Know Your Bones

Treating Knee Osteoarthritis: Synvisc

In knees with osteoarthritis, the cartilage surface wears away and the joint fluid (called synovial fluid) breaks down and can’t help your knee move easily. Synvisc is designed to relieve pain and stiffness by lubricating and shock-absorbing between the worn surfaces.   Currently, it’s only used to treat arthritic knees, but research is promising for other joints like the hip, shoulder, ankle and thumb.

                

A. Cartilage wears away          D. Synvisc coats the knee joint
B. Bone spurs may develop
C. Joint fluid breaks down

There are other brands that make a treatment like this, but I have been using Synvisc for my patients for over 10 years.  Synvisc is only part of your treatment to relieve arthritic knee pain (weight management, low-impact exercise, medication, cortisone shots, bracing, surgery…).  I usually recommend it for patients who:

 

• …have pain that feels mostly like an aching, stiffness, or rubbing; not warm and swollen from inflammation.  In this case, a steroid injection could be more useful.
• …do not feel locking or instability from loose flaps of worn cartilage.  These knees need arthroscopic surgery first to clean out the joint; we’ll use Synvisc at 6 weeks postop.
• …are taking medication by mouth that usually helps, but the knee is getting really painful.
• ...had cortisone shots that don’t help for more than 6 months.

 

Insurance covers most of the cost of the office visit, injection and Synvisc, but every policy has different rules.  My staff will work with you and your insurance company to determine your out-of-pocket cost.

 

Synvisc is administered in 1 injection that contains about 1 teaspoon of a clear gel.  After you receive the shot, avoid strenuous activity for the next 24 hours or so (no heavy lifting or standing/walking for more than about 1 hour).  Apply an ice pack for 15 minutes every few hours.  Most patients schedule an afternoon or Friday appointment, and then go home and rest.

 

Synvisc is not a steroid.  It does not cure arthritis and is a way to buy time and preserve cartilage before knee replacement.  It doesn’t work for everyone.  Most patients don’t have total pain relief, but do notice less soreness and stiffness for 6-12 months or more.  Climbing stairs, walking long distances and getting up from a chair will be easier. The treatment can be repeated every 6 months if it has helped you.

Learn more at www.Synvisc.com and in Chapter 9 of my book KNOW YOUR BONES: Making Sense of Arthritis Medicine. 

 

Is your shoulder ready for surgery?

The most common reason patients come to my office is for shoulder pain.  Most of them aren't major league pitchers or electricians working overhead.  Instead, they spend most of their time behind the wheel or behind a desk, and don't realize they're slouching.  The muscles around their shoulder blades get weak, and they're prone to tendinitis and bursitis from bone spurs they never knew they had.

Watch the shoulder move in 3-D at About.com--the best illustration of the shoulder's structure and function I've seen so far! (It's worth waiting thru the 15 second commercial)

If your shoulders have started to hurt, be honest about how you've been treating them.  Start with sitting up straight and strengthening the muscles across your upper back. Use mild anti-inflammatory or pain medicines.  See your doctor for an exam and X-Ray, and maybe your pain will go away with a cortisone shot and/or physical therapy.

If you've done your best, but pain persists, the next step might be surgery to remove bone spurs and inflamed tissue, or to repair a tear in your rotator cuff:  click here for information from the AAOS. 

What is Carpal Tunnel Syndrome?

Do you have carpal tunnel?  Actually, you have 2.  The carpal tunnel is the normal anatomic structure of the wrist: an arch of bones covered with a ligament, through which pass the tendons that flex your fingers and an important nerve to the hand. 

Carpal tunnel SYNDROME is the problem, when swelling within this closed space presses on the nerve, causing numbness in your fingers.  See it all in 3-D at About.com (it's worth waiting thru the commercial--hey, someone's gotta pay for these great graphics!)

Cool your symptoms by respecting the way you use your hands:  takes breaks from repetitive tasks, manage your weight and chronic health problems (like diabetes), wear wrist splints at night to rest the tunnels. 

If the problem continues, surgery to release the ligament and decompress the tunnel is very successful.

How Do Nutritional Supplements Help Relieve Osteoarthritis Pain?

