Sunday, June 28, 2015

Moving Beyond the pain of Arthritis-CASE HISTORY OF CHERYL LEWIS (Part 3)

Cheryl Lewis, 48, is another convert to using regular exercise to control a moderately severe case of rheumatoid arthritis, another type.
Three years ago, Cheryl started to develop mild pain in her joints on both sides of her body. Her knuckles, middle joints of her fingers, wrists, elbows, knees, and ankles all bothered her to some extent as she went about her daily household chores.
Over a period of 3 months, the pain began to worsen, but that was not Cheryl’s only problem. Her mantel state was deteriorating even faster. The fear of developing a severe case of arthritis, like the one had made an invalid of her father, was beginning to paralyze Cheryl. The picture of him sitting idly in his favorite rocking chair by the kitchen windows, day in and day out, began to haunt her thoughts. He had developed such bad arthritis before age 50 that he’d been forced to quit work and live on disability insurance. Cheryl was too frightened to see her father’s footsteps. Instead she endured her aches and pains in silence, hoping that she’d wake up one day to discover it was all a bad dream.
Instead of awakening   from a bad dream, Cheryl began awakening in the morning with a body that was stiff all over. It took about 2 hours before her stiff joints would loosen up. Not only those, her joints were often swollen and warm to touch. And she was having a hard time coping with her usual housework. She tired more easily and, for the first time in her life, was losing weight without trying.
Cheryl’s husband noticed the changes and insisted she see the family doctor for a checkup. It didn’t take Cheryl’s doctor long to confirm her worst fear. Yes, her father’s nemesis was also hers. Although there was still no cure for rheumatoid arthritis, her physician explained, treatment of the disease had come a long way since the time her father suffered from it, 30 years earlier. There was a reasonably good chance she could still lead an active, productive life by adhering to a special treatment and rehabilitation programs; he referred her to a specialist, called a rheumatologist.
Cheryl’s rheumatologist was even more optimistic. She immediately put her on medication to alleviate the pain, stiffness, and swelling and monitored her progress closely for months, modifying her drug therapy according to her response to it. Once Cheryl started to feel better physically and stopped her mental brooding, she moved into the second phase- a comprehensive rehabilitation program that included physically as well as occupational therapy. The rheumatologist also encouraged her to join the Arthritis Foundation to meet others with her condition and to learn more about the disease and treatments. (For information about the foundation and its many outstanding service, contact your local chapter or write to Arthritis Foundation, P.O Box 19000, Atlanta, GA 30326, United States.)
About 18 months after the first onset of symptoms, Cheryl had reached the happy state in which her condition was no longer active: The arthritis wasn’t progressing and, if anything, seemed to be getting better. However, her functional capacity was limited to class 3 of the scheme. That’s when she came to the Cooper Clinic for exercise therapy at our Cooper Fitness Center. I first met Cheryl in our medically supervised exercise program. As was true for her peers in the program, her still-fragile condition necessitated exercise under the watchful eyes of health professionals, ready to respond to any emergencies.
I started Cheryl on range-of-motion and stretching exercise plus isometric muscle-strengthening exercise. After 4 weeks of isometrics, her strength had increased enough for her to start on isotonic exercise using resistance rubber bands, which she preferred to the hand-held weight that many of our other patients use. The rubber bands were easier for her to grip because her arthritis had caused finger deformities.
At the same time, Cheryl was doing an aerobic exercise program of stationary cycling and slows walking. I gradually increased the duration over 12 weeks until she was able to do 20 minutes of each during a session. However, frequent fatigue made it necessary to introduce Cheryl to concept of interval training. If aerobics made her unduly tired, she could slow down until she got a second wind-or, if really necessary, stop until she felt able to continue.
After 3 months in this program she was still earning less than 50 health points each week-the minimum recommended level. But her stamina and confidence were so much improved that I allowed her to go it alone from then on, provided she did only the exercise I assigned to her. If she wanted to branch out and try new physically activities, she had to confer with me first.
Today, Cheryl does water aerobics twice a week augmented with vigorous walks around the path of our center. She fills in with stationary cycling and an occasional outdoor bike excursion with her family. It’s the rare week when she earns 100 health points, but that’s okay. For Cheryl, consistently earning over 50 points is all that I ask. Even that much is enough to confer the health benefits she needs to aid her recovery. The health benefits are already obvious: Her aerobic fitness has increased by almost 50% and her strength by a staggering 75%. Interval training is no longer necessary because her weakness and fatigue are substantially reduced. Although her medication hasn’t changed since she’s been exercising, she has less pain and stiffness overall in her joints.

I’m happy to report that the memory of her father’s affliction no longer haunts Cheryl because it’s clear to her that she’s broken the mold. She’s not confined to life in a rocking chair. Instead, she’s actively pursuing the good life and is living proof that despite rheumatoid arthritis you can defy the odds. For Cheryl, the real bonus from her workouts is being able to garden again.

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