When Someone Turns On The Light At The End of The Tunnel

A smidge over 22 years ago, while home on leave from the Navy, I was riding my motorcycle down a rural Wisconsin highway at night when I hit a fog patch. Coming at me was a car driven by a woman very new to America, and the whole driving thing. She was understandably anxious about the fog, and slipped off the road, putting two wheels onto the soft shoulder. She panicked and over-compensated. She swung all the way over to the left, and was wrestling the car back to the right when she met me.

I never saw her, but she sideswiped me on my right side. My crash bar dug into the front fender and started peeling the metal back. My right knee was right behind all the torn metal. The term ‘Laceration’ just doesn’t do that wound justice. I also had my right arm bend backward and shatter the elbow, as well as landing on my left arm, shattering that humerus.

All things considered, after getting scraped up off the highway and spending over 6 hours in emergency surgery, I’m doing alright ¹. Some sensory nerve damage on the left arm, and the right elbow doesn’t quite extend fully. A whole lot of bitchin’ scars.

The right knee, however, has always been problematic. The tendon that connects my thigh to my shin was shredded, and the cartilage in my knee was damaged. Early on, getting my knee to bend was a challenge, but these days, I can almost sit on my ankles.  I don’t walk with a limp, most days, but the knee is unstable, and will, often without warning, fold on me, or just swell up and hurt like hell for a day or two because the weather turned suddenly. Going for a hike is usually doable (although I always carry a stick with me), but I’ll pay for it for the rest of the week, because the knee suffers from osteoarthritis. My cartilage is, as one doctor described it, shag carpeting, when it should be smooth as silk. When I climb stairs, it sounds like popcorn. Aside from biking, kayaking, or swimming, I can’t do most athletics. No running, or martial arts. Cross country skiing is OK, but downhill is right out. You get the idea.

As you can imagine, this isn’t fun.

Over the years, I’ve tried cartilage boosters like Synvisc and Orthovisc, but those only work until you experience pseudosepsis, which I did, with both of them. They can try steroid injections, but that is a short term fix with long term downsides. I’m way too young for a total knee replacement, as they won’t do those before the age of 60, because the artificial knee has a life span of less than 20 years, and they don’t want to install a second one. So for the past few years, what I’ve been told is, lose weight (I can stand to shed 40 lbs, but that is hard to do when you got a trick knee), and take Advil if it hurts.

Until today…

A coupe of weeks ago, my wife was talking to her physical therapist (back injury), who mentioned to her that she had a patient who had bad OA in the knee, but underwent a Stem Cell treatment, and was feeling a lot better. So she got the doctors name who did the procedure, and I got an appointment with him. He took my history, did his exam, and I got to tell you, he turned on a light that I was starting to wonder if I’d ever see shine.

See, cartilage is a tricky thing. We can grow it easy enough, but we can’t get it to stick to bone. Usually when you hear of someone having cartilage replaced, it was in between some metacarpals or metatarsals, where the cartilage can be held in place by the muscles and connective tissues. But knees are pretty open, and a new pad of cartilage would just float around, causing trouble. My understanding is, when we are in the womb, our whole skeleton is made of cartilage, and then it begins to calcify, except for the ends, where it says soft and squishy, to act as a bushing. This is why it’s hard to get it to stick, because it isn’t a bushing, it’s the original bone.

So for the past 20 years, I’ve been told that an answer is just 5 years away. It’s like Fusion power. But a few years ago, they tried Stem Cells, and damn if they don’t seem to be working. What they do is a blood draw to collect platelets, a bone marrow aspiration to get Stem Cells, and a micro liposuction ² to get some more Stem Cells, and some fat to act as a binding matrix. Then they separate the bits they need, load them into a set of syringes, and inject them into the knee. The fat acts as the matrix, the Stem Cells figure out they are in cartilage and begin to grow, and the platelets cause an inflammatory reaction, which apparently lights a fire under the Stem Cells.

Start to finish, 75-90 minutes. The doctor said it takes about 3 months before you really begin to notice, but most people report things to be 50%-80% better after a year. No word yet on how long it lasts, but it’s been out there for two years now, and no one has had to come back for another treatment yet. Insurance won’t cover it yet, and the cost is $6,200, but I have to tell you, after 10 years of bad OA in the knee, $6,200 is like, “Oh, is that all?  Shit, let me write you a check.”

I mean, hell, this is what HSAs are all about, right? (PS, touching on the political, why in the Nine Hells are HSAs limited to $5K? There are tons of medical procedures not covered by insurance that cost way more than $5K, and most are not boob jobs or tummy tucks.)

I’m kind of in a daze, actually. Like, at any minute they’ll tell me I’m not suitable, or something. To be able to actually run around with my son and not go limping back to house every damn time. To be able to hike without fear of being hobbled for a week after. To just not be in near constant pain. I hope insurance starts covering it soon, because while I can afford to pay this out of pocket, ³  I know there are lots of people with this kind of damage – athletes, laborers, lots of vets – who probably can’t afford to drop $6,200, especially if it can save knees from having to be replaced down the line.

Anyway, it’s nice to see the light, and know it’s not an oncoming train.

1. Two things helped this; I had just passed the physical fitness test for the Navy SEALs, and the Navy had me undergo 8 months of daily physical therapy (3 hours a day, that’s an order). When you do it right, PT can make a world of difference
2. No, they wouldn’t get more out while they were in there, I asked
3. I will be hitting up the VA about this, since it’s a service connected injury, and I doubt they want to be dropping $60K or more in 20 years for the full replacement, especially since I hear they do this treatment at Madigan