Denial

“The attempt to escape from pain, is what creates more pain.”
― Gabor Maté

I’m back

I realize that I have disappeared from the Blog-iverse for a long time.  The name of my practice is “Aim For Change,” with the tagline, “Be a Resilient Athlete.”  Yes, I can write blog posts with tips based on the scientific literature for dealing with this or that. But what better way to really get into the nuts and bolts of injury, mental health, resilience and being an (aging) athlete, than sharing my own personal experience.  Several years ago, I use to blog like crazy about triathlon training, but sadly because of the increasingly debilitating arthritis in my knees I had to stop doing triathlons, which broke my heart, and my blogging became more informational during covid.  But now in 2024, I want to share my most recent personal journey of healing.  This is not only from the perspective of a professional, but also from perspective of someone who understands the pain, sweat and emotional rollercoaster that comes with the rehabilitation process. And so this is the start of my Bionic Knee Chronicles:

Disbelief and denial

Denial is a powerful mechanism.  It’s a psychological process where we refuse to perceive or acknowledge a potentially emotionally intolerable truth…a strategy that we use to cope with and avoid anxiety. We don’t do this willfully, in fact, denial lives just below the surface of consciousness.  It protects the brain from overload, and perhaps gives us time to adjust to a painful reality we must eventually accept. It’s part of grieving any type of loss.

My journey on the path of denial started before the last iron distance triathlon I did seven or so years ago. I noticed after the triathlon I just couldn’t control the pain in my knees.  I went to my sports medicine doctor, who is an internist, and asked him to hit me up with a cortisone injection so I could start training for the next triathlon.  He looked at me the way you look at someone with whom you’ve told the same thing repeatedly, but it wasn’t sinking in.  Then he said as gently as he could, “Marie we’ve talked about this and made a deal that this would be your last triathlon—and you have to stop running.  If you continue, your knees will be so bad, you’ll have to have surgery to even be able to walk and could even end up in a wheelchair.” I can remember so vividly the blank look on my face.  I was thinking surely, he must have me confused with another patient, because I never recalled any conversation about having to stop running.  I was shocked he would even suggest this!  After I met with him, I thought, “I’ll just make an appointment with a sports medicine orthopedist who maybe has more experience in complicated knee rehabilitation in older athletes.”

So, I found an orthopedist that specialized in treating sports related knee injuries.  I went to the appointment, had the usual x-rays and then met with the orthopedic surgeon.  He said to me just quite bluntly, “This is not a sports medicine issue—you have bone on bone arthritis that isn’t going to improve with rehab.  You need to go to the arthritis clinic in our practice, right across the hall to discuss surgery.”  Again, this was such a blow.  I felt like he kicked me in the stomach and sent me on my way.  It also felt like he was saying, “You’re not an athlete, you’re an old lady with bad knees.”  Of course physical therapy was not even mentioned, only surgery.  I high-tailed it out of there, thinking that I would find someone that specialized in running injuries with a more holistic approach.  Basically, I kept going to different doctors, until I found one who told me what I wanted to hear, that “sure we can get you back to running”.  But the treatment involved experimental procedures that were over-the-top expensive as in thousands of dollars and had no empirical data or clinical trials to back up their effectiveness.  I would have been willing to explore that further, but my scientist side smelled snake oil.  Or not even snake oil, but maybe a procedure that might work for someone 20 years younger that had some cartilage left. At that point I decided they were all wrong, and that I would just keep getting cortisone injections and strengthen the muscles around my knees to compensate.  I would show them. I swore I would never have surgery.

Little by little over the course of the next several years, the activities that I loved doing were whittling away.  Not only was I advised not to run, but I was at the point where even if I wanted to be non-compliant I couldn’t because of the pain and instability.  I thought, “I’ll just focus on my cycling so if I ride faster, I can just walk the run leg of a triathlon”.  But now it was starting to become painful to ride my bike.  Or do squats or leg presses or lunges or basically any activity that required bending…which was needed to strengthen my quads.  And then I couldn’t swim because you can’t kick when your knees are so unstable.  

The final blow was a trip to Italy that involved walking several hours a day, up and down cobblestone streets, hills and stairs.  Did I mention that by then, I already had to go up and down stairs only one leg at a time?   As opposed to alternating legs, like what most people do, and which we take for granted.  My knees were so inflamed by the time I got home, that just about anything caused pain.  The worst aspect was the grinding noise and sensation when I would try to bend even the least little bit.  Hell, I couldn’t even garden because when I would even bend from the waist, I could feel the wobbling. This was the result of bone on bone.  Because I had waited so long, the bone was creating spurs (spiny bone growth that shouldn’t be there), and one of my patellas  (knee caps) was fusing with my femur.  Ewww.  You may be thinking that’s gross, and you would be right-it was.

