Arthritis Treatment and Prevention at Home and Clinic http://www.youvsarthritis.com Your resource for comprehensive information about arthritis symptoms, arthritis pain relief and arthritis home remedies. Wed, 30 Nov 2011 04:41:49 +0000 en-US hourly 1 http://wordpress.org/?v=318 Alternative Exercises for People With Arthritis http://www.youvsarthritis.com/alternative-exercises-for-people-with-arthritis.html http://www.youvsarthritis.com/alternative-exercises-for-people-with-arthritis.html#comments Wed, 30 Nov 2011 04:40:19 +0000 Russell http://www.youvsarthritis.com/?p=45 The slogan “No pain, no gain” doesn’t apply here. Alternative exercises are designed to avoid pain and at the same time produce healthy benefits.

Each of three disciplines from the ancient East — yoga, tai chi and qi gong — strengthens muscles, improves balance and releases endorphins, the brain chemicals that give you a sense of well-being and relaxation.

These three are designed to promote mental and physical relaxation and can offer some of meditation’s benefits. Faithful practitioners sometimes report that their improved mobility reduces their need for painkillers.

But these disciplines do not provide aerobic benefits or the strength building that comes from weight lifting. For some, they are a natural complement to other exercise, such as walking, aquatics and weight training.

Yoga
“Yoga” means union, and it focuses on bringing the body, mind and spirit into harmony.

There are several types of yoga — all originating from the holistic Indian healing system — but the most commonly used in Western cultures is hatha yoga. Hatha yoga provides low-impact, full-body conditioning and involves gentle stretches and balancing exercises.

Its benefits can include:

  • Relief from chronic pain.
  • Reduced depression.
  • Improved circulation.
  • Lower cholesterol.
  • Balancing the immune and hormonal systems.

Experts say that yoga is especially helpful to people with arthritis because it impacts many body systems including the muscular, lymphatic, endocrine and immune systems.

A yoga session involves a series of postures called asanas and breathing exercises called pranayama. Sitting, standing and prone postures are used with careful attention to breathing and awareness of body sensations.

Classes last from an hour to 90 minutes and are recommended at least weekly. Of course, greater benefits come from daily practice.

Tai Chi
Tai chi is made-to-order for people with arthritis because it involves little impact. It stretches muscles, lubricates joints and increases circulation.

Traditional Chinese medicine asserts that tai chi nourishes the body’s organs by circulating “qui,” (pronounced CHEE). Qui means “essence of life” or “vital energy.”

There are many types of tai chi, but all are based on meditation and gentle movements.

It is best to take a class to make sure you are doing the movements correctly. After you learn the basics, you can practice on your own.

Developed about 600 years ago, tai chi is a combination of martial arts, spiritual practice and exercise. Movements are slow and graceful and have descriptive names like “grasping the bird’s tail.”

The exercises are done with joints held softly, not in locked or stiff positions. Loose clothing and comfortable shoes (or no shoes) are appropriate.

Qi Gong
Dating back more than 3,000 years, qi gong is designed to direct the flow of qui through the body to promote health and self-healing.

Although it offers similar benefits, qi gong is different from tai chi because its movements are less graceful. Whereas tai chi movements are fluid, qi gong postures are separate and distinct, and positions are held for a few seconds.

If you have severe osteoarthritis in the knees or hips, you may find qi gong easier to perform than tai chi. People of every age and fitness level — even those in bed or a wheelchair — can do qi gong.

Classes usually begin with meditation and breathing exercises to help quiet your mind and body. Then there are simple calisthenics-type movements with concentration on breathing.

Some people with arthritis have reported that after several months of qi gong, joint stiffness and swelling decreased markedly.

Finding a Teacher
To find a tai chi or qi gong instructor, check with health centers, community centers and senior centers. Physical therapists also are a good source for referrals. If there is a Chinese medicine center in your area, you can check there as well. The Qi Journal Web site also lists teachers.

There are no certification standards for teachers, so choose wisely. Instructors who conduct classes at a reputable health center are a good place to start.

Take Note
These methods are not meant to be strenuous. In fact, most instructors believe the internal effects of qi are more important than the exercise.

Be sure to check out a class before you sign up. Any class that emphasizes martial arts or self defense is not tai chi or qi gong. You are looking for an experience in soft, meditative movements.

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Medical Therapy — How Is It Used to Treat Arthritis? http://www.youvsarthritis.com/medical-therapy-how-is-it-used-to-treat-arthritis.html http://www.youvsarthritis.com/medical-therapy-how-is-it-used-to-treat-arthritis.html#comments Tue, 14 Sep 2010 06:23:17 +0000 Russell http://www.youvsarthritis.com/?p=41 There are many components to a treatment program for arthritis. Some of them include self-help, exercise, joint protection and a positive attitude. Another common treatment is medical therapy. When is this appropriate? What is most often prescribed? What is the function of that specific medicine?

There are many different kinds of medicine used. They are used for a specific purpose and for a certain kind of arthritis. Some medications are used for several different kinds of arthritis.

One of the first widely used medications for the treatment of arthritis was over-the-counter aspirin. It was and still is available without prescription, at a reasonable cost and is conveniently located. For many years this was the bulk of the medical therapy for arthritis. Aspirin is an anti-inflammatory. It has the ability to reduce or get rid of unwanted inflammation that is common with many forms of arthritis. At first it was just thought to be a symptom reliever. As the years went by and more research was done, they found that reducing the inflammation also helped slow the destruction of the joint components. Aspirin became valuable because it reduced swelling, therefore relieving the symptom, but in the process it also decreased pain and slowed the joint deterioration. It was like a miracle pill. But, as with most great things, it had one big side effect. When aspirin was used in large enough doses to keep inflammation in check, it could cause irritation to the stomach lining and increase the risk and occurrence of stomach ulcers. This was not discovered right away because, even when taken in fairly high doses, it took a while for the problem to develop in the stomach lining. Because scientists didn’t know the dangers of continual, high-dose aspirin intake, years went by before they made the connection between taking aspirin and stomach ulcers. Today it is a documented fact that aspirin can cause stomach-lining irritation and ulcers, but is it still widely used as an arthritis medication?

In the last two years, two new anti-inflammatory medications have been developed. They are considered the “new age” version of the anti-inflammatory. They are referred to as Cox-2 inhibitors. Basically, these medications are a “smarter” version of the old anti-inflammatory medications. These medications inhibit the production of prostaglandins (hormone-like substances that contribute to inflammation but also protect the stomach lining), but somehow recognize the protective ones lining the stomach. So, by taking a Cox-2 inhibitor, one can get the benefits of an anti-inflammatory and hopefully experience less stomach irritation.

People who have osteoarthritis with inflammation as one of the symptoms are usually prescribed an anti-inflammatory medication. If these same people don’t have inflammation, but do have stiffness, pain and loss of function, then they are most often prescribed Tylenol.

Early on, another common medicine called prednisone was used for the treatment of rheumatoid arthritis and other inflammatory forms of arthritis. It came in various forms: pills, in topical creams and by injection. Sometimes people were given the pills and the injections at the same time. The injection was used for more immediate relief, and the pills were to sustain the relief for a longer period of time.

In the late 1940s and the early 1950s, prednisone was also considered a miracle drug. It was not only used for the treatment of arthritis, but for other conditions such as asthma. But, as time went by and more research was done, scientists found that prednisone also had some devastating side effects over the long haul. The most common of these side effects is bone wasting. Prednisone, taken over a long period of time, can highly increase a person’s chances of developing osteoporosis. In addition to that side effect, it can also cause the early formation of cataracts and weight gain. Despite these troublesome effects, prednisone still is used widely today, in low doses for maintenance and in higher doses for a short period of time for an acute flare-up. Since prednisone is prescribed for reducing inflammation, it is only used in the treatment of the inflammatory forms of arthritis.

Medical therapy began to change in the late 1960s and early 1970s when scientists’ theories about what caused arthritis changed. Early on, scientists thought it was mostly due to hereditary factors. So, they just focused on treating the symptoms. But as time traveled on, a new theory developed about what caused arthritis. They thought possibly a virus could be the culprit. So, with a new focus came a different kind of medication. Now they wanted to target the virus and develop a medication to kill it. A new class of drugs were developed called disease modifying drugs. These drugs were designed to slow the progression or eliminate the disease altogether. Disease-modifying drugs were used extensively for many years, but eventual destruction of the joint still occurred. It seemed at best that these new drugs were only slowing the devastating effects of the arthritis.