There has been a lot of excitement recently about the potential relief from osteoarthritis (OA) one can gain from dietary nutritional supplements. These products are often called "nutriceuticals", a term used to explain benefits derived as being both nutrients and pharmaceuticals. In recent years, glucosamine and chondroitin, as well as naturally-occurring "good fats" have gained respect as pain relievers.

Nutritional supplements, however, have not proven to be any more effective in relieving pain than other remedies. Most studies contend that supplements are "just as effective" as certain pills for relieving OA symptoms. That in itself is good news.

Interestingly, we really don't know exactly how nutritional supplements relieve OA symptoms. Most of the compounds used in these supplements are found naturally in our bodies and are crucial to normal cartilage growth and repair. Different substances appear to work in different ways. So far, here's what the research suggests:

Glucosamine: Glucosamine is a mjor component of cartilage. It forms the building blocks for growth and maintenance of cartilage proteins. Remember that joint cartilage is 90% water - glucosamine absorbs water and keeps the joints lubricated. Taking supplements could promote the formation and repair of cartilage, perhaps slowing its deterioration and even preventing OA.

Chondroitin: Chondroitin is also found in your cartilage, bone and tendons. It is believed that chondroitin improves the durability of cartilage by helping its water retention and elasticity. It also appears that chondroitin can help block enzymes that can break down cartilage.

MSM and DMSO: MSM or methylsulfonylmethand (METH-ill-sul-FON-ill-METH-ane) and DMSO or dimethyl sulfoxide (DIE-meth-ill sul-FOX-ide) are related sulfur-containing organic liquids that are designed to relieve joint pain and inflammation. DSMO is a widely used commercial solvent, derived as a wood byproduct during the production of paper. Its many potential health benefits were first described in the early 1960's. It penetrates body tissues rapidly and is transformed into MSM in the body. These compounds quiet inflammation by scavenging free radicals released at the site of an injury, and keep swelling in check.

CM: CM or cetyl myristoleate (SEE-tull-meer-iss-TOLL-ee-ate) is a waxy fatty acid derived from beef tallow that seems to be an anti-inflammatory. Tests have shown that it prevents OA in laboratory mice.

Omega-3 "good fats": Omega-3 good fats come from fish such as salmon, mackerel, and tuna. A number of studies have supported their anti-infammatory effects as well.

There is also a wide range of other supplements, herbs, and oils that are believed to counteract inflammation. Certain foods are also linked with improving OA symptoms. The Arthritis Foundation is an excellent resource for reliable information about alternative and conventional therapies. You can find them online at www.arthritis.org.

Topical Pain Relievers - What Do They Do?

Topical pain relievers are applied to the skin over painful joints. Compare this to systemic, or system-wide, treatment you get from taking pills by mouth. Pills must be digested, absorbed by your intestine, processed by your liver, and then circulated via the bloodstream throughout your whole system. Topicals act right at the scene of the crime.

Topical pain relievers are a valuable addition to the cache of treatments on hand to alleviate your osteoarthritis (OA) pain. Many varieties of creams, rubs, and salves are available. They offer relief through one or more of the following ingredients.

• Counter-irritants: Counter-irritants distract your brain from your OA pain. Menthol, wintergreen, camphor and eucalyptus oil stimulate nerve endings in the same body area as your arthritic joint. A warm, tingly feeling diverts your brain's attention away from the pain in the joint itself. This "interference" happens where you apply the salve (say, at your knee). One of the additional benefits is that you don't become sleepy or confused like you could with some pain pills.
• Capsaicin (cap-Say-sin): Capsaicin is derived from cayenne peppers. This natural ingredient soaks into the nerves around your painful joint and depletes their supply of Substance P, the neurotransmitter that sends the pain message to the brain. Interestly, only the nerves that transmit pain are affected; normal sensation pathways are not involved. You aren't numb like you would be with novocaine.
• Anti-Inflammatories: Anti-inflammatories can either resemble the non-steroidal anti-inflammatory drugs (NSAIDS) you take in pill form, or the natural anti-inflammatories like omega-3 "good fats." These block inflammation at the site where it smolders and prevent the ensuing pain.

