Huntsville Medical Doctor About Arthritis

Introduction

Arthritis is a common disease that causes joint pain, stiffness, immobility, and swelling.  Arthritis is actually a term for a group of over 100 diseases that affect the muscle and skeletal system, particularly the joints.  Arthritis alters the cartilage in joints.  Cartilage is a very tough, shock absorbing material that covers the ends of many of our bones.  The cartilage forms a smooth surface and allows the bones in our joints to glide easily during motion.  Arthritis can cause the cartilage to wear away.  Loss of the protective lining can cause painful bone on bone rubbing.  Arthritis can be quite painful and disabling.  While this may be tolerated with medications, therapy, other modalities, and lifestyle adjustments, there may come a time when surgical treatment is necessary.

Anatomy

Bones are the hardest tissues in our body.  They support our body structure and meet to form joints.  Cartilage covers the ends of many of our bones and forms a smooth surface for our bones to glide on during motion.  A membrane called synovium lines the joint.  The synovium secretes a thick liquid called synovial fluid.  The synovial fluid acts as a cushion and lubricant between the joints.  It reduces friction between the bones and prevents “wear and tear.”

Ligaments are strong tissues that connect our bones together and provide stability.  Our ligaments are also lined with synovium.  The synovial fluid allows the ligaments to glide easily during movement.  Tendons are strong fibers that attach our muscles to our bones.  The tendons and muscles power the joint and enable us to move.

Causes for Arthritis

There are over 100 different types of arthritis.  Arthritis can occur for many reasons, including aging, “wear and tear,” autoimmune disease, trauma, and inflammatory disease.  Arthritis usually affects the bones and the joints; however, it can affect other parts of the body, such as muscles, ligaments, tendons, and some internal organs.  Two of the more common types of arthritis, Osteoarthritis and Rheumatoid Arthritis are discussed below.

Osteoarthritis is the most common type of arthritis, affecting some 21 million Americans alone.  It causes the cartilage covering the end of the bones to gradually wear away, resulting in painful bone on bone rubbing.  Abnormal bone growths, called spurs or osteophytes can grow in the joint.  The bone spurs add to the pain and swelling, while disrupting movement.  All of the joints may be affected by Osteoarthritis.

Osteoarthritis is often more painful in the weight bearing joints, including the spine, hip, and knee.  It tends to develop as people grow older.  Osteoarthritis can occur in young people as the result of an injury or from overuse of a joint during sports or work.

Rheumatoid Arthritis is one of the most serious and disabling types of arthritis.  It is a long-lasting autoimmune disease that causes the synovium to become inflamed and painful.  It also causes joint swelling and deterioration.  Pain, stiffness, and swelling are usually ongoing symptoms, even during rest.

Rheumatoid Arthritis most commonly occurs in the hand and foot joints.  It can also develop in the larger joints, including the hip, knees, and elbows.  Many joints may be involved at the same time.  Further, tissues surrounding the joint may also be affected.  Rheumatoid Arthritis can affect people of all ages, but most frequently occurs in women and those over the age of 30.

Arthritis  Symptoms

Inflammation is the main finding of arthritis.  Inflammation can cause your joints to feel painful, swollen, and stiff.  These symptoms are most likely continuous, even when you are resting.  Your joints may feel weak or unstable.  You may have difficulty moving and performing common activities, such as walking or climbing stairs.

Diagnosis

Your health care provider can diagnose arthritis by conducting a physical examination.  You will be asked about your symptoms and level of pain.  Your provider will assess your muscle strength, joint motion, and joint stability.  Blood tests and other laboratory tests may identify what type of arthritis you have.  Imaging tests provide more information about the condition of your joint.X-rays are used to see the condition of your bones and joints, and to identify areas of arthritis or bone spurs.  The tissues that surround the joint do not show up on an X-ray.  In this case, a Magnetic Resonance Imaging (MRI) scan may be requested to get a better view of the soft tissue structures, such as ligaments, tendons, and cartilage.

A bone scan may be ordered to identify the location of abnormal growths in a bone, such as bone spurs, cysts, or arthritis.  It is a sensitive test that can indicate joint degeneration in early stages that may not yet be visible on plain x-rays.  A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test.  The substance collects in your bones in areas where the bone is breaking down or repairing itself.  These imaging tests are painless.

