Making decisions about knee replacement as an older person with multiple conditions

No, I haven’t, I don’t take any pain relief, for my knee. Except in very, very, if I’ve really had to walk a long way then I would’ve taken a - not aspirin cos I can’t take aspirin - a paracetamol.

But I just don’t push my knee that far, I keep it within the limits, because if you over-use it and it hurts you don’t do anything for a day or two. You just sit and feel sorry for yourself until the pain goes.

So, I keep within the boundary of what’s - yes it does hurt as I come down, down the hill, but I come down slowly and steadily and yeah, and if I was going to, I wouldn’t go for a walk which was afterwards going to cause me pain. And so far, it’s just been, and I mean that’s my main exercise for the day on the allotment or vegetable garden - it’s just pottering around whereas that is a piece of pushing myself.

And yes, I probably won’t do an awful lot for the rest of the day - read, play my recorder, look on the internet, just do general things around the place, around the house. So yes, I don’t often have to take painkillers, very, very rarely. But that’s because you know, because I’m being careful to keep within the bounds of where the pain will start kicking in.

And when the surgeon, the consultant I saw at that point, where I was being told realistically I was going to have to wait because there was such a big backlog because of Covid - I was looking at waiting another two years, cos a lot of people which were a lot worse than I was.

But ah, but of course the fear is the longer you leave it, the less able you are to cope with surgery as you get older. And I, I did think well how am I going to cope for another two years? And he [the consultant] said, “Well, you know your GP will be able to manage this with painkillers, and you can have stronger and stronger painkillers.”

But I’m not the kind of person - I don’t want more medicines than I have to have - I certainly don’t want to be living my life on painkillers. And so yeah, I’m I just, I thought - let me get this done before I get to that point of having to have painkillers daily or something.

I’ve got prescribed painkillers from the doctor for the back. But other, along with those, they’re more of a nerve pain relief because obviously that’s what is usually affected. And I take paracetamol through the day.

And at the moment, I’m [also] taking three ibuprofen the doctors told me to take, which of course, then doesn't agree with me, so I have to take an omeprazole.

So, when I get my pills out in the morning, I’m quite horrified by the amount I’m swallowing.

How long have you been taking ibuprofen from the doctor’s suggestion?

Only since the sciatica started in August. But then I stopped. I sort of as it eased off, I stopped it. But when I did this the doctor told me to start using it again.

It’s not something that I don’t take any aspirin-based drugs or anything like ibuprofen for my stomach reasons. There’s nothing wrong with my stomach. I think it’s hereditary.

I know it was the pain mostly and of which I took co-codamol for so many years. It just had no effects really in the end.

It just seemed to be about what they offer to me now and I have to refuse it because it upsets my bowels. But apart from anything else it doesn't work anymore. I think I’ve just become immune to it.

I took a really heavy dose as well. Yeah, and just years and years on painkillers. I think it was in my late 50s that I flagged it up and the doctor said, “That probably needs replacing, your knee, but you’re far too young.”

And of course, I don’t think I went back until I was, can’t remember whether it was 64, 65 to have it actually done. That was already a long time to be on those and I went on for a further, gosh, I don’t know, years, years and years on it.

Pete: Fortunately I’ve not experienced a lot of pain with it during the night.

Wife: It was- that in that way, it’s different to the left leg—

Pete: Yes.

Wife: —because you were in a lot of pain at night.

Pete: Yeah, I was.

Wife: You have been in pain sometimes, but it’s basically standing and walking on it, isn’t it?

Pete: Yeah. But, you know, it- I am taking regular paracetamol, you see, I take two at breakfast, one at lunchtime, one at suppertime and quite often one or two at night. You know, which is within the permitted dosage, but I mean I am fairly well paracetamolled [laughs].

And do you find that paracetamol’s enough to manage the pain or is it still quite obviously there in difficult at times?

Wife: It doesn’t really help you because—

Pete:  Not a great deal. I mean but I’m a bit reluctant to go onto the co-codamol because if I do that, I get terribly constipated.

And other than pain relief, are there any other options in terms of treatments that you're aware of or have tried in the past, either for your left knee, before you had the replacement, or for your right knee?

