FAQ Category: General

The way we walk is called our gait pattern. Natural changes occur in our gait as we age. By the time we’re 65 years old, some of these changes become noticeable. With each passing decade, the changes are more obvious.

Men tend to become more stooped or bent forward and stop swinging their arms. Women adopt more of a waddling gait, most likely cause by hip muscle weakness. Both men and women decrease their step length in order to slow down. A shorter, wider base of support may be a natural way to reduce the risk of falling.

Encouraging your grandmother to walk faster may be possible. More likely she needs some specific exercises to help improve her joint motion, muscle strength, and balance. Loss of ankle motion is a key factor in gait, speed, and balance. Painful joints from arthritis can also make a difference.

A medical evaluation may be the next step. If there isn’t a medical reason for the changes in the way she walks, then see a physical therapist. The therapist can offer practical suggestions for things your grandmother can do for herself to improve her gait and possibly prevent loss of balance and falls.

Rheumatoid arthritis (RA) is a systemic disease meaning it affects many parts of the organs and body. It seems to have its greatest impact on the joints, especially the joints of the hands and feet.

Early intervention has been shown to reduce deformities and maintain function. With proper medical care, patients are often able to manage very well. Patients in stage 1 disease (first six months) are treated with antiinflammatory drugs.

If your symptoms progress or the medications don’t help, other disease-modifying drugs are available. It may take some time to find the right drug or the best combination of medications for you. The worst thing you can do is give up and stop seeing the doctor. A little investment of time and money now can save you a lot of grief and pain later.

A visit to the hand therapist (occupational or physical therapist) will get you set up on a program of joint protection, conditioning, and strengthening. It’s important to learn how to balance rest and activity, especially during flare-ups.

Without treatment, joint damage and deformity can get worse and worse. The final stage of RA involves bone destruction and collapse. Most patients today are able to avoid this kind of outcome with consistent medical attention and self-care practices.

It appears that some people are more naturally adept at using the Bodyblade. Others, like yourself, find it difficult, if not impossible, to master. Even some highly skilled athletes are unable to work with the Bodyblade.

The Bodyblade is a thin foil or sword-like instrument held in one or two hands. By using just the right amount of arm and trunk motion, the foil oscillates (moves back and forth) at a natural frequency of 4.5 Hz. Too much arm or trunk motion will interfere with the oscillations.

The blade must be held at just the right angle. Motion of the hand must be in the plane perpendicular to the length and flat side of the blade. Any extra motion in other directions will effect the blade resonance.

Exactly why there are such wide differences between users remains a mystery. For those who master it quickly and easily, it can be a valuable tool in spine rehab. Regular use of this device can help improve strength, balance, and coordination needed for spinal stability.

For others, the improper use of the Bodyblade can actually increase compressive forces making this a potentially unsafe treatment method.

Fosamax belongs to a class or group of drugs known as bisphosphonates. Bisphosphonates work by reducing how much bone is destroyed or resorbed by tiny bone cells called osteoclasts. They also work by keeping bone building cells called osteoblasts alive longer.

Bisphosponates have an added benefit. If you should ever fracture a bone, Fosamax will inhibit or stop too much inflammation from occurring. Under these conditions, healing is faster. And if you should ever need a joint replacement, Fosamax has been shown to help keep the implant firmly in place by reducing the bone loss from around the implant.

Fosamax improves bone quality and is effective in preventing fractures. Most people find this the most important benefit of this drug. Hip, wrist, and vertebral fractures are the most common sites of breaks in osteoporosis. Hip fractures are a common cause of disability and decline in the older adult population. This single drug can help prevent such events from happening.

Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced. The bone’s structural strength is decreased. This makes the bone more prone to fracture.

There are two basic kinds of bone: cancellous and cortical.
Cancellous bone is the softer, spongy bone tissue inside the long bones that are hollow. For example, the femur (thigh bone) and the humerus (upper arm) are long bones.

The inner cavity of these bones is filled with cancellous bone. It has low density and strength but there’s a lot of it. Cancellous bone contains the red bone marrow where blood cells are produced. This is also where most of the blood vessels (arteries and veins) to supply the bone with oxygen and nutrients are located.

The outside layer of bone is called cortical bone. It is very hard and more like what we think of when we talk about bone. Osteoporosis has its biggest effect on cortical bone where fractures occur.

Active bone cells called osteoclasts and osteoblasts build up new bone and tear down old bone that needs to be replaced. With osteoporosis, there is an imbalance in this process. Tiny fractures can occur here that don’t heal or aren’t completely repaired.

If a patient is too osteoporotic for a screw or pin to hold, then medications such as the new bisphosphonates can be used. You may have heard of the most widely known bisphosphonate called Fosamax.

