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  1. #21
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    Still in the grand scheme of things, relatively young. And a great retirement age! Man that's a great plan, get that new knee, rehab get strong. You could be in for a long hiking future anywhere you want. Good luck with everything.
    Last edited by JNI64; 01-17-2020 at 20:09.

  2. #22
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    Quote Originally Posted by stephanD View Post
    1. keep your BMI under 20, that is normal body weight, which I'm assuming is not an issue since you are a firefighter.
    Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.

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    Quote Originally Posted by kombiguy View Post
    Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.
    Like weight 170 lb. Body fat 18% and BMI 25 ?

  4. #24
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    Quote Originally Posted by bigben View Post
    The tear is medial, significant, and old. He said, theres 2 ways to deal with meniscus tears: cut them out or stitch them back up. Mine tear is too far gone to stitch up. He showed me the MRI said I'm not "bone on bone" but "getting there," as in my intact meniscus is worn and less thick than a perfect knee. When its bone on bone, TKR is the fix. THATS why I'm posting. I need to prolong it wearing all the way out, at least 8 years. I can get TKR in 8 years, retire, rehab and I'm good. Insurance isnt an issue. As far as it being "work related, " unless I fall off a ladder or tear a ligament on duty, BWC would totally deny the claim. And i can pinpoint no "specific event." MD said somewhere along the line you obviously did SOMETHING, but from there its wear and tear coupled with heredity/genetics.

    Like I said, I'm gonna hold off on making the big "should i keep section hiking" decision for after talking with them again. But in the meantime, I'm gonna try to lose some weight and only do low impact cardio exercises. If i keep hiking, I'll cut down on daily mileage and pack weight.
    Your knee woes sure sound familiar, so I'll share my short story.

    About 15 years ago, right at about your age (48 in my case), my right knee pain started and got worse over the course of maybe a year. At the time I was at the peak of my mountaineering days, so this was problematic. I finally went through the process of getting a thorough diagnosis, and the MRI showed a meniscus tear, though there was no specific event that might have done this. The ortho doc I went to was supposedly THE knee doc in town, who knows, but he did do work for the Denver Broncos.

    The prognosis was that I could do whatever I wanted up to my pain threshold, but he recommended surgery to relieve this pain. I pushed that surgery button. Easy-peasy, I could have walked out of the clinic after the surgery. After the very brief recovery of 2-3 weeks the pain was already less than pre-surgery, and a month or so after that, the pain was gone completely, like I had a new knee. Obviously, everyone's own results are vastly different, but mine was very positive. Sure, there are horror stories about various orthopedic surgeries, but I believe these are exceptions and not the rule.

    To this day, 15 years later, my right knee feels great, and in those 15 years, I probably have 15,000 miles of hiking on it. I did stop running though after the knee surgery, which was hard to do as I had been a runner since age 10, and a serious runner in HS and college and a few years after that. But hiking and climbing trumped running.

    Fast forward to a year or so ago and of course now the left knee is giving me fits. This however looks to be plain old OA, having recently been thoroughly examined (MRI, xray). Doc said it MIGHT be related to meniscus, but not conclusive. He recommended a cortisone shot, which I agreed to, and this helped pretty dramatically. Of course the shot was just a bandaid, but getting a shot every 6-8 months should keep me going for years.

    Knee replacement is eventually inevitable, but for now, cortisone shots and semi-regular ibuprofen, coupled with holistic anti-inflammatory measures (diet, mostly) is keeping me hiking relatively pain-free.

    One last thing: I find that if I hike pretty much every single day, my left knee pain is kept at a minimum. "Resting" it tends to make it worse.

    Just my own experience, we're all so vastly different.

  5. #25

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    Speaking strictly as someone with ZERO real medical knowledge,here's my take.I would second suggestions others have made about traditional repair first,use of supplements,use of knee brace whether it's hurting or not.

    I may not know anything about medicine but I do know quite a lot about PAIN.My back has ached with varying degrees of intensity since about 1992.Surgeon refused to operate because I had no apparent nerve damage or numbness.I went to a chiropractor for YEARS with limited results.Finally,my house painter shared his story with me and made some suggestions for a home gymn as opposed to the isometrics that the chiropractor and physical therapist suggested.It helped tremendously but I honestly attribute the biggest relief to the tumeric capsules I take twice per day,plus Baby Asprin.

