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- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2019
Osteoarthritis is generally regarded as a progressive disease related to aging, 'wear & tear' and former injury that can be kept at bay with anti-inflammatories and painkillers but will lead inevitably to disability, surgery and joint replacement. But do not despair! As Professor Sir Sam Everington, London GP and a board member of NHS Clinical Commissioners, says: 'This book is not just about length of life, it is about something much more important - a happy and healthy life, whatever is thrown at you. It is about self-motivation and wellbeing. It should be prescribed on the NHS by all doctors. It can't be, but if you have osteoarthritis or want to live a happier and healthier life, buying this book is the best investment you could make.' Health writer and long-term arthritis sufferer/tamer Frances Ive has been researching and experimenting with ways to live well with osteoarthritis for many years and has developed this new, holistic, practical guide embracing exercise, diet, weight loss, complementary therapies and other strategies that will allow a full and active life. While existing books focus on nutrition/diet alone, or on the dangers of prescription drugs, One Step Ahead of Osteoarthritis looks at a wide range of approaches and how each can contribute to being healthy and pain free.
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ONE STEP AHEAD OF OSTEOARTHRITIS
Stay flexible and keep moving
FRANCES IVE
Contents
Foreword 1
As a GP I can prescribe thousands of pounds a year of NHS drugs or Consultant time for the treatment of arthritis. I cannot prescribe this book on the NHS, yet the advice it gives is absolutely critical to minimising the pain and suffering of osteoarthritis. I would go further and suggest in many cases it offers far more than I or my medical colleagues can. Keep in mind the ineffectiveness of many of the painkillers and other drugs used in osteoarthritis, the overuse of opioid painkillers such as morphine and tramadol, and indeed their addictive qualities and a raft of serious side-effects.
In 2018, an article in the British Medical Journal1 stated: ‘A recent systematic review focusing on adverse drug events in ambulatory care (in A and E) found prevalence rates ranging from 2.8% to 34.7% up to a quarter of which were judged preventable.’ Another systematic review reported that 9.9% of all hospital admissions in people aged 65 years or over were as a result of an adverse drug event.
You must also add to this the growing evidence of poor diet, obesity and inactivity being among the causes of life-threatening and -shortening diseases.
The NHS has stated on many occasions that every 10 days of bed rest in hospital is the equivalent of 10 years of muscle ageing when it occurs in people over the age of 80, and it can take far longer to recover and a lot of hard work to get back to their previous condition.
A further study shows that inactivity increases early death by 7% and avoiding obesity could reduce deaths by nearly 4%.2 Many academics, such as Sir Muir Gray, say, ‘Sitting down is the new smoking’.
Many of us will face long-term illnesses, such as osteoarthritis, later in life. This book is not just about length of life, it is about something much more important – a happy and healthy life, whatever is thrown at you. It is about self-motivation and well-being. It should be prescribed on the NHS by all doctors. It can’t be, but if you have osteoarthritis or want to live a happier and healthier life, buying this book is the best investment you could ever make.
Professor Sir Sam Everington, GP in Tower Hamlets, Chair of NHS Tower Hamlets Clinical Commissioning Group and a board member of NHS Clinical Commissioners
References
1. Perez T, Moriarty F, Wallace E, McDowell R, et al. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admissions: longitudinal study. British Medical Journal 2018; 363: k4524. Doi: https://doi.org/10.1136/bmj.k4524
2. Ekelund U, Ward HA, Norat T, Luan J, et al. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). American Journal of Clinical Nutrition 2015; 101(3): 613-621. Doi: 1, https://doi.org/10.3945/ajcn.114.100065
Foreword 2
This easy-to-read book offers sufferers of osteoarthritis new ways of managing their symptoms, which in turn leads to a more positive outlook on their prognosis.
So often people with a diagnosis of arthritis are given a life sentence of pain and misery. They are led to believe that nothing can be done and they must learn to live with the consequences of their disease. Frances offers hope and, without preaching, she offers tools that can be used to alleviate symptoms. She shows that by taking responsibility for our own health, improvements can be made.