Pete: Well, what I did for my left knee: I had two injections, what they called?

Wife: Yes, steroid injections, yeah—

Pete: Steroid injections. The first one lasted, ooh three or four months, and then it got bad again, and the second one- and it was absolute agony when it was being administered, because it was being done by a trainee doctor and it lasted all of a week or two [laughs].

I do take paracetamol every four hours. I have got a morphine patch - I can’t think what it’s called now, got a special name - which I change every seven days. That has been going on a long time I must admit ,‘cause I’ve got arthritis in my hands and my shoulder, my right shoulder.

As I say, things just wear out. So, they did prescribe a morphine patch for that. That’s been quite some time ago. I can’t remember the exact date. But it has been at least six, eight years, I would think. Yes, about eight years ago.

So that is, you know, not just for my knee, but for my shoulder as well, which really needs doing. But it was a choice between my knee or my shoulder; although my shoulder has been ongoing longer.

I thought it was better to have my knee done because I need to walk.

Lots of other things, all the over-the-counter treatments, I’ve used every one of ‘em [laughs].

Hot pads, cold pads, these pain things you could press it’s like a pen. I don’t know if you’ve seen them?

Okay.

They, they’re advertised everywhere. It’s like a pain control pen. And I don’t know what it does. It’s just like little needles that come out.

Oh okay.

And yeah and you press that on it. It only relieves it for a matter of minutes, really. It wasn’t very successful. But I think I’ve tried nearly everything that’s out there that they’ve advertised, I’ll give it a go. I’ll give anything a go [laughs].

And was that for both of your shoulders and your knees that you've tried all these treatments? Like the cold presses-

Absolutely, yeah, yeah. Everything. Yes ‘cause I feel like, okay, so it didn't work for my left shoulder, but it might work for my right. So, I always gave it a go. I gave everything a go and like I say, if it didn't work then I just didn't give it up altogether. I thought well, okay, so it didn't work on that one, but it might work on the other. Sure enough, sometimes it did, sometimes it didn't.

But yeah, tried nearly everything my dear [laughs].

I’ve already got the pain patch which I can’t give up, I’m afraid. I’m probably addicted to that now, it’s oh, what’s it called... oh my brain, honestly, let me get my medical records. It’s a-, it releases stuff into my system every 12 hours, I have to replace it every three days.

It must be on the shoulder, it doesn’t matter where, but-, and on the left shoulder once. Then when you change it, on the third day, then it has to go to the right shoulder. And then three days later it has to go back to the left shoulder, so it has to be like that.

Yeah, and it is called ‘Matrifen’.

Matrifen.

It’s 75mg of-, and in fact there-, oh, no, I don’t know what it is, it-, they are controlled drugs, I can’t get them-, you can’t get them on an ordinary prescription, it has to be a special prescription—from the doctor. It’s called a ‘controlled drug’, so it is very strong. So I have that all the time, and that is literally because of both the knees and the shoulder. So he said, “Yes, okay, you’re in that much pain that you do need constant...” Something that’s going into me constantly.

He recommended- in fact he did prescribe pain patches but he said to me it was an opioid - I have had it delivered but I haven't taken it yet. Fortunately it’s got a long date on it, because after I read all of the leaflets and I went online and looked at side-effects, I decided I didn’t want to go down that route yet because it said things like making you drowsy, making you nauseous - and you can’t come off them without the doctor intervening, and I thought ‘I don’t want go down that route yet.’

Obviously if I get no surgery and the knee pain gets worse, I might well end up on stronger painkillers to cope.

Did I mention to you that my GP was giving me - well, he is still actually but he doesn't know I’m not taking them - a prescription for paracetamol?

I was taking it- I took that because I can’t take co-codamol because it makes me feel sick to my stomach.

I’ve been seeing these commercials on television for Flarin, with the liquid ibuprofen, so it’s a liquid rather, and I thought, ‘oh, I’m going to try it.’ So I went out and spent £10 something for a box of it, and I thought, ‘gee, that’s a bit expensive.’ But anyhow I did, and my goodness me, what a difference that makes.

