Shingo Kumadaki writes:
The patient Yoko Kashiwagi is a 42-year-old women. 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 her business responsibilities have prevented her from getting 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.
She has a father who was also an athlete suffered arthritis. Ms. Kashiwagi says that she's been feeling more and more fatigued lately, and the crackling and stiffness in her left knee sometimes is very painful. In addition, she has noticed that her left knee gets swollen and red, especially when she has to work late into the night. Ms. Kashiwagi would like you to help her relieve her pain, and she also wants to know what her prognosis might be for the future.
She is afraid that she might have rheumatoid arthritis or some other kind of arthritis. She will not undergo ACL surgery under any circumstances, but she also admits that she is afraid of becoming sicker.
To complete diagnosis for Ms. Kashiwagi, we need to ask her some other questions like (1) If she has any swelling and if the swelling is caused by inflammation; and (2) which daily tasks are hard for her? In a physical examination, we need to move or even stretch her sore joints to see if their movement is limited and to listen for crackling sounds. X-rays can show if a bone is damaged by osteoarthritis and, if so, how badly. Maybe we also need to test a sample of her blood or of fluid withdrawn from inside the affected joints to rule out other diseases and determine the type of arthritis that is causing the symptoms.
There are several types of treatment for osteoarthritis to reduce pain and stiffness, allow for greater movement, and slow the progression of the disease. As a first treatment, since she has been gain 7 or 8 kilos and has stopped doing exercise altogether, weight loss and doing regular exercise are recommended. 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. It can also help reduce the pain and stiffness in her knee. Regular exercise is can be very effective for relieving the pain and stiffness of osteoarthritis and it will help slow the progression of the disease. Exercise also helps her reaching or maintaining a healthy weight. One of the recommended exercise is to do stretching exercises and swimming. Stretching exercises are good to reduce stiffness in her knee and improve its flexibility and swimming is especially good for her because the water supports some of her weight and reduces stress on her knee. Medication is recommended only after weight loss and exercise have not been effective in relieving symptoms. Since she isn't willing to undergo surgeries, surgery is recommended. Also surgery is only for severe, disabling arthritis that interferes with a person's ability to carry out ordinary daily activities, such as dressing, bathing, or walking up stairs.
Although the arthritis can't be cured, most who have been suffering from osteoarthritis can live full, active lives by managing their disease. For her long-term improvement, we should recommend things like the following. She should change her lifestyle; quit smoking and doing regular exercise. These changes can reduce risks and can help her improve the range of motion in her affected joint and strengthen the muscles that support it. Second, she need some devices to cope with disease, such as canes, crutches, walkers, braces, or shoe inserts, and being fitted with splints that she can use to temporarily rest a sore joint.Å@Third, she should learn more about her disease. We should teach her the proper way to use heat and cold to relieve pain and stiffness, and the basics about using her joints with a minimum of discomfort and exertion. She should learn as much as she can about osteoarthritis and treatment options; ask her doctor what to expect.
Last, but not least, she should change her thinking and should reduce her stress, be flexible, plan alternate activities or schedules for those times when she is experiencing pain or is tired. She needs to learn how to break her own pain-stress-depression-pain cycle, and try visiting with friends, exercising, relaxing, and other activities she can enjoy. She should relieve negative feelings with positive activities such as exercising and share her feelings, fears, and concerns with her doctor, family members, and friends. She needs to understand that some things are beyond her control and focus on what she can do and what she can change and find new activities that she enjoy and that give her a sense of purpose.
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