How to fix elderly knee pain without a doctor?
December 25, 2017 1:12 PM Subscribe
My beloved grandmother is facing terrible knee pain that prevents her from even getting out of bed sometimes. She will try almost anything I suggest and anything I buy her, EXCEPT seeing a doctor. What is the best way to help her?
She is old-world stubborn: has health insurance, but fundamentally distrusts doctors because she has no connections to them and doesn't trust they will tell her the right thing to do. I can't communicate with her doctor because HIPPA, but what WOULD a doctor tell her? What is the best way to relieve severe knee pain in the elderly?
I know this is a thing that's eminently googleable, but the problem is it is TOO googleable. Everyone is trying to sell stuff directly to gullible seniors, and a lot of it is snake oil. Please share stuff that isn't!
She is old-world stubborn: has health insurance, but fundamentally distrusts doctors because she has no connections to them and doesn't trust they will tell her the right thing to do. I can't communicate with her doctor because HIPPA, but what WOULD a doctor tell her? What is the best way to relieve severe knee pain in the elderly?
I know this is a thing that's eminently googleable, but the problem is it is TOO googleable. Everyone is trying to sell stuff directly to gullible seniors, and a lot of it is snake oil. Please share stuff that isn't!
Unless she's torn or broken something, it's likely that strengthening specific leg muscles will help her knee to move in less painful ways.
Very much agreed. My elderly mom has reached an extreme level of "use it or lose it" when it comes to her mobility. It's amazing how helpful even a single visit from any sort of movement therapist* has been for her of late. It's very often all about atrophy.
* yoga instructor, physio therapist, just somebody that knows a few useful and easy stretches and routines
posted by philip-random at 1:30 PM on December 25, 2017
Very much agreed. My elderly mom has reached an extreme level of "use it or lose it" when it comes to her mobility. It's amazing how helpful even a single visit from any sort of movement therapist* has been for her of late. It's very often all about atrophy.
* yoga instructor, physio therapist, just somebody that knows a few useful and easy stretches and routines
posted by philip-random at 1:30 PM on December 25, 2017
HIPAA does not prevent you from talking to her doctor. The doctor cannot give confidential information to YOU, but you can tell him or her anything you want. You are not the one bound by HIPAA.
Anyway, seconding Margalo Epp's recommendation. My knees hurt, and I asked my doctor about knee replacement surgery. She said first, try physical therapy. I have not pursued that yet, but it is on my New Year's To Do list.
For my insurance, PT has to be ordered by a doctor to be covered. But maybe your grandmother's insurance is different, or she can pay out of pocket?
posted by merejane at 1:31 PM on December 25, 2017 [5 favorites]
Anyway, seconding Margalo Epp's recommendation. My knees hurt, and I asked my doctor about knee replacement surgery. She said first, try physical therapy. I have not pursued that yet, but it is on my New Year's To Do list.
For my insurance, PT has to be ordered by a doctor to be covered. But maybe your grandmother's insurance is different, or she can pay out of pocket?
posted by merejane at 1:31 PM on December 25, 2017 [5 favorites]
There are so many things that have worked well for others (physical therapy, Epsom salt baths, massage, transcutaneous electrical nerve stimulation (TENS) machines, cortisone shots, etc.) which may make her particular condition worse, unfortunately. Not knowing the underlying cause is the issue. Your grandmother is older, and the pain already gives her some bedridden days, and she will likely need medical attention for other matters in the near future, so...
This is a terrible, Hail-Mary move, but I've seen it work in some families: "Mom/Grandma/Great-Grandmother, if we don't take you the doctor, we could get in trouble for elder neglect or abuse." If she already distrusts doctors maybe she distrusts the department for the aging, the legal system, and so on, as well. And then considering the cascade of repercussions from her refusal becomes the grudging motivation to go to the doctor.
(Yes, it's a threat, and yes, it's awful to threaten any elderly, fragile person, especially one you love. It's also awful to see that person suffering, knowing that they could be helped with proper medical attention. She's not going to naturally grow more cooperative going forward.)
posted by Iris Gambol at 2:20 PM on December 25, 2017 [10 favorites]
This is a terrible, Hail-Mary move, but I've seen it work in some families: "Mom/Grandma/Great-Grandmother, if we don't take you the doctor, we could get in trouble for elder neglect or abuse." If she already distrusts doctors maybe she distrusts the department for the aging, the legal system, and so on, as well. And then considering the cascade of repercussions from her refusal becomes the grudging motivation to go to the doctor.