In the late 1970s and early 1980s, another theory was born. Now the scientists were focusing on the immune system as the possible target. It seemed that the immune system played an important role in the inflammatory process. For some reason, the body identified itself as the enemy and sent inflammatory cells to kill off the intruders. This over-production of inflammatory cells to the joint site caused the swelling and eventual destruction of the joint. So now the challenge was to develop a medicine to interrupt that immune system response. A number of new disease-modifying drugs were developed or discovered to be useful to doing just that. Some of these drugs had been used for the treatment of other conditions such as cancer and malaria. While being used to treat these other conditions, they also helped with controlling the inflammation caused by the arthritis. As with the other medications, these new disease-modifying drugs also had some worrisome side-effects.

Since these drugs were designed to suppress the immune system, they also decreased a person’s ability to fight off common ailments such as the flu and other viruses. Despite the risks involved in taking these medications, they have been very helpful in slowing the progression of the disease process for many people with inflammatory forms of arthritis. There are a number of these disease-modifying drugs being used today.

Scientists have known for many years that attacking the whole immune system was not the best answer. In the last couple of years, another new line of medications has been developed. These are called “biologic response modifiers.” They are referred to as the “smart bombs” because they target only the part of the immune system that contributes to disease. Since these medications only target part of the immune system, the side effects are minimal, but the disease-modifying benefit is still present. Like all the other medications developed before these, time will tell the real story in how effective they are and whether long-term problems develop.

Fibromyalgia is a form of arthritis that does not affect the joints. It is characterized by muscle pain, fatigue, achiness and a host of other symptoms. Medication used to treat this form of arthritis is very different from those used in osteoarthrtitis and other inflammatory forms of arthritis.

One of the most common complaints of people who have fibromyalgia is sleep disturbance. Doctors often prescribe low doses of antidepressant medication and selective serotonin re-uptake inhibitors to restore a normal sleep pattern. When the sleep cycle is restored, many of the other symptoms start to improve. Pain in the muscle is reduced with the help of muscle relaxants and pain medication. The main objective in medical therapy for people with fibromyalgia is to restore their function, which enables them to help themselves get better.

There are many other medications taken for the treatment of other forms of arthritis. In treating inflammatory forms of arthritis, medications are used in combination. This is also true with fibromyalgia. In the case of osteoarthritis, usually only one medication is used to control the symptoms. Controlling symptoms and slowing the disease process through the use of medical therapy is a life-long task. Occasionally, each person’s medical therapy program has to be re-evaluated and adjusted to stay effective. Most medications taken for arthritis need to be taken constantly and without lapses to have the best outcome.

If you are taking medication for the treatment of any form of arthritis, discuss the effectiveness and the side effects of each medication with your doctor or pharmacist before you consent to take it. Usually, a pharmacist is the best source for information concerning medication. Educate yourself and weigh the risks against the benefits over the short term and the long haul before starting a medication. Don’t give up on a medication too early in the start-up process. Many of the anti-inflammatory medications have to be taken up three to six weeks before they reach their maximum benefit to you. Don’t stop taking your medication unless you talk it over with your doctor first. In the case of glucocorticoid-type medications, stopping suddenly can have some unwanted health consequences. Report any usual symptoms or reactions to the medication to your doctor. It is also very important to inform your physician of any “natural” remedies or other over-the-counter medication you are taking. This will avoid a possible unwanted drug interaction that could be very harmful to your general health.

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The Prednisone Paradox: Are Corticosteroids Worth the Risk? http://www.youvsarthritis.com/the-prednisone-paradox-are-corticosteroids-worth-the-risk.html http://www.youvsarthritis.com/the-prednisone-paradox-are-corticosteroids-worth-the-risk.html#comments Wed, 30 Jun 2010 06:32:32 +0000 Russell http://www.youvsarthritis.com/?p=37 Cortisone—corticosteroids, glucocorticoids, Prednisone, etc—is used to treat over a hundred diseases, including—of course—rheumatoid arthritis. Prednisone and its cousins can cause dramatic improvement for those suffering from unmanageable flares and in some short-term cases, may be the only appropriate drug for treatment. Still, as anyone who has taken steroids can attest, this type of relief often comes at a very high price.

Disclaimer: Despite the unpleasant and even dangerous side effects of Prednisone et al, it is a legitimate, effective, and sometimes even life-saving drug. If you are currently taking Prednisone or some other form of steroids, please discuss your concerns with your rheumatologist. Please do not start, stop or modify your treatment without your doctor’s approval. Never stop steroid treatment suddenly or without notifying your doctor!

This article and the articles to follow are intended for informational purposes only and should not be considered medical advice. Any concerns or questions you may have about steroids or any other aspect of your treatment should be discussed with your doctor.

Note: Although steroids are available in dozens of different forms and brands, for simplicity’s sake, I will refer to the oral form of steroids as Prednisone.

Prednisone: The History
After serving as the Chief of Medical Service and Director of the Army’s Rheumatism Centre during World War II, Philip Showalter Hench returned to work at the Mayo Clinic and continued his twenty year research in rheumatoid arthritis and other autoimmune disorders. By the late 1940’s, it had become clear to Hench and others that in order to bring autoimmune diseases under control, it was necessary to suppress inflammation and the immune system. However, finding an effective agent remained elusive.

It was during this search that Hench began to notice a certain phenomenon among his patients. During pregnancy and in the presence of jaundice, the severe pain of rheumatoid arthritis decreased and in some cases, even disappeared. Hench, along with his colleague, Edward Calvin Kendall, began to consider the steroids of the adrenal glands as the endogenous substance “X” by which RA might be controlled and even cured, saying:

“Substance X…probably was a biologic compound specific in nature and function, one which was normal to the human organism and of which, perhaps, the arthritis patient did not have enough. Since pregnancy alters the concentrations of hormones, we began to suspect that substance X might be a bisexual steroid hormone.”

In 1948, Hench and Kendall tested their theory on a middle-aged woman afflicted with severe RA. After receiving a series of corticosteroid injections over several weeks, the woman’s symptoms disappeared and she got up and walked away from the bed in which she had been confined for several years.

Amazed by the results, Hench and Kendall treated other similarly affected patients. After only a few days, people who were so badly crippled that they couldn’t rise from a chair, shave, open a door or even lift a cup were walking and even dancing. Medical experts throughout the world hailed cortisone as a “miracle drug” and a cure for rheumatoid arthritis. Not surprisingly, P.S. Hench and E.C. Kendall were awarded the 1950 Nobel Prize in Physiology and Medicine.

By then, however, steroids were beginning to show its dark side. Patients taking cortisone in doses high enough to reduce inflammation were experiencing the now well-known side effects: increased appetite and weight gain; fat deposits in chest, face, upper back and stomach; water and salt retention leading to swelling and edema; high blood pressure; diabetes; osteoporosis; cataracts; acne; muscle weakness; thinning of the skin; increased susceptibility to infection; stomach ulcers; psychological problems such as depression; and adrenal suppression and crisis. In some cases, the cure became worse than the disease.

Prednisone Today

Despite the risk of dangerous side effects, however, cortisone treatment is still very much in use, simply because it is often the only effective drug available. Prednisone is used to treat hundreds of disorders, many forms of cancer, including leukemia; lupus, vasculitis, asthma, meningitis, ulcerative colitis,  allergies, tuberculosis, Myasthenia Gravis, dozens of skin disorders, including psoriasis; eye disease, pneumonitis, vasculitis, organ transplants (to prevent the body’s normal inflammatory reaction to foreign tissue and infection), and even autism.

Unfortunately, many people (and in some cases, doctors) have become so leery of “scare-oids” that they have refused much-needed treatment. And, while it is true that long-term use of Prednisone at high doses can cause serious side effects, when used judiciously, Prednisone can literally be a life-saver, especially when inflammation in the heart, lung, eyes and blood vessels are involved. A severe flare can cause extensive damage to joints and cartilage over time, but even in the most severe cases, Prednisone can often provide immediate relief.

