Knee Pain - Osteoarthritis

BigStar · August 4, 2022

2 hours ago, hotandsticky said:

the weight gain. That will be tackled but I really need the knee to be in working order to help me achieve that.

Having a knee in working order will have numerous advantages of course, but helping you to lose weight isn't one of them, so you can go ahead and start working on that issue now by seriously dieting.

7 hours ago, hotandsticky said:

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.

Good idea. If you follow usual forum nutritional advice--starve 'n' sweat, push away from the table, and unprocessed foods--you'd have done it already. If that were easy to do, 88% of the USA wouldn't be metabolically unhealthy. I won't bother going into what the usual issues are, but they mostly boil down to hunger. Hunger always wins.

Few know much about low carb here or are misinformed; and it gets a lot of hostility maybe because it implies giving up some foods sacred to the membership and a hard life of misery, like the one I lead. ???? But low carb + intermittent fasting is a great combo. So you can continue w/ Berg (he's good 'nuff) or browse some forums with sympathetic dieters, success stories, and some expert info:

https://reddit.com/r/owcarb/
https://reddit.com/r/keto/
https://reddit.com/r/intermittentfasting/
https://thefastdiet.co.uk/forums/
https://forum.lowcarber.org/index.php

Edited August 4, 2022 by BigStar

Sheryl · August 4, 2022

10 hours ago, hotandsticky said:

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.

Do not self prescribe a scan as it might not be necessary. See s good knee specialist first. From physical exam and Xray he will know if there is need for a scan.

Best knee specialist in Thailand is in Bangkok

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

hotandsticky · August 4, 2022

39 minutes ago, Sheryl said:

Do not self prescribe a scan as it might not be necessary. See s good knee specialist first. From physical exam and Xray he will know if there is need for a scan.

Best knee specialist in Thailand is in Bangkok

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

Thank you very much.

Whilst it would be great to see the best specialist, are you aware of any other knee specialists in Chonburi province?

Sheryl · August 4, 2022

11 minutes ago, hotandsticky said:

Thank you very much.

Whilst it would be great to see the best specialist, are you aware of any other knee specialists in Chonburi province?

No.

There are general orthopedists in the area but none AFAIK specializing in knees.

Also none as far I as can tell with training abroad

Exceptions being 2 docs at BPH but you said you don't want to go there

it is well worth the trip to see Dr. Panya.

Thunglom · August 4, 2022

you need a diagnosis from a doctor, not quackery. Pin especially things like joint pain leave you extremely vulnerable to every quack cure for pain relief rather than finding out what the problem is.

You need to find out EXACTLY what is coursing the pain and ten a treatment can be decided upon.

The problem is the Thai system. the Sattahip hospital is probably one of the better hospitals but it sounds like the doctor doesn't know what's wrong - then you start the going from specialist to specialist in order to get first a diagnosis and then treatment.

you might want to consider a trip to your home country to get a proper diagnosis first.

Edited August 4, 2022 by Thunglom

Thunglom · August 4, 2022

Just now, Thunglom said:

you need a diagnosis from a doctor, not quackery. Pin especially things like joint pain leave you extremely vulnerable to every quack cure for pain relief rather than finding out what the problem is.

You need to find out EXACTLY what is coursing the pain and ten a treatment can be decided upon.

The problem is the Thai system. the Sattahip hospital is probably one of the better hospitals but it sounds like the doctor doesn't know what's wrong - then you start the going from specialist to specialist in order to get first a diagnosis and then treatment.

22 minutes ago, hotandsticky said:

Thank you very much.

Whilst it would be great to see the best specialist, are you aware of any other knee specialists in Chonburi province?

"knee specialist"? - What you might need is an orthopaedic surgeon who specialises in knee treatment. but you are narrowing down your choice - I assume it is an orthopaedic problem??

The Hammer2021 · August 4, 2022

11 hours ago, hotandsticky said:

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.

X Ray first ..then MRI...THERE are 3 other hospitals here ...choose one that suits your pocket. Also they may want to do a bio or take a fluid sample

The Hammer2021 · August 4, 2022

11 minutes ago, The Hammer2021 said:

X Ray first ..then MRI...THERE are 3 other hospitals here ...choose one that suits your pocket. Also they may want to do a bio or take a fluid sample

One of my friends was diagnosed with gout on the knee

The other The Clap...yes on the knee!