    The recommendation I would make for you is to go ultralight.I hike with a young man in his 30's and his young son.The father had a automobile accident that injured his hip and he and the son have mastered the ultralight thing with packweights of about 16 pounds or so TOTAL.I think that would be something you need to explore.

    Keep in mind this advice is from someone who packs about 25 pounds total with one liter of water.

  6. #26
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    I had some pain after a long hike for more than a month, so went to doc and diagnosed with meniscus tear, told it doesnít ďhealĒ and that I would continue to have pain until he could cut the ďflapĒ out. Decided Iíd wait until later in the year when I was closer to meeting total out of pocket on med expense. Quit playing soccer and tennis and didnít hike.

    Month and a half later I had no pain, started playing tennis again, but pretty much gave up soccer, mostly due to age in mid 40s. Continued hiking. No issues since and that was 9 yrs ago. I did learn to be very careful about bending my knee all the way.

    Point is, donít underestimate what a little physical downtime can do, and understand that thereís a lot of knee factory docs out there that are more inclined to think what they do is the best way without really considering other options. IMO, you start down that surgery path, then yes, it does end up with replacement.

    A little rest at this point may be worth a shot, especially with regard to the long term and your profession. Youíre so active, as was I, that simple rest could be what your body needs. Because itís your profession to be active, you might consider filing a disability claim to simply sit for a while, though I think you actually have to get a professional recommendation for that. Iím a banker, so I didnít have to go that far.

    Just a suggestion since it worked for me.


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  7. #27
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    Quote Originally Posted by JNI64 View Post
    Like weight 170 lb. Body fat 18% and BMI 25 ?
    Without more facts, I couldn't answer your question. How tall are you, for example?

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    Quote Originally Posted by kombiguy View Post
    Without more facts, I couldn't answer your question. How tall are you, for example?
    It's not about me and I don't want to hijack the thread here, but big Ben, got his responses and conclusions. I'm 5'-8" and make that 168 lbs. Just weighed myself in the gym.

  9. #29
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    I dont put any faith in govt weight/BMI tables. Decades ago, when I was at my college football playing "best," I was 6'3" 268 lbs, had a body fat of 16.8%(as calculated the old hard way, via water immersion and calipers), powerlifted 1210lbs(bench, squat, deadlift) and ran a 6:43 mile. Our govt would and did say I was obese.

    People KNOW if they are fit. So long as a proper MD physical(bloodwork, cardio stress test, etc) confirms it, screw those charts.

  10. #30
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    Quote Originally Posted by bigben View Post
    I dont put any faith in govt weight/BMI tables. Decades ago, when I was at my college football playing "best," I was 6'3" 268 lbs, had a body fat of 16.8%(as calculated the old hard way, via water immersion and calipers), powerlifted 1210lbs(bench, squat, deadlift) and ran a 6:43 mile. Our govt would and did say I was obese.

    People KNOW if they are fit. So long as a proper MD physical(bloodwork, cardio stress test, etc) confirms it, screw those charts.
    Agree 100% , the only reason I know mine and it's probably off because this was just the hand held one. I guess it's supposed to send electric pulses through the body and back. But whatever the only reason I know mine is someone was getting theirs done at my gym and they asked me if I'd want mine done. I typically don't even weight myself, like you said you know if you're in good shape or not. And I know I am.

  11. #31

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    Quote Originally Posted by bigben View Post
    I dont put any faith in govt weight/BMI tables. Decades ago, when I was at my college football playing "best," I was 6'3" 268 lbs, had a body fat of 16.8%(as calculated the old hard way, via water immersion and calipers), powerlifted 1210lbs(bench, squat, deadlift) and ran a 6:43 mile. Our govt would and did say I was obese.

    People KNOW if they are fit. So long as a proper MD physical(bloodwork, cardio stress test, etc) confirms it, screw those charts.
    Obviously you were more of an outlier, the charts are meant to be used by many people and are simply a guide for the general population and have stated limitations such as these from NIH.gov. It's a slightly more targeted number than just the scale because it includes height. Sure someone may be fit and other tests may conflict with the chart but a LARGE percentage of people falling in the overweight or obese ranges for BMI really are overweight and obese.
    Although BMI can be used for most men and women, it does have some limits:
    • It may overestimate body fat in athletes and others who have a muscular build.
    • It may underestimate body fat in older persons and others who have lost muscle
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  12. #32
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    And they know they're over weight and obese. And don't necessarily need a BMI reading for confirmation either. Just saying. But if it helps motivation to change.......