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It’s the Economy, Stupid–Affording Arthritis http://www.youvsarthritis.com/its-the-economy-stupid-affording-arthritis.html http://www.youvsarthritis.com/its-the-economy-stupid-affording-arthritis.html#comments Fri, 18 Jun 2010 09:02:43 +0000 Russell http://www.youvsarthritis.com/?p=25 Let’s face it: rheumatoid arthritis is an expensive hobby. Quarterly or even monthly visits to the rheumatologist, multiple prescriptions, physical therapy…who can afford it? Well, if you have to, you can…

Whenever I research an article, I scan website after website for pertinent information…which means I often read the same general information several times a week. Usually, I am able to scan through without any major incident; the other day, however, I read something that I’ve read probably a dozen times before, but this time it made me want to put my fist into the computer: “People who are educated and affluent tend to deal with RA better than those in low-income homes.”

Really? Well, who would ever guess?

Apparently, not the researchers who conduct these very expensive, often taxpayer supported studies. Personally, I would like to use some of my wasted tax dollars to pay off some of my medical debts…or, here’s an idea: maybe I could use the money to get a couple of degrees so I, too, could afford to have arthritis.

Sorry. Guess that struck a nerve.

Still, if it weren’t for comments like that, the odious expression “Well, duh!” would have fallen the way of “far out” and “radical, dude!” into slang death. Of course, well-to-do people deal with RA better…they’re the few people in this country who can afford RA. Not only can they afford a rheumatologist, they can afford to go to Mayo or Duke or Johns Hopkins to get the full arthritis spa treatment: JAMA superstar rheumatologist, specially trained nurse, physical therapist, occupational therapist and even a psychiatrist to help with the transition. Afterwards, they can drive straight to their pharmacist with a prescription for Enbrel—absolutely secure in the fact that their insurance will cover it—and go back to their jobs which involve telling other people what they should build/design/type.

So, do I resent rich people? Hell, no. I resent that I can’t afford to be healthy. Without a doubt, America offers the finest medical training, technology and treatment in the world and yet we are ranked 12th in health care. (Italy, if you are interested, ranks number one). Sin is not a word that I frequently use, but I truly believe that it is a sin for anyone to be denied adequate medical care because they lack money…and as much as I love this great country of ours (and who isn’t patriotic, these days?), I believe that this have/have not system of health care is one of its greatest shortcomings.

Often, while on this subject, someone will say to me, “Yes, and look at the animals in prison. All of their medical treatment is paid for by you and me…” usually followed by the suggestion that bad people be put in a dungeon/ on a deserted island/ to death. My beliefs are even more radical: I believe that all members of the species Homo sapiens—even those of the slimy, single-cell variety—are entitled to health care. I honestly believe that it is our right as human beings to be treated when we are sick, no matter what our financial situation.

Don’t get me wrong: I may be a pinko, commie liberal, but I don’t have the first clue as to how to reform the health care system; I also respect that doctors, pharmaceutical companies and insurance companies would like to enjoy the fruits of a free market society as much as the next guy. (I also recognize that—given the times—it may be years before health care reform is even mentioned again).

I do, however, have an idea on how to get the lawmakers in this country to at least think about the high costs of health care: let’s take away their fancy health benefits. Why not? You and I pay for it, we should be able stop paying for it. Let these fat cats pay for their own colonoscopies and bypass surgeries. Maybe after shelling out $300-$1500 a month for prescriptions, they might decide it’s in their best interest to spend a little time studying solutions for an overlooked national crisis.

In the Meantime…

Some of the more astute readers out there may have detected that I am slightly bitter about this issue. You’re wrong…I’m very bitter. I’ve just concluded a two-year fight with my insurance company over Remicaide (they have finally conceded, if only to shut me up…but they still won’t pay for Enbrel), and while I am grateful to finally be able to use Remicaide, I can’t help but be angry for that wasted time, for all those flares, for the new deformities, and…for all those other people out there who are slowly being crippled because they, too, can’t afford to be healthy.

Or can they? Those who can afford to shell out $12,000 a year for Remicaide/Enbrel can afford the Cadillac-brand of health insurance that already pays 100% of prescription/hospitalization. And I’m not talking about the truly poor, who can qualify for Medicaid—which also pays out 100%. I’m talking about people whose insurance pays 70 or 80%. I’m talking about me (because when I really get angry, it’s usually because I’m mad at myself).

It wasn’t that my insurance company wouldn’t pay for Remicaide at all…it was that (and I won’t bore you with the details of why) they would only pay 70%. Well, by my calculations, 70% of $12,000=forget it. So I fought them and did without for two years, limping about the house and secretly resenting my husband for not saying, “Just go ahead and do it…we’ll manage somehow.”

And I’m the one who hates martyrs.

I know that I’ve used this analogy before, so bear with me: if I had cancer, I would do whatever it took to get well. If I had to hold fundraisers, collect cans by the side of the road, sell my body for pocket change…you name it, I would do it. So why didn’t I take my own treatment as seriously? Rheumatoid arthritis, if not treated, can ultimately be fatal. But, because it’s not fatal tomorrow, I think that many of us are shortchanging our health because we don’t want to add (more) financial strain on our families.

I’ve said it before and I’ll say it many times again: medicine is just as important as food. Just as you don’t need to ask permission to eat, you don’t need anybody’s permission to pay for proper medical treatment.

Are you sure you can’t afford your medical care? Do you have cable? Do you drive a late-model car? Do you cave when your children insist on labels instead of clothes? Most of us could cut expenses if we had to….and guess what, we have to.

And, because I am psychic (a lie…if I were psychic, I would be rich and this article probably wouldn’t even occur to me), I know what many of you are probably saying by now: haven’t I sacrificed enough? Hasn’t my family? Yes, of course you have…it’s obscene how much many of us have sacrificed and I doubt that any of us have unaffected families, either. But suppose the treatment you are denying yourself really worked! Perhaps you would even feel well enough to get/retain a job. In other words, denying yourself adequate medical treatment may actually be an exercise in false economy.

Please do not get me wrong. Smile warrior that I am, I am also deeply in debt. Even with insurance grudgingly picking up 90% of the tab, my medical expenses run roughly $300-$500 a month…and that’s not including treatment for my son’s asthma or my daughter’s chronic—and very debilitating—migraines. Every month, I scheme and scramble—through eBay or making and selling this and that—to come up with a hundred here and there to at least put a dent in our debt and keep my already-resentful husband from going on one of his tirades.

It has occurred to me that not only will some people remain silent in the face of need, they will sleep well at night if you are crippled because of it…and to hell with that. Even I’m not that much of a martyr.

So, though I scheme and scramble, I also remain resolute: I will get proper treatment…if I have to sell my soul to the hospital, I will not go without proper medical care again, nor will I ask permission to do so. And neither should you.

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It’s the Economy, Stupid: Resources http://www.youvsarthritis.com/its-the-economy-stupid-resources.html http://www.youvsarthritis.com/its-the-economy-stupid-resources.html#comments Wed, 02 Jun 2010 13:50:53 +0000 Russell http://www.youvsarthritis.com/?p=34 Okay…if medicine is as important as food, what do you do when the choice is between medicine and food? You swallow your pride and ask for help…

Really? Well, who would ever guess?

Apparently, not the researchers who conduct these very expensive, often taxpayer supported studies. Personally, I would like to use some of my wasted tax dollars to pay off some of my medical debts…or, here’s an idea: maybe I could use the money to get a couple of degrees so I, too, could afford to have arthritis.

Sorry. Guess that struck a nerve.

Still, if it weren’t for comments like that, the odious expression “Well, duh!” would have fallen the way of “far out” and “radical, dude!” into slang death. Of course, well-to-do people deal with RA better…they’re the few people in this country who can afford RA. Not only can they afford a rheumatologist, they can afford to go to Mayo or Duke or Johns Hopkins to get the full arthritis spa treatment: JAMA superstar rheumatologist, specially trained nurse, physical therapist, occupational therapist and even a psychiatrist to help with the transition. Afterwards, they can drive straight to their pharmacist with a prescription for Enbrel—absolutely secure in the fact that their insurance will cover it—and go back to their jobs which involve telling other people what they should build/design/type.

So, do I resent rich people? Hell, no. I resent that I can’t afford to be healthy. Without a doubt, America offers the finest medical training, technology and treatment in the world and yet we are ranked 12th in health care. (Italy, if you are interested, ranks number one). Sin is not a word that I frequently use, but I truly believe that it is a sin for anyone to be denied adequate medical care because they lack money…and as much as I love this great country of ours (and who isn’t patriotic, these days?), I believe that this have/have not system of health care is one of its greatest shortcomings.