Suggestions range from diet and lifestyle to alternative therapies and supplements. In fact, there are so many suggestions that no-one could fail to find areas where they can make changes and take charge.
I too suffer from osteoarthritis in my knee after years of sporting injuries but I am quite mobile and not in pain. I manage my symptoms with exercise, massage and diet and know that without these interventions I would not feel as good as I do.
Enjoy this book and the hope and inspiration it brings with it.
Barbara Cousins, nutritionist and author of Easy, Tasty, Healthy and the Cooking Without series
Acknowledgement
I would like to thank all the following who have helped me with certain aspects of this book:
Dr Christopher J. Etheridge; Dr Roger Wolman; Dr Rod Hughes; Professor Sir Sam Everington; Dr Tom Margham; Barbara Cousins; Dr Susan Aldridge; Dr Chris Steele; Versus Arthritis; British Acupuncture Council; Margaret Hills Clinic; Richard Kravetz; Ian O’Donnell; and Dr Miriam Ferrer of Future You.
I would like to thank the following for the use of their illustrations:
Knee and hip exercise diagrams courtesy of Versus Arthritis www.versusarthritis.org (pages 23-31)‘Get Paid While Running’ (page 89) courtesy of Varidesk†‘How Much Pressure Are Your Hands Under?’(page 91) courtesy of Penclic† Footnote: The citations for the Varidesk infographic are:
* Dr John Buckley (University of Chester). ‘Standing-based office work shows encouraging signs of attenuating post-prandial glycaemic excursion.’ 2013
** Harvard Medical School. Calories burned in 30 minutes for people of three different weights.
*** Calories burnt during a marathon. NY Daily News (statistics from the Cleveland Clinic Center for Consumer Health Information)
About the author
Frances Ive has been a health journalist for more than 20 years, with over 100 articles published in national newspapers and consumer women’s and health magazines. She runs the website www.healthysoul.co.uk, is a member of the Guild of Health Writers and has written several non-fiction books. Following the advice outlined in this book she has reduced pain and inflammation in her osteoarthritis and is able to manage it well.
Introduction
This book is about staying ahead of osteoarthritis, not letting it take you over; about staying mobile and, above all, enjoying life. It aims to make you feel much better.
It is for people who have early signs of osteoarthritis or have mild to moderate symptoms. But many of the tips could help someone with chronic arthritis and hopefully relieve inflammation and pain.
Whenever a doctor tells me that there is nothing they can do for a health problem, I decide to find out for myself what I can do. And so it was with osteoarthritis, which I had diagnosed in my hands and knee five years ago. With my experience as a health journalist and general interest in self-help and complementary medicine I tried to do everything I could to help myself, with considerable success.
I arrived on holiday in Devon a few years ago and could hardly get out of the car because I felt so stiff after the long journey. My knees and hands were painful and my whole body was aching. I decided to start with some changes to my diet – taking out certain foods and concentrating on trying to avoid acidic foods and drinks and making my intake more alkaline. I started taking supplements specific to osteoarthritis, and spent the week’s holiday doing lots of swimming and going in the sauna.
Back at home I began doing exercises designed to help osteoarthritis, including using an exercise bike; I continued to play tennis, and attend yoga and tai chi classes, and had regular acupuncture treatments. At the time of writing this book my fingers have become much straighter than they were and my knee barely hurts when I play two hours of tennis.
I have not cured my osteoarthritis, but I am certainly managing it, and preventing it getting any worse. I do have pain when the weather changes and my thumbs react when I overuse them, but in general I live a normal, active life and hope to continue doing so in the future.
A word of warning – if you’re buying this book for someone else who is resistant to change, they have to want to work on improving their condition!
Top tips to manage osteoarthritis
Chapter 1
Good health and osteoarthritis
The Spanish have a saying: ‘La esperanza es lo ultimo que se pierde’ which means ‘Hope is the last thing you lose’. Everyone needs hope in their lives and taking action to manage osteoarthritis is a positive move.
The aim of this book is to provide a range of helpful ways to manage osteoarthritis, and it can be used like a pick-and-mix to enable you to choose what type of exercise suits you, what changes you can make to your lifestyle and diet, and what practical measures or therapies you want to try.
