt like my normal self for the first time in 4 years. This was a miracle. Please also note this coincided with the beginning of the pandemic. I once again started enjoying life (as much as was possible during the beginning of the pandemic -- yes it was very weird to be happier than I'd been in years while the rest of the world was not feeling OK). I had never been on an SSRI, a type of antidepressant notorious for causing huge weight gain. (Effexor is an SSRI/SNRI.) Suffice it to say that between March 2020 and now December 2022, I have gained probably 60 or 70 lbs, I am not sure because I can't bear to weigh myself. There is a lot to say about this but this particular story is about my knees.

At this weight and at the age of 51 with the knees I have, it turns out my knees feel pretty terrible. I am in a lot of knee pain almost daily. I take a lot of turmeric which does help some. But I feel like my triumph of weight, mobility, and activity has been hugely impacted by the combination of the weight gain from Effexor, the changes in my daily life due to the pandemic and working from home so much, and the fact that my knees hurt so much it's hard to do the kind of walking for exercise I like. I feel dejected about it, honestly. I have continued to go to the gym weekly and so I am very strong, and I practice and teach yoga, but I feel much less mobile and much less flexible and I don't like it one bit.

As you all know, I work hard to be fat positive and compassionate with myself about my body size because of a lifetime of trauma around what it's like to be a woman with my body in this world. I know that a lot of the health indoctrination we get about body weight is bullshit. But I have a very clear picture right now that this significant weight gain is affecting my knees and my comfort and my mobility, because of my particular history of knee injuries and surgery. There is very little likelihood that I will be able -- because of my age and the Effexor -- to drop a lot of weight quickly right now, regardless of whether I want to or not. So I am at a decision point about my knees.

My options feel like this:

1. Go to the orthopedist, try getting the knee injections. See what happens.

2. Go to the acupuncturist and do very concentrated knee work for a while.

3. Go to the orthopedist and just say yeah it's time for knee replacements.

4. Do some combination of 1, 2, plus work to take off some of this weight to take some pressure off my knees.

5. Some other options I can't see.

My current plan is to start with the acupuncture.

So I am asking you, my community, hive mind, and beloveds: what has worked for you with your knees? What are your experiences that I can learn from to try to move forward? I am very knowledgable about my own health and body, I have been dealing with this stuff for a lifetime, so I am very educated about it all but I am having a hard time figuring out how to move forward, largely because I really DO NOT WANT TO HAVE KNEE SURGERY EVER AGAIN. But if that is the best option that will give me the best mobility and outcomes so I can be active again in the ways I want, I will maybe do it.

Please comment here or on my Facebook and give me your thoughts. Thank you.

xoxo