Arthritis  Treatment

Most cases of arthritis can be treated with non-surgical methods.  Temporary joint rest and pain relievers are sometimes all that are needed.  Over-the-counter medication or prescription medication may be used to reduce pain and swelling.  If your symptoms do not improve significantly with these medications a cortisone injection may be successful in reducing inflammation and pain.

Viscosupplementation is another injection option for arthritis, but currently is FDA approved for use only in the knee.  Studies are underway to test its usefulness in other joints.  Several products are on the market that when injected in a series into the knee can reduce pain by temporarily improving the health of the joint.Occupational or physical therapists can help you strengthen the muscles surrounding your joint.  The resulting added joint stability can help relieve pain.  Aquatic therapy in a heated pool can be especially soothing.  In addition, the buoyancy of the water takes stress off the joints while exercising, and the resistance of the water can help strengthening efforts.  Your therapists may also apply heat to treat stiffness, and ice to decrease pain.  They may recommend splints, walkers, or canes to help relieve stress on your joints.  The therapists will instruct you on how to do your daily activities, such as housework and meal preparation, in a manner that puts less stress on your joints.

Acupuncture is a time-tested treatment for pain.  Very fine needles are strategically placed around the body to block or interrupt pain pathways.  Acupuncture should be administered by a trained professional, and can often be extremely helpful.

A variety of herbs and nutritional supplements have been shown to be helpful in treating arthritis.  Two of the more commonly known supplements are glucosamine and chondroitin.  They have been studied most in arthritis of the knee, and have shown some good results for treating arthritis in other joints. Some research has also shown that a proper diet consisting of fruits and vegetables, with a minimum of fat, can benefit arthritis.

Exercise regimes, such as yoga, Pilates, and tai chi can improve arthritis pain in many ways.  Physically, the stretching and strengthening provided by these programs has a direct positive effect for many with arthritis.  Additionally, the stress-reducing relaxation that usually occurs from these types of exercise can have a significantly positive effect on arthritis pain.

Surgery

Because arthritis is a degenerative and progressive disease, it may get worse over time.  When non-surgical treatments no longer provide relief, surgery may be recommended.  The type of surgery that you receive will depend on your type of arthritis, its severity, and your general health.  Your doctor will discuss appropriate surgical options to help you decide what is best for you.There are several types of surgical procedures for arthritis.  The surgeon may remove the diseased or damaged joint lining (synovium) in an operation called a synovectomy.  The bones in a joint may be realigned with a procedure called an osteotomy.  The bones in a joint may also be fused together to prevent joint motion and relieve pain.In advanced arthritis, the damaged joint can be replaced with an artificial one.  Artificial joints are made of metal, plastic, ceramics, or a combination of the materials.  The material selected depends on the reason for the surgery, as well as which joint is being replaced.  Joint replacement can provide significant pain relief and improved mobility.

Recovery

Recovery from arthritis surgery is very individualized.  Your recovery time will depend on the extent of your condition, the joint that was involved, and the type of surgery that you had.  Your doctor will let you know what you may expect.Generally, traditional open joint surgeries take several months to heal, depending on the joint.  Minimally invasive surgery and arthroscopic surgery use smaller incisions and typically heal in a shorter amount of time, from several weeks to a few months.  Your doctor may restrict your activity for a short time following your surgery.  In most cases, rehabilitation is recommended to mobilize and strengthen the joint.

Prevention

Some types of arthritis and arthritis symptoms may be prevented.  It is important to know what type of arthritis you have and to ask your health care provider what you can do to prevent symptoms.  For example, for some types of arthritis it is helpful to reduce your weight or stop performing repetitive joint movements.  It may be helpful to consult an occupational or physical therapist to learn how to use proper body mechanics to protect your joints during your daily activities.Assistive devices, such as a walker, shower chair, or raised toilet seat may enable you to perform tasks while minimizing the stress on your joints.  It may also be helpful to participate in aquatic therapy in a heated pool or exercise to keep your joints strong.

Fixodent Can Cause Nerve Damage?

Fixodent: Can Excessive Use of Popular Denture Cream Cause Nerve Damage?

