Knee Pain - Osteoarthritis

[hotandsticky]

Never had a knee problem until I slipped on my daily walk last year and banged my right knee.

 

After a week of pain I was able to resume walking although I would get occasional restrictive pain.

 

 

The pain has become worse over the last 6 months and is currently affecting quality of life and daily activities (walking, bowls etc)

 

Last month I visited a doctor at the naval hospital in Sattahip and an X-Ray was taken. The doctor prescribed Celebrex 200mg (NSAID) plus a muscle relaxant. 

 

I completed the prescribed course of tablets (which I think helped) but as want to try to avoid being tablet dependent I did not get a repeat prescription. After a week or so I bought Diclofenac from a local pharmacy to take on an 'as and when needed' basis.

 

 

The Sattahip doctor said if I did not see an improvement I should consult a knee specialist.

 

 

I would welcome advice from anyone with a similar conditions, and advice on the options available to me.

[lopburi3]

If you have lost moisture you might be helped by shots to replace (although not cheap - cost us 24k each last week for Hyruan 60mg/3ml) which seems to have helped wife (over 80 - but perhaps too early to know for sure) as was unable to walk Monday and since only slight pain in one knee (was both knees Monday).  As has kidney issues normal NSAID was questioned by pharmacist and replaced with Locoa transdermal patch which was used second evening when some pain in one knee and it was relieved immediately.

 

I do see black sesame oil capsules being advertised as a non medical supplement and seems to be some basis for calms it may help. 

[Bagwain]

I have done this 3 times over the years and works great. No drugs.

 

2" of cold water in a glass add 1 level teaspoon of gelatine and leave at room temp for at least 2 hours. Then mix with a fruit or milk drink.

 

1st time I did this it took about 10 days to have an effect

2nd time 15 days & 3rd time couple of months.

 

 

 

 

[Lacessit]

Anti-inflammatories should only be used for short-term relief, long-term they cause kidney damage. Diclofenac is one of the worst NSAID's in that respect.

 

X'rays are fairly useless, in your shoes I would be getting a MRI done.

 

Given the circumstances you describe of the first occurrence, it is possible you have torn the knee meniscus. That can only be fixed with surgery, via an arthroscopy.

 

I had an arthroscopy on my right knee about 15 years ago. One month of rehab, and I have been good to go ever since.

[hotandsticky]

19 minutes ago, Lacessit said:

Anti-inflammatories should only be used for short-term relief, long-term they cause kidney damage. Diclofenac is one of the worst NSAID's in that respect.

 

X'rays are fairly useless, in your shoes I would be getting a MRI done.

 

Given the circumstances you describe of the first occurrence, it is possible you have torn the knee meniscus. That can only be fixed with surgery, via an arthroscopy.

 

I had an arthroscopy on my right knee about 15 years ago. One month of rehab, and I have been good to go ever since.

 

Thank you (and to others for their replies).

 

 

I don't wish to sound skeptical but I was concerned that I might be being fobbed off with "osteoarthritis". I imagine an X-Ray will reveal wear in tear in most old blokes! Having suffered nothing for 65 years and then the pain starts, only after the trauma of falling on the right knee, I find it hard to rule out physical damage to muscles etc. 

 

I am ignorant on this subject but MRI sounds like the way to go. Are there any recommendations for where to go for a scan in the Sattahip/Pattaya areas. I would like to avoid BPH.

[retiree]

Fwiw re injections:

https://www.statnews.com/2022/07/06/hyaluronic-acid-injections-dont-help-knee-osteoarthritis-review-finds/

 

Re torn meniscus, this is apparently very common -- ~40% of randomly selected men 60-69 had tears (usually asymptomatic), and about 6% more meniscal "destruction": 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897006/

 

Re surgical treatment, you can track down the long-term studies -- here is a good starting point:

https://pubmed.ncbi.nlm.nih.gov/27712957/

 

Bottom lines are a) lots of people are walking around with torn menisci, and b) it's not clear that surgery is a win long-term if it can be avoided with more conservative treatment.   

 

I'd think that MRI or arthroscopy (without committing to repair) would be your next step if the pain is really out of hand, and if it won't heal if given the chance (see next).  

