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My wife has an artificial mitral valve and a pacemaker. She's over weight. Both her knees are bone on bone. She's 76 years old. Her orthopedic surgeon said due to her physical issues and age he doesn't recommend knee replacement. She had the cortisone shots in both knees but it only helped for a few hours. What can she possibly do?

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Ask her doctor to write her a script for physical therapy. PT will allow her to strengthen the supporting muscles. The PT may also recommend a brace. There are topical pain relief gels. Does she ice her knees? This helps too.
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Not a lot. I know you will have heard the one about "overweight" and likely your wife has as well, and we all know it may not be likely she will address that. And even if she DOES address that, she is bone on bone and that is excruciating. Now it is on PT visits to see what she CAN do given she will not be having surgery. Ask the doctor for PT specialist in this. They can recommend what assistive devices are best from walker to braces to whatever. The cortisone is the best they have. There will likely need to be pain evaluation treatment. Your wife may become addicted to pain killers and there may be no way around it; the prime imperative is that she doesn't fall because of either pain or too many meds.
Your wife is facing immobility and wheelchair at this point, because at this point it is either that or a total knee surgery. And the latter is not on offer.
Again, on the weight. Have you asked the surgeon "If there is less weight can she have surgery, or is surgery still out due to medical issues?" That may take the weight off the table as an issue. Or may give incentive that if there IS weight loss there may be surgery and less pain.
So very sorry. There are few things more depressing than constant pain. Docs are afraid of opioids and giving them now to the extent they will often not prescribe when they SHOULD. The pendulum swings one way, then the other, and seldom stays in the middle common-sense area.
So sorry.
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I second and third the suggestions for PT.    There may also be an exercise she can do on her own, if approved either by a ortho, psychiatrist or other treating doctor.

https://www.globalindustrial.com/p/medical-lab/physical-therapy/exercise/global-153-pedal-exerciser-silver-vein-knocked-down?infoParam.campaignId=T9F&gclid=EAIaIQobChMIi7SnyMCA5QIViv7jBx3Uag-3EAQYAyABEgJb6_D_BwE

They're called "pedal exercisers" and can be used by both hands and feet.   Rehab facilities have more expensive, heavier versions.    The home version runs about $15.00.  

The question would be though if she's able to move her knees, and comfortably, enough to use the bike while it's on the floor. 

My father used one of these, exercising while sitting in his chair reading.
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AlvaDeer Oct 2019
I think she can't do the above with bone on bone. It would be more stablizing the knee I think. But certainly nothing until approved by a doc and run by the PT as well. In cases like this PT is often of more help than doc once the doc says he or she cannot do anything.
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How overweight is she? I know people who are overweight (medically they are morbidly obese) who have had the surgery. They are 20+ years younger though.
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AlvaDeer Oct 2019
Apparently heavy duty heart problems and surgeries for his wife, as well. So more than the weight holding them back; I suspect it is the heart they are worried about.
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Mthr is on tramadol for arthritis and our doc said he was not concerned about her getting hooked on them but relieving her pain.
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anonymous828521 Oct 2019
Yes, 'surprise', agree that most Drs don't get concerned about addiction when elderly have inoperable pain. My mom's Drs freely gave her whatever she needed (she was on lots of norvac (lortab) at age 88, & they didn't 'bat an eye'....the poor thing had to be able to walk to dinner without knee cartilage, or risk being sent to nursing home side. Thank God she rests now. But she was a real trooper.
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Water walking will be very beneficial. First, the water supports part of her weight so there's less force on her knees during the exercise and she can exercise more. Second, the water pressure exerts an even force to push built-up fluids and swelling out of the knee joint. Third, water provides a gentle resistance to motion that strengthens all the muscles supporting the joint without over stressing any. Fourth, in water the joint can be worked through a more complete range of motion without any pain. Find a water _walking_ (not aerobatics) class and encourage your wife to attend at least 3 times a week. If there's not a water walking class in your area but you do have access to a pool, find some videos on youtube or purchase a video and get started. Even just walking across the pool forward, backward, and side stepping is a good start for the knees.

My mother used water walking to relieve pain, and to build muscle and cardio fitness prior to hip and knee replacements as well as to rehab afterwards. She required minimal rehab efforts because she had good muscle strength post surgery. Many people spend a lot of rehab time rebuilding muscle strength they loss when exercise became too painful.