Medical Doctor Huntsville Nerve Damage FixodenMark Jacoby had no idea why his body was failing. Symptoms appeared gradually, said the 41-year-old former construction worker from York, Pa.

“I started getting tingling in my fingertips. And then it started happening in my toes,” he told ABC News’ 20/20 anchor Chris Cuomo, who is the Chief of the Law & Justice Unit. “I started getting weaker and, you know, I couldn’t walk right, off balance and I’m at this point now.”

Jacoby, who now uses a wheelchair, said his doctors searched for years for the cause of his debilitating neurological illness that robbed him of his independence.

Doctors eventually tied his disorder to high levels of the mineral zinc in his body. Jacoby, who has worn dentures for 20 years, said it came from his denture cream, Fixodent, which contains zinc.

“I can almost guarantee you it was the Fixodent,” said Jacoby. “It’s soaked into your body and it messes with the nerves.”

Similarly, 48-year-old Anne Coffman from Maine said she was a heavy user of Fixodent because of ill-fitting dentures, and after three years her body felt different.

“I started getting numbness in my toes. I wasn’t sure so I kind of didn’t do anything about it at first,” Coffman told Cuomo. “Then it started moving over to both feet and then … up to my knees.”

After many painful tests, she was diagnosed with zinc poisoning, a condition in which high zinc levels interfere with the body’s absorption of copper, which can lead to serious and irreversible neurological problems.

“[Fixodent] is the only product that I’ve ever used that had zinc in it,” Coffman said.

Coffman is now in a wheelchair and struggles with everyday tasks because of weakness in her hands and arms.

“I have trouble eating,” said Coffman. “I drop the fork a lot, so it gets frustrating.”

Coffman and Jacoby are part of a class action lawsuit against Procter & Gamble, makers of Fixodent, alleging that their use of the product has caused their devastating problems.

“I don’t know if you can put a dollar value on my health or anybody else’s, for that matter,” Coffman told Cuomo. “I would prefer to see [the makers] take the zinc right out of the product … or take the product right off the market.”

Used by many of the 35 million Americans who wear dentures, the cream is marketed with the catchy tag line, “Fixodent — and forget it.”

But what the maker didn’t tell consumers for years was that the adhesive contains zinc, which when ingested or absorbed in large amounts over time can lead to serious nerve damage.

The possible connection first was made five years ago by researchers at the University of Texas, who studied four denture users with neurological disease.

“They had high zinc levels that we could measure in the blood,” said Dr. Sharon Nations, author of a study in the journal Neurology. “And all of them reported that they were using very large amounts of denture cream.”

That study was completed in 2006, but its publication in Neurology was delayed for more than two years.

It was delayed, according to its authors, because of a peer review by Dr. Kenneth Shay, a dentist, who lambasted the study and called the link between excessive use of denture cream and neurological disease “little more than speculation.” He said that the authors “don’t understand the nature of the material they are writing about.”

But an ABC News investigation found that that Shay, at the time, also was a paid consultant to Procter & Gamble, the maker of Fixodent, when he reviewed the study.

“It is an outrage. This was wrong,” David Rothman, a professor at Columbia University Medical School, told Cuomo. “That is a fundamental transgression of professional medical ethics and not to be allowed.”

In e-mails and documents obtained by ABC News, Shay not only made recommendations that, according to the authors, led them to water down the study’s finding, but also sent draft reports of the study to Procter & Gamble.

In one e-mail, he said, “Please be circumspect because, as a reviewer, I’m not supposed to be passing an unpublished manuscript around.”

It is unclear what, if anything, Procter & Gamble did with the information Shay passed on to it.

It wasn’t until 2009, after the study was published in the journal Neurology, that Procter & Gamble added a “new label information” warning to the side of Fixodent packages, and on the back, cautioned that “prolonged zinc intake may be linked to adverse health effects.”

Shay declined to be interviewed, but in a phone call with ABC News he defended his review of the study, saying that the research report had “objective shortcomings.”

Procter & Gamble sent a written statement to ABC News reading:

“Procter & Gamble is committed to providing safe and effective products for all consumers. That is who we are and what we stand for. We go to great lengths to ensure that our products safely deliver best-in-class performance, so consumers can choose our products with total confidence. Fixodent is safe for use as directed, as supported by the experience of millions of consumers over many years. Our Fixodent formula has undergone extensive scientific testing, and we continuously monitor for its safe use. … We know of no valid scientific evidence that using Fixodent as directed causes any ill health effects.”

