Ask Dr. Keith Roach M.D
Torn meniscus does not always require surgery
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't 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. — D.C.
ANSWER: 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't tell you what exercises to do, since it depends entirely on your specific type of tear and how it's affecting you. My colleagues in physical therapy have different training from 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'd 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't see why your doctor isn't recommending the usual course of PT. If it doesn't 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't work. Third night, I went back to the ibuprofen, with similar success as before.
I am concerned about longterm 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.
ANSWER: 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's 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 like ibuprofen. Omeprazole (Prilosec) and medicines like it do reduce risk, as does misoprostol.
Given the expected modest risk from a low dose, I don't recommend taking a medicine to reduce your risk, but it's 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 ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.