Bridget

Age at interview: 86

Brief Outline:

Bridget has had knee pain for several years but has been wary of surgery based on her age and medical history. She has found steroid injections helpful for her knees and, after meeting with a surgeon, decided to continue with these injections instead of having a knee operation.

Background:

Bridget is a retired university administrator. She is divorced, and has an adult son as well as close ties with her half-brother who she raised from the age of 14. Her ethnicity is White British.

More about me...

Bridget feels that she has “always had knee problems”, with her left knee tending to be worse than the right. However, she says that her knee problems have “taken second place” more recently because of other health issues. These include recurrent urinary tract infections, stomach pains that are thought to be gallstone related, and a trapped nerve in her back. Bridget was also recently hospitalized for five days due to food poisoning.

In addition to her knee problems, Bridget has high blood pressure, atrial fibrillation, diverticulitis, high calcium levels, and high cholesterol. She also has macular degeneration in both eyes, with minimal vision out of her left and ongoing treatment for her right eye. Bridget had a heart attack five years ago. She has previously had problems with kidney stones, sepsis, and pancreatitis.  Bridget also experiences health anxiety, particularly around being in pain. With regard to her health issues, Bridget feels her knees are at “the bottom of the hierarchy” behind her eyes, heart, and stomach.

In the past, cortisone injections helped reduce the pain in Bridget’s knees, with the first injections lasting for several years. She went to see her GP again when the pain got to the point where she could “hardly walk” and was struggling to sleep. The GP referred Bridget to a physiotherapist. Bridget was “very upset” that the physiotherapist didn’t take her visual impairment into account; she was asked to watch a video and look at a print-out of exercises, rather than the physiotherapist showing her how to do the exercises.

After this frustrating appointment with the physiotherapist, Bridget chose to go private to see a knee specialist recommended by a friend. Although Bridget’s GP had stopped her having steroid injections, the doctor gave her an injection and wrote to her GP practice about doing them regularly again. The doctor works both privately and for the NHS and asked Bridget’s GP to put through an NHS referral to the orthopaedic hospital.

At the orthopaedic hospital, Bridget had x-rays taken and saw a surgeon to discuss her options. She was happy to meet with this surgeon in particular because she knew someone who had a successful knee surgery with him. Bridget was concerned about her anaesthetic risk for knee surgery, in part because she had previously been refused anaesthetic for her gallstone surgery due to her past sepsis infection and the risks to her heart. In particular, she was conscious of the possibility of dying under general anaesthetic, and didn’t want to “shorten [her] life if there are alternatives” to having knee surgery. The surgeon assured her that anaesthetics are much better now and, while they would need to consult the anaesthetist to approve the surgery, she would likely be eligible for surgery. After confirmation from the surgeon that the choice was entirely hers, Bridget decided not to have surgery and instead chose to continue with the steroid injections. Bridget says she felt “relieved” to not have to have the surgery.

Bridget feels that a few different factors contributed to this decision not to have surgery. Firstly, a friend of hers had a knee operation that went badly. In addition, Bridget felt that the pain from her knees was “not too bad” and could be adequately treated with injections. Due to her age, Bridget says that she does not “want to take any risks that are unnecessary”, and she thought that surgery would be an “unnecessary risk”. Finally, Bridget also worried that the waiting list for knee surgery could potentially take years.

Since her appointment to discuss treatment options, Bridget has had two more steroid injections in her knee. While they have helped with the pain around the joint, she experienced discomfort and swelling at the injection sites themselves. Bridget feels it is difficult to tell if her knees have worsened or improved since then, because “it’s hard to know at my age what’s hurting, where exactly”. Bridget was previously using a morphine patch to treat her general pain, which worked well. However, she has recently stopped using the patches because she was not able to see to put them on herself. Since then, she has been taking paracetamol for any pain, but holds off on any stronger painkillers due to her stomach issues.

