Too Young to Feel Old

INTRODUCTION

I have been treating arthritis, in all of its many forms, for more than twenty years. During that time, I have seen people of all ages—kids and adolescents as well as younger, middle-aged, and older adults battle with pain and stiffness that intrudes on their lives every moment of every day.

As physicians, we learn many things in medical school, but the most important lesson is to listen to our patients. Mine have taught me that it makes no difference whether you’re a teenager, a mother of three, a graying businessman, or an active retiree; we all want to be able to perform at our peak, to go through our life feeling well. Arthritis keeps us from doing that. Unlike most other illnesses, it’s always reminding us of its presence through the constant pain it causes.

That pain can wear you down. It can make you feel older than you are. When it hurts every time you take a step, every time you brush your hair, every time you move, there is no such thing as performing at your peak or going through life feeling well. In fact, you go through life feeling downright old.

Most of my patients are a feisty bunch. They don’t want to sit there and passively hand over their care to a doctor. They want to know what they can do to help themselves, and they haven’t been shy about sharing their own remedies with me (some of which actually work). In response, I have taken what I believe to be the best research, science, recipes, exercises, and supplements—along with my patients’ best input—and put it into a program that can relieve the pain, stiffness, and swelling of arthritis in a few short weeks.

It is my hope that you will find this book both an easy read and a source for factual information about arthritis for either you or a loved one. In it, I have tried to combine the best of traditional medicine and the best of complementary medicine into an integrated plan of attack. It is time for you to regain your life, renew your vitality, and feel youthful again. After all, no matter what your age, you are too young to feel old.

1 CHAPTER
Arthritis:
You Don’t Have to Live with It

IF YOU BELIEVE that joint pain is a natural and inevitable consequence of aging, you’re certainly not alone. Most people do. The idea is that our parts wear out just like the moving parts of a car’s engine, and there is nothing we can do about it. Sounds logical. Seems reasonable. And it would be if we were made of metal and plastic. Luckily for us, we’re made of tougher stuff.

Unlike a car, the human body is composed of material designed to repair and maintain itself. It mends bones, heals wounds, kills germs, gets rid of poisons, and performs millions of other complex biological processes every day in order to stay healthy, whether we’re young or old. That doesn’t mean that our parts never wear out, but with a little tender, loving care from its owner, a body can get through a lifetime feeling good, strong, flexible, and young.

The fact is that there’s nothing predestined about joint pain. It’s no more natural or inevitable than diabetes or cancer. It isn’t necessarily associated with age, and it often has nothing to do with the “natural wearing out” of the body’s tissue. The pain comes from a common disease, so let’s call it what it is: arthritis.

Arthritis has many causes and appears in more than one hundred forms, the two most common of which are rheumatoid and osteoarthritis. Whatever the variety, however, from the everyday to the most exotic, they all share one characteristic in common: joint inflammation. It’s that inflammation, not wear and tear, that is the hallmark of the disease and the main cause of its symptoms: pain, swelling, and stiffness.

Like many diseases, you’re better off dealing with arthritis in its earliest stages, but unfortunately, that rarely happens. Why? Because as mentioned above, people believe joint pain is an inevitable, natural consequence of aging, so when they first begin to feel it, they don’t take it seriously. Here’s a typical story.

Wendy’s Rude Awakening

Wendy was a 51-year-old office manager who gave piano lessons to school children in the evenings to earn extra income for her family. With a garden to tend on the weekends and a hyperactive Border Collie to care for—not to mention a husband, a teenage daughter still living at home, and three grandchildren who frequently came for visits— slowing down never seemed an option for her. She depended on her body to be up, running, and in perfect condition every morning at 6 a.m. And so it was . . . until a morning arrived when it didn’t seem quite as perfect as usual.

On that day, she awoke to strange sensations in her hands, especially her fingers. When she tried to move them, she felt a sharp twinge, almost like a bad sting, followed by a cold, achy stiffness. Several times she balled her fingers into fists, as if tightening and un-tightening them would work out the kinks, but that didn’t help much.