Click here to reach the full statement.

But Mark Jacoby and others like him said it all comes too late. He has stopped using Fixodent, but said the damage to his body has been done.

“Fixodent and forget it?” said Jacoby. “Well, apparently I can’t forget it ’cause it took a lot away from me.”

If you have suffered from adverse reaction to Fixodent, send your story to Chris Cuomo.

Source: http://abcnews.go.com/TheLaw/fixodent-popular-denture-cream-nerve-damage/story?id=12866372&page=1

Medical Doctor Huntsville: Carpal Tunnel Syndrome

Carpal Tunnel Treatment in AlabamaTreating carpal tunnel in the elderly: early electrodiagnostic testing is key. Early diagnosis crucial.

Approximately 90% of mild-to-moderate cases of carpal tunnel syndrome respond to conservative management.

However, given that the condition is progressive, the earlier it is diagnosed the more likely it is to respond to conservative intervention.

Conservative management, of course, typically includes nighttime wrist splinting, use of nonsteroidal antiinflammatory drugs (with or without diuretics), oral or injectable steroids and physical or occupational therapy.

Naturally, though, before commencing conservative management of carpal tunnel syndrome, the patient’s complaint must be diagnosed as such. The “gold standard” of testing for carpal tunnel syndrome is an electrodiagnostic study performed by or under the direct supervision of a board-certified specialist adhering to testing standards and guidelines developed by the American Board of Electrodiagnostic Medicine.

The most relevant electrodiagnostic tests for diagnosing carpal tunnel syndrome are electromyography (EMG) and nerve conduction studies (NCS). In addition to identifying abnormalities associated with specific symptoms and signs of carpal tunnel syndrome, these two tests are capable of excluding other neurologic diagnoses.

Further, these tests can yield data of the sort necessary for accurately assessing the severity of nerve damage. Typically, testing that demonstrates nothing but sensory abnormalities will be found to have mild carpal tunnel syndrome, while sensory abnormalities accompanied by motor dysfunction are usually taken as evidence of moderate severity. The condition is considered truly severe when testing reveals decreased or absent sensory or motor responses distal to the carpal tunnel or neuropathic abnormalities.

These tests can be repeated at future dates to gauge the effectiveness of therapy and other interventions.

Conclusions

Carpal tunnel syndrome is a serious problem for the elderly.

It is treatable, but treatment is most effective when started while the condition is in an early stage. Carpal tunnel syndrome should be suspected when patients – old or young – present with symptoms even loosely characteristic of the condition. These patients should promptly undergo electrodiagnostic testing to establish or rule out carpal tunnel syndrome as the diagnosis.

However, a problem with electrodiagnostic testing is that often the interpretation of the raw data is reported in ambiguous terms. Worse, delivery of the unhelpfully vague report takes many long weeks, during which time the specialist who performs the interpretation is uncommunicative.

At the medical offices of Eric R. Beck, MD, PhD, FAAPMR, none of these shortcomings exists. We are very clear as to whether a study comes back normal or abnormal; if the latter, we then spell out the degree of severity so that you can confidently proceed with treatment planning. Further, we offer extremely rapid turnaround on our reports of findings:

Typically, we put a summary report in your hands within 24 hours and a full report a short time later.

We also see your patients quickly, usually seven days after we are contacted with a request to schedule an appointment.

Once your patient arrives here, he or she is treated with utmost courtesy. Moreover, we strive to make the examination as painless and stress-free as possible by offering ethyl chloride numbing of the skin prior to needle testing.

We welcome your referrals of patients suspected of carpal tunnel syndrome and other musculoskeletal-neurologic problems. We can perform comprehensive evaluations of your patients and, if you desire, initiate treatment and perform follow-up, keeping you apprised every step of the way. But no matter the way you choose to utilize us, know that your patients will be satisfied by the high-quality services and interactions delivered at each encounter and will return to you as willing as ever to continue entrusting you with their ongoing care.

For more information about carpal tunnel syndrome diagnosis and treatment, please call Valley Center for Nerve Studies in Huntsville, Fort Payne and Birmingham, Alabama at (256) 382-1603.