heavy toll. “Each year, arthritis accounts for 44 million outpatient visits and more than 900,000 hospitalizations. In fact, it’s the leading cause of disability in the United States and is a more frequent cause of activity limitations than heart disease, cancer, or diabetes. By some estimates, 67 million Americans will have arthritis by 2030.”
So what can we do? Knee, shoulder, and, of course, hip replacements are the drastic remedies. And they are really the only full cures, since bone spurs and lost cartilage simply will not dissolve or regenerate in our present state of technology. Most arthritis sufferers, though, are not there yet. As even my orthopedic surgeon, Dr. Roy Davidovitch, director of the New York Hip Center, NYU Hospital for Joint Diseases will agree, it’s only when your lifestyle is completely compromised and you can’t take another moment of pain that you have to bite the bullet and get the joint replaced.
However, there is much to do in between. Says Phyllis Crockett, DPH, in the Express Scripts Rheumatoid Arthritis and Inflammatory Disease Therapeutic Resource Center, “Each patient is different, and a physician can help determine the best treatment plan, including managing the symptoms and pain of arthritis, starting with exercise. It is a valuable tool in the fight against arthritis. Osteoarthritis and RA patients particularly can benefit from both endurance and resistance training.”
Maintaining a healthy weight and protecting against joint injury can help prevent OA. “Every pound of weight lost reduces the pressure on each knee by four pounds. Even a small weight loss can be a big help in fighting it.”
For patients who are already on medication to treat the condition, adherence—taking medications as prescribed—is critical to healthier outcomes. But never self-medicate! “Combining over-the-counter medications with prescription medications can be risky and can cause side effects, such as an increase in gastrointestinal (GI) irritation or a GI bleed. And don’t adjust doses or make changes to the medication regimen without checking with your healthcare team.” Watch for drug interactions. “Some common drugs like acetaminophen can have an interaction with arthritis medications. Limit intake, and remember that acetaminophen often is a component in common sinus, cough/cold, and pain medications.”
Diet can also play a role. Opt for an anti-inflammatory dietary regimen (see Rung 3—Nutrition) and go easy on acidic foods such as sugar, white flours, and alcohol. “Also, some foods and beverages can block the effects of arthritis medications,” Crockett adds. “These include grapefruit, apple, and orange juice, as well as milk and yogurt. Wait at least four hours after taking medications before eating or drinking these. Exact times can vary depending on the disease and the treatment. Check with a trained clinician.”
Arthritis, in its many forms, is a continuing challenge. But with continuing focus it is possible to manage it successfully.
Osteoporosis
While we are discussing bones, we need to talk about osteoporosis, literally porous bones. After you turn 50, it’s a good idea to measure your height every year, which will assess your posture and skeletal health. A decrease in stature can be as informative as a change in a bone density test for monitoring your overall bone health.
If your doctor determines that you have osteoporosis—or osteopenia, a precursor to it—it’s still no reason to stress. True, the diagnosis creates visions of shattered bones and rounded backs, but it may just mean that you have a higher risk for fractures. And in the past 15 years or so, doctors have learned a lot about how to prevent those breaks.
Says Ethel S. Siris, M.D., director of the Toni Stabile Osteoporosis Center of the Columbia University Medical Center at New York-Presbyterian Hospital, “We now know that bone density loss is tied to decreases in calcium and impacted by low levels of vitamin D. So just make sure you take enough calcium and vitamin D every day. I generally recommend 1,200 milligrams of calcium from food or supplements, and 1,000 to 2,000 international units (IU) of vitamin D.” Your doctor may also prescribe a bisphosphonate drug to lower fracture risk.
But don’t sit around in fear of breaking your bones, which can actually be counterproductive. Load-bearing exercise, such as walking, is good for all bones. An exercise routine can not only preserve bone mass, it can improve flexibility, strength, coordination, and balance—all of which can help a person avoid falls.
Don’t overdo it, though. And if you are close to someone with osteoporosis, try to sensitively steer her or him into sensible habits. As Dr. Hammerness advises: “Be clear about what concerns you, and get the facts so that you can have a reasonable conversation. Emphasize that you want your loved one to keep enjoying her favorite activities—as long as she makes her health an equal priority. If she’s a hiker, for example, propose that she go only in daylight, avoid areas known for unstable terrain, wear boots with good traction, carry a walking stick or trekking poles for balance, and take a hiking partner. Remind her that by minding her own safety, she can do what she loves for much longer.”
While for the moment, arthritis and osteoporosis may be incurable, the symptoms can largely or wholly be managed or even prevented.
Breathe Easy
There is nothing we take more for granted than breathing. Until we can’t! Many moons ago, working through weeks of intense negotiations in smoke-filled conference rooms, The Lawyer began to suffer from what he thought were allergies. He ended up in the hospital for eight days with pneumonia. Happily, antismoking rules and more powerful antibiotics lessen the incidences of that now. However, in its place, we have almost an epidemic of asthma and, whether you believe in global warming or not, seemingly the same for allergies, and the two can be related. So much so that 50 million Americans are affected by them, and the numbers are growing.
The first time I came face to face with asthma was when my daughter, Elise, was in ninth grade and I got an urgent call from the school nurse, who told me Lisi was having trouble breathing. I dropped everything and raced up to her school. When I arrived, her chest was tight and she was still coughing and wheezing—all classic symptoms of asthma. What possibly could have triggered this sudden attack?
The nurse had an answer: “It came on right after she ate a pear. Probably some chemical in the skin.”
As we drove off to the pediatrician, I noticed the nurse running after the car, frantically flailing her arms, a half-eaten pear dangling by the stem in one hand. She caught up and tossed in the offending fruit. “Here, take this with you,” insisted the nurse, no doubt a CSI devotee, “to be inspected.”
The good news? My daughter wasn’t poisoned. But we were faced with the diagnosis that she had childhood asthma. Fortunately, after a few years of needing an inhaler from time to time before she exercised, she eventually outgrew it. Nevertheless, to this day, she has never eaten another pear.
No one is certain what causes asthma—most scientists believe it is partly genetic, partly environmental—and while some children, like Elise, see symptoms resolve with age, there is no cure. It is known that inhaled allergens and irritants, such as smoke, pollen, dust, mold, and strong odors and fumes, as well as certain common products and foods, even a beloved furry pet, can cause the airways leading to the lungs to become inflamed and swollen. Furthermore, the difficulty in breathing experienced by asthmatics often leads to anxiety attacks. And when stress levels increase, so do asthma symptoms. It’s a vicious cycle.
Living with chronic asthma is challenging. So the first thing to do is to approach it head-on. “Managing asthma is a team effort,” advises Dr. Norman H. Edelman, the American Lung Association’s (ALA) leading medical authority. “Patients (or parents) should work with their healthcare provider to develop an ‘asthma action plan’ such as the one developed by the ALA, specifying medications and how to alter them if the condition worsens. For children, the action plan should involve teachers and school officials.”