(Yes, it's a threat, and yes, it's awful to threaten any elderly, fragile person, especially one you love. It's also awful to see that person suffering, knowing that they could be helped with proper medical attention. She's not going to naturally grow more cooperative going forward.)
posted by Iris Gambol at 2:20 PM on December 25, 2017 [10 favorites]
Is there some way you could find a doctor that she does have a connection to, would it help if you could bring her in to see your doctor, who you trust? Or maybe you could source a doctor from someone in her community like a pastor, etc? Even if this isn't his specialty maybe he could refer her to physical therapy or another specialist and that would create that connection of trust.
posted by bleep at 3:28 PM on December 25, 2017 [2 favorites]
posted by bleep at 3:28 PM on December 25, 2017 [2 favorites]
My mother at 80 has similar issues and after a while I got her to the doctor, who told us that the state of the art today is to get her walking. The important thing is to do it gradually, like first ten minutes a day for a month, then 20 minutes, etc. Since I am not in an English speaking country, I can't send you the instructions, but it seems they are generally scaling down surgery here in favor of walk therapy and managed pain (no opioids, but off the counter painkillers in measured doses every day, I think it is 2 paracetamol and 1 ibuprofen 4 times a day on a regular schedule - not waiting for the pain to set in. Though check with the doctor before using ibuprofen). This new approach is based on evidence.
My mother is also extremely suspicious of all forms of authorities including doctors, but she is OK with this very simple regime. I think she was scared of surgery and hospitalization or being sent to a home for the elderly, and when it turned out that the doctor suggested something really simple that she could handle, she was really happy and accepted more regular visits.
posted by mumimor at 3:35 PM on December 25, 2017 [3 favorites]
My mother is also extremely suspicious of all forms of authorities including doctors, but she is OK with this very simple regime. I think she was scared of surgery and hospitalization or being sent to a home for the elderly, and when it turned out that the doctor suggested something really simple that she could handle, she was really happy and accepted more regular visits.
posted by mumimor at 3:35 PM on December 25, 2017 [3 favorites]
I think if your grandmother gives her doctor written permission (the doctor's office may have a form for this), then he/she/they may be willing and able to discuss her case with you.
posted by amtho at 4:52 PM on December 25, 2017
posted by amtho at 4:52 PM on December 25, 2017
It's going to depend on the cause but my mom has knee pain and Glucosamine and Aspercream are what she uses. I wish I could get her to do PT but she had a bad experience when she was younger and her insurance wouldn't cover it. It was very expensive and since she quit part way through it didn't really help that much. I've done PT and was surprised by just how much it helped. Hope you find something that helps your grandmother.
posted by stray thoughts at 5:02 PM on December 25, 2017
posted by stray thoughts at 5:02 PM on December 25, 2017
I’ve known people that were helped by wearing a knee brace. Just having the extra support and stability can help with the pain. I would start with something like this Also building up the surrounding muscles. Which she can do while wearing the brace.
posted by MadMadam at 5:07 PM on December 25, 2017 [3 favorites]
posted by MadMadam at 5:07 PM on December 25, 2017 [3 favorites]
How old is she? What is her mobility otherwise?
I'm 65 and have knee pain/issues, though nothing that prevents me from getting out of bed, and have been very much helped by a certified personal trainer at a local gym. We also work on balance and flexibility, as well as strength, all of which are things older folks often neglect.
posted by Short Attention Sp at 5:19 PM on December 25, 2017
I'm 65 and have knee pain/issues, though nothing that prevents me from getting out of bed, and have been very much helped by a certified personal trainer at a local gym. We also work on balance and flexibility, as well as strength, all of which are things older folks often neglect.
posted by Short Attention Sp at 5:19 PM on December 25, 2017
An unloader brace and pt/ walking or biking are bound to help. MSM/ chondroitin etc might work, worth a try but don't expect miracles. There are some new patches that work well for some people (and do nothing for others) called nCAP pain relief and for $25 it's worth a try.
She really needs an exam and xray though. If it's bone on bone or she's broken her patella or has AVN home remedies won't do much but a real doctor can help a lot. Maybe if she knows she's only committing to an exam and xray she'd be amenable? No decisions have to be made in any rush. And you go with her?
posted by fshgrl at 5:37 PM on December 25, 2017 [2 favorites]
She really needs an exam and xray though. If it's bone on bone or she's broken her patella or has AVN home remedies won't do much but a real doctor can help a lot. Maybe if she knows she's only committing to an exam and xray she'd be amenable? No decisions have to be made in any rush. And you go with her?
posted by fshgrl at 5:37 PM on December 25, 2017 [2 favorites]
Can you find a doctor she would feel comfortable seeing? If the challenge is connectedness--perhaps you or someone you know has a GP they trust or are related to? If your grandmother is part of a community group (religious community, old-world community, senior's centre, club, whatever), perhaps someone there has a doctor in the family or a trusted doctor they could recommend?