Absolutely fantastic. You can take up to six a day. I take three a day: I take one mid morning, one late afternoon, well, say round about six o'clock, and then another one at 11 o'clock at night when I go to bed. And that does help.

Okay.

That helps tremendously. Of course, I always take it with something in my stomach so I’m very careful of that. But yeah, it’s helping tremendously. And my chemist, my local chemist who delivers my prescriptions, I’ve explained it to him and he now orders me in three boxes to come out with my prescription. I give him my debit card over the phone and he just includes it in with my prescription once a month.

It depends on how I feel, sometimes I just take para-, cos I don’t want to take the co -  I take co-codamol at night but I don’t want to take it all - you know? So I take a paracetamol or maybe paracetamol and aspirin, if I’m going out for two or three hours.

Because otherwise what it is. If I don’t then I start getting a sw-  I didn’t realise at first what it was, but the swelling, as soon as your knee starts to swell then it starts to hurt, especially in the kneecap area.

Because the knee’s not fully functional, they start swelling and then the walking becomes very painful.

Another thing you see because of my kidneys, you’ve got to be careful with the medication because taking too much paracetamol and, you know, painkillers, is no good for your kidneys.

And so, but I do. When the doctors tell me ,“Look, you might have, you might finish up chronic kidney disease you know,”.

So that was twenty years ago when I read an article how to look after your kidneys, you know? So I do that procedure like in the morning I get up, I make sure I drink lemon water and that sort of thing, a lot of warm water and that kind of thing, and then a good diet they said helped.

And then well the doctor, the hospital told me, “Look, you’ve got to have this heart valve repaired,” I said, “No, I’ve got this other condition.” “What?” he said. I said, “My kidneys not functioning very well.”

So, he sent a letter to my GP, he said, “Send him to a kidney specialist to sort it out.”

And my GP looked, he said, “Look.” [laughs], "In fact your kidneys is same as eighty percent of people who are over 70," something like that.  He said, “Of course with age your kidneys' function do go down. So, but you’re not having any, adverse effect from it, are you? Are you asking a question?”

And I said, “No.” I said, “You’re reading everything and so forth.” “Yeah,” he said, “No”.

So and of course reading about it, people who take a lot of medication or you know ibuprofen and painkillers, it’s not good for your kidneys. So, I try to keep it down to a very minimum, you know?

I don’t like taking, cos I take so many pills generally for my heart, I don’t like taking painkillers, however you know I do. When things are a little bit worse than normal.

Sometimes, certainly at night, sometimes I wake up and take a couple of paracetamols. But to be perfectly honest with you, they don’t, paracetamols now don’t seem to have much effect. I haven’t been down to the doctor to take stronger ones because with all the pills I am taking, you know, [laugh] I don’t want to start going down the road of taking strong, strong painkillers unless of course, I’m advised to.

But I’d rather not [laugh].

Do you take painkillers either for the pains you’ve got in your feet or the knee pains that you get?

No, I try to resist it as absolutely as much as I can. There’s only been an odd couple of occasions where I’ve took painkillers. But yeah, I don’t wanna be starting that really.

But they, as I said before they just hurt, they don’t touch wood, they don’t give out or lock or anything nasty like that. They just hurt.

I don’t take painkillers for them. No, I, you know, I take enough tablets for my angina and all that I don’t take, I can’t be taking, you know, painkillers for my knees as well, you know. Not unless, like I say, unless it got absolutely excruciating, in which case,  I’d want the surgery then, you know.

Oh yeah, obviously pain relief, you know, but to be honest if I had to be on pain relief all the time for my knees, I’d rather have the surgery I think if it got to that point.

I wouldn’t be keen, I wouldn’t be keen on taking you know, permanent pain relief for my knees. You know, I’d rather have the surgery if it got to that point.

Well, I don’t like taking painkillers, to be honest. I’ve had two injections in my knee and that sort of lasts for a little while, but not very long. The last injection he gave me, he gave me a little bit extra and that did last a little bit longer. But the pain is back again now. When I wake up first thing in the morning, I’m very, very stiff sort of thing and it takes me a long time to get going. And I do take an ibuprofen.

Just to get the pain in the-, get me a bit of relief sort of thing.