 

I looked into all this after what was almost certainly a meniscus tear mid-60's (from running).  Knee would not bear weight.  I prescribed myself RICE, plus Celebrex 200mg daily for a while.  Took about 6 weeks.  I did some light rehab (e.g. spinning with little or no resistance) along the way,   Seems ok now, but I power-walk rather than run, and ice and/or wear a tight knee wrap (the velcro strap kind with sewn-in side struts) at the first hint of any inflammation.  

 

Oh -- if it helps, you can get diclofenac gel (e.g. Emulgel 1% most drugstores, or 2% via Shopee) or piroxicam gel (Neotica, also  OTC).  This is the safest NSAID route.  Otherwise, celebrex 200 appears to be safer than oral diclofenac, see e.g. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)02332-6/fulltext 

 

Good luck!

-- Retiree 

[hotandsticky]

2 minutes ago, retiree said:

Fwiw re injections:

https://www.statnews.com/2022/07/06/hyaluronic-acid-injections-dont-help-knee-osteoarthritis-review-finds/

 

Re torn meniscus, this is apparently very common -- ~40% of randomly selected men 60-69 had tears (usually asymptomatic), and about 6% more meniscal "destruction": 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897006/

 

Re surgical treatment, you can track down the long-term studies -- here is a good starting point:

https://pubmed.ncbi.nlm.nih.gov/27712957/

 

Bottom lines are a) lots of people are walking around with torn menisci, and b) it's not clear that surgery is a win long-term if it can be avoided with more conservative treatment.   

 

I'd think that MRI or arthroscopy (without committing to repair) would be your next step if the pain is really out of hand, and if it won't heal if given the chance (see next).  

 

I looked into all this after what was almost certainly a meniscus tear mid-60's (from running).  Knee would not bear weight.  I prescribed myself RICE, plus Celebrex 200mg daily for a while.  Took about 6 weeks.  I did some light rehab (e.g. spinning with little or no resistance) along the way,   Seems ok now, but I power-walk rather than run, and ice and/or wear a tight knee wrap (the velcro strap kind with sewn-in side struts) at the first hint of any inflammation.  

 

Oh -- if it helps, you can get diclofenac gel (e.g. Emulgel 1% most drugstores, or 2% via Shopee) or piroxicam gel (Neotica, also  OTC).  This is the safest NSAID route.  Otherwise, celebrex 200 appears to be safer than oral diclofenac, see e.g. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)02332-6/fulltext 

 

Good luck!

-- Retiree 

 

 

Excellent, thank you.

 

 

Prior to the onset of pain, following my slip, I would walk 10/15k steps per day - most being on my morning walk. I thoroughly enjoyed the exercise and fresh air. Despite being overweight (95kg-115kg) the walking never caused any obvious issues with the knee. Now there are days when I cannot walk up and down for a game of bowls. I accept that I haven't got the balance of medication right but I really don't want tone on NSAIDs longer than necessary.

 

I have probably been a bit blinkered to walking, as my main exercise, when this is clearly unviable. I perhaps need to look at exercising the knee in the condo swimming pool and finding the way to the gym to use the static exercise bike.

 

It seems logical to pursue the MRI route so that I can be confident - first - with the professional diagnosis, and then look at the best way of treating the results.

[BigStar]

Typical that the only possible remedies you'll get here are pills, creams, injections, supplements, and surgery; i.e., nothing that might involve any effort on your part and spending little to no money. Effort, OMG. I love this forum.

 

First thing to do would be to try some physical rehab on your own that might well fix your problem IF you keep at it consistently a couple of months. Lots of free vids on youtube, for example:

 

https://www.youtube.com/watch?v=kbe_DqMJfzg
https://www.youtube.com/watch?v=nSZkzh4BaxU
https://www.youtube.com/watch?v=ikt6NME0k9E
https://www.youtube.com/watch?v=4UxUfRb619A

 

And if you can't work on your own, you can also see a good physical therapist if you can find one. Maybe the members will have some recommendations; had some in a thread not too long ago here. Mostly we like to resort to physical therapy only after we've had surgery first, however.???? Doctors much prefer it that way as well, of course.

 

You can also use a knee brace for a while to supplement the rehab. It's not a fix. Cheap on Lazada or Alieexpress.

 

Nothing I don't do myself. I do some strengthening exercises, stretching, foam rolling, and massage to keep my knees rockin' along. Just massage is rather helpful; got that from Bob & Brad. I do it manually on the kneecaps and use a foam roller or sometimes a massage gun on the muscles surrounding.

