FAQ Category: General

Joint and muscle stiffness is a natural part of aging. It can also be an early symptom of other medical conditions like osteoarthritis, lupus, or thyroid problems to name a few. It might be a good idea to have a physical check up, especially if you haven’t done this in a while.

If your stiffness is normal then a few simple guidelines may help. First stay hydrated. Drink plenty of water, clear liquids, or clear, fruit juices. Stay active. Regular exercise as simple as walking or biking done three or four times each week has been shown to help.

Consider trying a stretching class, yoga, Tai Chi, or other form of slow, rhythmic movement. It may take several months, but this type of exercise often helps maintain motion and may even restore motion lost over the last months and years.

Get to bed early enough at night to get up 15 to 20 minutes earlier in the morning. Try to do some gentle movements of the head, neck, shoulders, and hands while in the shower. After getting dressed, take an extra five minutes to do a little stretching, yoga, or Tai Chi.

Aging is linked with osteoarthritis (OA) of the joints. The hip and knee are affected most often.

Stiffness is also common as we get older. There are many reasons for this. Tendons and ligaments have less water in them. The drying effect makes the joints seem stiff. The cells that make up soft tissues are called collagen. Fewer new collagen cells are formed so we lose some elasticity in the joints and muscles.

There are other changes going on in the joints. The cartilage loses strength. Changes in the cells of the cartilage lead to OA. There is a thinning of the joint space as the cartilage breaks down. This loss in joint space can be seen on X-ray. It’s the most common way to diagnose OA.

A medical doctor will use tests of motion and strength along with X-rays to make the diagnosis. An early diagnosis is best so that early treatment can limit problems.

Glucosamine is a very popular product on the market. It’s used to stimulate growth of the joint cartilage. Many patients with osteoarthritis are using it with good results.

Glucosamine can affect insulin. It can keep the pancreas from forming insulin. Or it can affect how quickly insulin does its job. Insulin keeps the body from having too much sugar in the blood.

If you are already borderline diabetic, then some doctors advise stopping the use of glucosamine. Others suggest monitoring each patient carefully. There are no specific guidelines yet. Not enough is really known about each herb and how it affects individuals.

Doctors are telling patients to stop taking all supplements before surgery of any kind. The reason for this is the potential for problems. Herbal products can affect both anesthesia and any drugs used for the operation.

There’s still so much we don’t know about this problem. There are no official guidelines on the use of herbal medications before surgery. The American Society of Anesthesiologists suggests stopping all herbs two weeks before any operation.

Make sure your doctor knows what you are taking in advance of the scheduled operation. Follow his or her guidelines closely to prevent any problems.

Herbal products can affect the patient about to have surgery or who has recently had an operation. First the supplements can directly affect any drugs you may need for the total knee replacement (TKR). They can alter the way the drug is absorbed and sent throughout the body.

Herbal products can also affect the way other medications are broken down and eliminated from the body. Your risk of bleeding can increase. Sometimes the herbs affect the way your body handles the anesthesia.

Wisely, doctors try to reduce as many risks as possible for the patient going into surgery. There are enough possible problems with any operation. For best results, follow your doctor’s advice. You can always start taking these two products again once you’ve recovered from the TKR.

Studies show heat wraps are well tolerated by users. There are no serious problems. Sometimes minor skin redness occurs. This will go away when the wrap is removed. The wrap can even be worn to bed at night.

One of the major advantages to the new heat wraps is the ability to move while wearing the wrap. Standard heating pads require the person to stay immobile in a chair or bed. The heat wraps don’t have a cord and don’t have to be plugged in. The heat wrap has small discs made of natural chemical ingredients that heat up when exposed to air.

It’s likely that part of the therapeutic benefit of the heat wrap is that it allows patients to have continuous, low-intensity, heat while still doing normal daily activities. The benefits of the heat wrap last even after the wrap is removed.

Not necessarily. This method of finding the right exercise intensity is called the Talk Test. The Talk Test can be used safely and effectively to find the right level of exercise by all adults. Research comparing types of exercise, for example walking
versus biking, using the Talk Test has been done on men and women.

So far there’s nothing to show that there’s a difference between men and women using this test. They both use about the same amount of breath at the same levels of exercise intensity.

The real issue may have more to do with differences in age and health condition. More studies are needed to compare these variables.

This is a good question and one that a group of researchers at the University of Wisconsin (La Crosse) studied. They measured the heart rate and oxygen use of 16 healthy adults walking or biking while talking at the same time. Oxygen use was the same for both activities when the subjects talked at the same time.

