DEAR DR. GOTT: I am a 75-year-old with severe osteoarthritis in both knees. I have done well without knee-replacement surgery, owing to a knowledgeable physical therapist. The therapy goal of nearly a year ago was to walk a new puppy a short distance.
Early last year, a torn cartilage was surgically repaired, but the post-op pain continued. Cortisone injections offered no relief. A wheelchair was necessary to get any distance. Otherwise, a cane was necessary for support. Periodically, a lidocaine patch was applied with limited pain relief.
Six months post-therapy, I wear braces for support on both legs while walking my now year-old dog two miles — without pain. I also exercise and participate in yoga at a local health center comfortably and without the braces.
The purpose of my letter is to share my story to encourage other patients to consider alternative treatments before rushing to a surgical option.
DEAR READER: And encourage them you will. Osteoarthritis is a common disorder that can be extremely debilitating. It is more common in older people than it is in those younger, and women are affected twice as often as men.
Treatment is directed toward controlling the pain while maintaining regular movement and preventing joint deformity. Over-the-counter acetaminophen such as Tylenol is often the first step, because it has fewer side effects than some other choices. Other OTCs include topical skin creams such as Castiva, non-steroidal anti-inflammatory drugs (NSAIDs) or a glucosamine/chondroitin combination. Corticosteroids injected directly into the painful joint might fall into the line of progression; however, more than two or three a year could be harmful in the long run, and relief is limited in terms of time.
On the home front and only with the permission of a personal physician, readers might ask an opinion regarding applying heat/ice to affected knees, weight loss if appropriate, diet modifications and the incorporation of an exercise program. Perhaps they could also benefit from physical therapy, acupuncture or yoga.
As you pointed out, a cane, brace or wheelchair might be of assistance. Following all this, surgery might be necessary. I certainly take your position that numerous steps can be included into each day before this important step is taken. Thank you for writing.
Readers who would like additional information can order my Health Report “Understanding Osteoarthritis” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
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