Taking responsibility for your health
We know so much more about healthy living these days, and doctors, nutritionists, complementary therapists and, consequently, many other people have a much better idea about how to maintain and enhance our wellbeing.
In an attempt to modernise the NHS and promote good health, British people are being asked to take more responsibility for their own health. The advent of social prescribing in doctors’ surgeries can only be seen as positive. It means that when someone visits their doctor with a variety of ailments, they will of course be treated if there is an obvious infection or serious illness, but doctors will try to establish the person’s wellbeing and see if there are ways of improving their quality of life as well as the health problems they are taking to the GP.
It’s quite common to think that good health means not being diagnosed with a serious illness. But what does it really mean? To attain and maintain good health we need to pay attention to several key aspects of our lives.
Sleep: Everyone knows when they are getting good quality sleep for enough hours each night because they feel good and in control. If we’re regularly getting short, interrupted nights we will start to feel depressed and anxious and any health problems are likely to become much worse.Healthy food: Making time to eat and enjoy three meals a day with plenty of vegetables and a good spread of nutrients sustains the body and keeps us feeling fit both mentally and physically. The digestive system accounts for some 70 per cent of the health of our immune system.Mobility: Most of us spend years taking our unimpeded mobility for granted, but it takes considerable effort to ensure that this continues as we get older. Inactivity leads to loss of muscle tone and strength, which are necessary to protect and support the joints. Conversely, activity and exercise stop us stiffening up and becoming immobile. Becoming immobile limits lives and can lead to isolation and subsequent emotional problems.Relaxation: For many people, life is so hectic that there is virtually no time to sit down and just be. Stress is a massive problem in this fast-moving technological age and it not only makes health issues worse but can actually cause them. Relaxing and having some quiet time are essential to keeping sane even if it’s just for 10 minutes a day, as well as enjoying social activities or hobbies we love. Read about mindfulness and relaxation techniques in Chapter 11.Environment: Everyone needs to feel that they have a home where their heart is, where they can relax and feel safe and comfortable. It means not contending with difficult neighbours, a dangerous area and/or pollution that is damaging to health. Think about how your environment affects you and, if it has a negative impact, find out about how you can change it.A diagnosis of osteoarthritis
You go to the doctor with persistent pain or swelling in your joints and you may have an X-ray or an MRI scan. The diagnosis is osteoarthritis. So, what happens next? Provided you are not in chronic pain, you may be told that this is a normal part of the ageing process, and if you’re lucky the doctor will give you some lifestyle tips.
At this point you have to take the bull by the horns and find out how you can maintain your mobility and prevent chronic inflammation and pain. Taking charge and managing your osteoarthritis are really the key to a hopeful future.
There’s no magic bullet for curing osteoarthritis but it can be managed, enabling people who have it to remain active and enjoy a good quality of life through self-help: diet, weight loss, exercise, therapies, and a whole raft of practical measures. The overall aim is to remain mobile and pretty much pain-free, to continue enjoying an active and sociable life and not to suffer alone in silence.
‘Focus on what is important to you in life – that is what you want to continue being able to do and what activities are special for you,’ is the helpful advice given by Professor Sir Sam Everington, OBE (a GP in east London; Chair of NHS Tower Hamlets Clinical Commissioning Group; and NHS England’s national adviser on general practice care models).
What is osteoarthritis?
Severe osteoarthritis is at best uncomfortable but at worst it is disabling and even crippling. Although it is often considered an inevitable part of ageing, there is much that can be done to prevent it getting severe. This book focuses on osteoarthritis, and only refers to rheumatoid arthritis to explain the difference.
The difference between rheumatoid arthritis and osteoarthritis
Rheumatoid arthritis is an auto-immune disease, which means that the immune system attacks the body. Rheumatoid arthritis causes swelling, pain and stiffness in the joints, and it is managed with drugs when caught early.Osteoarthritis happens when there is a loss of cartilage – the protective surface over the ends of bones – particularly on the fingers, knees, toes, hips, base of thumb and spine. This can be seen and felt in some joints which are enlarged or swollen.There are several other types of arthritis which are less common, including psoriatic arthritis.Osteoarthritis is the most common type of arthritis; it is thought to affect 8.75 million people in the UK. However, there are many other people who have aches and pains but have not been given a diagnosis, so the number could be much higher. It takes years to develop, so there is plenty of time to start being proactive.
