“You HAVE to tell all your patients about this! It’s the BEST gadget I’ve ever tried – and believe me, I’ve tried dozens!” said my patient as she pulled this out of her purse the minute I walked into the exam room. She’s not a representative of the company in any way. In fact, the brand isn’t anywhere on the gadget. It’s a 6-in-1 tool that can open soda cans, bags, bottles, jars. Anyway, if you can find it, my patient says to snap it up (and wanted me to spread the word on the blog).
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.
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Some research out of Rush University in Chicago suggests that flip-flops or other flexible shoes may be easier on the knees than clogs or supportive walking shoes. I have to admit that I found this news contrary to what I have learned and what I usually advise patients. However, given all the recent interest in the running community about barefoot running, I must say I’m not entirely surprised. After reading the article, I asked for some advice from one of my foot and ankle orthopaedist friends on Twitter (@thomasleemd) and if you follow him, you can read his personal impressions of barefoot running. From the article,
“Stiffness is also a factor. We’ve shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial ‘stomping’ movement created by a stiff-soled shoe.”
In the present study, Shakoor said, flip-flops and the walking shoe were flat, flexible and lightweight and seemed to mimic the mechanics when walking with bare feet.
“Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less ‘support,’ flatter heels and more flexibility,” Shakoor said.
Will this change how I counsel patients? I suppose I won’t be quite so hard on flip-flop wearers. However, those with foot pain or “fallen arches” may need the stability of athletic shoes or shoes that accommodate orthotics. Personally, I have so far tried out a few dog walks in plain old flip-flops instead of putting on my running shoes as I would have done otherwise.
Interesting article on early knee OA today in the New York Times’ Well Blog. During my fellowship at the University of Pittsburgh, I often heard about the research being done there on cartilage structure and function.
The New York Times Well Blog recently had a story on “voices of RA.” Perhaps the #1 arthritis question I get about RA is how to differentiate it from OA. I’m going to give you a very simplified answer. OA, or osteoarthritis, is “wear and tear” of the joints. Some people get it earlier in life than others, in some people it will progress faster than in others, but we all use our joints so we will all develop some wear and tear in them. RA, or rheumatoid arthritis, is an autoimmune disease with inflammation occurring in the lining of the joints. Many people are surprised to hear children can get RA. I have been a speaker for the Arthritis Foundation and recommend further reading on their site, www.arthritis.org.