If your father is not already taking this medication, ask his doctor about it. A recent report suggests systemic use of bisphosphonates can help improve the fixation of hardware in osteoporotic bone.

Myositis ossificans (MO) also known as heterotopic ossification is the formation of bone in soft tissue. The most commonly affected soft tissue are muscles that have been injured or traumatized. During a total hip replacement, muscles are often cut in order to remove the old hip and put the new one in. Calcifications form at the site of the injured muscle.

Pain, tenderness, and swelling are common. Muscle atrophy and loss of joint motion can also occur. The most significant risk factor has already been mentioned: trauma. Myositis ossificans is less likely to occur after a total disc replacement (TDR).

The reason for this is because muscles are damaged or cut during the TDR. The iliopsoas (hip flexor muscle) has to be moved out of the way with a retractor but it is not split or removed.

If you develop MO after a total hip replacement, this does not put you at increased risk of the same condition after every operation. The type of procedure is really the key factor.

Studies show that about four per cent of patients with a TDR develop ossification but it doesn’t seem to affect motion or pain. The only way to know it is present is by looking at an X-ray.

Any form of exercise if done consistently has benefit to the heart, lungs, bones, and muscles. Hiking has become a popular activity around the world. As an activity, hiking is a continuous, low intensity form of exercise.

Studies show a positive effect on the cardiovascular and cardiopulmonary systems. There may be one downside and that’s the effect on your joints. Many people hike up and down hills with the added weight of an external day or back pack.

Research has shown that the more external load carried, the greater the force on your joints. Just walking downhill without a pack increases the force on your knees three to four times more than walking on level ground.

One way to offset this load is to use a walking stick. By using a stick, hikers can reduce the force on the knee while increasing balance and support. One study showed that hiking poles can reduce up to 25 tons of force on the joints after only one hour of trekking.

You can still get your heart rate up while using the stick, so you don’t negate the aerobic capacity of hiking the hills. Most experts agree that it’s best to combine a wide variety of exercise types to maintain and improve overall fitness.

It would be good if you could add some other types of exercise to your walking and hiking regimen. Swimming, tennis, golf, dancing, t’ai chi, yoga, and pilates are just a few of the many possible choices.

Septic arthritis is also known as infectious or bacterial arthritis. As the name suggests, there is an invading microorganism causing inflammation of the synovial membrane lining the joint.

Septic arthritis can occur in a natural or prosthetic (replacement) joint or in joints damaged from rheumatoid arthritis. The bacteria can come from some other place in the body. The microorganisms travel via the bloodstream directly to the joint.

Septic arthritis can cause serious damage and destruction to the cartilage even after it has been removed. This is why early treatment is important. The diagnosis can be difficult to make without an arthroscopic exam. Lab results and imaging tests may not be enough to tell.

Once the surgeon looks inside the joint, a clear cause for the problem can be identified. The joint can be irrigated with a saline solution to flush out any remaining bacteria.

Experts say that pool therapy has several advantages over a land-based exercise program. For one thing, the buoyancy of the water helps take the load off your joints.

Many people with arthritis are able to move and perform exercises in the pool that are too difficult on land. Pain and stiffness are reduced in the warm water making it even more likely that someone with arthritis can move and exercise more freely.

The water itself can act as resistance for you when you’re ready to progress your program. Doing exercises in shallow water offers less resistance compared with exercising in deeper water. By increasing the percentage of your body immersed in the water, you can increase the resistance accordingly.

Despite all the obvious advantages of pool therapy, many studies have compared aquatic based exercise programs with land-based programs. The evidence does not support one over the other. Each one has its own advantages. Both are better than not exercising at all. Perhaps a combination of the two will give the best results of all. More studies are needed to answer this question.

These terms are often used interchangeably by different people and in different countries. In the United States, hydrotherapy usually refers to a hospital-based physical therapy program for patients with wounds or other acute injuries. In Europe and Australia, hydeotherapy is a term used to describe rehab exercises done in a heated pool.

Pool therapy was a term used by American physical therapists to describe exercise programs carried out in a pool. In the last 10 years, this term was changed to aquatic physical therapy to help distinguish it as a rehab program separate from group exercises.

Aquatic physical therapy begins with an individual exam and assessment. A specific treatment plan is developed for each patient based on past medical history, present illnesses and conditions, and any risk factors present.

The therapist uses his or her knowledge of hydrostatics, hydrodynamics, and the physiologic effects of immersion to prescribe exercises for each patient. Evidence from research studies is used to avoid exercises that are not beneficial and to include those that have the greatest potential to help the patient.

