Fun with knees

I’ve said before that I’ve got a tear in the lateral meniscus of my right knee, and that I’m supposed to get that patched up with arthroscopic surgery in less than two weeks. But my right knee is the good one, that until last summer never gave me any problems! It’s my left knee that has been a lifelong troublemaker: I dislocated it while shoveling rocks when I was 13 (child labor is bad, trust me on this) and again when I was in high school playing basketball against the Kent-Meridian High School varsity football team (they didn’t understand that tackling wasn’t part of the official rules.) Both were treated by wrenching my kneecap back into place, and putting me in a hip-to-ankle cast for 3 months. Kids, don’t injure yourself while living in the middle ages.

As long as I was going in for surgery on the right knee, the doctor figured we should check out the left. I had an MRI this week, and just got the text summary, which looks like it’s mostly normal, but with some minor funny business that I can’t tell if it’s in the normal range, or if I ought to get it repaired now, before I retire. I understand all the words, but lack the context to know what to do about it.

EXAM:
MRI KNEE LT WITHOUT CONTRAST

INDICATION:
Meniscal injury, knee,r/o meniscus injury,Internal derangement of left knee

TECHNIQUE:
Multiplanar multisequence knee MRI without contrast

COMPARISON:
Prior radiographs

FINDINGS:
Bones:Patella and trochlear subchondral reactive edema with small cysts.
Normal marrow. Minor patellofemoral osteophytes.

Ligaments, tendons:

ACL, PCL: Normal

Extensor mechanism: Proximal patellar tendinosis. Distal quadriceps normal.
Attenuated anterior fibers of MPFL suspicious for old proximal tear. Also
medial retinaculum. Minor thickening lateral retinaculum.

MCL and post/med corner: Distended bursa versus ganglion cyst along the
posterior/medial corner between pes anserinus and semimembranosus.

Lateral and post/lateral: Normal

Gastrocnemius tendons: Normal

Joint spaces:Small effusion. Minor reactive synovitis suprapatellar recess.
Diffuse patellar and trochlear cartilage loss mostly grade 2 and grade 3 with
small surface area grade 4 both sides. Small subchondral cysts.

Low-grade chondrosis medial, lateral compartments

Soft tissues:

No Baker’s cyst. Diffuse grade 1 muscle fatty infiltration

Tibial, common peroneal nerves: Normal

Menisci:

Lateral:Free edge surface fraying midbody. No definite tear

Medial: Normal morphology, signal

Comment: Abnormal MRI findings very common in asymptomatic volunteers,
frequently not a source of symptoms. Many studies demonstrate meniscal tears
in up to greater than 50% asymptomatic volunteers, cartilage defects >24%, bone
marrow lesions up to 50%, 21% tendon abnormalities, prevalence increasing w
age. Nearly all pain-free adult knees have at least 1 MRI abnormal finding, so
MRI findings must be interpreted under supervision of expert clinical
assessment.

Culvenor et al, Br J Sports Med 2019

Parkar & Adriaensen, Eur Radiol 2024

IMPRESSION:
1. Small effusion, reactive synovitis, patellofemoral cartilage loss
2. Mild patellar tendinosis
3. Suspected old partial tear MPFL retinaculum complex
4. Posterior/medial corner bursal distension versus ganglion or synovial cysts

That’s entertaining, and I appreciated that comment that “Nearly all pain-free adult knees have at least 1 MRI abnormal finding,” so I don’t feel any need to freak out. But I would raise my hand and say that I’m not pain-free, it’s been a chronic source of low-level pain for 50 years, and I don’t know what part of that is relevant to my situation.

I’ll talk to my doctor in the next few days to find out.

The drudgery begins…now

I’m done with classes! Last final given yesterday and grading complete, and grades submitted to the registrar. This does not mean celebration and relaxation, but instead that it’s time to catch up with all the work I’ve put off until now. My goal for today is to clean up the genetics lab — I have a bunch of fly bottles to scrub and autoclave, and all the microscopes have to be reshelved, and I’m going to scrub benchtops. This is why I got a PhD.

I might take time off tomorrow, though. And then commencement is on Saturday. And then my summer is going to be spent tidying up my lab and office and dispersing my huge collection of books. Anyone want some?

I had nothing to do with Kyle Rittenhouse’s recent hospitalization

Rittenhouse has been hospitalized with a spider bite, and I’m getting all this email asking if I was responsible. No, don’t be silly. If I had the power to sic spiders on people I don’t like, Mar-A-Lago and the White House would be so thickly infested with Black Widows and Brown Recluses that the entire Republican ruling class would be dead or hospitalized. I would not start with blubberin’ Kyle, much as he deserves it.

The communists couldn’t take me out and i’ll be damned if I let a brown recluse take me out

So now his paranoia is imagining invisible communists and spiders under his bed. He’s a weird sad sick individual.

Keep crying, killer.

The curse is hereby lifted!

Yesterday was a day of end-of-semester meetings, cleaning up pending assignments, and putting out the online final exam for the students. All grades for all of my classes are done (sans the one final, but the spreadsheet is setup so I can just plug in that last score and all the grades will be recalculated). I will be submitting grades Wednesday evening.

Tomorrow I have a couple of appointments — I’m getting an MRI of both knees, and I have a pre-op visit to clear me for surgery. The surgery itself is two weeks from today, and should be relatively quick, with a couple of days recovering at home, and several weeks of physical therapy.

So what about today? I have nothing scheduled for today. The semester is essentially over, the doctors are poking me tomorrow, but today…nada. The calendar square is blank. All obligations have ceased. I am free.

So today is all fluff. My first act is to lift a curse that has rested lightly on my house for over a decade.

Many years ago, my two sons had moved out and moved on, leaving only my daughter still living at home with us, and that caused a minor problem. You see, my wife is a female, my daughter is a female, even our cat is a female — I was outnumbered. There are certain stereotypically female habits that were therefore amplified, in particular, greater demands for hair care. I was discovering that every morning, when I got up and wanted to quickly brush away my bed head, our hairbrush had gone wandering away from the bathroom. My first solution was to buy a second hairbrush for the bathroom, easy. But then both would vanish every morning. My wife has a habit of absent-mindedly taking things and walking off with them and putting them down wherever she is when she’s done with them.

Don’t even ask about coffee cups. Before I do the dishes I have to search through the house and gather up all the coffee cups. Yesterday I found ten of them scattered haphazardly about, most of them half full of whatever Mary was drinking out of them.

I knew I was on a rising exponential curve with the hairbrush thing, so rather than buying a third, a fourth, an eleventh, etc., and filling the whole house with hairbrushes, I came up with a simpler solution. I used a sharpie to draw a skull and crossbones on one, along with a short declaration that this was a cursed hairbrush that must never be removed from the bathroom, or a dire but unspecified fate will befall the thief.

It worked!

That’s what magic and curses are all about — creating reminders about what behaviors should be followed, shaping customs, flagging what is prohibited and what is allowed. They work even if there is no power behind them.

Well, today I declare the curse is lifted. My daughter has moved on, and I’m still outnumbered by the females in the house, but the cat doesn’t use the hairbrush anyway. The sharpie marks have faded, and the bristles in the hairbrush have been falling out, so the animus haunting the brush has disappeared. Even curses can die.

Although…maybe I should transfer it to some coffee cups.

I’ve been shirking today

Yesterday, I got a text from Caliber Works Watch Repair, informing me that my great-grandfather’s pocket watch was ready to go after 18 months. The 18 months was fine — it’s an old family heirloom, it’s not as if I needed it right away, since it was just going to be displayed on a shelf. This watch was made in 1908, my great-grandfather the dairy farmer owned it as his work timepiece, it got passed on and mostly neglected. I did wear it on my wedding day, but then my grandparents took it back and stashed in a drawer. After they died, it bumbled about in various storage containers, neglected and ignored, and was damaged in major ways: the watch crystal was smashed, one of the hands was broken off, it had run down and was allowed to freeze up for decades. I got it a few years ago.

I wound it up and put it to my ear, and it worked! So I took it in to be restored and repaired. I was supposed to be grading papers today, but instead I drove all the way into Minneapolis and back — a 6 hour round trip — and got the watch back. It’s beautiful. I’m wondering now whether I should get rid of the iPhone and carry this robust, elegant piece of machinery instead. It wouldn’t ring and take calls, but that might be a positive advantage.

And here it is without my noise:

Now I better get to work on all those papers.

Capitalism has lost the plot

Stephanie Stirling has been right all along. She’s always insisted that video game company CEOs were heartless, greedy monsters, and now one of them has stepped forward go confirm their well-deserved reputation. The CEO of a company called Ustwo, Maria Sayans, made a speech declaring what she thinks is the future of her business.

We’ve been a little bit too romantic about the idea that we should have employees and give people long-term job security. I think that got us into a place where, reaching the heights of Monument Valley 3 [production], contractors were always a relatively low percentage of our employee base. I think that’s something we’re looking to change going forward.

I think going forward, we’ll see that we’ve got a core team and any growth will come through contractors, which is something I hate about the industry. I’ve been in the industry for 20 years, and those of us who joined in the early 2000s, we had it very good. You want to be able to give that kind of stability […] but I think that’s a shift in how we want to work with people going forward.

There’s the capitalist ideal: the company is an empty shell that houses CEOs who get extravagant salaries, but no employees. The actual work, the output the company produces, is to be farmed out to external contractors on the cheap. A game, the purported purpose and product of this company, is to be produced by an executive with an MBA who has no artistic talent, no creative talent, and definitely no ability to code.

Instead of getting rid of the employees, how about firing all the CEOs?