Akari Nishi writes:
The patient is Yoko Kashiwagi, a successful 42-year-old media executive. She now lives in Denenchofu, just outside Tokyo, and works in Tsukiji downtown. Ms Kashiwagi was marathon runner in her college days, and continued to run and exercise regularly well into her 30s. But for the last five her business responsibilities have prevented her from getting much exercise, and over the last two years she has stopped exercising altogether,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 collage. She has a father who was also an athlete, underwent ACL reconstruction surgery last year. She tells that she has 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.
As far as this information goes, I can not determine whether the problem is osteoarthritis or rheumatoid arthritis. Since osteoarthritis usually begins after age 40 and usually dose not cause inflammation, her problem may be rheumatoid arthritis. But rheumatoid arthritis usually affects the same joint on both sides of the body (such as both feet), so it is difficult to make an accurate diagnosis. To complete her diagnosis, I need her to undergo a physical examination and special tests. X-rays can show if a bone is damaged by osteoarthritis and, if so, how badly. Testing a sample of her blood or of fluid withdrawn from inside the affected joints may help rule out other diseases and determine the type of arthritis. I also need more information of her family health history, especially the history of her father who underwent ACL reconstruction surgery. But diagnosis is only the first step toward managing arthritis. It is very important that Ms. Kashiwagi and her doctor work together as a team.
(Arthritis can not be cured, but it can be treated. The goal of every treatment for arthritis is to reduce pain and stiffness, allow for greater movement, and slow the progression of the disease. If she does have osteoarthritis, I can recommend several general types of treatment for osteoarthritis. If she has osteoarthritis, she ought to lose weight. 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. The best way to lose weight and maintain a healthy weight is to eat less and exercise more.
Should she have osteoarthritis, she will have to exercise. Regular exercise is known to be very effective for relieving the pain and stiffness. If she is busy for her business, I want her to recommend stretching exercises for a few minutes every day. And if she can, a combination of stretching exercises will be the most effective exercise, for example, mild strengthening exercises (such as lifting weights) and low-impact aerobic exercises (such as swimming, walking, or bicycling).
If she has osteoarthritis, and if weight loss and exercise have not been effective in relieving her condition, I have to recommend some medication. But it is important to remember that all drugs used to treat arthritis can cause side effects in other parts of body. For this reason, if she feel anything unusual when she are taking a medication for arthritis, she should tell the doctor immediately. Since Ms Kashiwagi feels the pain and inflammation, Nonsteroidal anti-inflammatory drugs (NSAIDs) may help her. NSAIDs are often used for relieving the pain of osteoarthritis,and they may reduce inflammation as well. But those drugs can cause stomach irritation when they used several months or longer.
If those medication have not been effective, and if she is not afraid of injection, I recommend Corticosteroids. But Corticosteroids are strong drugs that can cause serious side effects,such as damage to bone and cartilage. For this reason, those shots are given no more than a few times a year. A combination of several treatment usually works best, b()ut it can take some time to find the mixture that works best for each person. This is why it is so important for her and her doctor to work together as a team to develop the treatment plan that will be most effective.
If she has osteoarthritis, the first thing I want her is to accept that she has osteoarthritis. Once she accept that she has arthritis, she can adapt her lifestyle to meet the challenge 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. Next, I want her to have a positive attitude and have an optimistic outlook. Arthritis can make her feel angry, sad, resentful, irritable, helpless, frustrated or afraid. But having an optimistic outlook can increase her ability to control her symptoms and greatly improve the quality of her life. And then, I want her to manage her disease in partnership with her doctor and to join a support group of other people who have arthritis. I recommend she ask her doctor or check her local newspaper or telephone book for information about arthritis support groups in her area. Many hospitals keep lists of local support groups, their locations, and meeting times. The support groups can help her getting ideas of living with arthritis or controlling her disease and also being successful her treatment.
The next thing she can do is to protect her joints by learning new ways to use them. It is important for arthritis to avoid excessive stress on smaller, more fragile joints by using larger or stronger joints to carry things. And the most important thing is to ask for help. She should not be afraid to ask for help whenever her needs it. Her doctor and friends and other people can play critical role in helping she learns to live with arthritis.
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