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Arthritis-It's a Joint Thing
By Anne McNulty

I'd never planned on getting a new hip as a 60th birthday present. I'd thought about a new bike or maybe a set of golf clubs, which, believe me, would have been a lot more fun. But it was becoming hard to play golf or ride a bike because I could barely move my left leg. It just didn't want to work anymore. Last year I was learning how to slalom water ski. This year I was trying not to hobble. It was time to face the troubling truth. I had arthritis; my left hip was full of it.

My first symptom started several years ago, but I was too busy to pay much attention.

One day I went out walking with a friend. "You're limping," she said.

"I am not," I said.

"Okay. Have it your way, gimpy."

Soon everyone was telling me, "You're limping."

"Just a little," I said, "but not much."

"Right."

Soon the pain and stiffness began. Yoga, which had always helped to keep me limber, now was too hard on my hip. I just couldn't twist like a pretzel anymore. When I bent my left knee, it snapped and crackled like a bowl of Rice Krispies. Sleeping became a problem because the pain woke me up in the middle of the night. I quit watching the weather forecast, because I could tell exactly when it was going to rain-felt it right in my arthritic joints.

Things got worse. I had trouble pedaling my bike. When we were out on the golf course, other players stared at me when I used my clubs as canes. It got hard to stand up; it got hard to sit down; then it just got plain hard.

"You're waddling like a penguin," remarked my supportive husband.

It was finally time to do something besides complain. Even shopping didn't help anymore. "I'm limping," I told the doctor. "My legs hurt."

Up on the examining table I went. "Can you move your leg this way?" he asked.

"Nope."

"Try that way."

"Can't do that either."

"I think we need to take x rays."

"Hmm," he said as he studied the pictures. It wasn't an optimistic "hmm."

Not good, I thought.

"Not good," he said. "Looks like degenerative arthritis."

"What's that mean?"

"You're not going to get better." He pointed to the protrusion that looked like my left hip. "There's no cartilage left. You've got bone rubbing against bone."

He shook his head. "That must be pretty painful for you. Has to hurt."

"Oh, just a little," I said as I struggled down from the examining table.

I asked, "What's next? What can be done?"

"I'd recommend a total hip replacement in your case," he said, raising an eyebrow. "It's the only thing that's going to make you better."

At that point, I couldn't have agreed more. It was time for surgery.

Remedies, from Least to Most Invasive Nutrition and diet Exercise Nutritional supplements Herbal products Massage Acupuncture Meditation Aqua therapy Assistive devices Braces Topical creams and ointments Coping strategies Support groups Electrical and magnetic devices Over-the-counter medications Prescription medications Physical and occupational therapy Hyaluronic acid knee injections Corticosteroid injections Knee arthroscopy Joint replacement surgery

You've Got Arthritis

I soon discovered I wasn't the only person in this situation. According to the federal Centers for Disease Control and Prevention, one out of three people has arthritis.

So what exactly is arthritis? Answer: It's Greek to me. Derived from the Greek arthros, meaning joint, and itis, meaning inflammation, it's basically an inflammation of the cartilage and lining of the joints, characterized by pain, stiffness, and swelling.

Arthritis most frequently affects the fingers, knees, hips, and shoulders, but it can form anywhere there's a joint. More than 100 types of arthritis exist; the two major forms are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, which I have, is the most common type. It's sometimes called the "wear and tear disease" because almost all of us will develop it to some degree as we age.

According to the National Arthritis Foundation, it's a chronic condition characterized by the breakdown of the joint's cartilage. When the cartilage begins to wear away, bone starts to rub against bone. Then the joint lining, called the synovium, starts to get inflamed and bits of bone and cartilage start floating in the joint fluid. Bone cysts and spurs can develop as the bone deteriorates.

So, you may think, it's tough to get old. Think again. Many people begin to feel symptoms when they're young. Research indicates that most people will have some degree of arthritis by age 60. And guess what? According to U.S. News and World Report Online, it occurs more frequently in women than in men and can affect them as young as age 40. The National Arthritis Foundation states that 25.9 million women have doctor-diagnosed arthritis. In men, arthritis usually begins at about age 50 and 16.8 million are afflicted.

Baby boomers are now at prime risk. More then half of those affected are under age 65. Those are the statistics.

Illustration by Kate Feirtag

One of the reasons the rate of arthritis continues to rise every year is because obesity exacerbates the condition. As the number of overweight people increases, so does the incidence of arthritis. Obesity puts a lot of pressure on the joints, especially knees. You might say that arthritis is becoming a weighty problem.

What are the symptoms of arthritis? Glad you asked. First, you'll start feeling some mild stiffness and swelling. Soon you won't be as flexible as you used to be and you will get cranky. Just ask my family. It will become harder to walk, to bend, and to move. Climbing stairs will be like scaling Mt. Everest, and it will seem that getting up from a chair would be easier if you had a catapult. We won't even mention getting up off the toilet. If you have arthritis in your neck, it's going to be difficult to turn your head. If it's in your back or shoulder, you'll have problems with bending and lifting. In short, if you have arthritis, you'll have problems.

