Katsuharu Kameta writes:
Yoko Kashiwagi is a 42-year-old. She was a marathon runner in her college days, and continued to run and exercise regularly well into her 30s. But for the last five years she could not get much exercise. And over the last two years she has stopped exercising altogether, has taken up smoking cigarettes, and has gained 7 or 8 kilos. Over the same period, she has been finding it increasingly more difficult to move her left knee, the same knee she injured during her running practice when she was in college. So she is afraid of having rheumatoid arthritis since her father, who was also an athlete, underwent ACL reconstruction surgery last year. And, she has noticed that her left knee gets swollen and red, especially when she has to work late into the night.
In addition, she's been feeling more and more fatigued lately, and the crackling and stiffness in her left knee sometimes is very painful. Ms. Kashiwagi would like her doctor to help her relieve her pain. She said that she will not undergo ACL surgery under any circumstances, but she also admits that she is afraid of becoming sicker. In her business, a youthful and vigorous appearance is most important, and she is frankly afraid of looking older than she is Since she is unmarried, she is fearful of becoming much more isolated if her knee causes her much more trouble.
Other information for her doctor to complete her diagnosis might be 1.) her medical history, 2.) a physical examination, 3.) special tests and/or X-rays. Each of these sources of information helps her doctor determine whether the problem is arthritis and, if so, which type of arthritis it is. In addition, each test and each piece of information helps the doctor rule out diseases other than arthritis. If she has arthritis, an accurate diagnosis will ensure that she gets appropriate treatment. Such treatment is more likely to be successful if she and her doctor work together as a team to manage the disease. The diagnostic examination is the first step in forming this doctor-patient partnership. To make an accurate diagnosis, her doctor needs as much information as she can provide. It's a good idea to start keeping written records as soon as she notices symptoms. Bring these records with her to her first visit with her doctor. Here is the information the doctor needs more about her:
1. When it hurts. Knowing the time of day when her pain is most severe will help the doctor determine what type of arthritis she has. For example, prolonged pain or stiffness in the morning is often associated with inflammatory types of arthritis.
Osteoarthritis cannot be cured, but it can be treated. Beginning treatment as early as possible can help reduce long-term damage to her joints and bones. The goal of every treatment for arthritis is to reduce pain and stiffness, allow for greater movement, and slow the progression of the disease. First, about her weight. Ms. Kashiwagi continued to run and exercise regularly well into her 30s. But over the last two years she has stopped exercising altogether, and has gained 7 or 8 kilos. So, she had better lose weight. There are two reasons to lose weight. 1.) Being overweight is the most common cause of excess pressure on the joints and can increase her risk of developing osteoarthritis. If she has osteoarthritis, being overweight can speed the rate at which the cartilage in her joints wears down, worsening her symptoms. 2.) Losing weight can help relieve the pressure and strain on her joints, reducing the wear and tear that can cause damage to the tissues inside the joint. Weight loss can also help reduce the pain and stiffness in the affected joints, especially those in the hips, knees, back, and feet.
The best way to lose weight and maintain a healthy weight is to eat less and exercise more. There is no scientific evidence that eating or not eating certain foods will prevent or control osteoarthritis. Basically, she should eat the same healthy diet that is recommended for everyone?one that includes lots of foods that are low in fat and high in fiber, such as fruits, vegetables, whole grains, and legumes (dried beans, peas, and lentils). If she needs to lose a large amount of weight, she should work closely with her doctor to develop a weight loss program she can follow safely.
Second, about exercise. Although questions remain about how much exercise is too much, regular exercise is known to be very effective for relieving the pain and stiffness of osteoarthritis and may help slow the progression of the disease. Exercise also helps her reach or maintain a healthy weight, which reduces the stress on her joints. Follows are the information about exercise for her. Stretching exercises, which are also called range-of-motion exercises, are good for helping to reduce stiffness in her joints and improve their flexibility. Stretching exercises include anything that requires regular movement of a joint to its fullest capacity. Some forms of water exercise use warm water to loosen joints and help them stretch. Doing stretching exercises for a few minutes every day can significantly improve the movement in her joints. Strengthening exercises help maintain or build the muscles around her joints, which helps keep the joints stable. Stronger muscles also improve the joint's movement. Lifting light weights, such as 1-to 2-pound dumbbells, every other day is often enough to make a difference. (Muscles need a day off in between to rest and rebuild.) But before she begin any type of weight training, talk to her doctor. She will need to be carefully instructed in this type of exercise to avoid injury and further damage to her joints. Some forms of water exercise include strengthening exercises. Walking is also a good exercise for relieving the pain and stiffness of arthritis. And it's convenient; she can do it anywhere, at any time. Going for regular walks with a friend or family member is a good way to develop the habit of staying active. If she exercises too much and if she has sharp pains or more pain than usual while she is exercising, or if she has pain 2 hours after she exercises, she should stop exercising immediately and call her doctor if she has chest pain, severe dizziness, difficulty breathing, or an upset stomach.