She felt an even sharper jolt as she turned the valve handles in the shower stall, and a new ache in her hand below her thumb made her drop her bar of soap. She tried to remember if she had demonstrated any particularly demanding passages for one of her piano students the previous evening. It was the only explanation that made sense—except that she had touched the keyboard only twice to play a simple scale. So if not the piano, then what? What had she done to herself ? Then the unthinkable occurred to her: Maybe I didn’t do anything to myself. Maybe I’m just getting old.

She shook her head. The day had to come sooner or later. Well, there was no time to sit and stew about it. It was just another change she would have to get used to—like graying hair and “age spots.”

By the time she left the house for work, her discomfort had begun to subside, and by mid-morning, it had gone away completely. She didn’t think about it again until the following morning . . . when it came back. In fact, from that time forward, it made an appearance nearly every day.

Eventually, it became part of her morning routine. She tried to shrug it off, although sometimes the pain was severe enough to make brushing her teeth or lifting a cup of coffee a little more difficult. It also lasted longer into the day now, and she found that occasionally she had to give her fingers a rest from the computer keyboard. She began using an over-thecounter pain reliever to take the edge off. That helped a little, but the aching and stiffness remained persistent.

More Than a Feeling

Wendy finally began to take her pain more seriously when she noticed some tenderness and swelling in the joints just below her fingertips, which doctors call the distal interphalangeal or DIP joints. For many of us, seeing is believing, and believing means worrying. It’s much harder to stay in denial when the evidence is right in front of you, twenty-four hours a day, seven days a week. Something was wrong with her hands, and she feared she might have to stop giving piano lessons. She had already reached a point where she was explaining far more than demonstrating to her students. It was time to see a doctor.

For Wendy, that meant her family physician, whom she’d been with as a patient for more than twenty years. (At this point in the progression of their disease, people will generally come to see me, a joint specialist, only if a friend or relative—most likely a current patient—passes my name along. Otherwise, their regular doctor is their natural choice.)

Predictably, Wendy’s doctor didn’t take her condition much more seriously than she did. His advice: “You’ve got a little arthritis. Take some Aleve, and you’ll be fine.”

Of course, that’s what she had already been doing for months—and now her stomach was beginning to pay the price with burning, cramping, and even nausea. So she figured she would just have to live with the discomfort in her hands. That might have been the end of the story had the pain remained only in her hands, but eventually, she developed tenderness in her knees as well. This time she was tempted to blame it on kneeling in the garden, but just in case it might be something more serious, she returned to her doctor. He referred her to me.

Assessing the Challenge

The first thing I do when I see a patient like Wendy is give her a thorough medical evaluation. Among other things, that meant a general physical exam. As a rheumatologist, I understand that systemic diseases can make their first appearance as joint pain. So we needed to know if she had any medical conditions—such as thyroid disease or diabetes—that might cause a secondary form of arthritis.

It also meant her answering a series of questions designed to determine how much her problem had forced limitations on the way she lived her day-to-day life—what she could and could not do, and to what degree her pain interfered with normal activities.

I asked her about difficulty getting out of a chair, walking up steps, brushing her teeth, combing her hair, cutting food with a knife, writing with a pen or pencil . . . about 30 different activities in all. The test was very subjective, of course, but that’s exactly what I wanted. I see thousands of patients a year. To my eye, someone like Wendy might seem pretty average in terms of her discomfort, but my opinion doesn’t matter. Wendy was the one who had to cope with her limitations, not me, and if she perceived her pain as being severe, then that was the standard we would work from.

After all, this is a real quality of life issue. People with heart pain may become aware of it only when they exert themselves, but people with arthritis feel it every single time they move. Ordinary activities—ones you probably take for granted such as wiping yourself when you go to the bathroom—become a chore.

Wendy rated her discomfort during each activity on a scale from one to ten, ten being the worst. (By the way, my patients do a new pain assessment at every visit so that I can follow their progress over the days, weeks, months, and years.) She rated her pain at an average of six, but felt it sometimes flew up to eight.