Several Sources of Relief

So, what can be done? Well, as I discovered, managing arthritis covers a broad spectrum of options. Hundreds are out there. Some are way out there, and others are more conservative. Let's start with the most common remedy-exercise.

Some of the best activities, according the National Arthritis Foundation, are walking, biking, and dancing. These low-impact exercises strengthen muscles around the joints and preserve cartilage. Swimming is also a great option, if you don't mind getting your new hairdo wet.

Range of motion exercises, which consist of stretching and strengthening, keep joints flexible.

Strengthening exercises, such as lifting weights, help keep muscles, ligaments, and tendons strong. (You can find specific examples on the All about Arthritis and National Arthritis Foundation Web sites.)

Tai Chi, a Chinese exercise, is a series of gentle, fluid postures that helps work muscles and increase body and mind connection. Like yoga, it's been around for nearly as long as arthritis and is gaining in popularity to help fight the disease.

Although exercise is beneficial, don't overdo it. The rule of thumb is, if it hurts-stop.

Before you start any regimen, it's wise to consult with your doctor, who should probably be exercising too.

John Murphy, owner of Island Athletic Club, in Grasonville, works with physical therapists and orthopedic surgeons to develop a systematic program for his arthritic clients. "I'd recommend starting out easy," he says, "and then gradually adding to it." He stresses the importance of stretching and strengthening muscles to develop a greater range of motion and reduce stiffness. "Exercise is also important to encourage blood flow," he adds.

Other simple arthritis remedies are topical creams and ointments. Applying ice packs or heating pads to sore joints and muscles also works. Hot tubs, heated pools, and whirlpool baths are good warm-water therapies-not to mention relaxing. Aqua therapy is becoming more popular these days and more physical therapy centers are offering it. When I visited an aqua care facility in Easton, the pool was heated to 91 degrees. The facility offers aquatic therapy and classes. It also has scheduled times for open swims.

Okay, you can brace yourself, too. Available in any pharmacy, knee, ankle, and foot braces can make you feel steadier and relieve pain.

Assistive devices such as canes are helpful when symptoms become more troublesome. They also make good pointers and ward off unruly dogs when you're out walking. A raised toilet seat can be an asset when you're on the throne.

However, when arthritis becomes more severe, it's time to consider good pain management techniques. Since the condition is not going to go away, the best thing to do is to keep the pain and stiffness at bay.

I started taking nutritional supplements glucosamine and chondroitin sulfate a few years back, and they seemed to work. Dr. William Seeds, an orthopedic surgeon from Ohio, writes that the National Institutes of Health (NIH) is presently studying the effects of these supplements, which are both components of cartilage. The study is to determine their efficacy in reducing inflammation and keeping joints healthy.

Other supplements sometimes tried are gingerroot, omega-3 fish oil, and garlic, to name just a few. The most interesting one I came across in my research was golden raisins soaked in gin. Now there's an option!

For a more middle-of-the-road treatment, consider over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS). Aspirin and Tylenol are examples of these drugs, which are often used as a first line of defense.

More aggressive pain management options are the prescription NSAIDS. These medications should be a carefully considered choice made by both patient and doctor.

A device that uses electrical stimulation to block pain is called a TENS unit. It works by applying a mild electric shock to the affected area. My husband, who has arthritis in his back and shoulders, uses it almost daily.

"Does that work for you?" I ask.

"Yeah-seems to."

"How come it hasn't stimulated you to get out of your recliner?"

"Cute," he says as he fiddles with the remote.

Corticosteroids are a more potent option. These powerful anti-inflammatory hormones, which can only be given a few times a year, are injected into the affected joints. A friend of mine had such an injection in her neck. "Did it help?" I asked. "Not much," she replied. Others, however, have gained relief from them.

In addition, physical and occupational therapy are important options to consider. Physical therapists develop individualized programs of exercise and therapy to help your specific arthritis. If you do decide on surgery, you will most certainly be required to take physical therapy afterward. Occupational therapists can suggest ways to perform tasks of daily living more easily and provide assistive devices.

Going Under the Knife

So, when is it time to consider surgery? The standard answer has been, "Wait until you can't stand the pain anymore." That's changing nowadays. Joint replacement surgery is becoming much more sophisticated and successful. Your artificial parts will withstand more wear and tear and will last longer-about 15 to 20 years-than those used in the past. Even though almost half of joint replacement patients are under age 65, 90-year-olds have had successful surgery. According to the Web site About Arthritis, each year about 200,000 Americans undergo total hip replacement. Knee replacement surgery is just as common.

Was my surgery successful? Yes. It's been more than 2 months now and I'm recuperating nicely. Thanks to a great doctor and medical staff, by next month I should be well enough to get back on track.

"So, Grammy," my granddaughter asks, "are you glad to get rid of that cane?"

You bet I am.

Our Eastern Shore correspondent Anne McNulty lives in Queenstown. She recently retired from a teaching career and is now a freelance writer.

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Some Types of Joint Replacement Surgery

• Minimally invasive hip surgery
• Minimally invasive knee surgery
• Knee resurfacing
• Total hip replacement
• Total knee replacement
• Total shoulder replacement
• Knuckle replacement
• Total elbow replacement