  13. #33
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    FWIW, I had a medial meniscus tear causing issues beginning about age 49. This may/may not have occurred about 2 years earlier when I fell on a backpack trip and injured my right knee. Alternatively, it may be the result of long term wear and tear following a fracture of the same leg when I was 25. I wound up with my right leg about 3/4" shorter than my left and had adopted a compensating gait. It was not so much the pain but rather the feeling that my leg was about to collapse under me while descending stairs that sent me to the orthopedic surgeon. I had my right knee scoped at age 57. I also had a procedure to correct a problem with the joint between my right big toe and the metatarsal. Likely that was a result of 25 years of my compensating gait. At the followup for the toe surgery, the surgeon remarked about my old fracture and the shortness of that leg. He recommended a wear a heel lift in the right shoe. I bought one and immediately noticed an improvement in my posture and my back felt better. Fast forward 4 years to age 61 when I did my first long distance thru hike---the AT nobo. I did experience some knee pain and used a couple ibuprofen at the end of each day and a knee brace (a Chopat). I found that after 3 months of hiking, my knee joint was much more stable and I no longer needed the brace (actually left it behind one day and had hiking friends bring it back to me). Since then I've continued long distance hiking and tried to walk a few miles each day. Altogether, I've hiked over 15,000 miles to date and still backpacking at age 74+. I know there is osteo-arthritis in the right knee and that the cartilage is compromised, but it hasn't reached the point of casing constant pain. I continue to treat the inflammation, only when backpacking, with 2 ibuprofen at the end of the day.

    I think your surgeons advice to delay the meniscus repair until the pain tells you it's time is good. Later, you can cross the total knee replacement bridge when you get to it. Who knows, there may yet be further improvements in the artificial knees and in surgical techniques. You may even be a candidate for partial knee replacement.
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  14. #34

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    Quote Originally Posted by JNI64 View Post
    And they know they're over weight and obese. And don't necessarily need a BMI reading for confirmation either. Just saying. But if it helps motivation to change.......
    I was addressing his faith in the reading comment, not its utility. But I'll play, although I'm not particularly invested in using it. It is better than a scale alone though because it normalizes for height. Plus a doctor or Dogwood can say, get your BMI down to 20 and not worry too much about differences in height. People do know when they are overweight but when they see that they are obese (with a measure that takes into account being "big boned") that tends to get their attention because that's where your health starts to go south. It's more objective than just a scale reading and easier than say a bunch of different rules for heights based on weight.

    Personally I don't use it, I've only been overweight once for a short period of several months. Otherwise I'm always in the normal category. If I was underweight by BMI, according to my calculations for me, I'd have to be at <3% bodyfat and a weight I haven't seen since my early teens when I was probably shorter. A 145 pound 6'2" man is gonna look like he walked out of the wilderness after 40 days on a 9 day food supply. I use the scale and body fat % myself.
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    Lol, I'm sure he could but do we have that much room ?

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    I'm 70, have bone on bone osteoarthritis for the last 3 years. I've dealt with the pain by doing no more than 8 to 11 mi days on the AT. Ive been section hiking the AT since 2015 and will complete my last 382 mi. late this summer from norther NH to Katahdin. My ortho surgeon agrees with my workout plan, i.,e. treadmill, cycling and weights for upper body strength. With treadmill I focus on cardio since its the heart muscle that's carrying the load in delivering oxygen. Exercising the heart also exercises its surrounding tissue and muscles. This I do religiously EVERY day since last August when I got off the trail doing my last section. Doc's recommendation is NOT to have surgery unless pain is quite high. As noted in other posts, too many side effects and greater risks. If it gets real bad on the trail (7/10) I'll take a zero, ice it (if available), Naproxin (500mg) and its all good.

    Best of luck with your plan and future hikes!
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  17. #37

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    Quote Originally Posted by kombiguy View Post
    Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.
    Maybe BMI by itself alone is not a good indicator. the point is, you do not want to have excess weight, whichever way you define it. Every extra pound you carry, is extra burden on your knees.

