aging · disability · health · injury · monthly check in

Sam’s monthly check-in: What’s up, what’s down, the May version

May! Finally warm weather. The best thing about May is riding my bike. It was 50 km the first week and 60 km the next . Weekdays I’ve been exploring my new home, Guelph, after work and running errands on bike. That’s what’s up. It feels great.

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Not so much “up” is my left knee. It doesn’t feel great.

I met with the knee surgeon again. Total knee replacement still looks far away. At least I hope so. See 9 Things No One Ever tells You About Getting a Knee Replacement for details. We’re still seeing how things go with the goo injections and the brace.

I’m wearing the brace for walking. I’m doing physio still. And I’m riding my bike. That’s all good.

The surgeon and his team are busy telling me that all the activity I’ve done isn’t responsible for my knee osteoarthritis. They do also tell me never to even say the word “running” again. Fine. See Sam struggles not to run, ever!

But they do say I’d be in less pain if I lost weight. More seriously they say that losing weight would help me put off total knee replacement. That’s big.

Now they used to also say that knee patients should lose weight first, before the surgery. See Researchers Find Weight Loss Not Necessary for Joint Surgery

But if you think you must lose those extra pounds before a knee or hip replacement, think again, as researchers with UMass Medical School found long-term relief from joint replacement surgery was almost the same in obese and non-obese patients.

“The conventional wisdom is that the lower your body weight, the lower your body mass index, the better you will do in joint replacements, and there has been an increasing push to say that if you are obese you should not have joint replacement – either knee or hip replacement,” Dr. David C. Ayers, chairman of orthopedics and chairman and professor of orthopedics and physical rehabilitation at UMass Medical School, said Thursday.
Dr. Ayers is the co-author of a study reporting the findings published last month in the Journal of Bone and Joint Surgery.

“What this study shows is that people who are overweight and are obese get the same type of pain relief and improved function that non-obese patients do,” he said.

Surprise! Fat people are people. Fat bodies are bodies. And knee pain hurts a lot no matter what your size.

The old wisdom sounds just like, “You’re fat so must pay the price! Suffer! No knee replacement for you!” Doctors can be jerks.

But in my case we’re not talking about weight loss before surgery. The issue is weight loss to put off the necessity of joint replacement. Total knee replacement is worth avoiding. Right now knee replacements last 20 years max. So if all goes well, I might need a second one. It’s big painful surgery with a very lengthy recovery time. I don’t want to do it twice.

See here. Point 1: “For many, weight loss is a basic but crucial way to help avoid knee surgery. Shedding just 15 pounds can cut knee pain in half. And should you need arthritis knee surgery later, you’ll decrease your risk of complications and reduce strain on your knees, which will make your rehabilitation go more smoothly.”

So, what to do?

I’m reading a lot about knee pain and weight. No surprise there!

But I’m also researching weight loss for medical reasons. Maybe like me you thought that weight loss is hard but once you’re told you need to lose weight for medical reasons, you just do it.

I’m here to tell you the sad news that it’s not so simple. Your body doesn’t care what your motivation is. It’s not like it ignores the diets for beauty’s sake and pays attention to the diets for urgent health reasons.

I think when I was younger I even thought it would be good to have a medical reason to lose weight because then you’d be serious about it and just do it. I could be a feminist and be skinny because I was dieting for health reasons. Bah.

Now I have very good reasons, I’m being serious about it, and I’m still struggling.

Tracy and I were chatting today about whether it ever makes sense to talk about weight and weight loss on the blog. It’s not something we talk about much. It’s a blog about fitness not weight and shape and we’re very keen to distinguish these things. In this case though weight loss isn’t a goal that I want to result from my fitness efforts. Weight loss may be necessary to keep me active.

We’re all about staying fit and strong in midlife and beyond. That’s the overarching message of our book. But given my knee and the state it’s in, staying active may mean losing weight. I’m trying. I won’t post much about my successes and failures. I know that’s too much for those of you with histories of disordered eating. Even though I’m one of the larger bloggers here, that’s not me. I like food and my relationship with it. But I also feel the need to be honest on the blog about what’s up with me fitness wise.

Have you had or contemplated having knee replacement? Have you struggled with medical reasons to lose weight? Tell me your story

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Also, hello May, I’m tentatively making plans. There are plans afoot for bike/boat holidays, for canoe/camping trips, for long bike rides. I love the summer and I’m going to enjoy it.

