Arthritis 4: What I'm Going to Do

After sorting through the information I have gathered from doctors, tests, and online, I’ve decided on an approach to dealing with the osteoarthritis that I now have. 

1. I will ease off a little (but not much) on my cardio workout.  I’ve been doing intervals on the cross trainer averaging 138 bpm, almost 90% of maximum heart rate for 33 minutes three times a week.  I’m dropping down to 133 bpm or 85% for 35 minutes.  This probably won’t make much difference in terms of calories burned and my heart will still get a good workout.  Less intensity may mean less oxidative stress which will probably be easier on my hands.
2. I will be cautious about repetitive motion activities and about gripping anything for an extended period of time.  On the cross trainer, instead of clutching the handles for thirty-plus minutes straight, I will alternate with pumping my arms and not holding on, better for my balance anyhow.
3. I will start using a higher quality calcium supplement.  I have been buying a calcium caplets from Target, along with a separate vitamin D gel cap, plus vitamin K₂ from an online supplier.  I’ve now ordered New Chapter Bone Strength Take Care, which has all three of these, plus other ingredients that are supposed to preserve bone health.  New Chapter supplements are expensive but their products are tested for potency and safety and recommended by some physicians.
4. I will try hot water soaks, paraffin dips, and the Voltaren gel prescribed by MHO.
5. I will exercise my hands in order to try to increase range of motion – or at least hold on to what I have now.  In the following picture you can see that my right hand is stiffer than the left.  On the left side I can pull my fingertips all the way back to the base of the fingers.  On the right side I can only get to within about ¼”, especially the index finger, because of swelling and adhesions.

Twice a day I work each hand, pushing against the straight part (phalanx), never the joint itself, moving it forward and down as far as it will go and holding for a few seconds, three areas on each finger, two on each thumb.  For most of the joints there is little or no pain but with my right index finger, especially the middle joint, there is a sore, raw sensation that I recognize from when I used to work on my shoulder.  My hope is to loosen up the adhesions and at least maintain the space I’ve currently got at each of the joints.  It may be months or years before I know whether this will do any good but I’d rather try than do nothing.

Arthritis 3: More Insights

In order to get a clearer picture of what was going on, I made an appointment with my husband’s orthopedist (MHO), whom I had met five years ago.  I gathered up the DVD and all the test results and made a list of questions.  When MHO came into the room I almost didn’t recognize him; he seemed to have lost at least fifty pounds and looked tan and fit.  I told him my story and he gave me his version of the situation.  Like my PCP, he thought that the pain and inflammation were caused by a flare-up of pre-existing osteoarthritis.  He thought the arthritis, especially in my right hand, was more serious than the radiologist did.  He was intrigued by what I said about the workouts and the gliSODin, which he hadn’t heard of either.

The bottom line, as I already suspected, was that this condition was not going to go away.  The bone spurs were there to stay and so was the swelling in my index finger.  To help the inflammation I could do warm water soaks and paraffin dips (the same treatment beauty salons use to soften hands).  There was also a more expensive therapy involving corn husks (?), which I probably didn’t need.  I could try glucosamine/chondroitin supplements or a capzasin-based cream or a prescription gel called Voltaren.  Years before I had tried glucosamine/chondroitin to see if it would help my knees.  It made them swell up; when I was doing Sleeping Child pose I felt as though I was kneeling on balloons.  I had also tried capzasin and found it too irritating to my skin – it’s based on hot pepper.  I decided to try the Voltaren gel.  

I also asked MHO about exercising my hands – the  parts of my body that get lots of exercise don’t seem to have bad arthritis, though they probably have some – and he had a couple of helpful comments.  He said, “If you’re going to work with exercise, work on stretching.” He also told me that in arthritic fingers bands of tissue build up around the joints limiting range of motion.  Since he does surgery on people’s joints, he has seen this firsthand.  Since I can only look at my hands from the outside (and in the x-ray), I would not have known about this.

Over the next few days I thought about this conversation, especially the part about the bands of tissue, and was reminded of when I had dealt with frozen shoulder many years ago (see my post “Frozen Shoulder:  What Worked For Me.” 8/25/2011).  I had torn something in the back of my shoulder.  In order to avoid the requisite surgery, which takes a long time to heal, I went to an acupuncturist.  Her treatments healed the tear but left me with frozen shoulder, otherwise known as adhesive capsulitis.  When the body experiences injury or inflammation it sometimes constructs protective bands (adhesions) around the affected area.  In the case of the shoulder, this can make it difficult to do put on a coat or fasten your seat belt in a car.  In the case of my hands, it was starting to prevent me from bending my fingers, which I need to do in order to hold a pen or a pair of scissors.   

The way you deal with adhesions, as I discovered with my shoulder, is to work into them a little at a time.  Over a period of six months, I used yoga and other stretches to work into the affected area and get back the range of motion in my shoulder.  I still have a bone spur where the injury was but the muscle slides right over it when I do rotator cuff exercises.  Perhaps I could apply the same approach to the present situation. 

