Naoki Murai writes:
This is a case study of a Ms. Yoko Kashiwagi, a 42- year-old media executive. To begin with, we have to appraise her present condition and then get some extra information to properly determine the status of Ms. Kashiwagi's condition. Before complaining about her left knee, she was exercising regularly but stopped doing so two years ago, because of her work schedule. After that, she gained 7 or 8 kilos, she has taken up smoking, and most important, she has difficultly moving her left knee, the knee which is crackling and feels stiffness. It's necessary to know whether any other part of her joints also hurts besides her left knee. If the same joint on both sides of the body is affected, the possibility of rheumatoid arthritis will be higher. Additionally, if there are activities that make the joint painful, it is important to know what kind of activities these are, because it may help us to know the other affected parts. More description of the pain is also needed. This is because the pain from osteoarthritis can be deep and aching in or near the affected joint. Arthritis in the knees can cause pain if they are bent or if the person walks up or down stairs. Though she said that her left knee gets swollen and red when she has to work late into the night, we need to ask her whether it hurts in the morning. It is because many people who have osteoarthritis have the most pain in the morning. Most of all, it will be most effective for her to keep track of her level of pain, at what time of day it occurs, where on the body it is, and how long it lasts. This can be done by keeping a journal.
Other important information can be gathered from physical examination. Feeling of affected joints or stretching the sore joints to see their movements and to listen for crackling sounds may help us get some strong information about which type of arthritis the patient is suffering from. From this point of view, not only from her personal information, we'd better have some objective information. Some instruments can give us a strong evidence of the affected joint. For instance, x-rays of affected joints can show if a bone is damaged by osteoarthritis or not. Another instrument called arythroscopy can be used if the patient agrees. It can be performed using local or regional anaesthesia. Examination of a fully relaxed knee for ligament stability should be undertaken before commencing the arthroscopy. A systematic arthroscopic inspection of the joint is necessary before any operative procedure is undertaken, and begins via the anterolateral portal. But in the case of Ms. Kashiwagi, we need to ask her whether this type of examination is too much like surgery for her in order to respect her idea. More easily, testing a sample of blood or of fluid withdrawn from inside the affected joints can also help rule out other diseases and determine the type of arthritis.
Next, we need to give Ms. Kashiwagi some information about the likely forms of treatment she should require if she does have osteoarthritis. And suggestions of specific things she can do now to relieve her condition. First, we have to let her know that osteoarthritis cannot be cured. And also let her know that it could be treated. According to her recent lifesytle, that is, lack of exercise and gaining 7 or 8 kilos, the simplest treatment will be weight loss and exercise. Losing weight can help relieve the pressure and strain on the joints, reduce the pain and stiffness in the affected joints. To do this, she should eat diet 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). Exercises that may relieve her pain is another important treatment. Since she doesn't have enough time, it must be convenient. For this reason, she must start from taking a walk which may relieve the pain and stiffness of arthritis. If she can get enough weekends off, then we can recommend her swimming which is not just good for the knee but also increase her endurance, and will give her energy. These are the treatments that she can do constantly. Besides these treatments above, there is a good way to reduce the temporal pain. Applying cold is one of the way. But there must be some attention not to apply ice directly, because it can burn the skin. So it is necessary to wrap them in a towel or some other kind of clothes like that. This kind of information all together must be given to her to carry out the appropriate treatment.
Now we need to think of the problem if these treatments do not work effectively. If so, we need to depend on some kind of medication. Applying medication needs more careful attention than those treatments above, since some medicines have serious side effects. Capsaicin is said to have no serious side effects. It reduces the sensation of the pain by blocking the ability of the nerve endings around the joint to send pain messages to the brain. Capsaisin-containing creams are available. In summary, there are many ways that may treat the pain without using surgical procedure. So she doesn't have to be so nervous about ACL surgery. But she may have keep in mind that ACL surgery is a powerful way of long-term treatment of arthritis. Besides treatment taught by the doctor, she needs to know how to protect her own joint. For example, taking positions like squat and kneel put too much stress on the knee so avoid taking these positions to protect the affected knee. Just a little care can manage it.
In case Ms. Kashiwagi should have osteoarthritis, there will be some ways she can overcome her fears and sense of isolation. First, she has to know that most people with osteoarthritis live full active lives. And she should not be so scared about the illness since she is not the only person suffering from the arthritis. This way of thinking can prevent her from being isolated. If she can accept this idea, second, she can join a support group of other people who have arthritis. There people can learn from each other by sharing their experiences and insight. To find it more beneficial, educating herself might be another good way. That is, she herself must learn about osteoarthritis and its effects and treatments. Although she said she doesn't want to become a sicker, she must ask her colleagues for help. She must know that people are willing to help, they usually just need to be asked. Colleagues are not just partners for business, but they are also partners for daily life. Anyway, whatever she tries, she must keep a positive attitude. A change of mind can heal the person better than any other treatment. Having an optimistic outlook can increase the ability to control the symptoms and greatly improve the quality of people's lives.
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