Sunday, June 28, 2015

Moving Beyond the pain of Arthritis-CASE HISTORY OF ALAN HOFFMAN (Part 2)

Two year ago, Alan Hoffman, a 53-years-old dentist, went to his doctor for a routine annual checkup, complaining of chronic pain in his right hand and left hip. The pain in his joint wasn’t new, he admitted, but he’d stoically endured it for years because the aching was intermittent. Now it was turning into an everyday occurrence, and he was worried. As a dentist, he stood on his feet for hour everyday and, to make things worse, he was right-handed. How could he continue to make a living if his hip and hand gave out on him?
Alan was moderately overweight, and his doctor could easily see that a weight-bearing joint like his hip might be crying out for relief. Twenty pound (9 kilograms) or so less body weight, hence less stress on the painful hip joint, would certainly be a step in the right direction. But clearly there was more to Alan’s problem than mere excess poundage. Alan’s doctor examined his joint, X-rayed them, and took blood test, all the while inquiring at length about Alan’s lifestyle and medical history.
The results, particularly of the X-rays, revealed osteoarthritis, but the doctor could find no readily identifiable cause, meaning Alan had primary osteoarthritis. (Another form, called secondary osteoarthritis, results from such predisposing factor as specific joint trauma, usually injuries, and certain diseases. Billie Jean King’s arthritis is a perfect example of secondary osteoarthritis.)
Yes, arthritis is a chronic condition, Alan’s doctor explained, but the doctor had several ideas about how to relieve Alan’s painful symptoms to the point where they would be unlikely to interfere with his livelihood. First, his doctor prescribed medication to relieve the joint pain and any inflammation that might be present. Next, the doctor referred Alan to our Cooper Fitness Center for exercise therapy and a weight loss program.
On Alan’s arrival at the center, he was in class 2 of the functional capacity classification. In the intervening year and a half, he’s lost 25 pound. He eats more selectively and works out faithfully, both at home and at the center. At home, Alan does stretching exercise and strength training, followed by a stint on a stationary bike while he’s watching the news. He likes the bike because its design works arms and legs simultaneously.
During his first year as a Cooper Fitness Center member, Alan used brisk walking in the winter and swimming in the summer to supplement his home stationary cycling and to earn his recommended weekly quota of 100 health points. Alan has also recently embarked on a more serious muscle strengthening program.  Twice each week now, after cooling down from his walk or swim, he tackles the resistance training machine at the center.
Alan still has some joint stiffness in the morning and his pain recurs occasionally, but it’s much better. He used to wake up with his left hip joint so stiff he limped for about 10 minutes before he could walk properly. Now his hip joint might feel a little stiff as he slings his legs over the side of the bed to get up, but walking energetically to the bathroom is no longer something he has to think about. Today Alan takes pain medication only on those rare occasions when his joints really act up.

Alan readily admits that the linchpin of his recovery is faithful adherence to regular exercise. He calls exercise a “miracle cure” though not in the usual sense of its being instantaneous or making a disease disappears forever. “Exercise requires perseverance and time to work its magic. But it does eventually work wonders, “say Alan. The miracle it worked for him was to increase his aerobic fitness (which we measure at the Cooper Clinic via treadmill exercise testing) by 30% and his strength by almost 60%. His blood-lipid profile is also much improved; though this doesn’t affect his arthritis, Alan is pleased, because heart disease runs in his family.

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