That’s a relatively high level, but she seemed to be doing okay with it. She was able to function, go to work every day, and give piano lessons in the evening. Still, there was no reason for her to continue living with all that discomfort if she didn’t have to—and she really didn’t have to. I offered her three options, any one of which would have brought her relief:

• Physical and Occupational therapy consisting of exercise and heat treatment of the affected areas.
• Medication that could be taken orally for her hands, and in the case of her knees, an injection with a substance that acts like an artificial cartilage.
• Alternative therapy consisting of supplements (especially omega–3 fatty acids), a special anti-inflammatory diet, and an exercise routine that might not only relieve pain but dramatically reduce inflammation as well.

Wendy’s Choice

Physical therapy is a good option for some folks, but for those, like Wendy, who have extremely busy lives, taking several hours out of their day two or three times a week is simply too difficult. Medications can work miracles, but sometimes they can also have side effects—occasionally very powerful ones, such as Wendy’s stomach problems. Alternative or “complementary” treatment, on the other hand, is inexpensive, requires a minimal time commitment, and for people with mild to moderate disease, can be just as effective as the other two approaches and sometimes even more so. Not surprisingly, this was the option that Wendy chose.

My recommendations for her started with diet. As I mentioned above, all forms of arthritis are diseases that cause tissue inflammation in the joints. Inflammation is an important weapon in your immune system’s arsenal against wounds, infections, and other insults it has to fight off or heal every day. It’s what causes you to have a fever when you’re battling against destructive bacteria, viruses, or parasites in your system. It’s also what kickstarts the skin around that cut in your finger to begin knitting together.

Excessive or inappropriate inflammation, however, often proves too much of a good thing. We’ve recently learned, for example, that inflammation in the arteries can lead to the buildup of circulation-stopping plaque, which in turn can cause a heart attack or stroke. Recent research also strongly suggests that cancer can be the outcome of the body’s inflammatory processes. We know for certain that the pain and swelling of arthritis is the result of uncontrolled inflammation.

The Food Connection

Many of the foods we eat support the body’s inflammatory reactions. When we have destructive inflammation, however, supporting it with diet may not be such a good idea. So for Wendy, we recommended that she start cutting back her consumption of certain items, including fried foods, most processed baked goods, and anything made with corn oil, safflower oil, butter, margarine, or shortening. These foods are rich in omega–6 and omega–9 fatty acids—fats that the body converts into substances called arachidonic acids, which in turn become pro-inflammatory compounds (actually hormones) called prostaglandins.

The typical American diet generally contains too many of these foods and too few of those containing anti-inflammatory compounds such as omega–3 fatty acids. So I also recommended to Wendy that she increase her consumption of omega–3 foods, which include deep water fish (wild salmon, tuna, cod, mackerel), whole grains, certain fruits, vegetables, nuts, and other anti-inflammatory spices and condiments, including ginger, turmeric, and garlic. I also suggested that in place of corn oil she should cook with more healthful oils such as walnut, olive, canola, or macadamia nut (which you can even use for frying). Flaxseed oil is a great choice for salads.

Because a diet that is well balanced in omega–3s and omega–6s also tends to be low in simple carbohydrates and unhealthful fats, it would also help her lose weight, which in turn would take some of the pressure off of her knee joints.

The Dos and Don’ts of Supplements

To give Wendy’s omega–3 intake an even bigger boost, I recommended that she take some fish oil every day. Fish oil comes in either capsule or liquid form. The capsules can be pretty large and difficult to swallow, so most of my patients have switched to taking a couple of teaspoons of the liquid form. For those of you who may have grown up being force-fed cod liver oil, which has one of the foulest tastes known to man, that’s not the fish oil I’m talking about. Pharmaceutical grade fish oil generally comes from salmon, not cod’s liver, and it is so super-purified that it has much less of the fishy taste or smell of the old-fashioned home remedy your mother gave you. In fact, several brands have added flavors like lemon, orange, and ginger to the oil, which make it quite pleasant to take.

I also told Wendy she had the option of taking flaxseed oil or flaxseed meal as a supplement. Flaxseed also contains anti-inflammatory fatty acids.

