Own Your Destiny
How a major knee injury taught me the value of advocating for myself, and how I healed in the process.
I walked into the appointment with my orthopedic surgeon to hear the results of the MRI on my right knee. He was already sitting in a chair next to the examination table. He carried a strange energy, and I remember thinking it was odd that he had been sitting there waiting for me to walk in; I’d never seen that previously or since. He looked up and I could see his sadness and dejection. “Graham, I’m just going to tell you this straight,” he said. “This isn’t good news. This is pretty much the worst case…”
Over 35 years of working out, including running 30+ miles per week for nearly 20 years on a 180-pound frame, I had worn away the cartilage on the inside of my knee. Because I am slightly bow legged, this area absorbed a disproportionate amount of the impact. Without cartilage, my bones rubbed together with every step I took, creating excruciating pain. At this point, I had been in pain for more than nine months, hobbling with a straight-leg Frankenstein-like limp. The pain had become the dominant force in my life. When the doctor said “worst case,” I wondered if I would ever walk freely again.
Left alone, cartilage doesn’t regenerate. According to this doctor, I was going to need major surgery, and the surgery he recommended was much more severe than a total knee replacement. As he continued, I heard a glimmer of hope. The good news was that the surface area in question was small, so there was a path to repair it. I was eager to get going, but I had previously learned the value of getting multiple medical opinions. And in this case, thank God I did.
My first run-in with an orthopedic surgeon
Several years earlier, I tore my right bicep entirely off my arm while skiing in Vail. My bicep tendon snapped off my forearm and rolled up into my arm like the cord of a window shade that had just been released. The doctor at the Vail Valley Surgery Center told me I didn’t need to get it repaired. He said my second bicep muscle would compensate, and I would be fine. That sounded suspicious to me, but he was a well-regarded surgeon, and he sounded 100% certain of his recommendation. He also didn’t offer any other alternatives. I would discover shortly that, despite his confidence, he was also 100% dead wrong.
On a flight the next day to New York, using only my left hand to type, I started researching torn biceps. My research continued late into the night. I went on chat sites, read medical journals, and participated in online forums. Over the next eight hours, I came to believe that not only did I need to get my arm surgically repaired, but I had to do so in roughly 72 hours. If I didn’t act fast, my torn tendon could shrivel up to the point that I might need to have it replaced with a cadaver’s tendon.
So much for that Vail orthopedic surgeon’s confident diagnosis.
“The ordeal with my arm taught me that I am the only person I can rely on entirely. I needed to become my own medical advocate.”
The ordeal with my arm taught me that I am the only person I can rely on entirely. I needed to become my own medical advocate. Studies show that cancer patients who take an active role in educating and advocating for themselves have better outcomes and a range of other benefits (reduced medical costs, better relationships with providers, and overall increased satisfaction) compared with those who do not. National Institutes of Health 2017 study. To this day, I believe I would have never recovered full use of my right arm (I’m right-handed) had I listened to that first doctor in Vail.
Self-advocacy
After getting the MRI results on my knee, over the course of the next several months, I saw a total of six knee surgeons in the Bay Area. Each gave me a different opinion, and several were directly contradictory.
One doctor recommended cutting out the dead part of my femur and replacing it with a similarly sized cadaver.
Two doctors believed my femur was not dead, and this was an awful idea.
Three doctors recommended a tibial osteotomy – which meant sawing open the inside of my shin long bone (tibula) right below the knee and inserting a wedge into it. The purpose of this procedure was to change the angle of my leg so that the inside of my knee didn’t continue to absorb all of the impact.
Two doctors thought the tibial osteotomy was a horrible idea, including one who refused to perform the procedure on patients because the procedure and recovery were excruciatingly long and painful.
One doctor recommended a double osteotomy which would involve cutting my shin bone in two places, the second to take pressure off my patella.
Two doctors recommended a total knee replacement.
Two doctors recommended a MACI, a procedure in which a good piece of cartilage from my knee is extracted and sent to a lab and used to generate more healthy cartilage that matches my own cartilage.
One doctor recommended a cortisone shot, no surgery, and physical therapy.
None of the doctors had the same advice, and several directly contradicted each other, often emphatically.
I have found that one of the greatest tools in decision making is to first start with the objective and then to list every possible alternative. The most disturbing thing about this process was that none of the doctors I saw–either for my arm or my knee–laid out multiple alternatives, let alone the full list of alternatives. Each gave one diagnosis followed by one confident recommendation.
“I have found that one of the greatest tools in decision making is to first start with the objective and then to list every possible alternative. ”
I supplemented the doctors’ recommendations with many hours of my own online research. Since I was highly active and reasonably young, I concluded that I would solve for the procedure that gave me the best chance for a full recovery, irrespective of the difficulty of getting there; I had my entire life in front of me and was willing to do whatever it took for however long it took to achieve a recovery.
To achieve a full recovery, I ended up choosing a combination of the MACI to repair my cartilage and the double osteotomy to make sure I fixed my bowleggedness, the root cause of my injury. These alternatives seemed to offer the best chance for a full recovery and lowest risk of re-injury, despite what was consistently described as the longest and most painful recovery time.
I strapped in for a long and painful process.
Two years later…
The surgery was just as painful as advertised. The recovery was long and arduous. I couldn’t put any weight on my leg for three full months, which caused my right quad and calf muscles to atrophy significantly. I went to physical therapy twice a week for nearly a year, supplementing those sessions with 15-30 minutes of strengthening and stretching almost every morning. I was prepared for a long recovery, but I still found myself getting frustrated with the slow rate of progress. Each time I pushed my leg in PT trying to gain range of motion or strength, my leg would rebel (swell up and be painful) for several days, setting me back. More was not always better, something I consistently struggled to manage, after all, I had spent my life pushing harder and becoming faster, stronger, and more skilled. Recovery forced a mindset shift.
Two years later, I still stretch and do strengthening exercises nearly every morning. At the suggestion of a close friend of mine, Ryan Clark, at the end of every workout, I use a foam roller on my quads, hamstrings, calves and hips, and I try to press as much of my body weight as possible into the area touching the roller. My legs are now officially stronger than they were pre-surgery, and I have gained nearly full range of motion in my knee. I no longer go on long runs and likely never will again—there is no reason to risk re-damaging my cartilage. I cycle, row, lift, and play tennis. If I play tennis several days in a row or lift too hard, my knee still swells up which is painful, but I’m typically better by the following day.
For all practical purposes, I’m recovered.
My Advice
You get one body in this lifetime and you need to take care of it. In your early years, you feel invincible, but be careful. Whether it’s your hips, knees, back, or shoulders, the damage is often cumulative and there is no going backwards. Try to choose low-impact forms of exercise (swimming, cycling, rowing, or walking) over high-impact ones and avoid sports like skiing, basketball, and soccer where a sudden impact can create a massive injury. My orthopedic once said, “Lake Tahoe keeps me in business.” I don’t think he was joking.
While I certainly wouldn’t wish this injury, surgery, or recovery on anyone, it is likely that over the course of your lifetime you or someone close to you will have a serious illness or injury. The silver lining in my knee injury? I learned that you need to be your own advocate. Get several opinions and treat each doctor as a consultant, not as a decision maker. You are the decision maker. Trust your instincts, do the research, and know that you’re the best person to take charge of your health and recovery. After all, no one knows you better than you know yourself. Approach learning about and recovering from your injury or illness as the most important job you will ever have. Because it likely will be.
“Trust your instincts, do the research, and know that you’re the best person to take charge of your health and recovery. After all, no one knows you better than you know yourself. ”