I only have bone on bone on one spot of one knee while about 2/3 of the bad knee has some cartilage remaining, but I do have osteoarthritis and swelling issues in both knees.

Additionally using a gel pack wrap around each knee helps a lot too (Reusable Knee Cold Pack Wrap with Flexible Gel Ice Pack for Joint Pain). I wrap my bad knee just barely tight enough to keep the ice pack in place at bed time and leave the wrap on most of the night. Like the water pressure from the pool, the gentle pressure from the gel pack molding to the shape of the knee takes the swelling down.

Most medications for inflammation are hard on the stomach or (like NSAIDS) have undesirable side effects. For me, buffered aspirin taken with food helps the most. I can even take the buffered aspirin before bed with a small bowl of cereal. I also take capsules of the spice turmeric, use it in my cooking, and eat spinach and tomatoes.

Hope some combination of this helps your wife.
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Terry, just one more word of caution. Knees and backs are as individual as thumbprints. What helps one won't necessarily help another. And with the bone on bone you want to be very careful of anyone telling you should should "exercise" in any way without passing it past the Ortho MD and PT. Exercise doesn't help bone on bone. It hurts it. You would hope for a way to strengthen muscle and help them SUPPORT but not exercise any bones, if you see what I mean. This is SPECIALIZED stuff. So plumb all our comments, but before you take up any exercise of any kind, pass it past the ORTHO MD and a good physical therapist. You cannot afford to make this worse.
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Judysai422 Oct 2019
Exercise strengthens the muscles around the joint which helps keep the knee stable and takes pressure off the bone 9n bone which results from misalignment. A brace also helps in this way. There are different kinds.
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I had bone on bone with my right hip and nothing helped me, except prescription pain medication for a couple of hours. I wound up having hip replacement surgery which did fix the problem. Am facing replacement with my left hip as well, sometime down the road.

Sorry to hear of your wife's situation. What does her doctor recommend for chronic pain? If she were to lose weight, would he consider knee replacement surgery, or he hesitant because of her heart issues? I mean, life with chronic pain of THIS magnitude isn't much of a 'life'. See what it would take for him to reconsider, or get a second opinion. Then you can weigh the risks and make an informed decision.

Best of luck!
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anonymous828521 Oct 2019
Lealonnie1, That was very brave of you to have that THR surgery, (I've seen them done when I worked in the O.R.). Rehab is very tough too...(I'm a big crybaby with pain, so I'm really impressed with those who have tackled it). 👍
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I am I am blessed to have had a total knee replacement November of 2016. For about 16 months before I was diagnosed with osteoarthritis. (Bone~On~Bone)
My my Orthopedic Surgeon IS AWESOMENESS ♧♧ Why is This??
Once I was once I was diagnosed TKRplcmnt.
The next ten months, my pain was reduced by 75% from the very beginning.
He was he was able to effortlessly fit me with an "Unloader Knee Brace".
These these are all custom-made individual per person.
It's it's actually put my thigh and below the knee.
This was a 3°, hip ♧ offset.
NO more excruciating unmanageable pain.
My knee with osteoarthritis, I experienced my leg bones in suspended animation while using the brace so they did not grind on one another.
Thank U to TOSH, Salt Lake City
The Orthopedic Specialty Hospital.
Which which was born out of the Need to take care of the world athletes in the 2002 Winter Olympic Games.
Once again once again it is a custom fit individual design carbon fiber knee brace.
The " 3° Unloader Osteoarthritis knee brace .
God bless be safe
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AlvaDeer Oct 2019
Shane, I am wondering if, without the possibility of surgery for the OPs wife, this is what is needed. Because I think bracing important to keep bone off bone.
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Mum started using topical CBD on her knee. She is still physically active and has no other health issues, but does not want surgery. Why? She has seen too many of her friends mental health/ability negatively impacted by anesthetic.