 

So that's it. Getting ready for my walk on the beach (sun's out!) and then up 15 flights of stairs.

Edited August 4, 2022 by BigStar

[BigStar]

4 minutes ago, hotandsticky said:

Despite being overweight (95kg-115kg) the walking never caused any obvious issues with the knee.

Just a matter of time. Overweight friends of mine had no issues but then finally ended up with knee replacements. Lose weight.

[Lacessit]

8 minutes ago, retiree said:

 

Bottom lines are a) lots of people are walking around with torn menisci, and b) it's not clear that surgery is a win long-term if it can be avoided with more conservative treatment.   

 

I'd think that MRI or arthroscopy (without committing to repair) would be your next step if the pain is really out of hand, and if it won't heal if given the chance (see next).  

 

AFAIK arthroscopy is repair, surgeons don't waste their time going in to just look around.

 

Surgery was certainly a win for me, after a couple of months trying to sleep upright in a chair. About 30 seconds after I laid down flat in bed, the knee would start aching, and ramp up to about 8 out of 10 on the pain scale. As soon as I sat up in a chair, the pain went. I could walk without pain.

 

After the surgery, the surgeon said he had just done a bit of trimming, and my recovery was completely dependent on the work I put into the rehab. I have not needed RICE, Celebrex, knee bandages or any other paraphernalia for 15 years.

 

A couple of other things the OP could do to assist his cause. Ditch sugar entirely from the diet, and lose weight.

[bkk6060]

MRI to find the truth I have had 2 kness surgeries.  It is a constant battle as you get older to keep it strong.  There is no medication available that is not addictive or is bad for your organs.

If you fell on your knee cap, you may have some tissue damage under your cap and it could take some time to heal.  If you are doing the wrong exercises it can make it worse and cause more irritation.

Anyway, I would go to a good Ortho Doctor, get an MRI and figure it out from there.

[hotandsticky]

11 minutes ago, BigStar said:

Just a matter of time. Overweight friends of mine had no issues but then finally ended up with knee replacements. Lose weight.

It is in the plan............................

Edited August 4, 2022 by hotandsticky

[Lacessit]

5 minutes ago, bkk6060 said:

  There is no medication available that is not addictive or is bad for your organs.

 

Amen.

[hotandsticky]

9 minutes ago, Lacessit said:

 

 

A couple of other things the OP could do to assist his cause. Ditch sugar entirely from the diet, and lose weight.

Sugar is gone - except in alcohol and that is only the occasional San Miguel Zero and a glass of wine.

 

I need to revert to my mainly keto based diet  -  I bought into the likes of Dr Berg and low-card diets some time ago. I need to apply some discipline to that.

[retiree]

Well ... I try to visualize my next visit to the doctor, and then do what he/she would probably have told me ????  Hence, "RICE, come back in two weeks if it's not getting better, take an NSAID for the pain, but stay off it" is my usual self-prescription (absent some obvious mechanical injury like a ruptured tendon or ligament).    

 

Note that the R(est) is an essential component.  Given your weight, I'd wonder if the NSAID had simply relieved the pain enough to let you keep the original injury from healing.   If it were me, I'd try a couple of weeks of "active sloth"; i.e. serious RICE, no pills, and as much non-weight-bearing activity (like swimming or no-resistance spinning) as you're willing to do. 

In this case, pain is your friend -- it lets you know that you're putting weight on your knee too soon.  And whether or not you are still in pain will help you & the MRI doc make an informed choice about what to do next.  

 

Oh, and maybe start doing the pushaway, too; 115Kg? seriously?  Lol I'm 5'11", and if I were walking around with a (checks scale) 47.5 Kg backpack I imagine my knees would hurt, too ????  That's like carrying my wife around all day ???? 

 

-- Retiree 

 

[Lacessit]

48 minutes ago, hotandsticky said:

Sugar is gone - except in alcohol and that is only the occasional San Miguel Zero and a glass of wine.

 

I need to revert to my mainly keto based diet  -  I bought into the likes of Dr Berg and low-card diets some time ago. I need to apply some discipline to that.

Beer is the worst for carbs, whisky and other spirits are zero. Not sure how San Mig does that.