Exercising at a level that allows normal conversation is called the Talk Test. This level of exercise is considered safe and effective. Its use is widely advised for anyone with health concerns.

So long as you can talk while exercising, you won’t overstress your heart or lungs. Of course, many people can exercise at a much higher intensity. Humming or talking under your breath increases your breathing more than you think. It’s not as reliable a measure as the Talk Test.

Exercising while holding a conversation is called the Talk Test. It’s a simple tool that can be used no matter what form of exercise you engage in. If you can exercise and talk at the same time, then you are exercising at a level that’s safe. This is especially important for anyone with health concerns and problems.

For example, people with high blood pressure or heart disease need exercise. They may not need an expensive test to find out how much exercise. Using the Talk Test keeps the person within a range of intensity the body can handle.

If you’re in good health, exercising at a higher intensity isn’t a problem. You can work at a level where you’re breathing hard and unable to talk at the same time. You’re probably exercising at or above your target heart rate.

Studies show that regular physical activity and exercise has many benefits. This is true even if the person doesn’t breathe hard or sweat profusely. Exercising beyond the Talk Test has other benefits as well. Not everyone can exercise to that level or intensity.

Actually two developments have occurred in the last few years that have improved post-operative symptoms for many patients. Nausea is much improved thanks to increased amounts of oxygen during the operation and better pain control after.

Better pain control is obtained through two means. The first is a single injection nerve block. The block is given to the major nerve(s) in the anatomic area where surgery is
going to be done. The second is patient-controlled local anesthetic.

Patients can give themselves a small dose of pain meds on an as-needed basis. A portable pump is used to dispense the drug. The patient pushes a button to release the pain reliever. The unit is programmed to allow the patient to decide when better pain control is needed. Most patients report fewer problems after the operation including nausea.

Encourage your father to ask his doctor about ways to control the nausea. Find out what’s available in your area.

There are plenty of studies to show that osteoporosis (brittle bones) prevention begins in childhood. Children and teenagers can actually make “deposits” in their “bone banks.” Impact activities such as gymnastics, basketball, soccer, and volleyball put loading forces on the bones.

These forces actually stimulate bone growth. As we age, there is a decline in bone density. This is much worse in women after menopause.

The National Osteoporosis Foundation (NOF) recommends daily calcium and vitamin D along with regular physical activity and exercise to prevent loss and maintain bone density. Weight-bearing exercise and activities is best. Avoid smoking and excess alcohol.

To help you understand your own personal risk of osteoporosis read the NOF brochure: Take Action: Healthy Bones, Build Them for Life! [Available online:
https://www.nof.org/osteoporosis/web_SG_broch.pdf]. You’ll see in that brochure that
a calcium-rich diet is very important in children and adolescents. This can be
supplemented with calcium pills starting in young adulthood. Activity and exercise are important throughout the lifespan.

Physical activity is very important in this condition. Studies show activity must be ongoing. The old saying “use it or lose it” is very true with bone density. So congratulations, you’re on the way to better bone health!

In adults physical activity helps maintain bone mass. Regular exercise and physical activity prevents further bone loss. It’s not proven yet that it builds up bone already lost. Studies show high intensity or high resistance exercise may help bone density
increase, but most older adults can’t exercise at this level.

Many doctors combine exercise with a new bone-building drug. The drug is most often a bisphosphonate called Fosamax. Under this treatment program, bone mineral density
can be improved. Turnover of bone cells is a fairly slow process. It takes three to four months for one full cycle of bone resorption, growth, and mineralization. It’s a minimum
of six to eight months to show measurable changes in the bone.

Your doctor will tell you when it’s best to be retested. In the meantime, stick with your exercise program faithfully and keep it up for the rest of your life. You’ll benefit not only your bones, but the rest of you as well.

In order to stimulate bone growth, two things must happen. The muscles must contract and pull against the bone. This is called overloading. And overloading must be strong enough to actually physically deform the bone. This means that getting the heart rate up high
enough to breathe heavy or sweat isn’t enough.

Ground-reaction forces are the second thing needed to cause bone growth. This means force from the ground up through the foot and leg (weight-bearing activities) are required to maintain bone mineral density. During swimming, the muscles do contract against the bone, but there’s no ground-reaction force.

Swimming is still a very good form of exercise. It can benefit your health in other ways. But you should alternate days with a weight-bearing activity such as walking or weight-lifting. More active exercise like jogging, tennis, volleyball, or basketball are also
good.