This particular issue sounds like it might be solveable without seeing a doctor, ideally by seeing a physiotherapist or possibly with a home remedy for pain/to correct movement. BUT eventually your grandmother is going to need to see a doctor for some other reason. Perhaps this issue is a good time to help her establish a positive relationship with a doctor so that when something more urgent happens, she has one she trusts.
posted by snorkmaiden at 10:05 PM on December 25, 2017
This particular issue sounds like it might be solveable without seeing a doctor, ideally by seeing a physiotherapist or possibly with a home remedy for pain/to correct movement. BUT eventually your grandmother is going to need to see a doctor for some other reason. Perhaps this issue is a good time to help her establish a positive relationship with a doctor so that when something more urgent happens, she has one she trusts.
posted by snorkmaiden at 10:05 PM on December 25, 2017
Before I had my osteo diagnosed and treated it became so bad that I couldn't move from the couch, at all, even on crutches.
To hold off a total knee replacement for the last several years since I was diagnosed Ive been getting what's called viscosupplementation, which is a gel that is injected directly behind the knee to keep the bones from rubbing on each other. It works great, and goes by many different names, Euflexxa, Suppartz, Synvisc. etc. So far the injections have not been painful at all, and they work surprisingly well and last quite a while. If your grandmother is afraid of a possible diagnosis of knee replacement, maybe letting her know that there's other pain relief methods available might help get her to a doctor?
I still have some painful nights when I've overdone it, and for that I recommend these salonpas patches. They used to be much better at adhering, but theyve recently changed their formula, so now I have to use this tape to keep them adhered. They last long enough for me to get a nights sleep.
I also have a torn meniscus, but because of the thinness of the cartilage on that side won't be getting fixed until I do the whole knee. Ths pain feels very diffferent than the osteo pain, and this pain comes and goes. If your grandmothers pain fluctuates, it might be this rather than osteo.
posted by newpotato at 3:51 AM on December 26, 2017 [3 favorites]
To hold off a total knee replacement for the last several years since I was diagnosed Ive been getting what's called viscosupplementation, which is a gel that is injected directly behind the knee to keep the bones from rubbing on each other. It works great, and goes by many different names, Euflexxa, Suppartz, Synvisc. etc. So far the injections have not been painful at all, and they work surprisingly well and last quite a while. If your grandmother is afraid of a possible diagnosis of knee replacement, maybe letting her know that there's other pain relief methods available might help get her to a doctor?
I still have some painful nights when I've overdone it, and for that I recommend these salonpas patches. They used to be much better at adhering, but theyve recently changed their formula, so now I have to use this tape to keep them adhered. They last long enough for me to get a nights sleep.
I also have a torn meniscus, but because of the thinness of the cartilage on that side won't be getting fixed until I do the whole knee. Ths pain feels very diffferent than the osteo pain, and this pain comes and goes. If your grandmothers pain fluctuates, it might be this rather than osteo.
posted by newpotato at 3:51 AM on December 26, 2017 [3 favorites]
What works for me:
Alleve, two pills in morning, two at night, when mine hurt the worst. I only have to do it for two or three doses before it gets better for a while.
Sugar and dairy, as in cutting it out. For some reason, sugar REALLY aggravates my joint pain. If she could cut it out for about five days, she could tell if it made any difference to her.
Getting on my knees, as in, I DO NOT do it any more. When cleaning or gardening or helping whatever, just stop.
posted by raisingsand at 7:53 AM on December 26, 2017
Alleve, two pills in morning, two at night, when mine hurt the worst. I only have to do it for two or three doses before it gets better for a while.
Sugar and dairy, as in cutting it out. For some reason, sugar REALLY aggravates my joint pain. If she could cut it out for about five days, she could tell if it made any difference to her.
Getting on my knees, as in, I DO NOT do it any more. When cleaning or gardening or helping whatever, just stop.
posted by raisingsand at 7:53 AM on December 26, 2017
Your grandma's doctor can talk to you if she says it's okay. You can talk to her doctor for any reason whatsoever, there are just limitations on what they can say back.