BigStar · August 5, 2022

11 hours ago, Thunglom said:

the Sattahip hospital is probably one of the better hospitals but it sounds like the doctor doesn't know what's wrong

The initial hsp wasn't Queen Sirikit but the other smaller Navy hsp in Sattahip. Got an X-ray, good; problem not obvious from the X-ray, and doc recommended seeing a specialist if anti-inflammatory didn't help. Reasonable first step that cost little.

So the next step, assuming no efforts or success at self-therapy, would be the specialist. If cost-conscious, seeing a specialist at QS could be useful, but time-consuming of course even if the location's convenient. Must be some competent orthopedic surgeons there as one member had two hip replacements at Sirikit; no complaints, evidently.

Sheryl has given the recommendation for the best-known knee expert, Dr. Panya at Bumrungrad. An MRI there would be relatively expensive, if quick, but it could be obtained for lower cost at an MRI center.

I saw one ortho at BPH re: a case of tennis elbow. The diagnosis and solution was, "Yep, tennis elbow, here's a script for paracetamol at our pharmacy." In fact he and I seemed to share a mutually poor impression of each other.

I skipped the paracetamol, ordered a Theraband flexbar from Amazon, did the exercise and stretching and fixed the problem myself. I'd not go back.

11 hours ago, Thunglom said:

What you might need is an orthopaedic surgeon who specialises in knee treatment.

Hammers tend to see only nails, esp if they work at private hsps. Friend of mine saw two surgeons recommending hernia ops to the tune of B200,000+. A third at Phyathai Siricha assured him no op was needed. Dr. Olivier in PTY later agreed with that diagnosis. Made sense: both hernias are very small and causing no problems or foreseeable problems.

A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment.

--https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

If you can't trust Swiss dentists, who can you trust?

But I'm sure Dr. Panya would give an honest, objective opinion recommending conservative treatment if possible.

Edited August 5, 2022 by BigStar

scubascuba3 · August 5, 2022

29 minutes ago, BigStar said:

A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment.

--https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

If you can't trust Swiss dentists, who can you trust?

But I'm sure Dr. Panya would give an honest, objective opinion recommending conservative treatment if possible.

This doesn't surprise me, as a kid I'm sure i got unnecessary fillings, they just think it's easy money and new teeth will come through anyway. I asked a dentist about this and he said yes it was rife back then.

On the subject of knees i vaguely remember someone getting a knee replacement from Queen Sirikit

Edited August 5, 2022 by scubascuba3

Thunglom · August 5, 2022

5 hours ago, BigStar said:

The initial hsp wasn't Queen Sirikit but the other smaller Navy hsp in Sattahip. Got an X-ray, good; problem not obvious from the X-ray, and doc recommended seeing a specialist if anti-inflammatory didn't help. Reasonable first step that cost little.

So the next step, assuming no efforts or success at self-therapy, would be the specialist. If cost-conscious, seeing a specialist at QS could be useful, but time-consuming of course even if the location's convenient. Must be some competent orthopedic surgeons there as one member had two hip replacements at Sirikit; no complaints, evidently.

Sheryl has given the recommendation for the best-known knee expert, Dr. Panya at Bumrungrad. An MRI there would be relatively expensive, if quick, but it could be obtained for lower cost at an MRI center.

I saw one ortho at BPH re: a case of tennis elbow. The diagnosis and solution was, "Yep, tennis elbow, here's a script for paracetamol at our pharmacy." In fact he and I seemed to share a mutually poor impression of each other.

I skipped the paracetamol, ordered a Theraband flexbar from Amazon, did the exercise and stretching and fixed the problem myself. I'd not go back.

Hammers tend to see only nails, esp if they work at private hsps. Friend of mine saw two surgeons recommending hernia ops to the tune of B200,000+. A third at Phyathai Siricha assured him no op was needed. Dr. Olivier in PTY later agreed with that diagnosis. Made sense: both hernias are very small and causing no problems or foreseeable problems.

A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment.

--https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

If you can't trust Swiss dentists, who can you trust?

But I'm sure Dr. Panya would give an honest, objective opinion recommending conservative treatment if possible.

I was referring to the Naval hospital......as it is run by the navy, it has the cream of the crop when it comes to available doctors etc.

Orthopedics is not using a hammer

I think you are falling fowl by not understanding how the Thai healthcare system works.

when laypeople make judgements based on perceptions of medical diagnoses, they invariable get it wrong. You need to understand the system, not medication or therapies to get a result.