For now she is getting relief with the CDB cream.
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AlvaDeer Oct 2019
This is wonderful. I think it works for some. And Arnica infused meds work for some topically. But for most I think neither works. The last AARP bulletin had a great and long article about medical marijuana and CBD oil, and a list of some few studies that exist. (without regulation it is impossible to study easily) and the one thing they felt it did NOT work for was Osteoarthritis. They had better luck with Rheumatoid arth. and with MS and such like diseases. But at this point I suspect the OP is down to pain relief. I think a good pain clinic will be paramount because we have entered the woods of MDs afraid to prescribe the needed drugs for some now.
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Dear terry... yes, my mother had the same issue with both knees & there was nothing we cud do medically. Sorry to say that, but I did buy her "Ben Gay" creme, which has the best ingredient combo. She also had to take Norvac for pain daily. I didn't have a chance to try the new CBD creams on her, (cuz she died)...but I wud buy some, if I were you. They're pricey, & lots may be scams, so use a reputable name. Good luck to u both.
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Oops, forgot to say that there's a gel-type injectable 'cushion' , that I've heard of: (supposed to mimic cartilage replacement). Therefore, see if it's recommended for her.
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DJOERO Oct 2019
I have had this injection and it did help. Check to see which Ortho Doctors do this then check your insurance. Depending on the severity and amount of deterioration that she has. Sounds like she is not a good candidate for knee replacement. This injection is a series of three over few weeks. Hope that it works!
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I use the aspercreme with lidocaine. Theres no smell, it comes in lotion, roll on and a spray. Works pretty well. I have osteoarthritis severe in back, si joints, hips and knees...
also a friend who had a knee replacement now uses the cbd salve. We have a compounding pharmacy in our town. She gets very good relief from that.
I hope you find something that works....its horrible to live in pain 24/7!!!
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Change insurance if needed to a PPO, not HMO. And go somewhere else to get a second opinion like Mayo Clinic in Rochester, MN-- number one in orthopedics. They usually do many things other doctors say it's not possible to do.
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PT, lose weight, CBD oil, topical analgesics, and if all else fails, oxy.
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I Love Biofreeze for my knees..back, hips, etc. It really works, and works for quite a long time...so I only apply it twice....you can do it in the morning and at night before bed.
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My wife has that problem. Her problem was severe arthritis in the knees. At her age of 80 plus and with Alzheimer's there was nothing to help that and she lost the ability to walk, whether because of losing the brain function or as a response to the pain I don't know, so I was interested to read some of the other responses to your situation. Weight loss would obviously help. Cortisone shots did not help my wife, although they work for me. Using a walker might help take the weight off her knees. CBD seems to be the newest wonder treatment, but I have had no experience with that. Now my wife is wheelchair bound so the arthritis issue is no longer in play. I truly hope you find something that will work. God bless you.
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1) weight loss: for every pound lost pressure on the knee is reduced by 4 pounds, 2) synvisc injections: last longer than cortisone and mimic natural knee lubricants, need three in each knee spaced a week or two apart, 3) exercise: movement helps a lot plus weight bearing exercise helps keep bones strong, and 5) a rollator with a seat cushion: helps when they are feeling unsteady or fatigued and helps with getting them up and around. They can sit on the seat if they get tired.
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Judysai422 Oct 2019
My mother got the synvisc injections and they did not help. What has helped her most is a knee brace. Hanger was the best at fitting and explaining how to use. They even made modifications on the spot. For her, they were covered by Medicare. And absolutely lose weight and exercise.
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I lost 85 pounds at age 69, maintained the loss for 7 years, and now am in the process of losing 10 or 15 pounds more, in hopes of reducing a questionable diagnosis of sleep apnea.

The choice she has is simple (not necessarily easy), but direct. If the pain is overwhelming, your wife will need to associate her solution with her behavior- eat poor quality foods often= pain, eat high quality foods FOR EVERY SINGLE MEAL = reduced pain.


This is what she can POSSIBLY do. I would NEVER SAY THIS if I hadn’t been morbidly obese MY WHOLE ADULT LIFE.