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.   

Should I Be Taking This? 5

LYRICA is not for everyone. LYRICA may cause serious, even life threatening, allergic reactions. Stop taking LYRICA and call your doctor right away if you have any signs of a serious allergic reaction. Some signs are swelling of your face, mouth, lips, gums, tongue, throat or neck or if you have any trouble breathing, or have a rash, hives or blisters.

Drugs used to treat seizures increase the risk of suicidal thoughts or behavior. LYRICA may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call your doctor right away if you have new or worsening depression, suicidal thoughts or actions, or unusual changes in mood or behavior. If you have suicidal thoughts or actions, do not stop LYRICA without first talking to your doctor.

LYRICA may cause swelling of your hands, legs and feet, which can be serious for people with heart problems. LYRICA may cause dizziness and sleepiness. You should not drive or work with machines until you know how LYRICA affects you. Also, tell your doctor right away about muscle pain or problems along with feeling sick and feverish, or any changes in your eyesight including blurry vision or if you have any kidney problems or get dialysis.

Some of the most common side effects of LYRICA are dizziness, blurry vision, weight gain, sleepiness, trouble concentrating, swelling of your hands and feet, dry mouth, and feeling "high." If you have diabetes, tell your doctor about any skin sores.

You may have a higher chance for swelling and hives if you are also taking angiotensin converting enzyme (ACE) inhibitors so tell your doctor if you are taking these medications. You may have a higher chance of swelling of your hands or feet or gaining weight if you are also taking certain diabetes medicines. Do not drink alcohol while on LYRICA. You may have a higher chance for dizziness and sleepiness if you take LYRICA with alcohol, narcotic pain medicines, or medicines for anxiety.

Before you start LYRICA, tell your doctor if you are planning to father a child, or if you are pregnant, plan to become pregnant, or are breast-feeding. If you have had a drug or alcohol problem, you may be more likely to misuse LYRICA.

In studies, a specific type of blood vessel tumor was seen in mice, but not in rats. The meaning of these findings in humans is not known.

Do not stop taking LYRICA without talking to your doctor. If you stop suddenly you may have headaches, nausea, diarrhea or trouble sleeping and if you have epilepsy, you may have seizures more often.

LYRICA is indicated to treat fibromyalgia, diabetic nerve pain, and pain after shingles. LYRICA is also indicated to treat partial onset seizures in adults with epilepsy who take 1 or more drugs for seizures.

Arthritis 1: Strenuous Exercise and GliSODin

In late December of last year I was volunteering at our local food bank a couple of hours a week.  We were scooping rice from 25 lb. bags into 1 lb. zip lock bags for distribution to client agencies.  Sealing the zip lock bags involved pressing my right index finger and thumb together over and over again.  At some point I noticed that my index finger was starting to hurt; the middle joint was swollen and there was a sensation along the outside edge as though I had a burn or cut.  I switched jobs at the food bank and tried soaking my hand in warm water twice a day.  The pain got better for a few weeks, then worse again.  The little fingers on both hands started to hurt, especially the top joints, and I was beginning to avoid using my right index finger.  I called and made an appointment with my doctor.

Clearly, I had some sort of arthritis.  For many years I had occasional aches and pains in different parts of my hands that came and went.  I assumed that this was the osteoarthritis that people in my family tend to get after a certain age.  But my situation was a bit odd:  osteoarthritis usually develops gradually over months or years, not all of a sudden as the result of one repetitive-motion episode.  I started thinking about what I had been doing differently in late December.  Finally it clicked – I had stopped taking gliSODin.

During the years when I had cataracts I took several supplements that I had hoped would improve my vision.  By the fall of 2011 my eyesight was bad enough that surgery had become inevitable so I had it done just before Thanksgiving.  After the surgery I looked at the bottles of eye-related supplements and said, “Well, I don’t need to be taking these anymore!”  I used up what was left and didn’t order new supplies.  The gliSODin lasted until mid-December.  Shortly after that my hands started hurting.  Maybe the gliSODin had been doing something for them without my knowing it.

GliSODin was first developed by European scientists in 1998.  Its active ingredient is superoxide dismutase (SOD), which is enclosed in gliadin, a wheat derivative, to keep it from being destroyed by the digestive system.  Superoxide dismutases are enzymes produced by the body to defend itself against toxins.   These toxins can come from outside sources like pesticides and pollutants but they can also arise from within the body itself.  Because gliSODin is a relatively new supplement, research on its effects is in the early stages but people take it for a variety of reasons.  GliSODin is thought to protect the body from sun damage, which is why it is taken to prevent or alleviate cataracts.  It is believed to have anti-aging properties and to assist the body in fighting off various diseases.  Studies have also shown that it can enhance athletic performance and offset the oxidative stress caused by strenuous exercise. 

