Tag Archives: Exercise

Now I’m just angry!

High on the list of things making me angry is the weather. A foot of snow each week? Really, Mother Nature? Really? Global warming or not, it’s wearing on us. I’ve tried making idle threats against the earth, which go something like this – “Make the snow stop or I swear I’ll never recycle anything ever again! Look at me holding this peanut butter jar! It’s going in the TRASH. That not enough for ya? OK, I can do better. Here’s a laundry detergent bottle! OOOOH all that plastic, bobbing around in your oceans. Gonna stop the snow now???” Yeah, well, I think all the snow is making me loopy. Not to mention that we’ve had so many snow days causing patient cancellations that it’s really fouling up everyone’s schedules.

What else makes me angry? An article with the headline “Docs Don’t Follow OA Guidelines.” Why so accusatory? In my mind that headline assumes there’s a bunch of guys smoking cigars sitting around a table saying, “To hell with guidelines! We don’t care about guidelines! We’re doing what we want!” (I don’t know why it’s like a 1920’s mobster scene, but that’s my vision here).

Here’s the first paragraph:

Physicians are apparently disregarding standard guidelines to manage osteoarthritis — relying on painkillers and surgery rather than on steps like exercise and weight loss that could help reduce morbidity — adding to the soaring costs of treating OA, researchers argued.

Let’s think about that for a minute. A patient comes in with osteoarthritic knee pain. Usually it hurts when getting up after sitting for a while, hurts going up and down stairs. Maybe they’re already active and it hurts when exercising. Maybe it used to respond to an OTC analgesic but isn’t anymore.

I am fairly certain that most doctors almost always if not always counsel patients with OA about diet and exercise. I’ve given the “even a little bit of weight loss would help take some pressure off your knees” talk so many times I wouldn’t be surprised if I say it in my sleep. But here’s the clincher – diet and exercise are the PATIENT’S responsibility. I can’t go home with you and cook your food (though I can help you find some great internet resources for healthy eating) and I can’t take you to the gym. I have enough trouble getting myself out to exercise and to avoid the lure of the office candy bowl! But when patients come to the doctor they expect us to DO something. Dieting and exercise are slow. They’re hard to do. Your knee still hurts when you’re exercising. Painkillers, injections and even surgery can help you feel better as youre working on healthier lifestyle modifications. So please don’t tell me that I’m “disregarding guidelines” by recommending other treatment options. I’m just trying to help.

Didn’t the bionic man run?

[picapp align=”left” wrap=”false” link=”term=hang+glide&iid=184215″ src=”0180/28acefb5-5b41-4526-be46-4810a69a9645.jpg?adImageId=11353302&imageId=184215″ width=”380″ height=”253″ /]A story about playing sports after knee replacement came this week in one of my daily medical news emails. You can read the MedPage Today article here.  I send a lot of patients to the Orthopaedic surgeons for joint replacements. Unless there is something else I see them for, sometimes they don’t need a Rheumatologist anymore and don’t come back, so I don’t know how they’re doing. A fair amount do come back, though, for their RA or OA of other joints, and we talk about life after knee replacement. According to the article, here are the accepted and discouraged post-replacement activities:

Encouraged activities include bowling, croquet, golf, doubles tennis, table tennis, ballroom dancing, square dancing, stationary biking, swimming, low-resistance rowing, walking, hiking, and low-resistant weight lifting.

Discouraged activities include baseball, basketball, football, hockey, soccer, high-impact aerobics, gymnastics, jogging, power lifting, rock climbing, hang gliding, and parachuting.

I think we have to first decide if we’re talking about an elite athlete or just an every day person trying to remain fit and active. Not many of my patients wanted to rock climb or hang glide BEFORE their surgery, let alone after. I have a hard enough time trying to convince people with arthritis that they CAN and SHOULD exercise (check out my prior post on exercise resolutions). Sports medicine doctors are probably seeing a different patient population than I am. I also found this interesting:

The revision rate for mechanical failure of the implant was lower in the patients who participated in high-impact sports (8.5% versus 11%), although the difference was not statistically significant.

How can I use this information in my practice? Well, if it seems to be OK for super athletic patients to get out there and occasionally do high-impact exercise after joint replacement, then us average Joes and Janes can certainly keep up a healthy low to moderate intensity workout post surgery. Good news!