The Hammer2021 · August 5, 2022

Lose weight is excellent advice.

On 8/4/2022 at 11:38 AM, Lacessit said:

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.

Sheryl · August 5, 2022

Unhelpful bickering posts have been removed.

The Hammer2021 · August 5, 2022

My knee problem turned out to be gout, my friend it turned out had an STI and my other friend had some kind of fast keyhole surgery and flushing stuff out. If you really had a problem you would not be choosy about the BPH nor would you hesitate to go to Bangkok. I strongly suggest you go now to get it sorted before it gets worse and gets more damaged.

hotandsticky · August 6, 2022

On 8/4/2022 at 9:19 PM, Sheryl said:

Do not self prescribe a scan as it might not be necessary. See s good knee specialist first. From physical exam and Xray he will know if there is need for a scan.

Best knee specialist in Thailand is in Bangkok

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

Booked online for Bumrungrad....a very simple process.

hotandsticky · September 1, 2022

I was asked by a member for an update.

I went to Bumrungrad to see Dr Panya Wongpatimachai. It was a positive experience and after a physical inspection he also wanted to take an X-ray.

He actually said "I am surprised, for someone of your age and weight I expected to see a lot more damage....."

The conclusion was what members on here had already identified - nothing obvious from the X-ray but 'up to me' if I wanted an MRI scan to check for damage to the knee meniscus. Dr Panya said that whilst Bunrungrad could obviously do the MRI scan he suggested that I do it elsewhere - and return to see him with the results.

Amongst the wealth of advice was the suggestion to visit a physiotherapist. I knew that I was not going to be in a position to follow up on the MRI scan/revisit so I arranged to see Nat at the Royal Physiotherapy Clinic on Third Road, Pattaya.

Basically, I pay 800 Baht a session and after initial investigation I was given sonar, laser and heat treatments (3x20min each session).

I have had 4 sessions and can honestly say that there is a huge improvement. I know that I would want to say that if I am paying 800 Baht a time - but it is true. I was also given light twisting/moving exercises to strengthen muscle around the knee. I was advised not to do too much walking and exercise in the pool + exercise bike was good.

In the last couple of days the knee has felt 95% normal and I feel comfortable walking. I also feel more confident with the knee and no longer feel the need to 'protect' it in the way that I walk. I have no noticeable pain at the moment so I will test it out next week by playing bowls.

Last week we were in Cambodia and I felt it after 10,000+ steps around Angkor Wat. The next day was a bit sore.

couchpotato · September 1, 2022

38 minutes ago, hotandsticky said:

I was asked by a member for an update.

I went to Bumrungrad to see Dr Panya Wongpatimachai. It was a positive experience and after a physical inspection he also wanted to take an X-ray.

He actually said "I am surprised, for someone of your age and weight I expected to see a lot more damage....."

The conclusion was what members on here had already identified - nothing obvious from the X-ray but 'up to me' if I wanted an MRI scan to check for damage to the knee meniscus. Dr Panya said that whilst Bunrungrad could obviously do the MRI scan he suggested that I do it elsewhere - and return to see him with the results.

Amongst the wealth of advice was the suggestion to visit a physiotherapist. I knew that I was not going to be in a position to follow up on the MRI scan/revisit so I arranged to see Nat at the Royal Physiotherapy Clinic on Third Road, Pattaya.

Basically, I pay 800 Baht a session and after initial investigation I was given sonar, laser and heat treatments (3x20min each session).

I have had 4 sessions and can honestly say that there is a huge improvement. I know that I would want to say that if I am paying 800 Baht a time - but it is true. I was also given light twisting/moving exercises to strengthen muscle around the knee. I was advised not to do too much walking and exercise in the pool + exercise bike was good.

In the last couple of days the knee has felt 95% normal and I feel comfortable walking. I also feel more confident with the knee and no longer feel the need to 'protect' it in the way that I walk. I have no noticeable pain at the moment so I will test it out next week by playing bowls.

Last week we were in Cambodia and I felt it after 10,000+ steps around Angkor Wat. The next day was a bit sore.

I have issues that might be helped by physio, so anymore info on the clinic would be helpful. I looked at their website and it looks clean and professional.

So from what you've seen, and the service you've received, do you feel its a proper and legitimate clinic with qualified therapists.