  18. #38
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    Quote Originally Posted by kombiguy View Post
    Interesting, but marginally absurd. To achieve a BMI of 20, I would have to weigh less than 150 pounds. That would be Bataan Death March weight for me. The goal is not a number which may or may not be statistically relevant, but a body weight which is healthy, sustainable, and results in all the other metrics being in a healthy range.
    Yeah, me too... according to the CDC, at 6-1, 151 pounds is a BMI of 20. I've never weighed less than 165 since I reached 6-1 height, even as a competitive long distance runner in College, when I was as lean as lean can be. My current BMI=24ish, at 182 pounds. No one would call me overweight, probably, though there is now some extra body fat, but that will erase on next long hike, as it always does.

    A BMI of 20 is ridiculous, unless I'm using a faulty BMI calculator or I'm missing some point???

    All that said, yeah, weight is crucial for knee health, goes without saying. Hence why pack weight is also critical.

  19. #39

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    Quote Originally Posted by colorado_rob View Post
    Yeah, me too... according to the CDC, at 6-1, 151 pounds is a BMI of 20. I've never weighed less than 165 since I reached 6-1 height, even as a competitive long distance runner in College, when I was as lean as lean can be. My current BMI=24ish, at 182 pounds. No one would call me overweight, probably, though there is now some extra body fat, but that will erase on next long hike, as it always does.

    A BMI of 20 is ridiculous, unless I'm using a faulty BMI calculator or I'm missing some point???

    All that said, yeah, weight is crucial for knee health, goes without saying. Hence why pack weight is also critical.
    You're an inch shorter than me. What's your body fat percentage? Personally I am at 165# but my scale is saying 15% body fat. This type of scale is not noted as very accurate for that sort of measurement but I consider it reasonable. That means I have roughly 25 pounds of body fat. If I were to lose 10 more pounds to weigh 155, I would be at a BMI of 20. I would be at 9.5% body fat then (15/155). I did weigh that in high school running track and playing soccer. Which brings me to 2 points. Normal BMI runs 18.5-24.9, which for me is 145-195#. That's about 4 waist sizes for me. Without adding in a bunch of muscle, I've got a core nonfat weight of 140. At 175, I'd have 35# body fat, 20%. I don't look anywhere near overweight at 175. If I weighed 195, I'd be at 28% body fat. I'd feel overweight because my jeans would be splitting but I still wouldn't look overweight, maybe starting a beer but. Point 1 therefore is there is a range of normal BMI. Point 2 is that our perception of overweight has changed to where what people think of as normal may actually be overweight, which means on the low side of normal people call that emaciated.
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  20. #40
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    Quote Originally Posted by Alligator View Post
    You're an inch shorter than me. What's your body fat percentage? Personally I am at 165# but my scale is saying 15% body fat. This type of scale is not noted as very accurate for that sort of measurement but I consider it reasonable. That means I have roughly 25 pounds of body fat. If I were to lose 10 more pounds to weigh 155, I would be at a BMI of 20. I would be at 9.5% body fat then (15/155). I did weigh that in high school running track and playing soccer. Which brings me to 2 points. Normal BMI runs 18.5-24.9, which for me is 145-195#. That's about 4 waist sizes for me. Without adding in a bunch of muscle, I've got a core nonfat weight of 140. At 175, I'd have 35# body fat, 20%. I don't look anywhere near overweight at 175. If I weighed 195, I'd be at 28% body fat. I'd feel overweight because my jeans would be splitting but I still wouldn't look overweight, maybe starting a beer but. Point 1 therefore is there is a range of normal BMI. Point 2 is that our perception of overweight has changed to where what people think of as normal may actually be overweight, which means on the low side of normal people call that emaciated.
    Good info, thanks.

    My take after reading your post and thinking a bit more is that a BMI of 20 would be in the general vicinity that elite runners probably have, including trail runners. I'm certainly not saying that I was an elite runner back in college, when I weighed 165, BMI=22, but I was competitive (I was doing about a 31 minute 6 mile, yeah, pre 10K days). Maybe those 2 BMI points that I was over would have made that difference!

    But overall, a BMI of 20 for a long distance hiker starting out is probably not a good idea. Calling it "ridiculous" like I did before might be an overstatement though.

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