The truth hurts and stings

I still worked out to the best of my ability.  I boxed once a week (with no hopping or lateral motion) and did strength training with my trainer 2x a week.  But the strengthening activities were becoming more and more limited even though my trainer is pretty creative. She finally said to me, “I know you don’t want to hear this, but your knees are not going to get any better, no matter what you do. You need surgery”.  There was something about that conversation that finally struck me.  I remember for the first time thinking, “Omg could she be right?” She had been my strength trainer for the last almost ten years and watched the deterioration. And then, the terrifying reality hit me like a ton of bricks.  For the very first time it sank in.  Being the control freak that I am, I had to extensively research the different types of total knee replacement and find the best local surgeon I could.  I decided on an ortho practice that does robotic surgery which involves more precise and less bone shaving (again ewwwww).  Now I did have a few valid reasons why I kept putting off the surgery.  I’m a widow and single mom and at the time my daughter was too young to drive and needed me not only to transport her everywhere, but she was a young teenager trying to navigate the loss of a parent.  Now five years later, she could drive and was off to college and I had no excuse.

When I met with the surgeon, I had a long list of reasons why I wanted to do both knees at once.  I had my ammunition lined up because I heard that many surgeons will refuse to do both at the same time especially on someone my age. In fact, I read that only 6% of knee surgeries were bilateral. Usually they are scheduled between a month to a year part. The hell if I was going to go through the recovery process twice.  When he looked at my x-rays and I asked about bilateral replacement, he didn’t even bat an eyelash and said, yup, you’re a good candidate, let’s do this. And for the first time in many years, I had hope.  Not the false hope of denial that somehow things will magically work out, but real hope that with hard work, I could get my life back.  I finally accepted that to move forward, I would have to go back several steps. All I could do in the months following up to the surgery was prepare myself mentally (which I’ll talk about in another post), and work on core and upper body strength because that was all I would have to rely on during the early stages of recovery.  And really, with the inability to bend my knees there wasn’t a whole lot I could do with my legs except isometric exercises.  I felt my quads slowly withering away. I can’t even imagine what my life would be like even five years from now if I kept putting off surgery.  It would have been a life so limited and sedentary all because of my stubbornness and denial.  There was no going back.

So how do you know if you’re in denial?

1. Looking back, I was extremely defensive any time the topic of surgery came up. And I pretty much avoided the topic. You know that specific look you give to people when you know they are totally deluding themselves? I was getting that look from people when I said I would improve my knee function myself.

2. I also was ignoring facts and instead was looking for a miracle cure. The ones that boast, “Don’t let doctors talk you into surgery-our product is guaranteed to reverse arthritis”. There are countless products out there that claim to rejuvenate cartilage. These products usually have their own “research studies” posted on their websites. I know better than to trust those studies–I’m a scientist. If it’s not a randomized double-blind study published in a peer-reviewed journal, then the product doesn’t have much more reliability than swinging a dead cat over your head.  But none-the-less, I would take these miracle supplements that would improve cartilage growth (you can’t find a single study that suggests we can grow new cartilage in our knees).  I also kept adding to my knee brace collection with the hope that the next one would work.  It was after the custom-fitted, titanium, hinged, spring loaded, blah blah blah knee brace failed that I started to scratch my head.

3. I kept rationalizing and justifying that I didn’t really need surgery, by focusing on the activities I could do, albeit at a very reduced capacity. I could box, but couldn’t do any drills that involved lateral motion, and could basically just punch. I did cardio but could get my heart rate up by pretty much just using upper body strength. I could walk in the water, but walking and swimming are two very different activities, and you most definitely could not walk in the water during a triathlon or aquabike.

4. I was blaming the doctors for what I perceived to be narrow-minded and ageist opinions. (Not that doctors are always right, but they were in my instance.

5. I was numb, not feeling joy nor sadness. Instead, I minimized the consequences of my decision (or should I say non-decision). I put on a front that I was ok, despite feeling this deep sense of sadness and grief about all I had lost.

And then finally after I couldn’t avoid, find a miracle cure, or rationalize any further, came the process of acceptance….

Next time…Acceptance, freaking out, and honing my mental toughness skills as surgery day cometh.

If you’re having mixed or conflicting emotions about your injury, it might be worth seeking support and talking about your feelings.