Often, while on this subject, someone will say to me, “Yes, and look at the animals in prison. All of their medical treatment is paid for by you and me…” usually followed by the suggestion that bad people be put in a dungeon/ on a deserted island/ to death. My beliefs are even more radical: I believe that all members of the species Homo sapiens—even those of the slimy, single-cell variety—are entitled to health care. I honestly believe that it is our right as human beings to be treated when we are sick, no matter what our financial situation.

Don’t get me wrong: I may be a pinko, commie liberal, but I don’t have the first clue as to how to reform the health care system; I also respect that doctors, pharmaceutical companies and insurance companies would like to enjoy the fruits of a free market society as much as the next guy. (I also recognize that—given the times—it may be years before health care reform is even mentioned again).

I do, however, have an idea on how to get the lawmakers in this country to at least think about the high costs of health care: let’s take away their fancy health benefits. Why not? You and I pay for it, we should be able stop paying for it. Let these fat cats pay for their own colonoscopies and bypass surgeries. Maybe after shelling out $300-$1500 a month for prescriptions, they might decide it’s in their best interest to spend a little time studying solutions for an overlooked national crisis.

In the Meantime…

Some of the more astute readers out there may have detected that I am slightly bitter about this issue. You’re wrong…I’m very bitter. I’ve just concluded a two-year fight with my insurance company over Remicaide (they have finally conceded, if only to shut me up…but they still won’t pay for Enbrel), and while I am grateful to finally be able to use Remicaide, I can’t help but be angry for that wasted time, for all those flares, for the new deformities, and…for all those other people out there who are slowly being crippled because they, too, can’t afford to be healthy.

Or can they? Those who can afford to shell out $12,000 a year for Remicaide/Enbrel can afford the Cadillac-brand of health insurance that already pays 100% of prescription/hospitalization. And I’m not talking about the truly poor, who can qualify for Medicaid—which also pays out 100%. I’m talking about people whose insurance pays 70 or 80%. I’m talking about me (because when I really get angry, it’s usually because I’m mad at myself).

It wasn’t that my insurance company wouldn’t pay for Remicaide at all…it was that (and I won’t bore you with the details of why) they would only pay 70%. Well, by my calculations, 70% of $12,000=forget it. So I fought them and did without for two years, limping about the house and secretly resenting my husband for not saying, “Just go ahead and do it…we’ll manage somehow.”

And I’m the one who hates martyrs.

I know that I’ve used this analogy before, so bear with me: if I had cancer, I would do whatever it took to get well. If I had to hold fundraisers, collect cans by the side of the road, sell my body for pocket change…you name it, I would do it. So why didn’t I take my own treatment as seriously? Rheumatoid arthritis, if not treated, can ultimately be fatal. But, because it’s not fatal tomorrow, I think that many of us are shortchanging our health because we don’t want to add (more) financial strain on our families.

I’ve said it before and I’ll say it many times again: medicine is just as important as food. Just as you don’t need to ask permission to eat, you don’t need anybody’s permission to pay for proper medical treatment.

Are you sure you can’t afford your medical care? Do you have cable? Do you drive a late-model car? Do you cave when your children insist on labels instead of clothes? Most of us could cut expenses if we had to….and guess what, we have to.

And, because I am psychic (a lie…if I were psychic, I would be rich and this article probably wouldn’t even occur to me), I know what many of you are probably saying by now: haven’t I sacrificed enough? Hasn’t my family? Yes, of course you have…it’s obscene how much many of us have sacrificed and I doubt that any of us have unaffected families, either. But suppose the treatment you are denying yourself really worked! Perhaps you would even feel well enough to get/retain a job. In other words, denying yourself adequate medical treatment may actually be an exercise in false economy.

Please do not get me wrong. Smile warrior that I am, I am also deeply in debt. Even with insurance grudgingly picking up 90% of the tab, my medical expenses run roughly $300-$500 a month…and that’s not including treatment for my son’s asthma or my daughter’s chronic—and very debilitating—migraines. Every month, I scheme and scramble—through eBay or making and selling this and that—to come up with a hundred here and there to at least put a dent in our debt and keep my already-resentful husband from going on one of his tirades.

It has occurred to me that not only will some people remain silent in the face of need, they will sleep well at night if you are crippled because of it…and to hell with that. Even I’m not that much of a martyr.

So, though I scheme and scramble, I also remain resolute: I will get proper treatment…if I have to sell my soul to the hospital, I will not go without proper medical care again, nor will I ask permission to do so. And neither should you.

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Arthritis and the Fine Art of Germ Avoidance. ll http://www.youvsarthritis.com/arthritis-and-the-fine-art-of-germ-avoidance-ll.html http://www.youvsarthritis.com/arthritis-and-the-fine-art-of-germ-avoidance-ll.html#comments Thu, 20 May 2010 13:42:02 +0000 Russell http://www.youvsarthritis.com/?p=31 continued…

Sick Anyway

Okay, so what if you overcame your needle phobia and got the flu shot, alienated all of the shunned sick people in your life, scrubbed your hands scaly, lived like a well-nourished hermit and you get sick anyway?

Hey, it happens. None of us are bulletproof, especially those of us with ignorant immune systems.

And those of us with the aforementioned immune systems need to take extra care when we do get sick. Many felonious bugs elude scientists and refused to be identified, so for practical purposes, I’ll divide the next section into caring for colds and flus. First of all, which do you have?

Colds
May include some or all of the following symptoms:

* lasts 2-14 days
* nasal congestion/sneezing
* sore throat
* dry cough
* mild fatigue
* slight fever

Flu
May include some or all of the following symptoms:

* can last up to 2 weeks; fatigue can last for several weeks
* nasal congestion
* sneezing
* sore throat
* dry cough (more severe than with cold)
* aching muscles
* severe headaches
* extreme fatigue

There is a commercial that illustrates the difference between a cold and a flu with images of a gentle rainstorm (cold) to a hurricane (flu). Even so, medical advice is pretty much the same for both:

* Drink plenty of clear fluids.

Dehydration can occur more quickly than you think, especially if you have a fever. Drink more water than you think you need and avoid caffeine.
# Rest.
Rest is an ambiguous term (there was a time when I would interpret that to mean cutting back on one of my three jobs), so I’ll let the medical establishment spell it out: STAY IN BED AT LEAST ONE FULL DAY. Those of you still living in the real world with troglodyte bosses and mortgages to pay are sneering, so I’ll amend that to: AT LEAST GO STRAIGHT TO BED AFTER WORK. There…is that better?

# Use OTC meds for comfort…carefully.
Tylenol and its ilk are a godsend for various aches and pains, but please be careful. Even the most benign-sounding drug is still, in fact, a drug and should be respected as such. If you are taking prescription medication for your arthritis do not take anything without your doctor’s permission! Think I’m being paranoid? Okay, how about this: there is some evidence that ibuprofen should not be combined with methotrexate. Apparently, ibuprofen can raise the level of methotrexate to toxic extremes. Make friends with your doctor’s nurse and call before you take anything not approved by your doctor.

Inhale hot steam.
A nice hot bath or, better yet, a steamy shower will relieve your nose and head congestion, which may accelerate the healing process. Humidifiers and vaporizers work, too, but there is some controversy that bacteria can become trapped within, which could actually make you sicker. Ask your doctor.
# Avoid tobacco.
All of you smug (albeit, smart) folks who have never smoked are probably saying, “Jeez, this chick has a gift for the obvious.” True. But as non-practicing tobacco junky (I won’t say ex-tobacco junky because I still want to smoke. Sheer willpower and blackmailing children prevent me), I understand what it is like to crawl on my hands and knees from the sick bed to an ashtray. If you can’t stop completely, at least try to keep it down to 5 or less a day.
Okay…Real Sick, Now

There is some controversy as to whether methotrexate leaves you more vulnerable to colds and flus (of course it does, you scientific nitwits!); however, there is no question about the dangers of Prednisone, Remicaide and other cytotoxic drugs. If you are taking any drug that suppresses your immune system, never ignore persistent symptoms. You are more susceptible to infections—especially of the lung—and the same drugs that help you function can impair your ability to heal. Don’t ever be afraid to “bother” the doctor with seemingly minor symptoms. Studies show that “good patients” (friendly, compliant, hesitant to speak up or complain) have poorer prognoses than pain-in-the-butt patients who advocate for their rights and their health. Don’t be an arthritis wimp…raising a little hell may keep you out of the hospital.

