Arthritis Deserves Respect

Arthritis is a bummer. There is no question about it. You can't get cured and you don't even get a ribbon. I think we need to change the name of arthritis to: Juvenile Pre-Cancerous Joint Lesions. Why? Because all the money in this country goes to the research of cancer (especially breast cancer) and pediatric diseases. Arthritis affects everyone - including men. Sort of fits into my Titanic theory of public relations - women, and children first, let the men die.

There is a particular quirky discrimination in the government concerning people with arthritis - you are not allowed to get from the car to the curb if you did not drive to the curb in the first place. How does this play out? In NY State you cannot get a handicap sticker unless you are the driver and have a license. I have an elderly couple with the wife as my patient. He drives, she does not. She has severe arthritis. They have been denied a handicap sticker because according to the powers that be "he can drop her off at the curb, park in a regular spot and meet up with her." Which idiot thought this one up? Why doesn't the law simply say "You may throw her out of the car at 35 miles per hour so you don't need some extra consideration."

Maybe, just maybe arthritis patients need some extra help. Maybe we can loosen up on the rules a bit for 43 million Americans who are in daily pain. We really need to treat people with disease and disability with a bit more dignity.

- Dr. K.

Related Topics: Managing the Outside World, Living Successfully with Chronic Illness, Devices to Help With Arthritis

Tags: accessibility,disability,elderly,arthritis

Pain Management Post-Surgery

In general the issue of pain management is a surgeon choice and often regional variations in treatment vary.

I personally do not use MS Contin. There are many protocols. In general, pain management should be a sliding approach from stronger to less strong medications.

Initially, intravenous medications through a patient controlled analgesia machine (PCA Pump) are used in the hospital. Medications for months after can include:

• Oxycontin- strong, highly addictive
• Fentanyl patches- strong, addictive, constant relief, expensive
• Dilaudid- powerful, addictive
• Percocet- a good standard for intermediate use
• Hydrocodone (Lortab, Vicodin)- lower strength but effective

- Dr. K

Related Topics: Pain Management: Drug Management and Addiction, Pain Treatment Agreement

Technorati Tags: pain,surgery,medication

Arthritis and Glucosamine

Know what you have and learn the truth about glucosamine

It is very interesting in all the years I have answered questions on my WebMD Message Board that there is often a missing component to many questions. This is the failure to appreciate that a diagnosis needs to be made.

It sounds simple doesn't it? But it often escapes patients I meet as a second opinion in the office or on the Web. Here is how it goes:

Patient: I came to see you because the joint replacement placed by Dr. X is not doing well.
Dr. K.: I am sorry to hear that. When was your surgery done?
Patient: 2 years ago.
Dr. K: What did your surgeon tell you what is wrong?
Patient: He told me it failed and needed to be replaced.
Dr. K.: What failed?
Patient: He didn't tell me.
Dr. K: Why did it fail?
Patient: He said he doesn't know?
Dr. K: Did he give you at least a few ideas as to why it failed?
Patient: No.

Obviously, this is a simplified version but is happens more than enough times. The appraoch to any problem that occurs in surgery is to make a diagnosis.

1. What failed
2. What are the consequences of this failure (pain?- loss of function?)
3. What are the causes of the failure.

WHAT IS THE DIAGNOSIS!!!

The most basic approach to medicine is making a diagnosis. An important review of this was posted on WebMD. It was written by Jeanie Lerche Davis and reviewed by Charlotte Grayson, MD

The only problem with this excellent review is the following statement:

"Alternative supplements. In recent years, several studies have shown that glucosamine and chondroitin sulfate can help relieve pain from osteoarthritis. In addition, research has shown that these supplements, particularly glucosamine, can slow, or even stop, progression of osteoarthritis. Most research has been done on knee osteoarthritis, but experts suspect that other joints would benefit as well. "

This statement is clearly not supported by evidenced-based medicine. The articles in respected journals- I repeat- respected journals- consistenty show no statistical significance in using glucosamine over placebo. Words like- "there is a tendency" and "there is optimism" are used but that is not science.

This does not mean that someday there will be neutraceutical answers to arthritis. It also does not mean that some people on a case by case basis get help but:

1. Glucosamine has no proven affect over placebo. End discussion.
2. Gucosamine does not and has never shown that it can stop the progression of arthritis.
3. Glucosamine DOES NOT build cartilage.

You can keep on buying it at Wal-Mart. A Playstation would do more to exercise your fingers.

Dr. K.

Related Topics: Alternative Ways to Easing Arthritis Pain, Arthritis Diet Claims: Fact or Fiction?

Technorati Tags: arthritis,glucosamine