Don't expect these treatments to penetrate all of the tissue layers to reach inside the joint itself. OA pain can also arise from strain on the soft tissues that are trying to stabilize a worn, wobbly joint: muscles, tendons, liagments. Topical pain relievers work here.

Five Health Tips In Fighting Osteoarthritis

Osteoarthritis (OA) is a degenerative process that will continue at its own pace until its cause and cure is discovered. Until that time comes, maintaining good health can be strong fighter in staying relatively pain-free and active. Here are six health tips worth following:

1. Remember that all of your joint components are made of living tissue. These tissues rely on healthy blood flow and the right nutrients to repair themselves and stay strong and resilent. Eating poorly robs your body of the tools it needs to maintain itself, and smoking constricts your blood vessels, limiting the circulation to these tissues.
2. Daily activities may strain shrunken, stiff and irritated tissues. It may be easy to "over do" it unless you keep your joints limber and resilient with regular exercise.
3. Although osteoarthritis is often called "wear and tear" arthritis, don't be afraid that physical activity will wear you out. On the contrary, joints are designed for motion, and motion helps circulation nourish your joints.
4. Good health and a state of "wellness" means you respect the way all of your body's organs and systems are interrelated. Do everything you can to sustain your vigor and balance in order to ward off anything that threatens it with desease.
5. Choose your pharmacist as carefully as you would choose a physician. Thanks to his/her training and expertise, your pharmacist is a valuable consultant who can advise you about how to get the best results from your medications, potential drug interactions and side affects, possible allergy complications, drug costs, insurance coverage and lower-cost options.

You've got better things to do than let OA rule your day. Maintaining good health habits is certainly part of the right treatment strategy.

Some Tips On Applying Heat or Ice To Painful Joints

When you have a painful joint caused by osteoarthritis, applying heat treatments or ice treatments can help. But which should you choose? Why? How often and how long? Here are some answers.

The only time you must choose ice is during the first 48 hours after an injury or surgery. Cooling the area causes the nearby blood vessels to constrict. There's less swelling and, therefore, less pain. Conversly, heat opens up the blood vessels, improving flow. This increased circultion brings oxygen and healing elements to the scene while flushing away wastes. Kind of "in with the good and out with the bad."

Try heat to warm up your joints before activity, or while resting - ice afterward. Apply a warm or cold compress for 15 minutes. If it feels better, you've made the right choice. If not, switch. It's OK to experiment here.

Over a lifetime, your osteoarthritis (OA) symptoms will wax and wane. Modify your activities, apply heat or ice as needed, and keep your body strong and flexible to minimize your need for drugs. Over-doing household chores, a strenuous hike, or a slip or fall can irritate your joints and could cause a flare-up.

Some things to remember.

• OA is a complex disease with a variety of symptoms including pain, stiffness, swelling, and limited activity.
• OA also progresses at different rates in different patients (even in different joints in the same patient).
• Your personal treatment plan may have you using different drugs for different symptoms as your symptoms change over time.

Applying heat or ice treatments can play a helpful role in relieving pain that you may suffer.

[The above article was taken from excerpts  from Know Your Bones: Making Sense of Arthritis Medicine, a guidebook written for those who suffer from osteoarthritis.]

Is There a Cure for Osteoarthritis?

Currently, there is no cure for osteoarthritis (OA). Unfortunately, there is no magic wand that can rebuild the very complex cartilage tissue. However, there are dozens of arthritis medications available to relieve the pain, swelling, and stiffness of OA. But remember, the rate at which your cartilage wears away will not change for better or for worse whether or not you take your medicines.

A sudden increase in your OA symptoms does not mean that your joints are wearing out faster. Usually, a surge in your symptoms means a flare of inflammation. With this in mind, and because you can readily feel the symptoms, you can take your osteoarthritis drugs on an as-needed basis. If you have a lot of pain and stiffness every day, then take the medicine every day. On the other hand, if you're fairly comfortable today, you can skip it. If you don't have pain, you don't need the medicine.

