Why 93 is not too old to get a new hip

MY 93-YEAR-OLD mother is in constant pain from having osteoarthritis in her hip, but her age rules out joint replacement surgery. Her GP recommended co-codamol but it affects her digestion, so she takes paracetamol. Are there other drugs that can help?

ONE in four of us develops osteoarthritis by our 80s. Your mother has now reached the point where her mobility is restricted, and this is bad for her overall health as well as compromising her independence.

Paracetamol can work for some but not all patients. Adding codeine may help (co-codamol is a mixture of codeine and paracetamol), but the side-effects often make it unacceptable, as your mother has found: drowsiness, constipation, nausea and headache are common. Dependency is also a worry when codeine is taken regularly for long periods.

Other painkillers include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac.

But rather than take them daily, it’s more appropriate to take them when needed, such as before your mother’s about to leave home for shopping or other similar activities. Routine usage is discouraged because these drugs may cause ulceration of the stomach lining and increase the risk of cardiovascular disease and kidney damage.

If your mother does take an NSAID, try to make sure it’s at the lowest effective dose and for the minimum possible duration.

Non-drug treatments include, surprisingly, exercise, and walking aids. Ideally she would see a physiotherapist for an exercise programme, an approach that’s been shown to improve function and reduce pain.

The aim is to improve the range of motion and strengthen the muscles around the hip.

As for surgery, hip replacement should not be ruled out on the grounds of her age alone.

This is a safe and effective operation in older patients — the more important consideration is whether the patient is well enough to have the operation.

Hip replacement is one of the most successful procedures in orthopaedics — might it be worth investigating once more if it would be suitable for your mother?

I’VE HAD a fungal nail infection for years, though in the past month it has given me a lot of pain. At my last appointment the chiropodist said my nail is loose and wanted to pull it off! But is that the answer?

EXPERTS — particularly microbiologists — find fungal nails fascinating because they have such a range of causes, including yeasts and moulds.

But for GPs and patients there is one main focus: how to beat this often very difficult-to-treat problem.

In my experience, it’s often best left alone unless it’s causing pain, or so disfiguring to the nail that it becomes very unsightly.

Pain is not common, but when it occurs, it’s usually because bacteria have invaded and triggered an inflammatory response.

In some patients who have other conditions, particularly type 2 diabetes, this can lead to infection spreading into the soft tissues of the toe and foot, even the leg.

Topical anti-fungal drugs aren’t terribly useful — and while oral anti-fungal medication is potentially more effective, it can cause unpleasant side-effects such as nausea.

I wouldn’t oppose removal of the nail by your chiropodist. This is a straightforward procedure performed under a local anaesthetic.

The pain you have experienced will be resolved, and there will be an immediate cure.

There is a high probability the problem will recur as the new nail grows out — usually because microscopic traces of fungal spores remain in the area.

You can try to prevent this by applying an anti-fungal to the nail bed — the standard treatment is with amorolfine (brand name, Loceryl). It’s prescription-only, so your GP will need to prescribe it or you could try an online pharmacy service.