Suggest treatment for arthirtis
Patient: hi....my husband has arthirtis in his knees real bad and he s not strong enough for a knee replacement although the ortho doctor said they could give him a epidural but am not sure if hubby could walk enough. he is also diabetic and takes insulin....lantus and novolg. he has had trouble voiding and when i took him to the doctor his white blood count with was high but the PA didn t know where and gave him ciproflaxin because he was pretty sure it was in his lungs. but anyway i thought maybe he had bladder or kidney infection was the trouble he was having going to the bathroom. urine sample showed no kidney or bladder infection so the PA gave him samples of toviaz to help him void. he took it for a week and was way worse than it was before. the PA has him on (2) 50 mgs pf tramadol every 8 hours...i took him to the er a couple of weeks ago and they told him his white blood count was up a little but still no one knows where the infection is and the er doctor put him on a predisonne regimen. i forgot to mention he also had shingles on his left buttock and on his gentials. that started last october.....what a year it has been...he is afraid if i take him to a bigger hospital they won t find anything wrong. he also lost 50 to 60 pounds in a year....i am very worried about him Doctor: Hi your husband is diabetic and has severe arthritis in the knee joint . He also has an intractable infection with increased white blood counts. he has difficulty in voiding but urine reports are normal. He also had shingles on (R) Buttocks and genitals. In my opinion , with his problems , I would recommend      1. Search for the cause of Elevated WBC Counts- could be lungs , any infection of nails , foot or a small sore in back .     2. For knee pain I would recommend Intra-articular injections  injections of  Viscous substance  ( Viscosupplementation) or PRP Injections.    3. For urinary problem- I would suggest MRI L S Spine and NCV Tests along with urine C/S , S Vit B12 levels,         Will proceed according to reports.