(Note: the following advice is intended for healthy people…those with dysfunctional immune systems should report troublesome symptoms even sooner).

When to Call the Doctor

Cold

* if it lasts longer than 2 weeks
* if you have an earache
* if you have sinus pressure
* if you have a fever over 100 degrees Fahrenheit (could be an indication of infection)

Flu

* high fever
* chills
* yellow-green mucus
* difficulty breathing
Please, please don’t ignore this symptom, particularly if you are taking methotrexate and Remicaide. Both drugs make you more vulnerable to pulmonary disease…and people still die from pneumonia in this country. To illustrate my point, my doctor (after chiding me for not reporting a month-long bout of the flu) told me about another “good patient” of his who ignored a persistent cough for a few days because she didn’t want to use up her sick leave at work. She ended up having a nice, long vacation under an oxygen tent. It was months before she was well enough to take care of herself and she may have breathing difficulties for the rest of her life. You’re not being silly, you’re not a hypochondriac and it’s not your imagination: if you are having persistent symptoms—especially any type of chest pain or impaired breathing—call your doctor.

The Tao of Dealing With a Recalcitrant Immune System: A Modern Metaphor

I’ve noticed many similarities between my wayward immune system and my teenage daughter. They’re both moody, capricious and cause me a great deal of anxiety–and yet, they are not without their good days. As with raising teenagers, we of the weak immune systems have to perform a balancing act of knowing when to restrain and when to let go.

Let’s just hope that my immune system makes better grades and doesn’t try to date Goth stoners with bad personalities.

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Arthritis and the Fine Art of Germ Avoidance. l http://www.youvsarthritis.com/arthritis-and-the-fine-art-of-germ-avoidance-l.html http://www.youvsarthritis.com/arthritis-and-the-fine-art-of-germ-avoidance-l.html#comments Wed, 05 May 2010 13:41:45 +0000 Russell http://www.youvsarthritis.com/?p=28 What does one shiftless immune system, one or more cytotoxic/immunosuppressant drugs and the flu season equal? A rather naked vulnerability to illness. Read on for defensive measures you can take during the cold and flu season…

Recently, my family was struck down by a mongrel virus that seemed to be comprised of part cholera and part Ebola. It would strike with sudden viciousness: stomach cramps, fever, migraine, chills, which ultimately led to having bad stuff come out of every part of the body. We weren’t the only family affected, either; this nasty little bug swept all of the children at my son’s elementary school (along with the corresponding teachers and parents), and took half of Radford with it. Even my Pathologically Healthy husband, he of the Teflon immune system, was struck down.

The difference was, however, that while everyone else seemed to bounce back after a couple of days, I was down for ten: every time I thought the saga was over, I would get sucker-punched by a nasty little sequel.

It’s just a plain, sad fact that those of us with rheumatoid arthritis are more vulnerable to bugs. Perversely, that confused, overactive immune system of ours is so busy beating the crap out of us that it takes awhile for it to notice our legitimate illnesses. And, until scientists can develop a drug that instructs rather than suppresses, many of us will be stuck with damn ineffective defenses.

An Ounce of Prevention…

If only we were as sensible as the Japanese. During the cold and flu season, it is not unusual to see dozens of businessman/women sniffling behind surgical masks. In fact, it is considered the height of rudeness not to wear a sterile mask; after all, the Japanese are as overworked as Americans, their sick leave just as meager. Quite frankly, they just don’t have time to be exposed to your germs. Here in America, however, wearing a mask is a culturally silly thing to do. John Wayne would never wear a surgical mask; neither would Clint Eastwood. Michael Jackson would and frequently does, which is probably the number one reason why Americans refuse to don the mask.

Despite our refusal to resemble Michael Jackson or other alien life forms, we are apparently no more resistant to germs than the Japanese. Every year, 62 million people catch a cold; 100 million will be struck down with the flu. Big deal, right? It is, actually: 20,000 Americans die from the flu every year; it’s unclear how many die from a cold turned into pneumonia.

Yet, even those of us with weenie immune systems can prevent many illnesses, just by taking care of ourselves, i.e. taking the time to use good hygiene. Taking the following steps will not guarantee good health, but it is likely to prevent nasty little bugs from abducting your body and holding you hostage.

Avoid Children

Okay, I’m being a little facetious, here. Anyone who knows me for longer than 30 minutes know that my entire raison d’etre is my children. Had arthritis not struck (along with accompanying fetus-hating drugs), I would have had five. Nevertheless, it cannot be denied that children are seething cauldrons of bacteria. They touch foul things, pick at rude places, share things with dogs and turtles and slide their infested little hands over every possible surface. If you have a child—and especially a school-age child—you will have to resign yourself to sharing at least some of their many illnesses. Take the following advice (below) and square it.

Avoid Sick People

This isn’t as simple as it sounds, especially if you work in an environment with stingy sick leave. The American workplace has rather stupid policies regarding sick leave, which forces walking microbes (formerly known as your coworkers) to hover in the cubicle nearby. Be sympathetic from a distance and—as soon as they turn their heads—wipe all surfaces (and yourself) with antibacterial wipes.

Avoid Indoor Crowds

The reason so many people get sick in the winter is not because of the cold but because we cram ourselves into overheated buildings, like malls, schools and home. Statistically speaking, there is bound to be at least one sick person there, politely sneezing into their hands and then using those hands to touch everything in your path.

Whenever your are confronted with the above situations, take the Howard Hughes approach and become a bit obsessive. If it seems silly or a waste of time, just remember the year before when that cold turned into an infection that wouldn’t go away or that flu that lasted for 6 weeks. That oughta do it.

* Do not kiss, hug, shake hands with or sleep next to an obviously sick person.

If the sick person is a reasonable individual, tell them the truth about your sissy immune system. If the person is a narcissistic jerk, tell them you are sick as well and you don’t want to make them any sicker.
# Assume all surfaces are contaminated.
Assume doorknobs, phones, counters, and coins/cash (I guess there is some truth to the phrase “filthy lucre”) are infested and act accordingly. Open push doors with your arm instead of your hand; bring along your own handkerchief for doorknobs and phones. For other situations, bring along some antibacterial wipes or gel. And keep your hands away from your face; like it or not, you’re germy, too.

# Wash your hands!
The number one way to avoid contagion is by washing your hands frequently and well. That means using plenty of soap and warm/hot water, taking off your rings and scrubbing all surfaces of your hands and fingers for at least one minute. Nurses time themselves by singing the alphabet song. Don’t use communal towels, either. Either assign a hand towel for every member of the house or use paper towels. Finally, you should probably finish up with a little bit of lotion. Chapped hands can crack and lead to infection, especially for those of us on Prednisone.

# Eat and sleep well.
Get at least 5 servings of fruit and vegetables a day; get at least 6-8 hours of sleep a day. Yeah, yeah, yeah, you’ve heard it all before, but how many of you are actually doing it?

# Exercise—when you are well.
Exercise boosts the immune system and makes you stronger, but exercising while sick can accelerate a minor illness into something serious. Exercise when you are well, rest when you are sick. And, no, your thighs don’t look fat.

# Take Vitamins…within reason.
So far, there is no replicated evidence that vitamins C, zinc or any other vitamin can prevent a cold…but taking a daily multivitamin certainly can’t hurt. What can hurt are mega doses of vitamins. A recent study (to be fair, I don’t believe that the results of this study have been replicated, either) that large doses of vitamin C actually caused gene mutations. Certain vitamins, like vitamin A, can become toxic at relatively low doses, so follow the directions of your doctor, not your guru.

# Reduce stress.
Yeah, well…good luck. After all, life is stress. However, many people—especially nice, suburban mom-types—suffer from self-inflicted stress by currying to everybody’s expectations except their own. Learn how to say NO.