6 thoughts on “Sam’s monthly check-in: What’s up, what’s down, the May version

  1. This post got me excited, I am not averse to seeing more about weight loss for health reasons and as a matter of keeping mobile into the later years. That is different than weight loss to achieve certain appearances or fit certain jeans etc, in fact, the difference should be pondered on a bit more…. by the time you are 40+ ‘weight loss’ has become a somewhat ‘evil’ and boring and tired out pair of words….. for some (me), we are tired of it, we are exhausted of it, we are sick of thinking/hearing about that, we have (hate to say this but) sort of gotten accepting and complacent in our bodies (which is good! but not always ideal for those reasons you are talking about). However, something else is happening into my 40’s… I am realizing, I want to live long and HEALTHY, I have kids who need to see me healthy, active, mobile! I want to do things with them forEVER! so the old reasons for weight loss have faded but new ones are coming up to me now. ALSO, a couple years back I fractured a bone in my foot (for no particular reason, no I wasnt running a race or anything)… just was a single mother of 3 young kids, after 3 pregnancies, carrying babies around etc, my foot just fractured, it was excruciating for weeks. I limped around, it was swollen, I went to a doctor, physical therapist, chiropractor, chiropodist and no one knew what it was or what was wrong, I dont think they believed my pain level, finally I insisted on an x-ray which indicated that, yes, the 3rd metatarsal was fractured and by now was already mostly healed (should have had a walking cast but too late by that point, well I hope it healed right!), now I have orthotics and the best shoes etc.. (I never was a high-heel wearer or anything but I did find out I need shoes in Narrow and a bit longer to get the right support). I still have foot pain (maybe some arthritis in the area), it scares me, as I want to start jogging again and I fear another fracture, there is no way to know if or when it could happen, land wrong once and crack! The fact hasnt escaped me (thanks to my mom for enlightening me) that being a little lighter would most likely (definitely?) help my feet issues! but then HOW to get lighter while dealing with feet issues!!?? Things are not too bad, I can walk, and I think I will work into jogging again (slowly as our bodies are just not as ‘elastic’ as they used to be) and hopefully lose weight which will in turn help my feet not fracture again etc….. its just a little insight though to get me thinking about HOW important it really is to look after our bodies and our health as we get a bit older….and we need to think about it differently, from a different focal point. I need to release the idea that I am exercising to get thin and look a certain way and re-frame it as exercising to feel better and preserve and prolong my level of health. It can be a difficult concept since our whole life we have been thinking otherwise which is what causes the distaste for that topic in general. I hope other readers would not be offended by this topic as its not quite the same as what we have always thought of as ‘weight loss’ and in fact maybe clarifying the difference could be helpful to some others too.

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  2. It’s terrible that successful weight loss is now being medically prescribed without any recognition that it’s almost (other than in exceptional cases) impossible to achieve and maintain, or that most explicit efforts result in damaged metabolism and eventual weight gain. I’m reminded of how the doctors and residents at the endocrinology rounds session we presented at expressed mostly frustration at their patients for not following their orders (rather than questioning how realistic their orders are). If medical reasons make no difference to outcomes then that seems to be something worth highlighting since lots of people might think otherwise and believe wrongly that health/medical reasons will result in a magical new ability to achieve “success.”

    Liked by 1 person

    1. It’s always been medically prescribed. For a wide range of conditions… Read Nat’s posts about blood pressure and being told to lose 40 lbs. Diabetics hear it all the time. Pregnant women. There’s a great cartoon of a woman with an arrow through her head and the doctor saying she’d feel better if she lost weight. It’s an epistemic burden fat people bear figuring out when the advice to lose weight is evidence based and when it’s not. A further question is the one you raise, how to do it.

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  3. Are people with weak/bad knees also told not to do heavy weight-bearing exercises with barbells. I’m thinking like those done in a standard Body Pump class at Goodlife. Have you been cautioned not to do those – or is it just body weight they caution about? Just asking because weights/strength training is seen as something very positive when body weight is seen as such a negative.

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  4. Depends on the impact on knees, So there are a range of weight lifting/strength training exercises I can do and others I can’t. So leg press, machine yes. But squats, no. I can do bicep curls and tricep extension exercises seated. So weight lifting is still something I do but I need to be careful and think about the load on my knees.

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