Osteoarthritis (OA) is a reality for me. I have been living with right knee pain for the last 20 years.
Admittedly, my lifestyle choices from my mid-20s on may not have been the best for preserving joint integrity in my knees.

In the late 1970s, I started jogging. Doing so helped me prepare to give up smoking. As part of my discipline, I increased my running to miles rather than blocks and soon entered my first race. Despite warnings from various friends and family members that my knees would not do well, I loved the freedom, culture and friends I met in the running community.

In early 1982, the spring after my first Marine Corps Marathon, I experienced a right hamstring strain. I had to stop running for a month and I endured true withdrawal. During this time, I learned how to swim. After undergoing a myofascial release with a physical therapist and applying a little more common sense, I resumed the sport I loved.

In December 1985, I met the man who became my husband. He was jogging along an elevated trail while I was on the lower path. In the spring of 1986, I ran the Boston Marathon. Rick met me at mile 21 with orange juice and then ran the last five miles and 385 yards with me. We married that October, had two children and might have sprinted blissfully into the sunset.

Then in September 1998, I was running my usual three miles in the morning and experienced an excruciating pain in my right knee that stopped me dead in my tracks. I had felt similar twinges there before, especially while speed training on the track or running down steep hills, but this pain was nothing like before.

After limping home, I made an appointment with Robert Blair, MD, a well-known orthopedic surgeon in my area. He drained effusion fluid from my knee and injected Kenalog (Bristol-Myers Squibb) and xylocaine, which was immediately helpful. I walked briskly and pain-free from his office that day but the pain eventually returned. A few weeks later, an MRI revealed possible meniscus damage and I subsequently underwent arthroscopic surgery. Unfortunately, I had irreparable damage from OA, a nightmare for athletes.
While I did resume horseback riding in the next couple of years, home and work commitments prevented me from pursuing most of the athletic endeavors I once loved.

Yet during one meeting in New Jersey earlier this year, I felt so good one spring day that I walked up and down hills to explore the neighborhood on foot. Two days later, I again experienced debilitating pain and an effusion.

I revisited Dr. Blair. He took me off naprosyn, which had been a daily staple for over 20 years, and gave me a prescription for Celebrex (Pfizer). Interestingly, I awoke with less morning stiffness just a week after starting Celebrex.

During the visit with Dr. Blair, he drained straw-colored fluid with cartilage debris from my knee and mentioned the possibility of a future knee replacement. He had also stated this back in 1998. He marveled that I had not yet needed the surgery, which may have been postponed by my self-prescribed exercise regimens. He injected triamcinolone acetonide 40 mg/cc into my knee and advised a few days of knee rest. Of course, I went on to work three 12-hour shifts and continued to have incapacitating discomfort.

In late June, Dr. Blair and I decided to try three weekly intraarticular injections of hyaluronic acid (Synvisc, Genzyme). In my research on this subject, I had heard about highly purified sodium hyaluronate (Euflexxa, Ferring Pharmaceuticals) but no orthopedist in my area used it. Thousands of dollars later, I was no better. I resumed swimming and am now improving, again motivated to postpone the knee replacement.

As a 54-year-old woman who has walked and run thousands of miles, I may be a future candidate for knee surgery. What have I learned over the years? If I had it to do all over again, I would have cross-trained more in my youth. I encourage my patients to do the same. Even a 10 percent weight loss can result in significant reduction of OA knee pain. I also continue to emphasize calcium and vitamin D-rich foods, and weightbearing exercise. Last year, I had a DEXA scan that showed my bone density well within the healthy range researchers have found frequently in postmenopausal athletic women.

My personal story may not correlate to every patient we see in clinical practice but certainly the continuum of experiences and literature give us all a wide base of learning and understanding.