Yeah, I don’t like taking too much, ‘cos I take quite a lot of medication for other things.

Do you mind me asking if…?

Kind of, I’ve got a high disc hernia and then I’ve got blood pressure. So, I take tablets for that and so I don’t wanna mess up too much, if you know what I mean.

Is that something that your GP’s talked about as well, about sort of interactions between medicines and-?

Yes. Yeah, I’ve talked to the doctor and he said that ibuprofen is all right so long as I don’t take too many. So, if I just take one with a meal, you know, my breakfast, that’s all right.

Because I did, years back, have a duodenal ulcer in my stomach.

I’ve got co-codamol from my GP. If I’m going on an outing or if - I went to - I go to a class for Golden Zumba, which is for old people [laughs] this morning and they do a normal impact, but I do a low impact.

I stand at the back of the class, and I just want to keep moving. And so that I know it’s gonna hurt a bit. So, I take two co-codamol from the doctors. And that helps. And but I did feel it a bit this morning.

And I did think that I would have to go and get something to like a brace for it, a sort of a soft elastic pull on, something to support it. A support bandage or something, you know?

But I don’t go mad. I just go, I sort of I just don’t want to stop moving. I don’t want to give in. But it’s, if I didn’t take the tablets, I don’t think I’d get, I wouldn’t be able to go.

The doctor’s given me some painkillers which I don’t- I’ve only taken a couple of times; I don’t like taking them because [they] can be addictive and I’m trying to stop- I take paracetamols and I take Ibuprofen.

And do you take that regularly or is it only if your knees really play?

Only if I need it—I mean I’m not-  I take- over the period when I told you I had this- my giddiness and all that, I was taking—paracetamols nearly every four hours because I was just- well, I was like a zombie.

But like Saturday afternoon, I took two Ibuprofen tablets because, you know, the pain was too bad.

And that’s it, I don’t like, you know- I take heart pills, and I take stuff for my stomach, and I take Aspro, that sort of thing, so I don’t like taking too many pills unless I have to take them.

The knees: they ache as they always have, but it’s bearable and I manage to get around and I can manage to walk as far as I want to. Although they ache, I still manage to walk, so it-, it’s not impairing me at all.

I've actually done away with all my painkillers whatsoever and I don't take anything at all.

How did you find that process of stopping the pain relief?

Yeah, that wasn't too bad, it was-, over the first couple of weeks it was, should I say, a bit challenging, but after that once you got used to the type of pain you were getting and how bad it was, it’s not a problem, it’s manageable. So no, it would have to get a lot worse than what it is.

In actual fact, as regards the ache, they're more stiff than achy, in pain, if that makes sense?

They're more, you know, you thought they're stiff, and when you bend them, you can actually feel them, but I think that’s because they're false knees and you can feel a difference in them.

I think you get into a habit, I think, of just keep taking the medication, and taking the medication, and in the end I was quite sure it wasn't working like it did in the first place, because I suppose my body got immune to it?

And so that was another reason, you know, I stopped taking it.

I use icepacks- those are essential.  I wouldn't be able to survive without that. I also use Biofreeze to help with the pain relief and that helps, especially in the night.

I have tried using the- I do sometimes use the Voltarol cream, but it doesn't really go deep enough for where the problem is.

So, it’s mainly ice, icepacks, that help, I think.

And I take turmeric twice a day.

Oh Okay. And do you find that makes a difference?

Oh, and I don’t know, but let’s put it this way: how I would have felt if I hadn’t taken it, I don’t know.

But I’m feeling okay.

Wife: And an anti-inflammatory.

Anti-infla- overall I’m feeling okay.

Where did you hear about turmeric as a sort of health supplement?

A friend of mine who owns a hotel near us- it must have been about two or three years ago, we just happened to see him in the, four or five years ago, in a local supermarket, we just happened to be talking away and he’s asked me how things are going, I just mentioned to him, he said “Why don’t you try turmeric?” He’s an Indian from [place] and of course there are- since I’ve found out, that’s in a lot of staple diets for-yeah, organic turmeric for Asian people.

Wife: And he took it.

So, I’ve been on it ever since.