When evaluating an advertised pool program, it’s best to ask some questions about what is offered and who is providing the class. In the case of mild arthritis, a general pool program may be all that’s needed. For patients with more complex problems or more advanced arthritis, an aquatic physical therapy program may give the best results.

Female athlete triad is a term used to describe three medical conditions in some young women. Osteoporosis, amenorrhea, and an eating disorder all together in young, ultracompetitive women has made the news.

Osteoporosis is a loss of bone density, seen most often in older, postmenopausal women. Amenorrhea refers to the absence of menstrual periods in premenopausal women. Overtraining or extreme sports participation can lead to a stop in the menstrual cycle for young women. Eating disorders such as anorexia nervosa are an increasing problem in female competitive athletes.

These three conditions in combination called female athlete triad can put young women at increased risk of stress fractures. Repetitive stress on normal bone can cause fractures. But when there’s osteoporosis, amenorrhea, and an eating disorder with lack of proper nutrition added to the picture, then fractures are even more likely.

In the past, hormone replacement therapy (HRT) was used to control the symptoms of menopause. One of the advantages of this treatment was the improved bone mineral density. The result was fewer bone fractures. Even women with reduced bone density from taking corticosteroids for their RA were helped by HRT.

But several studies showed that HRT increased the risk of cancer, heart attacks, and strokes in postmenopausal women. Other drugs for osteoporosis have replaced the use of HRT for many women. You may have heard of Fosamax (alendronate) or Actonel (risedronate). These are drugs called bisphosphonates most commonly used to strengthen bone and treat osteoporosis.

The use of HRT (estrogen) is still considered for some patients. You may be a good candidate for estrogen therapy if you have tried bisphosphonate without success and/or if you have severe menopausal symptoms. Some women use a drug called raloxifene to manage osteoporosis. This is a selective estrogen receptor modulator (SERM). It’s only half as good as estrogen or bisphosphonates in managing osteoporosis.

It’s best to review all your options with your doctor. Your age, menstrual status, and any other risk factors must be reviewed in any decision you make. Careful counsel about the risks and benefits of each treatment option must be given.

Experts are starting to advise the routine use of vitamin D daily for patients with rheumatoid arthritis (RA). Low vitamin D levels can contribute to decreased bone mass and osteoporosis. With the increased risk of fracture in patients with osteoporosis, measures to prevent this condition are important.

For anyone with RA, the risk of osteoporosis may be even greater. Treatment with corticosteroids to reduce inflammation can also cause bone loss. For women going through menopause, the risk of bone loss and osteoporosis goes up. Other health problems such as thyroid, liver, or kidney disease add to the risk of osteoporosis.

Ask your doctor to advise you on taking vitamin D. Two forms are available at your local drug store: D2 and D3. D2 may not work as well because it doesn’t last as long in the body and may not give you enough vitamin D.

Many vitamins and calcium already contain vitamin D. Supplementation with vitamin D is recommended at 800 IU each day. Check with your pharmacist or physician to determine what’s best for you.

There may be some truth to your statement. In a recent study comparing delivery of braces to children, government programs took much longer to provide approval and funding compared to private insurance. At the same time, it took families on government plans three times as long to pick up the brace compared to families paying for the brace themselves.

The brace makers in that study observed that families who got the braces free didn’t seem as eager to get their brace. Many phone calls had to be made and reminders given. Families who paid for some or all of the brace picked it up within 30 days. Families who did not spend their own money for the brace took an average of 81 days to pick up the brace.

On the other hand, funding may not be the only issue that low-income families face. Some may not have telephone service. Others may have to move and are more difficult to contact. Language barriers, lack of transportation, and no time off from work can also cause delays in treatment observed in this study.

Many studies have shown a link between access to health care, quality of care, and type of insurance. Government-sponsored insurance such as the state run Medicaid program take much longer to approve treatment recommended by a doctor.

In fact, delays occur in scheduling appointments, diagnosis of the problem, and treatment, too. These delays have been reported by patients trying to see a physical therapist, get a vaccination, or even obtain a simple X-ray.

A recent study in California showed major delays in authorization and actual delivery of braces for children covered by Medicaid. The type of brace made a difference. More expensive trunk braces that cost four time more than ankle braces also took four times as long to get Medicaid approval.

Improving health care delivery for children is an important goal. Finding ways to streamline the authorization process may be a good place to start.

Modern treatment of rheumatoid arthritis (RA) has changed with the new knowledge we have of this disease. Research has shown that patients have much better results with early, aggressive treatment.

In the 1980s, doctors were told to go low, go slow meaning they used drugs sparingly and in low dosages. Today, the motto is go steady, be ready. If the medication used by a patient with RA isn’t working, changes are made right away.