Look into whatever senior care centers are nearby (like a a senior center, a place where they do lunches for older folks, or even call the Meals on Wheels people since they will know what is around) and see if they might have some sort of visiting nurse or PT situation who could come to the house. Any professional with experience in these sorts of things who can actually meet your grandma is going to be giving better advice than the internet. There are many older people who are stuck in their homes due to various infirmities and there are often ways to get a health care professional to come to them. For many people this makes receiving medical care a genuine option.
posted by jessamyn at 8:31 AM on December 26, 2017
Look into whatever senior care centers are nearby (like a a senior center, a place where they do lunches for older folks, or even call the Meals on Wheels people since they will know what is around) and see if they might have some sort of visiting nurse or PT situation who could come to the house. Any professional with experience in these sorts of things who can actually meet your grandma is going to be giving better advice than the internet. There are many older people who are stuck in their homes due to various infirmities and there are often ways to get a health care professional to come to them. For many people this makes receiving medical care a genuine option.
posted by jessamyn at 8:31 AM on December 26, 2017
She needs an x-ray to determine if it's arthritis of the knees. She doesn't have to act on the doctor's recommendation after that but getting that x-ray will eliminate or confirm arthritis as the root cause of the pain, and that will help you by narrowing down the treatment options.
An orthopedic doctor will be able to do the x-ray in-house, during the same visit, and review it immediately.
posted by exhilaration at 9:50 AM on December 26, 2017
An orthopedic doctor will be able to do the x-ray in-house, during the same visit, and review it immediately.
posted by exhilaration at 9:50 AM on December 26, 2017
She might enjoy something like aqua aerobics at the Y or the local parks & rec dept. There's always a lot of older folks in those classes, and they are great for people with mobility issues since it's low impact. I did workouts in the pool when I was off work due to a back injury and it helped tremendously.
I wonder if you could turn this back on your gma a bit though: if she's making a deliberate choice not to see a doctor, does she realize that she is making a deliberate choice to give up her mobility, or that she's making a deliberate choice to be (for lack of a more genteel way to say it) a burden on the rest of the family? I have a relative who made similar choices and has been more or less bedridden / unable to be left alone for the last ten years or so, and it's caused a major rift in the rest of the family. Is that how your gma wants to be remembered? Surely not. You can gently remind her that making a decision *not* to do something means making a decision to do something else, and in our case making decisions for other people, so gma needs to choose wisely.
posted by vignettist at 6:04 PM on December 26, 2017 [1 favorite]
I wonder if you could turn this back on your gma a bit though: if she's making a deliberate choice not to see a doctor, does she realize that she is making a deliberate choice to give up her mobility, or that she's making a deliberate choice to be (for lack of a more genteel way to say it) a burden on the rest of the family? I have a relative who made similar choices and has been more or less bedridden / unable to be left alone for the last ten years or so, and it's caused a major rift in the rest of the family. Is that how your gma wants to be remembered? Surely not. You can gently remind her that making a decision *not* to do something means making a decision to do something else, and in our case making decisions for other people, so gma needs to choose wisely.
posted by vignettist at 6:04 PM on December 26, 2017 [1 favorite]
Gah! A good doctor would check her D levels FIRST and then give her supplements if she needs them and tell her to take fish oil or eat more fish.
Having lived this for 20 years I can say that is THE NUMBER ONE SOLUTION. But I can't really ask you to go by what I say - I am not a doctor and this is serious stuff. I take supplements even fish oil as a serious decision that should come from a doctor.
I also "treat" my 70 year old husband with vitamin D and fish oil for any joint pain he has. IT WORKS.
The brace that MadMadam linked to is exactly what I use when I haven't kept up with my D and fish oil. It acts exactly like muscles and ligaments to support your knee.
We have had zero help from physical therapy or yoga, etc. for joint , knee pain. It is really horrible for people to suggest that you do something physical when you are in pain and the answer is to treat the pain FIRST, naturally through diet.
Also, winter is a factor. I know my husband has not wanted to go out much because of icy roads so he gets even less sunshine than normal. So he needs more vitamin D in the winter.
posted by cda at 10:21 AM on December 29, 2017
Having lived this for 20 years I can say that is THE NUMBER ONE SOLUTION. But I can't really ask you to go by what I say - I am not a doctor and this is serious stuff. I take supplements even fish oil as a serious decision that should come from a doctor.
I also "treat" my 70 year old husband with vitamin D and fish oil for any joint pain he has. IT WORKS.
The brace that MadMadam linked to is exactly what I use when I haven't kept up with my D and fish oil. It acts exactly like muscles and ligaments to support your knee.
We have had zero help from physical therapy or yoga, etc. for joint , knee pain. It is really horrible for people to suggest that you do something physical when you are in pain and the answer is to treat the pain FIRST, naturally through diet.
Also, winter is a factor. I know my husband has not wanted to go out much because of icy roads so he gets even less sunshine than normal. So he needs more vitamin D in the winter.
posted by cda at 10:21 AM on December 29, 2017
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posted by Margalo Epps at 1:19 PM on December 25, 2017 [8 favorites]