There is strong evidence to show hormone replacement therapy (HRT) increases the risk of breast cancer. In a landmark study, women were on the HRT five years and showed a relative risk of 2.5 for breast cancer. This means women who take HRT have a 250 percent greater chance of getting breast cancer than if they didn’t take the drug.

There are other risks of taking HRT as well. The same study showed women at increased risk of gallbladder disease and blood clots. It’s best to sit down with your doctor and assess your risk of breast cancer recurring before taking HRT. You can also take a test on-line to find out your risk. Go to:
http://www.halls.md/breast/riskcom.htm. The results are estimates and should not be used to make medical decisions.

You will certainly want to review all of your mother’s medications with her physician and pharmacist. The Food and Drug Administration (FDA) does not recommend the routine use of
hormone replacement therapy (HRT). This is based on more than one study of the harmful effects of HRT.

Find out why your mother is taking each one of her medications. Women at great risk of bone fracture from osteoporosis are the most likely candidates for HRT. But there are new drugs on the market to prevent bone loss that can be used instead.

In the late 1990s, several large studies showed that the risks of using hormone replacement therapy (HRT) far outweighed the benefits for most women. The studies were stopped right away.

Since that time, more studies have been done and confirmed the findings. At the present time the FDA is telling doctors to use nonestrogen therapies to prevent and treat osteoporosis (brittle bones). Drugs like bisphosphonates, calcitonin, and parathyroid hormone can be used instead.

When women take HRT, they should use the lowest dose possible. They should take the hormone for the shortest amount of time. And finally, only women with a great risk of osteoporosis and fracture should think about taking HRT. Women should only take HRT when the risk of osteoporosis is much greater than the risk of the HRT.

Talk to your doctor about what to do. Many naturopaths and women’s support groups have good ideas on preventing symptoms of menopause. Your local library may have several books
on the subject of menopause with helpful suggestions.

You are, indeed, most fortunate. Doctors are trying to understand why some people are at increased risk for osteoarthritis (OA). There are many theories based on current research. Dr. David Felson from Boston University School of Medicine offers some ideas.

Older age and female gender are top on the list as risk factors for OA. Aging by itself isn’t enough as you have pointed out. Changes in the joint and loss of muscle strength are usually a part of the picture. As adults reach age 75 they have less joint pain than at younger ages. This may be because they are less active.

Ligaments tend to loosen up with age and the cartilage thins out. Some joints seem more susceptible to this from load and stress on the joint. Perhaps it’s a genetic-based event.

It’s not clear why women have more OA than men. Studies haven’t shown a hormonal link yet. Diet and lifestyle may be key factors. More study is needed to compare men and women before an answer will be known.

Surprisingly, some people just don’t have pain with osteoarthritis even with cartilage loss. Patients with painful OA usually have other symptoms such as swelling, breakdown of bone underneath the cartilage, and tendinitis or bursitis.

It’s not clear why some people have painful symptoms and others don’t. Clearly the majority of patients do have pain and other problems. In fact if scientists could find out why patients like you don’t have pain the information might be able to help others.

Pain is less likely when only the cartilage is affected since cartilage doesn’t have pain fibers. Damage to the underlying bone that does have many pain fibers can lead to severe pain. Some joints with OA seem less likely to be painful. For example hip OA is more likely to cause symptoms than OA in the hand.

Finally, the difference in patient-response to OA may be genetically linked. It’s uncertain what those genetic factors may be.

It sounds like you have a doctor who is up to date on some of the latest findings. Celebrex is a newer antiinflammatory called COX-2 inhibitors. These drugs reduce
inflammation without causing bleeding ulcers.

A recent study from Sweden did report delayed tendon healing when a similar drug was used after surgery. The study was done on rats and the drug was Dynastat, the first injectable
COX-2 inhibitor. Dynastat is in the same family as Vioxx, but not exactly the same. As a result of their findings, the researchers advised avoiding COX-2 inhibitors in the early days after tendon injury.

You may be without your Celebrex for a week to 10 days. After that time, COX-2 inhibitors are known to improve healing time. Their ability to reduce inflammation helps increase
the tissue remodeling process that occurs later in the healing phase.

Each third party payer makes its own rules and guidelines about payment for services. The same is true for what is considered medically needed or unnecessary. In the case of ultrasound treatment for bone fractures, the following is a list of when some companies will cover this treatment method: