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Many questions about knee pain, shots, NSAID use, & scoliosis
Hello--I'm 68, an age when trying to solve one problem might cause another! I'm waiting for a new FM doctor, as my old one retired last fall and they haven't yet been able to replace him.
Right-knee pain for at least 15 years (with my weight always hanging around 200 lbs, at 5'6" but shrunken now to 5'3.5") Until recently, the bad episodes were fairly short-lived, so tolerable. I had to stop taking my longtime daily Aleve (NSAID) because of minor stomach bleeding, and am maxed out on daily Tylenol. Occasionally I've cheated and taken 1 or 2 Aleve when I have a really hard day or when my overall decades-long achiness (probably fibro) gets REALLY too bad.
(I did notice after a really hard last weekend--reunions, babysitting, not enough rest and sleep--that my knee ached horribly along with everything else--but after 2-3 nights of good sleep and extreme rest, the knee stopped hurting along with everywhere else!)
During that awful time, I started using diclofenac (topical NSAID) on my knees (the left one hurts too, but less), which is supposed to be easier on your stomach, but can it still cause bleeding--and how would I know if it was? (I only found out about it in the first place because of occult blood showing up in the yearly FIT (stool) test. The GI doc said after my EGD & colonoscopy that I didn't need to do those tests anymore.)
I want to get another cortisone shot in my knee (had one last fall) just before a VERY intense week coming up in August (house guests, very big family reunion, etc.), but I also remember the dire words of my scoliosis doc years ago: "DON'T GET OSTEOPOROSIS." I don't have it now, but I'm worried about steroids compromising my spine, which would be worse than anything! I've never had back pain, but now my lower back has started to hurt and I'm worried about it. (I should have STAYED 67!!--turning 68 opened a can of worms!)
Last fall I saw an ortho PA who said that based on my x-ray, I could get knee surgery (I presume replacement) whenever I was ready, but I chose to "kick the can down the road." Now I wish I'd done it, because now I have to wait til after the August stuff is over. Plus I will have to move my whole life (computer & projects, bed, clothes, etc.) downstairs where the bathroom and kitchen are, because I hear you can't do stairs for weeks. A huge disruption which will stress my knee even more.
The PA did get me an unloader brace, which saves my knee from slipping badly out of place when I'm out shopping or whatever, and it helps some with pain, but it's not really enough by itself.
In addition, I've have a slight case of MS, or something like it, since 1999. (It's not formally diagnosed, but I've never been referred to an actual MS specialist.) Even when the knee isn't hurting, I can no longer walk more than half a block without stopping, and fatigue is overwhelming if I do too much or don't get enough sleep. I should have tried for a real diagnosis long ago, because now a neurologist couldn't judge my walking distance anyway, what with the painful knee.
That's a lot of complaints and few real questions. But I'd VERY MUCH appreciate hearing your thoughts, knowledge, and experiences with any of these things. Eventually I'm sure I'm going to have to move over to the joint-replacement forum, but I'm not there yet.
Nancy
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Find an excellent one on one dr of physical therapy that will get u in shape for knee replacement! They strengthen quads etc so recovery will be easier.
I did that prior to replacement, recovery went extremely well compared to my RTS which I did not do prior and wish I’d listened to my surgeon but took me a while to fine a one on one dr of physical therapy
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2 Reactions@nancyjt I echo @dmk in their advice about advance PT. In addition, if you want to schedule your TKR for a specific time frame, check with the surgeon first. I was required to wait 3 or 4 months (too long ago for absolutes) after my last cortisone injection before hip replacement surgery. It almost blew up my careful scheduling as I needed to get both hips done in a specific time frame.
Oh, wow, thanks for that advice!! I seem to remember hearing that they no longer required you to lose weight before knee surgery (but I'm working on it!), but did not know about pre-surgery PT. Thank you so much--I will ask about finding such a PT.
I'm a little uncertain how it will go, as my strength and stamina have declined due I'm sure to both age and (undiagnosed but I'm certain) MS...my legs have gotten wimpier even though I climb stairs all the time.
Thank you, that is exactly the kind of advice I was looking for!
Sue--that's very good to know, thank you! So many things to think about. I'm glad to know what kind of things to ask the PA next time I see her. I appreciate the info!!
Definitely get diagnosis! For pain and lack of energy etc - could be loads of things. I have RA and thought it was cause of most of my problems but last winter found out I also have undiagnosed muscular dystrophy! Important to know ( for offspring too!). I can’t have knee surgery as I might not heal. Do shots - but not great long. It’s all a puzzle. Best of luck to you - but check blood too - I found I had practically no antibodies. ( IGi deficiency) All important for your recoveries.
OMG! What a bummer to find out you have another serious condition out of the blue like that! I'm sorry you have to do deal with muscular dystrophy as well as RA, and to be shut out of the option of knee surgery. That's rotten.
Yes, I really do want a diagnosis of the neuro thing, or at least a plausible theory that takes into account my ACTUAL symptoms and history, which many doctors seem to have a lot of trouble doing. Or they assume that they won't be able to figure anything out and can't do anything for me, so don't want to say anything or be troubled further. Us complicated patients...
Take care, and I hope your RA and bloodwork improve!
Nancy
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1 ReactionHave you ever seen a pain management doctor? Research low dose naltrexone and ask about doing a trial to help with pain. Also a nerve block around your knee might help. Hope you feel better.
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1 ReactionThank you for the suggestions! No, I've never seen a pain-management doctor, but that might be a good idea. Until I had to quit my daily-double doses of naproxen last year, my pain was under good control.
I have heard of LDN but don't know much about it...I will look it up.
Thank you!
Before you seek a provider for naltrexone read this. It’s usually given to people who have addiction issues and it is not considered a very effective pure pain reliever. Consider buprenorphine patches which provides 24/7 pain relief.
Thank you--I seem to remember something controversial about LDN--it was a long time ago that I heard of it. My knee, as it does, has gone back to no significant pain on just the Tylenol, but I know that will change again at some point...I will discuss things with the PA in August (sooner if necessary).
Thanks everyone for the advice and perspectives! I really appreciate it.
Nancy