Over time, cartilage, the protective surface over the end of the bones, wears away, and joints become swollen and painful. When it becomes severe there is so little cartilage that where the ends of bones meet (at the joints) they rub on each other and the joint may change shape.
In the case of the knee, the muscles surrounding the joint become weaker and thinner, so exercise for the knees is very important because stronger muscles protect the knee joint (see Chapter 3, page 23).
Swollen and painful joints not only impede mobility, but arthritic fingers make it difficult to do things we expect to do all the time – such as opening bottles, picking things up, carrying shopping, and numerous other activities that we do with our fingers. Fortunately, there is plenty that can be done to alleviate pain and discomfort.
Statistics about osteoarthritis
It can start at around 40 years old, or even earlier, and the majority of older people have some osteoarthritis.
Around 10 million people in the UK have arthritis, but the vast majority of these (8.75 million+) have osteoarthritis.1Fewer than 500,000 have rheumatoid arthritis.2Osteoarthritis affects all ages, but the majority of people with the condition (41 per cent) are over 65.1One third of over 45-year-olds have sought treatment for osteoarthritis – more women than men.1Between 1990 and 2010, disability due to osteoarthritis in the UK increased by 16 per cent.3How osteoarthritis is diagnosed
Osteoarthritis can be found in the fingers and thumb joints, back, hips, knees, and toes. It is most common in the knees and hips, which are weight-bearing joints. Excessive use of a joint can lead to the cartilage being worn down. People who have overused their fingers, particularly with keyboards (especially the old manual typewriters), mobile phones, and other technological gadgets, may be more prone to it, as are sports people like footballers and tennis players, who have a tendency towards osteoarthritis in the knee.
It is also hereditary so if your mother or father has/had osteoarthritis, you are more likely to follow suit. If you have swollen or enlarged joints in your fingers, or your knee hurts when you walk up and down stairs or hills, the chances are you have early signs of osteoarthritis. Doctors can recognise it in the hands, but if it is not obvious they refer patients for X-rays and/or MRI scans. Sometimes an X-ray doesn’t show up osteoarthritis, but an MRI scan shows it clearly.
Can you get better?
How often have you seen old men or women whose fingers are bent and gnarled, who can hardly walk or get outside? When you have the first few twinges of arthritis in your fingers or knees it doesn’t mean that you will end up like them, but it’s essential to take action to prevent it getting much worse. Even people with crippling arthritis might gain some relief from trying self-help approaches.
In the first stages of osteoarthritis doctors are unlikely to prescribe drugs. They may offer some lifestyle advice on exercise and suggest that you stay active. So, if you have been told, ‘You just have to live with it’, you don’t have to!
Pain management
Living with constant pain is wearing and debilitating. It can affect sleep, make you depressed, and has other mental effects such as confusion and forgetfulness. It is a natural reaction not to want to move too much for fear of increasing the pain. Yet being immobile does not make you better in the long term, because you are likely to gain weight, and your muscles become weaker.
Long-term pain can make you so tired that daily activities become a chore and in some cases relationships become strained. All these problems have a negative effect on emotions as well, and it’s not unusual for people who feel that they are losing their independence and mobility to become depressed (see Chapter 11).
Professor Sir Sam Everington emphasises that pain is contextual: ‘If someone is in a warm cosy environment with their family the pain appears to be less.’ Alternatively, if they are living alone and feeling less mobile, they are likely to become lonely and focus much more on their pain.
It has recently been assessed that 25 per cent of the population are lonely, but when they visit the GP, they present a long list of physical and mental problems, including insomnia, digestive pain and discomfort, back pain, anxiety, depression and many more ailments.
It is a fact that people who are enjoying their lives are less likely to focus on their ailments, and this is true of osteoarthritis too. There is plenty that can be done to alleviate the symptoms of arthritis – the inflammation and pain – rather than prescribing painkillers.