If losing weight and exercise don't help to reduce her pain, the doctor will recommend medication. Arthritis medications generally are used to reduce pain and tenderness in the joints. No drugs are available that can actually stop the progression of the disease or cure it. Many medications that are used to relieve osteoarthritis pain are available over the counter (without a prescription). I don't recommend she undergo ACL surgery because she is afraid of becoming sicker. So I recommend that she should exercise and reduce her weight and, if they will not live her pain, take some pain killers.
Most people with osteoarthritis live full, active lives. Those who do best are managing their disease in partnership with their doctor. She can get life enhancing payoffs from learning as much as possible about arthritis, its causes, effects, and treatments. If she accept that she has osteoarthritis, she should adapt her lifestyle to meet the challenges that damage to a joint can create. By taking charge of her treatment, she can learn how to manage her pain, control her weight, and use exercise most effectively. She should also take advantage of the services in her community, such as swimming exercise classes, that are designed specifically for people with arthritis. Learning about osteoarthritis and its effects and treatment is the first step in managing the disease. The more she knows about her illness, the more control she will have over it and the more successful her treatment is likely to be. Look up information about arthritis in her public library or contact her local chapter of the Arthritis Foundation. Many national and local organizations, including the Arthritis Foundation, offer services, such as help with daily activities, or classes or videotapes that teach people who have arthritis how to manage their illness. Many people find it beneficial to join a support group of other people who have arthritis. In a support group, people learn from each other by sharing their experiences and insights. So check your local newspaper or telephone book for information about arthritis support groups in your area. Many hospitals keep lists of local support groups, their locations, and meeting times. One of the most powerful weapons against arthritis is a positive attitude. Having an optimistic outlook can increase her ability to control her symptoms and greatly improve the quality of her life. Thinking she can gain control over her pain and knowing she can accomplish everyday tasks gives her self-confidence and a sense of well-being. This self-confidence can boost the effectiveness of her treatment program. Arthritis can make her feel angry, sad, resentful, irritable, helpless, frustrated, or afraid. These feelings are normal.
Finally she needs to be taking an active approach to her illness. This can help her overcome these feelings and cope in a more positive way. Here are some things she can do to improve your outlook: Learn as much as you can about osteoarthritis and treatment options; ask your doctor what to expect. Learn how to break your own pain-stress-depression-pain cycle; try visiting with friends, exercising, relaxing, and other activities you enjoy. Be flexible; plan alternate activities or schedules for those times when you are experiencing pain or are tired. Relieve negative feelings with positive activities such as exercising. Share your feelings, fears, and concerns with your doctor, family members, and friends. Understand that some things are beyond your control; focus on what you can do and what you can change. Find new activities that you enjoy and that give you a sense of purpose.
In Ms. Kashiwagi's case, learning about her osteoarthritis; the symptoms of it, how to treat it, and how to protect to take a turn for the worse, and carrying out are the best way to get along with her disease. The most important thing for her is to be optimistic. This conception would help her to live with osteoarthritis.
2. When the pain first started. This information can help the doctor determine if her arthritis is caused by an injury, an illness, or general wear and tear on her joints. It will also help the doctor evaluate how much damage to her joints or bones has occurred since the disease started.
3. Which daily tasks are hard to do. This information will help her doctor understand which joints are most affected by the arthritis, providing another clue to the type of arthritis she has.
4. Her family health history. In addition to her symptoms, her doctor will ask about any serious illnesses, operations, allergies, or injuries she has had, because some forms of arthritis tend to run in families, her doctor will ask whether one of her parents, grandparents, or brothers or sisters has had arthritis.
5. Any medications she is taking. Some medicines that are fine to take alone can cause a harmful reaction when they are taken with another medicine. Before prescribing a drug for her arthritis, her doctor needs to know about any medications she is currently taking regularly -- both prescription and over the-counter ones.
6. Allergies to any medications. Some people are allergic to certain medicines. This is essential information for her doctor to know before he or she prescribes something for her arthritis.
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