# Getting a flu shot.
Ah, the gentle influenza vaccine, much maligned and quite benevolent. And yet, that silly myth persists that getting the flu vaccine will give you the flu. Impossible. The flu vaccine is made from a killed virus, which is incapable of causing disease. Still not convinced? Okay, how about this: the flu vaccine can prevent up to 70% of hospitalizations due to flu complications and 85% of flu-related pneumonia. The flu vaccine is widely available, relatively inexpensive and perfectly safe (check with your doctor, anyway). It’s not too late to get it, so what are you waiting for?
to beontinued…

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Exercise Spotlight: Pilates and Arthritis http://www.youvsarthritis.com/exercise-spotlight-pilates-and-arthritis.html http://www.youvsarthritis.com/exercise-spotlight-pilates-and-arthritis.html#comments Tue, 13 Apr 2010 09:00:51 +0000 Russell http://www.youvsarthritis.com/?p=22 What do dancers, athletes and movie stars all have in common? They are all devotees of Pilates, a not-so-new range-of-movement (ROM) exercise designed to build strong backs, firm abdominals and increased flexibility, all while giving you the sleek muscles of a dancer. Is Pilates safe for arthritis? Absolutely! So drag out that mat and make like Julia Roberts…

Chances are, if you’ve bought a  People magazine—especially the Hundred Most Beautiful People issue—you’ve heard about Pilates (as in Pi-lah-tees…not as in Pontius Pilate). Hollywoodites, trendy as ever, have latched onto the exercise that gives them long, lean muscles and helps them keep and stay in shape during rigorous filmmaking.

Think Pilates is just another Hollywood fad like that sudden yoga/Buddhism trend (which is, like, soooo ’98)? Well, don’t take Julia’s word for it…how about the great dancer/choreographer George Balanchine? Both he and the late Martha Graham were early pioneers of the Pilates method. Dancers have known for years—more than seventy years—about the benefits of this method of body conditioning.

Mr. Pilates

Joseph Pilates was born in Germany in 1880, a frail child who grew to become obsessed with fitness. Devoted to the idea of transforming his health, Pilates became an accomplished gymnast, boxer and circus performer, as well as a student of yoga and karate. Students of the Pilates method claim that he incorporated elements from each of these fitness regimens, but it was while interned in a prison camp during World War I that he began to develop his method in earnest.

During his stay at the prison camp, Pilates used whatever props were available—his bunk, the bedsprings, a chair—along with the core of his work, which he referred to as “the mat work”. While other prisoners grew sick and weakened, Pilates thrived. After teaching his method to the other prisoners, the guards were so impressed that it became a mandatory exercise for the entire camp. This was during the worst pandemic influenza of the twentieth century and yet not a single prisoner died. Later, he was hired to train the most elite cadres of British troops.

Over the years, many athletes—including boxer Max Schmelling—included this method into their training, while choreographer George Balanchine was so enamored of the Pilates method that he incorporated its mat routine into the dance piece, “Seven Deadly Sins”. Dancers, always vulnerable to injury, discovered that using Pilates led to quicker recovery time and have consistently used this method from its inception to this day Alas, Pilates did not catch on with the general public. Earlier in the century, Pilates predicted it would be fifty years before the importance of his work was recognized. Apparently, he was right. It is probably to his credit that he lived to be a healthy 87.

So, What is Pilates?

Although Pilates is usually shown being performed on huge, complicated-looking machinery, Pilates first defined his series of 34 specific exercises to be performed individually, on a mat, without aid or assistance from any machinery or equipment. In the Introduction to his 1945 book of exercises, Return to Life Through Contrology (guess he decided to change the name!), Pilates says: “Contrology is complete coordination of body, mind, and spirit. Through Contrology you first purposefully acquire complete control of your own body and then through proper repetition of its exercises you gradually and progressively acquire that natural rhythm and coordination associated with all your subconscious activities.”

In other words, this isn’t the exercise to do while watching the soaps. This method requires full participation, as it focuses on the whole body. There is no flailing about; huffing and puffing is not necessary nor is it desired. Instead, the upper and lower muscle systems are coordinated within the body’s center, working very specific areas with careful, fluid movements. All movements are extremely slow and rhythmic, allowing weaker muscles to be located, which leads to better support for the joints.

“Girdle of Strength”

Joseph Pilates often referred to the “girdle of strength”—the area including the abdominal muscles, extending out to the buttocks and the latissimus dorsi (the muscles in the back that control shoulder and arm movements)—claiming that the strength needed for the exercises originates in the abdominal muscles. If these muscles are not in control, then other muscles such as those in the back, neck or shoulders can be damaged. It is by using the abdominals and learning correct breathing that leads to strength and improved posture.

Breathing

Open any book on Pilates (and there are dozens, at least) and proper breathing will be emphasized, over and over again. Each movement is tied to a specific manner of breathing and the way that you breathe is just as important as the movements themselves…especially since most of us breathe “wrong”, expanding only the top part of our lungs. Instead, you should breathe from the diaphragm so that your stomach rises and falls, rather than your chest. Practice this way of breathing for five minutes and you should actually feel yourself relaxing.

Concentration

Often, we become so distracted by our various responsibilities that we are complete unaware of our movements. In Pilates, the movements focus on a very specific area of the body; concentration is essential.

Control

One of the reasons that Pilates is an ideal ROM exercise for arthritis is that the movements are very controlled; chances for injury are minimal. In the beginning, these movements may feel clumsy, but once you have a grasp of the move, you will be able to execute the movements with grace and control.

Fluidity

Each exercise leads to the next, moving seamlessly from one to the other. Even though each movement has a beginning and ending, you blend the movements into each other, stretching and continuing, so that the end of one movement gracefully becomes the beginning of another.

Are Those Exercise Machines or Torture Chambers?
Many people shy away from Pilates because they’ve seen it performed on huge, complicated machinery. Repeat after me: you do not have to use the resistance machines. Joseph Pilates designed 500 different movements, but they all evolved from the 34 core movements, what he called “mat work”. So if money is a problem or you live in a small town where even the fitness instructors say, “Pi-who?”, rest assured, you can still benefit from Pilates.

However, if you live near a Pilates studio, using the resistance machines helps you become more aware of how the movement works each muscle, which can also help you improve your mat work. Also, it creates an intensity which is hard to achieve on your own. If at all possible, at least try to find a qualified “mat work” instructor who can guide you, adjust your posture, demonstrate breathing and correct movements and add new exercises as you become stronger. Even in little ol’ Radford, Virginia, pop. 15,000 (with students; more like 12,000 without), we have a certified Pilates “mat instructor”.

Pilates and Arthritis

So, is Pilates safe for arthritis? Sure. Not only has Pilates been used (in conjunction with medical treatment) to treat rheumatoid arthritis, it has also been used for back and neck pain, osteoarthritis, mastectomies, joint replacements, scoliosis, lupus, fibromyalgia, chronic fatigue syndrome, and joint and muscle injuries. In fact, many physical therapists, orthopedists, and chiropractors have integrated the Pilates method of body conditioning into their rehabilitative programs. The slow, controlled movements are ideal for protecting joints and improving alignment. Even so, consult your doctor and/or physical therapist before starting any exercise program, especially if you’ve been sedentary for an extended period of time.

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Is There Such Thing as an Arthritis Personality? http://www.youvsarthritis.com/is-there-such-thing-as-an-arthritis-personality.html http://www.youvsarthritis.com/is-there-such-thing-as-an-arthritis-personality.html#comments Fri, 19 Mar 2010 09:48:19 +0000 Russell http://www.youvsarthritis.com/?p=20 Since the early twentieth century, the debate has been on: are people with certain personality traits more likely to contract rheumatoid arthritis or does rheumatoid arthritis induce certain personality traits? The answer may be more complicated than you think…

Rheumatoid arthritis is a maddening disease.
Despite all of the exciting breakthroughs in the field of immunology, the cause and cure of RA remains elusive. And then there’s the temperamental nature of RA—waxing and waning, virtually impossible to predict. It is understandable how many people—including some respected researchers—believe that a person’s personality determines who contracts RA and who doesn’t…that there is an actual “arthritis personality”.
Personality=Arthritis

The Mind/Body Connection

The idea that the mind influences one health is not a new concept. Hippocrates, the father of modern medicine said:

“The patient was the real thing, the disease not an entity but a fluctuating condition of the patient’s body, a battle between the substance of disease and the natural self-healing tendency of the body.”

And there is some rationale for the link between personality and illness. Nowadays, even the most conservative doctors will admit that an aggressive, “Type A” personality can lead to hypertension, heart attacks or strokes. There is rising credence to the idea of a “Cancer Personality” (e.g. repressed anger, excessive need for approval) although it should be emphasized this has not been clinically proven. And then there is rheumatoid arthritis—capricious and temperamental, illogical and cruel—a sort of Freudian symbol for women…and, of course, women are usually its’ victim.