As many of my patients do, Wendy asked about using a combination of glucosamine sulfate and chondroitin sulfate to treat her disease. These two substances have gained quite a bit of media attention because of their supposed ability to heal arthritis by growing new cartilage.

Actually, the body produces both substances naturally. Glucosamine is a sugar that commonly appears in connective tissue such as cartilage. Chondroitin is a carbohydrate that helps cartilage retain water. Unfortunately, there is no evidence whatsoever to show that either one, when taken orally in supplement form, can regenerate damaged tissue in a joint. In fact, it makes sense they wouldn’t work. Otherwise, they would somehow have to ‘know’ how to find their way to specific locations in the body, where they could be used to repair damaged tissue.

There is some evidence that they can relieve pain, although that too is controversial. In a study called GAIT (The Glucosamine/Chondroitin Arthritis Intervention Trial), funded by the National Institutes of Health, the supplements did barely better than a placebo at reducing mild to moderate osteoarthritic knee pain. However, there was some evidence that they could be of greater use in treating severe arthritic pain. Other studies have shown either the combination or glucosamine alone to be about as effective as acetaminophen (Tylenol) at reducing pain. My own experience with patients has led me to agree with these latter studies.

Treating for Pain

So then, Wendy asked if she should use them instead of over-the-counter (OTC) pain medications. Frankly, I couldn’t see why she would want to. While it’s true that OTC drugs like Tylenol and Aleve can have side effects when used improperly, so can glucosamine/chondroitin. Some recent studies, for example, have suggested that they may reduce the effectiveness of a class of drugs called statins, which are used to lower cholesterol. They may also block blood thinners like coumadin.

Bottom line: If you’re not taking other drugs that may interact with glucosamine/chondroitin, I don’t recommend against their use, but I can’t see that they have any advantage over OTC medications, and they’re far more expensive. By the way, for people who follow kosher dietary laws, these supplements are out of bounds. Often they’re made from byproducts of the meatpacking industry—to be more specific, the tracheas of pigs and cows.

In the end, the goal was to get Wendy off all pain medications—or at least to the lowest dose possible. Pain is caused by two factors. First, there’s mechanical pain, which simply comes from two bones rubbing together when the cartilage between them is too worn down to provide a cushion. Second, and far more importantly, pain is a byproduct of the inflammatory process, which manufactures a class of proteins, called cytokines, that cause pain. If the anti-inflammatory supplements and diets relieve pain by reducing inflammation, the need for pain medications is often reduced or even eliminated.

In addition to dietary changes and supplements, I recommended an exercise program for Wendy. These included range-of-motion and stretching exercises to help maintain her flexibility, strength exercises with light weights to help fortify the muscles that supported her joints, and cardiovascular exercises to help her keep her weight under control and her circulatory system in good condition.

Good Results

As patients get better, I’m looking for an eighty percent improvement. Wendy, like many patients, said she would be happy with just fifty percent. How do we judge? We’re looking at two main indicators: how patients say they feel generally and the results of their pain scale evaluations. If I can get them down to a five or three, I’m happy. But most get down to a two, one, or like Wendy eventually did, a zero. And it doesn’t take long. If there’s no dam- age showing on the x-ray, we’ll probably begin to see that kind of improvement in a couple of weeks. At most, it shouldn’t take more than a month.

Unfortunately, Wendy waited nearly a year to get help and suffered a great deal when she really didn’t have to. She’s not alone. The majority of undiagnosed arthritis patients put up with a lot of unnecessary pain. As time goes on, they rearrange their lives and limit their activities more and more in an effort to avoid discomfort. As a doctor, it saddens me to see this happen, because the solution is so simple, safe, effective, and fast— and people just aren’t aware of it. That’s the bad news.

The good news is that at this very moment, you’re educating yourself. With the program presented in this book, not only will you achieve significant relief from your arthritis symptoms, but you’ll improve overall health and lose unwanted weight as well.

Taking the First Step

Just as no two people are exactly the same, even identical twins, neither are any two cases of arthritis. That’s why the Arthritis Doctor’s Program provides a flexible approach to arthritis management, which you’ll tailor to fit your personal needs.