I do a very tough two-hour exercise routine three times a week.  I have to work this hard and eat about 1800 calories per day in order to keep my weight in the mid-140’s.  My metabolism is very slow, 1100 RMR, and I am hypothyroid, which probably doesn’t help either.  A couple of other people in my family are in the same situation; if they don’t work very hard at exercise they put on too much weight.  So they both do hard workouts and both of them have bad arthritis in their hands.  Perhaps we all inherited a predisposition to get osteoarthritis which was then worsened by the oxidative stress from vigorous exercise. 

After putting all this together, I went to the store, bought more gliSODin, and started taking it.  That was Sunday, April 15.  My hands felt better almost immediately and they are pretty much back to normal now, although there is still some swelling around the middle joint of my index finger and the top joints of my little fingers.  You can see this in the photo, as well as the beaten up parts of my fingernails still growing out.  Maybe the fingernails too were hurt by oxidative stress and helped by biotin. (See the 3/6/2012 post “Biotin-for Better Hair.”)

My Feet Are Changing!

During the past couple of weeks my right knee has been giving me trouble.  I go at my usual breakneck speed on the cross trainer – no problem there – but when I’m lying in bed at night there’s a disagreeable ache in the back, the fleshy part, of my knee and another one along the front of my shin, not conducive to falling asleep.  I know from past experience that my knee is probably fine.  This is a job for Dr. Hoffman. 

In an earlier post, “Respect the Feet,” (10/1/2011), I have written about my adventures as a podiatry patient.  I have custom-made orthotics, built up on the right side to compensate for my slightly shorter right leg. The orthotics get adjusted several times a year and my feet are fine.  Usually the adjustments are minor and I can identify the offending spots myself.  Sometimes I tape little pieces of cardboard to the orthotics to check out my theories.  This time I had no clue.  I brought the orthotic in to Dr. Hoffman and described what was happening.  He disappeared into his workroom for a minute or two and emerged with the orthotic considerably filed down, not just a tweak but a major change, and a change in the direction of greater stability.  Something between my hip and my foot has improved and I’d love to know what and why.

Two possibilities occur to me.  One is that I’ve been working on leg strength for six weeks or so, doing the Legs and Back workout in P90X about once a week.  This workout has plenty in it for feet as well as legs and I think it has also helped my balance.  The second possibility is more intriguing:  maybe the change has something to do with diet.  About a month ago I read about new research at the University of Texas Medical in Galveston about maintaining muscle mass as you age.  The resulting recommendations were that you eat at least 20 but no more than 30 grams of protein at each of three meals a day (“Get Older, Stay Strong,” 3/18/2012).  At that point I changed my breakfast routine.  I still have oatmeal and toast but I have added cottage cheese (14 grams of protein per ½ cup).  Some days I have eggs (6 grams each).  The oatmeal and toast have protein too but only about 5 grams each.  Perhaps this new regimen is helping my muscles, including those in my right leg.

Sadie Pearl

Sadie Pearl as a Kitten

“Sadie Pearl, born to run,” was what I used to say about our older cat when she was a kitten.  Tiny enough to sit on my folded arms, she was a mischievous, rambunctious creature who, because of her poor daytime vision, sometimes crashed into furniture as she careened around the house.  She would mock-attack Presto, then a venerable 9 years old, like a tiger going after a buffalo, front legs encircling his neck.  She adored Presto and would creep up to sleep beside him after he had dozed off.

Presto is gone now and Sadie is 14.  When she got to be 10 or 11 we started giving her the same proteolytic enzymes we had given him to help her maintain muscle mass.  Lately I’ve thought that her condition was deteriorating.  She was having more trouble jumping up on the bed and her coat was looking dull and starting to separate instead of lying down smoothly.  The vet prescribed a vitamin tonic, an omega-3 fatty acid supplement, and an NSAID (non-steroidal anti-inflammatory drug) for her arthritis.  After several weeks she seems more comfortable and her coat is shiny again.  If vets are giving enzymes, vitamins, and omega-3 fatty acid to their patients shouldn’t older human beings be getting them too? With us, as with cats, the body is a proficient scavenger.  If it doesn’t get enough of what it needs from diet because of malnutrition, illness, or old age, it breaks itself down in order to keep critical processes going – bones are raided for calcium, muscles for glucose – leaving the body depleted and weakened.

Left to herself, Sadie would probably sleep all day.  Fortunately, she has Rowan, the feline equivalent of a personal trainer.  Rowan is 6, no longer a kitten but still playful and energetic.  He has plenty of toys but he’s bored with them.  What he really likes is to chase Sadie Pearl.  The two of them enact a daily cat soap opera for our entertainment.  Rowan chases Sadie.  She growls and hisses but then goes to find him after he has left the room.  They take naps about a foot apart from each other on the bed.  Sometimes they lounge tail to tail on the top of the sofa like some Egyptian hieratic emblem.