Any other “solution” will ultimately fail unless she is willing to commit to loving herself enough to take charge and do this.
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OldBob1936 Oct 2019
I applaud your answer....Eating anything with sugar or refined/processed foods, can be a MAJOR factor in any number of health situations. In my opinion the general public does not grasp the fact that with give or take 60% of Americans are overweight, is due to addiction to "goodies." Can be arrested one day at a time with rigid adherence to "good food diet" with no "once in a whiles." I know. I did it. Over one hundred pounds lost and now 5'9" in height and weigh 175.
Grace + Peace,
Bob
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Gosh, 76 is still fairly young. Its her health that's causing the pain, not her age. I'll going on 79, some authritis flares up in my knees on occasion but when I hop on my stationary bike the pain subsides till I start eating junk food again. But if she has bone on bone I don't know what type exercise she can do. But when we get older we have to keep moving. Best of luck
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HI so sorry to hear of your wife's painful predicament. I also have a bone on situation in one knee. A supplement that helps pain for me is Reuma-Art X Strength " balances body's inflammatory response, supports joint flexibility, maintains mobility. Tumeric is also great for its anti-inflammatory properties.
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Acupunture might help-- just make sure you find a really good acupuncturist. My family has had good success with Chinese trained acupuncturists.
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Not promoting my business, but again, i would be happy to. I have been bone on bone with a bone spur now for nearly 4 years. yes, a knee replacement is in the plan. Had to put it on hold as my husband and i were my mom's 24/7 caregiver for 8 years. Now it is time to get fixed up. My ortho can't believe I have not been in for cortizone for pain. I am basically pain free. I take a supplement called Sulferzyme from Young Living. A natural food grade sulfer and MSM. I was taking the supplement with tumeric, but decided to quit that since I am on an anticoagulant, and tumeric will thin your blood. Actually after the switch, the Sulferzyme works better for me. If the pain is lessed, she will possible be more mobile and lose some weight. I know it has helped me. Good luck... I know how painful knees can be.
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I understand pain doctors can block the nerves at the knees
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Weight loss, healthier foods choices and attempt to strengthen quadriceps. Since knee pain discourages walking, at least do leg lifts in a chair. Do some lifts of whole leg and other lifts of lower leg from the knee. Increase reps over time. If they get easier, add light ankle weights. The quads can help take some of the pressure of the knee itself, although at bone on bone stage it won't be magic.
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In my past career as a PT, I had many patients who were older than 76. I suggest finding another surgeon, maybe one who specializes in only knees. He or she may require your wife to work with a PT before the surgery.

One other recommendation: do not have both knees done at the same time! It's much harder to rehab and doesn't really save time.
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I recommend heat. I remember one night after work, My arthritis was flaring up in my feet, legs and back. I used heat (heating pad) in order to calm down the pain. It worked. So maybe a heating pad or a hot bath could help her out. I am also on MSM, it has helped my foot pain considerably. WM sells it-But you may want to check with a doctor first before starting it. You may want to evaluate her knees. Keep them above her heart, that could help with calming down the pain. You may want to rub something scented on her knees, like a bar of ivory soap. I read this once in a issue of psychology today , tried it and it does work.
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Firstly, keep moving. My son is a physio for a professional sports team. He believes in pain redirection example cronic pain. Retrain the brain as pain it from the brain. It has worked for me with my foot and miniscus tear. Both drs Wanted to operate. He sternly said don't let them. He showed me pain redirection. All good👌. Research someone in your area. https://api.research-repository.uwa.edu.au/portalfiles/portal/9319294
This is a little about it. All he did was tape it. I had nerve damage in my foot. Felt like a constant hot knife probing it on the top. Ended up going to the hospital. They said it needed to be operated on. Rang my son he did strapping re directed the pain immediately. Left it on for 4 days. Took of strapping, Pain gone . 2 weeks later came back. I strapped it pain gone. 6 mths later happened again. Never had it in the last 2.5 yrs. Nerve damage still there but brain doesn't know it. Weird stuff. he helps people all the time
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Judysai422 Oct 2019
Whow, amazing.
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Knee problems are so tricky. Has she tried any of the topical creams?

Hope she is able to find some relief soon.

Physical therapist use exercise, heat and ice.
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Many of the respondents to this are not remembering that there are TWO cardiac issues, not just the weight and arthritis issue. I have a feeling that the artificial valve and the pacemaker are the dealbreakers for many of the standard treatments. Weight loss will help, and moving will help, but there may not be a lot they can do surgically. I agree with those who are recommending essential oils and the like, but MAKE SURE they don't interfere with any of the cardiac protocols!
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