I wrote this post back in January. Didn't realize that it had been sitting in Draft mode ever since...
I did something this week that I haven't done in nearly a year: I ran three days without pain. They weren't particularly good runs -- they were neither long nor fast -- but they were solid 5k's none the less, and they were pain free.
So why the change? After a year of braces and bands, anti-inflammatories, stretching and strengthening, and finally hyaluronic acid, what made the difference? Simple: I finally told my doctor I wasn't going to take a diuretic for my hypertension any more.
I started taking a diuretic about 15 months ago, when the other medication I was already taking wasn't adequately controlling my blood pressure any more. The effects of adding the diuretic were nearly immediate. In the first week I started taking the new pill, I lost over five pounds of water weight, and my blood pressure dropped by 10-11 points. All seemed very positive.
But about three months later, I started experiencing pain in my knees. The pain was focused at the base of my thigh, just above the kneecap. It started in the right knee, and I just figured it was a case of tendonitis. I didn't think much of it, so I committed to just running through it.
But over the course of about a month, the pain got progressively worse in my right knee, and I started experiencing similar issues in my left knee. Further, the pain that had been just above the kneecap was now spreading all around the kneecap. This was not tendonitis.
So I went to see an orthopedist about the issues I was having. He diagnosed me with patellofemoral syndrome -- a condition where the cartilage behind the kneecap wears, and the kneecap begins to rub against the base of the femur. The diagnosis fit, but I was surprised by the coincidence of developing the issue in both knees in the span of a month. So I asked him if the condition could be related to the diuretic I had started taking a few months earlier. Maybe the diuretic was drying out the cartilage, or making it somehow less thick/useful? He gave me a look like I'd asked if my warts were caused by kissing a toad and quickly dismissed the idea. And thus began my journey through pain meds and PT, which resulted in...not much help at all.
Not really liking the answer I got from the first orthopedist, I decided to visit another one for a second opinion. This time I chose an orthopedist who was also an avid runner, hoping his personal experience as a runner might make him better qualified to diagnose and treat the issues I was having with my knees. He gave me the same diagnosis (PFS) and was similarly amused by my suggestion that a diuretic might have something to do with pain in my knees. But he at least sent me for an MRI to ensure that my kneecap really was rubbing on my femur. It was.
While working the process with Orthopedist #2, I went back to my physician for a med check. I brought up the idea with her as well, asking if it was possible that the diuretic could be the cause of my knee pain. The sudden incidence of pain in both of my knees still seemed odd to me, and the only explanation that made sense to me was the new drug. She wasn't having it. In her mind, there was no way the pain in my knees was related to the diuretic.
So after getting nowhere with any conventional treatment, I started experimenting with hyaluronic acid pills in August. By September I was feeling some real benefit. I was back to running a couple of times a week, but there was still some residual pain, and I wasn't in love with the idea of taking unregulated supplements for the rest of my life. And I wasn't shaking the notion that the diuretic was the root-cause of my problems. In fact, the positive results I experienced from the hyaluronic acid made me more suspicious of the diuretic, since the HA pills worked my helping the cartilage attract and retain water.
When I went back to my physician last week for another blood pressure and med check, I told her that I didn't want to take the diuretic any more. I had recently had some success reducing my blood pressure below 120/80 using a 14:10 fasting regimen, and I wanted to see what would happen if I came off the diuretic. She agreed to let me try, though still scoffing at the idea that my knee issues could be caused by the drug.
This past Saturday morning, I stopped taking my diuretic. By Monday I was up three pounds of water weight, and I had one of my easiest runs in recent memory. No issues during the run, and the recovery after was better than it's been in a year. So I ran again Wednesday. Same thing. By today (Friday), I was up seven pounds of water weight, and my BP is hovering at about 130/88, but I ran again -- pain-free.
The obvious question (and one I've asked myself too) is if the change could be psychosomatic? It's surely a possibility, but there are a lot of reasons to believe it's not. First, there were lots of opportunities over the past year where I could have willed myself better if that were the case. Taking prescription anti-inflammatory meds didn't do it. Neither did the PT nor the cortisone shot. It took a good month for the HA pills to show positive results, so I'm confident this is not a psychosomatic reaction.
The other reason is that the past week has produced other obvious physical changes. My weight has shot up seven pounds this week. My blood pressure is up. My face is fuller, and my fingers even felt a bit stiff last night. There have been clearly observable changes in my body this week. Most have been negative, but the knees are a huge positive.
And that brings me back to an off-hand comment Orthopedist #2 made back in June. After injecting my right knee with cortisone, he worked the joint back and forth and told me, "The knee is just a large bag of fluid. Once we get the medication in there, we need to distribute it through the fluid so it can reach the effected areas." The knee is a large bag of...FLUID! I suspect the fluid has been fully restored to my knees now, and they feel much better.
The moral to the story is simply don't be afraid to question what your doctor tells you. That doesn't mean doctors are fools, and that you should discount everything they say. But they are human, and as such they are subject to the same biases and blind spots that any of us are. Take a scientific approach. Take time every day to observe and understand your body. Engage in dialog with your doctor. Share your thoughts. Ask questions, especially the "why" questions, and demand evidence. Develop a hypothesis, and then work with your doctor to test it safely. You need to know you best, and you need to be your best advocate.
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