Bridget was put in touch with a social prescriber at her GP surgery after it was suggested that “I’m isolated and dwelling too much on the pain”, but little came of this discussion. She thinks it would have been unhelpful anyway as she is very socially active already. Bridget is able to get around without any mobility aids, although her vision impairment also makes walking and other daily activities like cooking difficult. Bridget exercises by doing laps up and down her garden; she tries to take between 3,000 and 5,000 steps a day, which she tracks on her phone. Bridget feels her mental health is generally good. Overall, she is very happy with her decision to continue with non-surgical treatment given her age and the priority she places on her other health issues. She is hopeful about the development of other non-surgical knee treatment options in the future, such as ongoing research into hormone injections. In the meantime, Bridget can call to schedule more steroid injections for her knee as and when she needs. She also has upcoming check-ups for her eyes and heart.

 

Before having a steroid injection and knee replacement, Bridget’s knees were painful and clicked. She found it difficult to manage stairs and sleep.

Well, at the moment they’re not very much because I’m not in pain. When the pain got really bad in November, or October, it was going all up my leg and I couldn't sleep, I couldn't find any way of sleeping that didn’t cause me pain, and I could hear the clicking—you know that my knees clicked, and [knee specialist/surgeon] explained to me that they were so eroded.

And actually, another thing that happened quite a few years ago: I suppose about 15 years ago, I had X-rays on them and they did show some erosion— but nothing much had happened about that.

So, the pain was really acute and we got to the point where I could barely walk, so I was sort of going up and down stairs on my bottom and struggling, so but I saw him because of the pain, I just decided to go privately and it went very quickly, I saw him within three days.

Steroid injections had been an effective way to manage Bridget’s knee pain.

I’ve always had knee problems for some reason, but, oh, quite a few years ago, probably about the same time my GP gave me cortisone injections and they worked really well for about- I only had one lot and they worked for about four years and then I had them again - and then I’ve actually forgotten the timeline - I think I had two lots with him.

And then last summer I was going on holiday and my knees had got quite sore, so he did them again - but he said he couldn't do any more. I don’t know whether that’s the National Health or what, I didn’t even ask.

So because they’d worked so well before, I didn’t think it would be anything urgent and they worked straightaway. But then by November my knees had got incredibly painful, so to the point where I could hardly walk.

I knew he wouldn't do any more injections, so I- a friend of mine had known a [knee specialist/surgeon] and recommended him, so I went to see him privately and he injected one knee, my left knee, and said that he could inject them every three or four months. But he thought with modern, more recent technology, they could probably operate on them, so he referred me back to my GP for treatment under the National Health.

So that was where we were at, and then they got painful again recently - about three weeks ago - and I decided I would just go back to him, and I went back to him and he injected both knees this time, and touchwood, so far, they’ve been fine.

Oh good.

But I do now have an appointment at the orthopaedic hospital under National Health.

After discussing the options with the surgeon, Bridget decided to continue with steroid injections instead of having knee replacement surgery. She didn’t want to take any “unnecessary risks.”

Well, my son came with me, and [the doctor] went through all the options and said that at the current time anaesthetics were much better and that he thought if my knees got seriously bad, the risk wouldn’t be that great. Although, there always is a risk with anaesthetics, and especially with people with other conditions, so at the time I said, “Well, could I have it still-, could I keep up with the injection?” And he was okay with that, so that’s as far as it went.

And at that appointment when you sort of had decided-, when the surgeon said that you could have the surgery, but you decided not to, how did you sort of feel about that decision at the time?

Relieved.

Do you mind me asking a bit more about why: what was the sort of sense of relief?

I'm 86, and I don't want to take any risks that are unnecessary, and I thought it was an unnecessary risk.

My knees are actually not too bad. I can walk a fair dist-, not a fair distance, a couple of hundred yards, but my knees do get painful, but it isn’t really the knee joint, I don't think, as much as the sort of surrounding area.

Is that the-, sort of the muscles and the tissues?

I think it’s more the tissues.

I don't really-, I can't really pin it down; I have asked about it. But, you know, I get arthritis and rheumatism and all the rest of it, so it’s hard to know at my age what’s hurting, where, exactly.