 

I bought into Dr. Ken Berry's diet ( well, not completely ) after making a New Year's resolution to lose weight. I was 92-94 kg last year, I am now 81 kg.

 

It's not just the knees, it is axiomatic the heart and lungs have less work to do.

[scubascuba3]

i avoided meniscus surgery. You should see a specialist first before rushing to MRI. Check your BMI you sound obese so guess what?

[hotandsticky]

2 hours ago, scubascuba3 said:

i avoided meniscus surgery. You should see a specialist first before rushing to MRI. Check your BMI you sound obese so guess what?

Any recommendations for a specialist?

 

 

I was obese long before I slipped and hit my knee on the floor. 

[hotandsticky]

4 hours ago, retiree said:

Well ... I try to visualize my next visit to the doctor, and then do what he/she would probably have told me ????  Hence, "RICE, come back in two weeks if it's not getting better, take an NSAID for the pain, but stay off it" is my usual self-prescription (absent some obvious mechanical injury like a ruptured tendon or ligament).    

 

Note that the R(est) is an essential component.  Given your weight, I'd wonder if the NSAID had simply relieved the pain enough to let you keep the original injury from healing.   If it were me, I'd try a couple of weeks of "active sloth"; i.e. serious RICE, no pills, and as much non-weight-bearing activity (like swimming or no-resistance spinning) as you're willing to do. 

In this case, pain is your friend -- it lets you know that you're putting weight on your knee too soon.  And whether or not you are still in pain will help you & the MRI doc make an informed choice about what to do next.  

 

Oh, and maybe start doing the pushaway, too; 115Kg? seriously?  Lol I'm 5'11", and if I were walking around with a (checks scale) 47.5 Kg backpack I imagine my knees would hurt, too ????  That's like carrying my wife around all day ???? 

 

-- Retiree 

 

 

Good job I wasn't my previous 135 kg when I dropped on my knee. My walking (and a disciplined approach to food content/volume)  took me down to 94kg but inactivity during Covid + the knee issue + a fairly hedonistic 2 month visit to Europe has seen the weight gain. That will be tackled but I really need the knee to be in working order to help me achieve that.

[Mavideol]

7 minutes ago, hotandsticky said:

Any recommendations for a specialist?

 

 

I was obese long before I slipped and hit my knee on the floor. 

I know your situation, had a small accident and hit the ground with my knee, pain was unbearable and decided to visit a specialist, first he give anti-inflamation  and muscle relaxant, nothing changed, looked for a specialist and then another one, total 3 specialists who didn't know how to solve the problem, the last one was a sports )Knee, meniscus) specialist, had an MRI done (BTW X-Ray does show anything on the meniscus, need MRI) more anti inflamation, he didn't want to do surgery (didn't advise for my 69 years ex football hurt) meniscus, he wanted to inject my knee but I refused as had done it in the past many many times and the pain will always came back, then I decided to follow my gut and my mates advise to take 3 Prednisolone a day (1 after each meal) 5 days and it worked just fine, pain it's gone, but one has to be careful with Prednisolone it taken for long period of time it may affect the kidneys and can cause kidney failure, I had taken it for a couple times each time noever more then 5 days and so far so good
 

[hotandsticky]

4 hours ago, Lacessit said:

Beer is the worst for carbs, whisky and other spirits are zero. Not sure how San Mig does that.

 

I bought into Dr. Ken Berry's diet ( well, not completely ) after making a New Year's resolution to lose weight. I was 92-94 kg last year, I am now 81 kg.

 

It's not just the knees, it is axiomatic the heart and lungs have less work to do.

 

 

San Miguel Zero is a misnomer  - many people think it is zero alcohol.  P!ss poor marketing it is actually 3% abv but only 60 calories for a 330ml bottle. Best by a long way since the demise of Singha Light @ 97 calories.