OA drugs are categorized by drug class. Each class differs in the way your body deals with the drug, know as the mechanism of action. Different mechanisms of action target different symptoms of OA ( i.e. pain, stiffness and/or inflammation. However, it's important that you understand

• how each drug works,
• which drugs are related because they work in a similar way,
• what side effects can occur, and
• why a drug may or may not be right for you.

Combining smaller does of different medications to maximize relief while minimizing side effects may be the right answer. In future posts, I'll try to answer some of these questions and other frequently asked questions posed by my patients.

Remember, you can also ask your pharmacist about non-prescription treatments as well. Ask them to help you decipher the active ingredients label on the package of any over-the-counter medications you are considering buying. Your pharmacist can cross-reference theses ingredients with any of your other medications and advise you about possible drug interations.

Use only one pharmacy so all of your medication records are at one location. Most pharmacies use a computerized database to keep track of the prescriptions they fill for you. This database will cross-reference your medicines to check for potential problems...if it knows about everything you take.

[The above article was taken from excerpts  from Know Your Bones: Making Sense of Arthritis Medicine, a guidebook written for those who suffer from osteoarthritis.]

What Is Pain, Anyway?

Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." That is, it's your brain's way of telling you that something is wrong. Actual tissue damage is associated with problems like osteoarthritis (OA), where your joint is worn and irritated, or a broken bone or torn ligament.

Pain is also your body's way of protecting you from potential tissue damage. For instance, you'll pull away from something that's too hot to avoid a burn.

Your nervous system does a lot more for you than just telling you where it hurts. It regulates your body's response to any stimulus, good or bad, from within or from outside your body. Your nervous system tells your muscles where to move (and what to do when you get there), tells your eyes were to look (and what they see), and tells your ears what they hear. Each specific sensation has its own "wire" in the network connecting your body and brain.

Pain is transmitted by a "cable" or wires that is structurally and functionally distinct from all of the nervous system's other functions.

Medicines that relieve pain are call analgesics (an-ul-JEEX-ix). Their purpose is to quiet the way you perceive pain. That is, to minimize your awareness of pain. Ideally, they target on the pain cable and leave the rest of the network alone.

[The above article was taken from excerpts  from Know Your Bones: Making Sense of Arthritis Medicine, a guidebook written for those who suffer from osteoarthritis.]

What Is Osteoarthritis And Why Does It Hurt?

There are about 100 forms of arthritis. Osteoarthritis (OA) is the most common. "Osteo" is from the Greek word for bone. "Arthr" means joint. And "itis" means inflammation.

Osteoarthritic cartilage can become brittle, thin, and frayed. Eventually it wears away, leaving craters of underlying bone. This process can take many years, or sometimes happens quickly - perhaps after an injury. Irritated joints try to protect themselves by producing extra fluid, and can become swollen (called "water on the knee").

Normally, the synovial membrane (see my last post) that lines the joint looks like a sheet of satin. However, when inflamed, it becomes more like wet terrycloth. This inflammation of the joint lining is usually what causes arthritis pain. The swollen lining gets pinched between the moving bones. Once the cartilage layer is thinned and worn, the joint loses its spacer and becomes less stable. If your muscles are weak and flabby, they can't provide the necessary support.

Think of the rough surfaces within the joint acting like a match head on a flint. Imagine a wobbly knee where every step causes the jagged surfaces to rub together, igniting a little "fire." That fire is the inflammation of arthritis pain.

So what exactly is inflammation anyway?

Inflammation is the tissues' response to injury or irritation. It causes pain, swelling, redness and heat, and results from an elaborate sequence of biochemical reactions in the body. Although these biochemicals are associated with the undesirable symptoms of OA and fever, they also do good work.

• They begin the first steps of healing after an injury.
• They help the body fight off infection.
• They regulate kidney function.
• They balance acid and mucus production inside the stomach.
• They help maintain blood pressure
• They control blood clotting.

So when using medications that block inflammation to treat OA symptoms, the challenge is to block the bad effects of inflammation while permitting its healthy housekeeping functions to continue.

[The above article was taken from excerpts  from Know Your Bones: Making Sense of Arthritis Medicine, a guidebook written for those who suffer from osteoarthritis.]