Nobuhiro Shibata writes:
The patient's name is Yoko Kashiwagi. She is a 42-year-old media executive. She was a marathon runner in her college days. 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. In view of these fact, I think she might have arthritis, and not rheumatoid arthritis, but, osteoarthritis.
Although there are more than 100 different types of arthritis, many have the same symptoms some forms of arthritis affect only the joints while others affect many other parts of the body as well. But these differences require different treatments, and some types of arthritis can be life-threatening without proper treatment. So it is important to know which type of her arthritis. And knowing the type of arthritis helps her doctor develop the right treatment for her.
To know which type of arthritis she has, her doctor has to do some examinations. X-rays can show if a bone is damaged by osteoarthritis and, if so, how badly. The doctor may also want to test a sample of her blood or of fluid withdrawn from inside the affected joints. These tests may help rule out other diseases and determine the type of arthritis that is causing her symptoms. Some types of arthritis become obvious only as they develop over time. If the type of arthritis she has isn't clear immediately, her doctor may recommend more testing or refer her to a specialist.
In addition to the above, her doctor needs the following information.
1. Where it hurts . The location of her arthritis pain can help her doctor determine the type of arthritis she has and, possibly, the cause. Ms. Kashiwagi said I hurts in her left knee.
This information doesn't go far enough. Her doctor needs the rest of the two questions answered and more detailed information on the other seven questions to know which type of arthritis she has.
Ms. Kashiwagi said that she will not undergo ACL surgery under any circumstances. But surgery is usually done only in severe, disabling cases of arthritis for which other treatments have failed. In fact, most people who have osteoarthritis will never need to have surgery. So she does not need to undergo ACL surgery immediately. First, she will take some other treatment.
There are several general types of treatment for osteoarthritis. Weight loss and exercise are usually the first treatments recommended. Because of the potential side effects of many drugs that are used for treating osteoarthritis, medication is usually recommended only after weight loss and exercise have not been effective in relieving symptoms. A combination of several treatments usually works best but 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 for her.
And 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. Here are some good reasons to exercise if she has arthritis: 1. Exercise strengthens the muscles that support her joints, which helps protect the joints from further damage and can reduce the pain of arthritis. 2. Exercise improves the flexibility of her joints; the more flexible her joints are, the more easily she can move them without pain. 3. Exercise can make her feel better mentally and emotionally by relieving stress and elevating her mood. 4. Exercise can spark her energy and generally improve the quality of her life. The exercise program that will work best for her is one that fits her lifestyle and physical abilities. Doctors generally recommend a combination of stretching exercises, mild strengthening exercises (such as lifting weights), and low-impact aerobic exercises.
It's important to talk to her doctor before she begins any regular exercise program. Her doctor can help her determine which exercises are best for her, how often her should exercise, how much exercise her should do, and how to time her medication to make her exercise session more comfortable. Her doctor may recommend that her work with a physical therapist to design a program that is right for her.
If weight loss and exercise are not effective in relieving her symptoms, her doctor may 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). Some of the stronger arthritis drugs are available only with a doctor's prescription. However it's important to remember that all drugs used to treat osteoarthritis, whether they are over the counter or prescribed by a doctor, can cause side effects in other parts of the body. For this reason, if she is taking a medication for her arthritis, she should tell her doctor immediately if she feels anything unusual at all. Keep in mind that she may not have any problems until after she has been taking the medication regularly for a long time.
If the all treatments of the above do not go well, the last way is surgery. But she refuses surgery now. But she wants to be released from pains. So when the worst comes to the worst, she will chose if she undergoes ACL surgery or not by herself. But as mentioned above, most people who have osteoarthritis will never need to have surgery. So first she should undergo the above treatments before worrying about surgery.
I want tell Ms. Kashiwagi the following things.
Osteoarthritis cannot be cured. So she must get along with osteoarthritis all her life. But don't be pessimistic. It may be possible to live with osteoarthritis. 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. Once she accepts that she has osteoarthritis, she can 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.
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 around her. 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. If she cannot find these group, ask her doctor for information about arthritis support groups in her area. Many hospitals keep lists of local support groups, their locations, and meeting times.
And 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.
Her family members and friends can play a critical role in helping her learn to live with arthritis. People who have the loving support of others do better in all areas of managing their illness. Talking with loved ones about the difficulties she is having can help prevent depression and improve her ability to cope with her illness. Don't be afraid to ask for help whenever she needs it. People are willing to help, when she asks them for help.
This is all I can say to Ms. Kashiwagi.
2. 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. Ms. Kashiwagi said she has noticed that her left knee gets swollen and red, especially when she has to work late into the night.
3. 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. Ms. Kashiwagi said that 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.
4. If there is any swelling. The absence or presence of swelling in her joints can indicate the type of arthritis she have. If the swelling is caused by inflammation, she may have rheumatoid arthritis or another type of inflammatory arthritis. If the swelling is caused by growths of bone (bone spurs), she probably have osteoarthritis. Ms. Kashiwagi said she has noticed that her left knee gets swollen and red, especially when she has to work late into the night.
5. 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. Ms. Kashiwagi said that the crackling and stiffness in her left knee sometimes is very painful.
6. If the joint has ever been injured or overused. The doctor needs to know how she has used her joints over time. Has she ever done physically strenuous work that included repeated movements of certain joints? What types of exercises, sports, and hobbies has she engaged in? Does she spend or has she spent long periods during an average day moving very little? Ms. Kashiwagi said she injured during her running practice when she was in college.
7. Her family health history. 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. Ms. Kashiwagi said her father, who was also an athlete, underwent ACL reconstruction surgery last year.
8. 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. Ms. Kashiwagi has said nothing so far about her taking medicines.
9. 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. Ms. Kashiwagi has said nothing about allergies.
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