Tuesday, May 15, 2012

Arthritis 2: Tests

Even though my hands were feeling much better (thank you, gliSODin), I decided to keep the appointment with my primary care provider (PCP).  Doctors have a saying, “If you hear hoof beats, look for horses, not zebras.”  Translating to my situation, “If a 65-year-old women shows up in your office talking about pain and inflammation in her hands, think osteoarthritis, not oxidative stress caused by strenuous workouts.”  My PCP, a small, scholarly-looking woman in her thirties, listened politely.  

When I had finished talking she said she didn’t know anything about gliSODin but she was thought I had arthritis pretty much everywhere in both of my hands.  She very gently squeezed each of the joints and asked whether it hurt - only three of them did, a little – and how my hands felt when I woke up in the morning.  We agreed that I probably had osteoarthritis but she believed that I was already quite disabled, which was not my sense of the situation.  I told her about doing assisted pull-ups and lifting weights.  I also mentioned that the other heavy exercisers in my family do have serious arthritis in their hands.  

I asked why the pain and inflammation had appeared all at once, since osteoarthritis usually develops gradually over months or years.  She said that there can be flare-ups when the condition suddenly gets worse and that these usually subside after a while.  She said it was possible that the gliSODin had been masking the osteoarthritis symptoms.  (I’ve heard that word “masking” from doctors before when they believe that the supplement or treatment is having only a superficial effect.)  On the other hand, she seemed interested in what I said about the other extreme exercisers in my family.  We both agreed that it would be a good idea to get more information.  She ordered hand x-rays and a slew of blood work, both of which I got the same day.

The x-ray technician was kind enough to give me the DVD with my pictures after she had finished with it so I took it home and had a look.  Two of the six images appear above.  After looking at these I went online to get an idea of what they might mean.  It turns out that when radiologists evaluate arthritis in hands, they look especially at the spaces in the joints.  If you are young and healthy with good, strong cartilage, the spaces will be wider.  As you get older, especially if you get arthritis, the spaces get narrower.  Ultimately you can get to “bone-on-bone,” which causes a grinding sensation at the joints because there is no more space or cartilage to cushion them.

The radiologist’s report, when it arrived, was somewhat encouraging.  He talked about “mild space narrowing and slight spurring at the articular margins (little bone spurs at the edges of the joints),” as well as some “small subchondral cysts (cysts beneath the cartilage).”  This seemed to bear out my notion that the OA was not too bad yet.  The blood work turned up a couple of odd items, slightly low protein, in spite of all the protein in my diet, and slight anemia.  The vitamin D was also lowish, although I take lots of vitamin D supplement. 

There was nothing in any of these tests, though, to indicate why my hands had started to hurt so much in late December.  My PCP’s idea, that overworking my hands had caused a flare-up, seemed plausible enough; my interpretation, that oxidative stress from workouts plus going off a powerful antioxidant that I had been taking (gliSODin), seemed reasonable as well.  And then there was the question of what to do next.  Since there was little pain and since some arthritis medications can have very nasty side effects, I didn’t want any of those.  At the same time, it would be great if I could slow down the progress of the OA and maybe get rid of the swelling in my index finger.   

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