Would appreciate your thoughts. Thank you.

BigStar · September 1, 2022

3 hours ago, hotandsticky said:

I was asked by a member for an update.

I went to Bumrungrad to see Dr Panya Wongpatimachai. It was a positive experience and after a physical inspection he also wanted to take an X-ray.

He actually said "I am surprised, for someone of your age and weight I expected to see a lot more damage....."

The conclusion was what members on here had already identified - nothing obvious from the X-ray but 'up to me' if I wanted an MRI scan to check for damage to the knee meniscus. Dr Panya said that whilst Bunrungrad could obviously do the MRI scan he suggested that I do it elsewhere - and return to see him with the results.

Amongst the wealth of advice was the suggestion to visit a physiotherapist. I knew that I was not going to be in a position to follow up on the MRI scan/revisit so I arranged to see Nat at the Royal Physiotherapy Clinic on Third Road, Pattaya.

Basically, I pay 800 Baht a session and after initial investigation I was given sonar, laser and heat treatments (3x20min each session).

I have had 4 sessions and can honestly say that there is a huge improvement. I know that I would want to say that if I am paying 800 Baht a time - but it is true. I was also given light twisting/moving exercises to strengthen muscle around the knee. I was advised not to do too much walking and exercise in the pool + exercise bike was good.

In the last couple of days the knee has felt 95% normal and I feel comfortable walking. I also feel more confident with the knee and no longer feel the need to 'protect' it in the way that I walk. I have no noticeable pain at the moment so I will test it out next week by playing bowls.

Last week we were in Cambodia and I felt it after 10,000+ steps around Angkor Wat. The next day was a bit sore.

Thanks for the update. Always nice to hear some good news for a change.

So it went well. Dr. Panya, the best, didn't see any big need even for the MRI our members called for. Perhaps he also mentioned physiotherapy. If physiotherapy fixes the problem, then that's obviously far better than pills, injections, and surgeries. The price you're paying per session isn't unreasonable.

I suggest you later continue doing the recommended stretches and/or exercises. Might be good for the other knee as well. I myself devote at least 30 min daily to back, knees, ankle, and shoulder stretches (among others) and massage. And I do resistance exercise every week in such a way as to keep the muscles in balance. Boring, but seems working well.

And I hope the weight loss program is on track. It's a constant battle as you get older (if you're not too lazy) to keep things in working order and avoid the need for docs, hospitals, meds, and surgeries for as long as possible.

Edited September 1, 2022 by BigStar

The Hammer2021 · September 1, 2022

On 8/4/2022 at 10:00 PM, hotandsticky said:

Thank you very much.

Whilst it would be great to see the best specialist, are you aware of any other knee specialists in Chonburi province?

Both my friend and I were dogged with knee problems for ages in the end one turned out to be gout the other ghonera.

Anyway- just start off with an Xray - very cheap and anyway Pattaya to Bangkok is fast. Bumrungrad is right next to highway turn off.

Edited September 1, 2022 by The Hammer2021

hotandsticky · September 1, 2022

3 hours ago, couchpotato said:

I have issues that might be helped by physio, so anymore info on the clinic would be helpful. I looked at their website and it looks clean and professional.

So from what you've seen, and the service you've received, do you feel its a proper and legitimate clinic with qualified therapists.

Would appreciate your thoughts. Thank you.

No problem.

I went after a personal recommendation from a guy that I play bowls with.

The clinic is located on Third Road Pattaya, on the left hand side going towards Pratumnak/Jomtien just after Tony's gym. You can miss it and there is a pull in where you can certainly park a motorbike easily. Clean and professional, Nat is a soft spoken, slightly effeminate, person who seems very knowledgeable. No hesitation in making a recommendation.

couchpotato · September 1, 2022

24 minutes ago, hotandsticky said:

No problem.

I went after a personal recommendation from a guy that I play bowls with.

The clinic is located on Third Road Pattaya, on the left hand side going towards Pratumnak/Jomtien just after Tony's gym. You can miss it and there is a pull in where you can certainly park a motorbike easily. Clean and professional, Nat is a soft spoken, slightly effeminate, person who seems very knowledgeable. No hesitation in making a recommendation.

Thank you. Appreciated.

Felt 35 · September 26, 2022

On 8/4/2022 at 11:14 AM, 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

Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee - PubMed (nih.gov)

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