In fact, in some of the early research on arthritis and personality, you can find Freud’s indelible mark. Only women were tested, the arthritic personality said to be:

* self-conscious
* rigid
* inhibited
* shy
* conforming
* frigid

Later researchers concluded that the study was flawed by faulty research methods in that there was an inadequate definition of arthritis and that the personality information gathered during the interviews were inconsistent. Still, the idea of an “arthritis personality” was established.

The Birth of Psychoneuroimmunology

In 1964, psychiatrist George Solomon started the field of “psychoneuroimmunology”—the science that explores connections between personality and the immune system. He and Rudolf Moos of Stanford University conducted a study on women with RA and their non-arthritic sisters. He found that certain personality traits of the arthritic women were not found in the non-arthritic sisters. This time, the arthritic personality was said to be:

* passive
* self-sacrificing
* overly sensitive to the anger of others
* compliant
* anxious
* depressed
* unable to express anger

Solomon and Moos then concluded that people who are genetically predisposed to RA but are emotionally healthy could actually prevent the disease.

It must be kept in mind that these women were tested after contracting RA; it did not seem to occur to Solomon and Moos that their personalities could have changed in response to the disease. It is also interesting that—again—only women were tested. As a psychiatrist, it is possible that Dr. Solomon could have given credence to the Freudian idea of the “hysterical woman”, i.e. women being so swayed by their emotions that they could actually cause themselves to become ill and disabled.

This tendency for doctors to disregard women’s complaints as “being in their head” still occurs today. In a recent study, women were found to be twice as likely to die from a heart attack than men. Apparently, when men complain of chest pain, they are immediately hooked up to an ECG but when women complain of chest pain, doctors tend to attribute it to stress. Many women leave their doctors with a prescription for antidepressants—if anything at all

The Granola Effect

Psychiatrists aren’t the only people who blame RA on personality. Naturopaths, homeopaths, holistic “healers” and the like, also believe that a person’s personality can result in chronic disease, including RA. According to naturopath David Hoffman, the arthritic personality consists of:

* static anxiety
* rationalization
* dependency
* reduced ability to express emotions openly
* infantile aggression

Hoffman also believes that “friction in the joints” is directly attributable to the patient’s “friction with other people”. Since there has not been a single replicated study in which holistic medicine produced a measurable effect on RA, one is tempted to believe that the reason naturopaths blame the patient’s personality is to provide a ready-made excuse when their treatments fail (i.e. the patient doesn’t improve because she refuses to “change her personality”).

Arthritis=Personality

“Learned Helplessness”

The chronic pain, stiffness and malaise of RA can produce incredible stress. In a now infamous study, dogs were placed in cages with electrified bottoms. Intermittently, the researchers would shock the dogs. At first, the dogs would struggle and try to escape. After realizing that there was no escape, however, the dogs stopped struggling, and simply huddled on the floor…even when there was a means of escape. This rather cruel experiment lead to the theory of “learned helplessness”.

Other studies have confirmed that if there is a repeated inability to do something about stress, a pattern of behavior develops that is characterized by “giving up”. Eventually, the victim is unable to clearly assess the causes of stress or to formulate solutions for dealing with them. The relentless, seemingly inescapable pain of RA is a perfect example of a persistent stressor; its victims can easily conclude that any action on their part is futile.

While “learned helplessness” may be too generalized a term, depression is a common problem with RA patients; it has been estimated that at least 40% will experience a period of severe depression. Many of the personality traits espoused by Solomon and others: difficulty in expressing emotion, overly sensitive, inhibition—even “infantile aggression”—are likely the effects of depression.

Self-Conception and RA

If these traits are the result of arthritis-induced depression, can one’s personality be altered for a healthier outcome? Probably not. In a recent study in Sweden, researchers tested two groups. The first group had what was considered a “positive” personality, showing traits such as a “fighting spirit”, acceptance (as opposed to giving in), and revaluation. The second group demonstrated “negative” personality traits: they were reserved, tended to “protest” their fate and felt there was a significant deprivation of life. It was believed that there would be a correlation between the “positive” thinkers and lesser symptoms. However, disease indicators correlated only weakly with self-conceptions; there was little if any difference in the severity of the “positive” thinkers and the “negative” thinkers.

The Efficacy of Coping

In the same study, however, researchers noted that while personality had little to do with severity, it could make a significant difference in coping. The attitudes demonstrated by the “positive” thinkers helped them to deal with RA in a way that allowed them to function as normally as possible. In yet another study on personality traits, it was found that certain traits helped patients cope with RA more effectively than others. The traits—both “positive” and “negative” are:

* Neuroticism
Anxious, self-pitying, tense, touchy, unstable, worrying

* Extraversion
Active, assertive, energetic, enthusiastic, outgoing, talkative.

* Openness to Experience
Curious, imaginative, insightful, having wide interests.

* Agreeableness
Appreciative, forgiving, generous, kind, sympathetic, trusting.

* Conscientiousness
Efficient, organized, reliable, responsible.

It was found that the subjects who exhibited “positive” traits—extraversion, openness to experience, agreeableness and conscientiousness—managed their RA much better than those who exhibited neuroticism; that, while there was no difference in the severity of their symptoms, they were able to live their lives more freely. It also found that the more perceived control the subject had over RA, the more effectively he or she coped with pain.

Should we then conclude that there is no such thing as an “arthritis personality”? Yes and no. As of yet, there is no replicated clinical evidence that personality traits can trigger RA. However, many people with RA report that a major stressor (death in the family, divorce etc ) in their lives occurred just before onset of the disease. Even though there is no convincing evidence of a link between stress and severity of symptoms, it is known that stress can alter the immune system. Also, a link has been found between RA patients who have a history of depression or anxiety disorders and increased fatigue.

So far, psychoneuroimmunology and the treatment of RA has a fairly dismal record. The concept of an “arthritis personality” is not a harmless one, either. Many people with RA are beset with guilt—they do not need the added stress of believing that they “caused” their arthritis—nor do they need their families, friends and coworkers believing that RA is simply neurotic behavior, that, if they would just “think positive”, they would be cured. As far as studying the links between personality and RA, most patients with RA would probably prefer already-scarce funding to go towards finding a genuine cure.

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Arthritis Answers: Easing Back into Exercise http://www.youvsarthritis.com/arthritis-answers-easing-back-into-exercise.html http://www.youvsarthritis.com/arthritis-answers-easing-back-into-exercise.html#comments Fri, 05 Mar 2010 07:06:15 +0000 Russell http://www.youvsarthritis.com/?p=16 Yeah, yeah, yeah, we all know that we’re supposed to exercise…but when you have arthritis, exercise is essential, not only to protect your joints but also to prevent muscle atrophy. Still, if you have arthritis and you haven’t exercised in awhile (e.g. there was a “19” in the date), there is an art to getting back in shape…

If you are occasionally irritated by my aerobics teacher tone, here is my confession: I hate to work out. In fact, not only do I hate to work out, I will—at any given excuse—duck out of exercise the way a sinner skips Sunday school.

“I’m too busy,” is my excuse of choice and it’s true—this holiday season was more hectic than usual. At any rate, New Year’s Day came with all of its requisite guilt and I realized that I had not really exercised in nearly two months. Full of resolve, I pulled out one of my exercise tapes and some of my hand weights and set to work. Realizing that I was probably not up to my usual level, I did only half of the tape and used my lightest weights. True, I sort of glossed over the cool-down, but I got through the workout easily. In fact, I even felt a little cocky, knowing that I could have completed the entire workout, if I had wanted.

At 3 AM, I awoke in pain. At first, I thought that I had been slammed with a five-alarm flare—which was true—but it was more than that. It was my muscles. Gingerly, I made my way downstairs, taking a full minute and a half to reach the bottom. I increased the dreaded Prednisone, I iced, I heated, I rested…and still, I could barely even lift my arms, much less function like a human being.

The only thing that hurt more than my muscles (and, of course, my joints) was my pride. I couldn’t believe that such a baby workout could crip me out for three days. Then I remembered about muscle atrophy, another one of those fun components of rheumatoid arthritis. When you have RA, you must exercise, not only to keep your joints limber, keep your weight down, keep the circulation going, but also to keep your muscles from literally wasting away. True, by a certain age (which I passed, a while back) everyone has to exercise to avoid muscle atrophy. But when you have RA, the process is accelerated. It’s as if you have to exercise—not to get ahead, but just to keep up with your own body.