Remission of the disease is possible with the right choice of drugs. The Methotrexate (MTX) you’re on is a good choice for many patients. Break through symptoms does require a change in approach.

Many patients do very well with a combination of MTX and a newer group of drugs called tumor necrosis factor (TNF) inhibitors. Up to 90 per cent of patients with RA are well-controlled with this treatment method. Symptoms, function, and quality of life are all improved. Best of all, the disease itself can go into remission.

The next step is to go back to your doctor for a follow-up visit as soon as possible. Close monitoring of patient response to treatment is important in managing RA. But your physician won’t know how you are faring if you don’t check in when your situation changes. Call today and make an immediate appointment.

Methotrexate (MTX) remains a good choice for many patients with rheumatoid arthritis (RA). It was first used in the mid-1980s for patients with advanced disease who didn’t get the help they needed with nonsteroidal antiinflammatories (NSAIDs).

Today, it is often combined with tumor necrosis factor (TNF) inhibitors discovered in the late 1990s. Together these drugs give better control of disease activity.

Two new treatment options for RA came out just this year (2006): Abatacept and Rituximab. These drugs are able to change the way the immune system responds to RA. Both are given intravenously (IV). Studies so far have been on patients who did not get a good response to MTX with TNF inhibitors.

Other drugs remain in various phases of clinical trials. We can expect to see results of these drugs published over the next three to five years. Watch for information on: HuMax-CD20, Belimumab, Atacicept, Tocilizumab, Certolizumab, and Golimumab. These drugs work either by interrupting or blocking immune system signals.

It’s best to seek medical advice directly from your doctor for this type of question. Each patient responds differently based on history, body metabolism and type and severity of arthritis. A careful examination and knowledge of medications is required.

We can offer some information that may be helpful to you when talking with your doctor. As you may know, aspirin is a nonsteroidal antiinflammatory drug (NSAID). It is also an anticoagulant and can prevent the formation of blood clots. This is why it’s used with heart patients. But as you point out, it is also acidic and causes ulcers in some people.

The dosage used for heart attack prevention is very low and not likely to effectively treat painful joint symptoms. Patients with mild OA often try ibuprofen, a popular over-the-counter NSAID.

But studies show there is an increased risk of heart attack in aspirin users taking ibuprofen. Other NSAIDs may be a safer choice. Sometimes Tylenol® works well for pain relief of mild joint pain. Since it’s not an antiinflammatory, there is little concern about an increased risk of heart attack with its use. Your doctor will know what’s best for you.

Drug companies are working on a new line of drugs for many diseases called disease-modifying drugs. Right now there are disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis (RA).

DMARDs suppress symptoms of RA and slow the progression of the disease. They don’t reverse the effects of arthritis and they can have serious side effects. DMARDs for RA include Arava, Ridaura, Plaquenil, methotrexate, Leukeren, and Cytoxan. Only Arava and Ridaura were actually developed for use with RA patients. The others were being used for other conditions first and found to be effective with RA.

For osteoarthritis (OA), nonsteroidal antiinflammatory drugs (NSAIDs) are still the most commonly used agents. NSAIDs reduce inflammation bringing patients pain relief and improved function. Aspirin and ibuprofen are the most commonly used NSAIDs.

Disease-modifying OA drugs (DMOADSs) are not yet available and remain in the research stage. Scientists hope to develop DMOADs that can restore normal metabolism in the joints and possibly even repair cartilage cells that aren’t working properly. The goal is to find agents that will permit joint healing.

New understanding of the processes behind OA are quickly opening up doors into the search for an effective DMOADs. Such a drug may even replace NSAIDs and other drugs used in the treatment of OA.

An endoscope is an instrument used to look inside a hollow organ like the bladder or an opening such as the chest cavity. The endoscope is a long, thin tool with a tiny camera mounted on the end. There is also a light mounted onto the lens to help the surgeon see what he or she is doing. A cable attached to the camera connects to a TV screen. The surgeon sees a magnified picture of what the camera shows in a fairly narrow field of vision.

The endoscope makes it possible to use a small incision yet still work on deep structures of the body. When using endoscopy to remove a disc, a local anesthesia is given first. Then a small probe is inserted into the disc. A larger tube is placed over the probe down to the annulus. The annulus is the outer covering of the disc.

A tiny cut is made right into the disc itself. A special probe is then inserted through the endoscopic tube. The disc is sucked out and the surgeon removes any small pieces or fragments of disc material that have come loose.

Patients often get pain relief right away. If there are no problems, they may go home the same day. Some people have trouble with muscle spasms and need to take a muscle relaxant. It’s possible to go back to work several days later. There are restrictions on lifting and strenuous activities for the first few weeks.