Dear Dr. Roach: I was diagnosed with a torn meniscus in my knee. I do not want an operation.
I have read that physical therapy is as effective as surgery, but I don鈥檛 know what exercises to do. I had a cortisone shot and that helped. I felt that my doctor was too quick (two minutes) to say that I need surgery. I am 80 years old, am not overweight and am healthy. This seemed to start with some trauma to my knee.
听
D.C.
The menisci are cartilage structures that provide shock-absorbing support in the knee. Tears are quite common and treatment is based on the symptoms. Both physical therapy and surgery are used, but unless symptoms are really debilitating, it almost always is worth a trial of physical therapy. The goals of physical therapy are to help stabilize the knee through strengthening the muscles.
I can鈥檛 tell you what exercises to do, since it depends entirely on your specific type of tear and how it鈥檚 affecting you. My colleagues in physical therapy have different training than mine and are very skilled at what they do. Only an experienced therapist can tell you the appropriate therapies after a taking a history and performing a physical exam.
It sounds to me as though you may wish to bypass your doctor and try to treat yourself. I鈥檇 recommend against this. As the patient, you have the say on what you want your treatment to be and I think your doctor certainly would understand that you want to avoid surgery.
I don鈥檛 see why your doctor isn鈥檛 recommending the usual course of PT. If it doesn鈥檛 work and you really do need surgery, then at least you would feel comfortable knowing you did what you could to avoid it. But my experience is that most people with mild/moderate symptoms of a meniscal tear do very well with PT and most avoid the need for surgery. Tell your doctor that you want to try physical therapy first.
Dear Dr. Roach: I read with great interest your recent newspaper column about ibuprofen helping to reduce nocturia.
I recently started having intermittent bouts of six or more trips a night to the bathroom, with a now norm of three to four trips. The urologist diagnosed it as benign prostatic hyperplasia and prescribed Flomax. However, I could not tolerate it and he has put me on finasteride, which I understand may take a long time for full effectiveness.
After reading the correspondence about ibuprofen, I decided to try one 200 mg tablet. I was amazed that I woke up only once to urinate. I tried 325 mg of aspirin the next night, but it
didn鈥檛 work. Third night, I went back to the ibuprofen, with similar success as before.
I am concerned about long-term use of NSAIDs, since I have had a bleeding ulcer in the past and regularly take Zantac at night for GERD. Your thoughts?
Z.F.
Ibuprofen increases the risk of bleeding ulcers and two major risk factors are being over 65 and history of previous bleeding ulcer, so I think you are right to be concerned. However, the very low dose of 200 mg once nightly is not likely to trigger a large increase in risk, so it鈥檚 really a question of balancing a low risk of a serious problem (bleeding ulcer) against the benefit (relief from getting up so often).
Zantac and other medicines like it do little to prevent stomach bleeding from anti-inflammatory medicines such as听 ibuprofen. Omeprazole (Prilosec) and medicines similar to it do reduce risk, as does misoprostol.
Given the expected modest risk from a low dose, I don鈥檛 recommend taking a medicine to reduce your risk, but it鈥檚 appropriate to discuss with your doctor.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