Realistically speaking, however, there will probably be periods of time in which you don’t or can’t exercise. If you’re getting over a flare, maybe you’re even a little gun-shy. So how do you get back into the exercise groove? Very carefully, of course…

Easing Back into Exercise
See your doctor.

Overkill? Maybe. But if it’s been awhile, it can’t hurt to get checked out by your rheumatologist. Not only can he/she check on your general well-being (blood pressure, heart, lungs, etc), he/she can best determined your level of severity and make appropriate suggestions for getting back into shape.

If you RA is extremely active, if you haven’t exercised in years or if your general health is poor, you may be referred to a physical therapist. Don’t be embarrassed! There is no shame in having a problem, only in doing nothing about it. A physical therapist is specially trained to work your weakest muscles and joints. It’s hard and even painful, but a good physical therapist can work wonders for even the wheelchair bound and can certainly help you develop a realistic exercise plan.

Underestimate your exercise level.

Let’s say that—miracles of miracles—you wake up feeling almost normal on a coincidentally gorgeous day. You blow the dust off of your walking shoes, step out into the sunshine and tell yourself, “I feel like I could walk a mile!”

Terrific! Walk half a mile.

Chances are that on a good day, you probably could walk that mile without any major problems. But your body still benefits from that half a mile and you can always build up to a mile or two or even 5. Building up, however, is the key. If you’re feeling truly impatient, look at it this way: how many miles are you going to be walking if you are knocked back with a flare? In this case, the tortoise truly does win the race.

Choose your exercise carefully.

Speaking of walking, I would like to take this opportunity to state that, contrary to what the “experts” claim, walking is not for everyone. Some of us have severe deformities in the metatarsals, which leaves very little cushioning…even with good shoes and orthotics. This is just one example of comparing your exercise needs with your arthritic limitations. For someone whose feet are severely afflicted, swimming or rollerblading would be a better option.

Another example might be someone whose neck is affected. While walking might not present a problem, many yoga poses would be out of the question and might even be dangerous. This is why it is important to discuss your exercise options with your doctor before starting. Not only can he/she offer suggestions he/she can also discuss which exercises should not be attempted.

Study beforehand

Again, this probably sounds like overkill, but if you’ve been out of the game for awhile, it can’t hurt to watch others before attempting a workout yourself, especially if you are planning on taking a class. While aerobics/aquatics/yoga/tai chi/pilates teachers may be very knowledgeable in their field, chances are that they don’t know squat about arthritis. Ask an instructor if you can watch an actual class before signing up. Watch carefully and take notes about possible problems. Afterwards, approach the instructor and ask if certain poses, steps, etc can be modified (and they almost always can); you may even decide that this particular class is not for you. Most instructors will be happy to work with you. If not, that is a red flag that you may not be dealing with a professional. Avoid any instructor who seems unsure of him/herself, is unable/unwilling to answer your questions or who seems threatened by the idea of adapting any part of the routine.

This is also an excellent way to “review” an exercise tape. Most exercise videos can be rented from the local video store; if not, the more reputable exercise programs offer a money-back guarantee. Either way, try to watch the tape more than once before attempting to follow the routine. The terrific thing about workout videos is that you can stop them. If there is a part you don’t understand or a move that you feel you should modify (and even Tae Bo can be modified!), stop the tape and write a note to yourself. Later, after you have warmed up, you might want to try out the adapted form before you start the actual workout.

Plan your exercise time and keep it sacred.

Morning stiffness makes exercise nearly impossible for some of us; evening fatigue for others. Pay attention to your body and decide when the best time is for you. If you are a procrastinator or if you really, really hate exercise, you might even consider “scheduling” exercise time on your calendar. Writing anything down as an appointment somehow makes it seem more important…

Exercise Time!
You must warm up before any type of exercise…

That includes yoga, tai chi, pilates, swimming or any other kind of “soft” exercise. Some of you are probably saying, “You mean, I gotta stretch before I stretch?”—which is a common misconception. Warming up is not stretching; it is the light exercise you do to warm you muscles before you even stretch. A few minutes on the treadmill (or around the block), marching in place, or easy dancing are all excellent ways to warm up. Five minutes is fine for non-arthies, but I feel that arthritic folk should probably aim for ten. Since our muscles are stiffer, they are more prone to injury.

Still not convinced? Okay, well here’s what the experts at AskMen.comhave to say:

“The theory behind warm-ups is that muscular contractions are dependant on temperature. Because increased muscle temperature improves work capacity and a warm-up increases muscle temperature, it is assumed that one is necessary.

“The amount of knee fluid also increases with a warm-up, oxygen intake improves, and the amount of oxygen needed for exercise is reduced. This is why performance improves after warming-up. Nerve messages also travel faster at high temperatures. Your reflexes will be faster and so will your muscular reactions, therefore you will reduce the potential risk of injuries.”

And, as an infamous lover of the hard way, let me share what happened to me—pre-arthritis—when I didn’t warm up properly. I was late for ballet class, and instead of warming up properly, I jumped in with the rest of the class who were in the middle of the barre (a series of advanced leg stretches performed on a chest-high bar). Since the teacher didn’t notice me sneak in, I thought I was pretty slick; in fact, I was winking at one of my classmates when something popped in my left hamstring, sending me and my smartass grin to the floor. That was 7 years ago, and I still have problems with that hamstring. Please…it’s only ten minutes. Take the time to warm up.

then stretch.

Even so, it’s not enough to just warm up your muscles. They must also be stretched to avoid injury. Any reputable class or video will have both a warm up and a stretch incorporated into their routine; if you are on your own, and are unsure about what to stretch and how, Carol Dickman offers 21 different stretches on her website Stretch.com.

Don’t go for the burn.

The “burn” is for Jane Fonda and millions of other non-arthies; we have built-in burns that don’t need to get worse. If you are following an instructor, stay well below his/her pace; there will be time enough to catch up as you build up your strength. In fact, for the first few times, stay well below the level that feels challenging. This may seem frustrating, but it will help you prevent flares and muscle blowouts, which will ultimately help you attain the level that is best for you.

Cooling down.

Okay…everybody makes mistakes. Perhaps kickboxing wasn’t such a great idea. If the exercise you chose truly hurts you, by all means, stop—gradually. During any aerobic activity, blood is sent to the extremities and, of course, the heart rate is increased. If you stop suddenly without cooling down, it puts extra stress on the heart, causes the blood to pool in your legs and can lead to muscle stiffness and tenderness…and who needs that?

Cooling down is much like warming up except that you are gradually slowing rather than quickening your pace. Walking in place or on the treadmill, taking a couple of slow laps in the pool, or even just lifting your knees to waist level until your heart rate normalizes are all ways of cooling down. By finishing up with a five-minute stretch, you further decrease your chances of next-day muscle aches.

Afterwards…
Hit the water.

Warm water seems to have restorative powers for arthritic folk. Five minutes in a Jacuzzi is heaven, but even a hot shower or bath is a nice way to finish up a workout and prevent stiffness. Make it a bubble bath and you’ve rewarded yourself for a job well done!

Schedule lightly.

The first few days of a new workout—or an increase in level—is not the time to finish all those chores that you’ve put off for a week. Keep the errands and housework to a minimum. Order out. Give your kids the car keys or teach them the fine art of walking. Until you know how your body is going to react, allow yourself time to recover.

Re-evaluate.

Remember: the next morning is Judgement Day.

Ease out of bed slowly and assess your level of stiffness and pain. Some increased stiffness and soreness should be expected, but if you are truly in pain then you need to re-assess your workout. Could you reduce the intensity or adapt some of the movements? Would it be possible to perform the same exercise at a slower pace or at half the duration? Chances are good that by adjusting the tempo or time, you will be able to continue your workout. If, however, you don’t feel that an adjustment is possible, then it’s time to look for a different way of exercising.

Fortunately or unfortunately, exercise is not an option for folks with RA. We must exercise regularly to protect our bodies from further degeneration. If care is taken, if we are ready and prepared to adapt, there are many types of exercise that are still open to us. And, whether or not you truly like exercise, when you work out, it feels as if you have broken a barrier…and isn’t feeling less limited, even by a small degree, worth all of the sweat and soreness?

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