[The Hammer2021]

Celebrex is a modern NSAI. It's dangerous.  Diflenac is an old fashioned  NSAI. Long term  use is bad. Both are pain killers and reduce inflammation so if you still have the  problem go for an x Ray or scan.  Could be some old  cartilage  needs cleaning  out or  bone chips. Could be gout...Could even be an STD...GET IT  CHECKED NOW

[Lacessit]

21 minutes ago, Mavideol said:

I know your situation, had a small accident and hit the ground with my knee, pain was unbearable and decided to visit a specialist, first he give anti-inflamation  and muscle relaxant, nothing changed, looked for a specialist and then another one, total 3 specialists who didn't know how to solve the problem, the last one was a sports )Knee, meniscus) specialist, had an MRI done (BTW X-Ray does show anything on the meniscus, need MRI) more anti inflamation, he didn't want to do surgery (didn't advise for my 69 years ex football hurt) meniscus, he wanted to inject my knee but I refused as had done it in the past many many times and the pain will always came back, then I decided to follow my gut and my mates advise to take 3 Prednisolone a day (1 after each meal) 5 days and it worked just fine, pain it's gone, but one has to be careful with Prednisolone it taken for long period of time it may affect the kidneys and can cause kidney failure, I had taken it for a couple times each time noever more then 5 days and so far so good
 

I didn't know about the kidney problem, although nearly all medications do some damage. Prednisolone gave me short-term memory loss and hallucinations, one day on that <deleted> was enough for me.

[scubascuba3]

5 hours ago, hotandsticky said:

Sugar is gone - except in alcohol and that is only the occasional San Miguel Zero and a glass of wine.

 

I need to revert to my mainly keto based diet  -  I bought into the likes of Dr Berg and low-card diets some time ago. I need to apply some discipline to that.

Think again about that, better ways to lose weight. Keto is basically making people sick, plus the yoyo for good measure

[scubascuba3]

41 minutes ago, hotandsticky said:

Any recommendations for a specialist?

 

 

I was obese long before I slipped and hit my knee on the floor. 

No idea about a specialist, pick a hospital which has one in your area, but it's crazy to not see one otherwise you're just guessing, doesn't mean you need to go through with an op, I didn't go through with a meniscus op

[hotandsticky]

2 minutes ago, scubascuba3 said:

No idea about a specialist, pick a hospital which has one in your area, but it's crazy to not see one otherwise you're just guessing, doesn't mean you need to go through with an op, I didn't go through with a meniscus op

Thanks.

 

 

That is the recommendation I am looking for.

 

 

Obviously, the Sattahip naval hospital didn't have one or a next step referral would have been mentioned. 

 

Queen Sirikit hospital in Sattahip or Pattaya Memorial would be my next choices - but I would like to get a personal recommendation if anyone out there has experience of those hospitals.

[scubascuba3]

40 minutes ago, hotandsticky said:

Thanks.

 

 

That is the recommendation I am looking for.

 

 

Obviously, the Sattahip naval hospital didn't have one or a next step referral would have been mentioned. 

 

Queen Sirikit hospital in Sattahip or Pattaya Memorial would be my next choices - but I would like to get a personal recommendation if anyone out there has experience of those hospitals.

Queen Sirikit gets recommended a lot, I'd go there if it's in your area. Need a thai speaker otherwise it's hard work

[BigStar]

58 minutes ago, hotandsticky said:

Queen Sirikit hospital in Sattahip or Pattaya Memorial would be my next choices - but I would like to get a personal recommendation if anyone out there has experience of those hospitals.

Queen Sirikit can do MRIs, will take time & patience, gov't hsp. Take your current record, get an appt w/ the ortho dept. Talk to the low level ortho, show your records, note you've done the pills already and doc told you to see a knee specialist, try to get appt w/ knee specialist there, then get appt for the MRI. May need a new appt w/ the knee specialist for interpretation of the MRI result.

 

You can also get a copy of the MRI and take it to a knee specialist elsewhere for a 2nd opinion.

 

 

[hotandsticky]

29 minutes ago, scubascuba3 said:

Queen Sirikit gets recommended a lot, I'd go there if it's in your area. Need a thai speaker otherwise it's hard work

Thank you. I have heard friends speak highly of Queen Sirikit hospital before.

[hotandsticky]

3 minutes ago, BigStar said:

Queen Sirikit can do MRIs, will take time & patience, gov't hsp. Take your current record, get an appt w/ the ortho dept. Talk to the low level ortho, show your records, note you've done the pills already and doc told you to see a knee specialist, try to get appt w/ knee specialist there, then get appt for the MRI. May need a new appt w/ the knee specialist for interpretation of the MRI result.

 

You can also get a copy of the MRI and take it to a knee specialist elsewhere for a 2nd opinion.

 

 

Excellent. Much appreciated.