HEALTH MATTERS: Arthritis

HEALTH MATTERS: Arthritis


ON HEALTH MATTERS TELEVISION FOR LIFE LIVING WITH ARTHRITIS I could never just go for a walk before because it would hurt my joints and my bones so bad. HOW A WARM WATER WORKOUT IS BRINGING MOBILITY. Doing the exercises does relieve a lot of that pain. PLUS, A PROCEDURE BEING DONE RIGHT HERE IN SPOKANE THAT’s HELPING PATIENTS CAUGHT IN THE GRIP OF OSTEOARTHRITIS. WATCH HEALTH MATTERS Health Matters is made possible by the Friends of KSPS. and by Providence Health Care. I am Arne Peterson. I am a orthapaedic surgeon. And I work in the Sacred Heart Providence Medical Center. When I needed my hip replaced I chose Providence because of the professionalism and the care I knew I would receive. I never thought twice about going anywhere else.>>I’M GREG FRIESEN AND I WORK AT HOLY FAMILY HOSPITAL SURGICAL MEDICAL ADMIT UNIT. WHEN I NEEDED HERNIA SURGERY, I CHOSE PROVIDENCE. I TRUSTED THE DOCTORS. I TRUSTED THE NURSES. I WORKED WITH THEM AND HAD FULL CONFIDENCE I’D BE TAKEN CARE OF.>>GOOD EVENING AND WELCOME TO “HEALTH MATTERS.” I’M YOUR HOST TERESA LUKENS. ARTHRITIS IS OFTEN LINKED TO MINOR ACHES AND PAINS THAT STRIKE AS PEOPLE GET MUCH OLDER BUT IT IS MUCH MORE THAN THAT. 50 MILLION AMERICANS HAVE IT INCLUDING 300,000 CHILDREN. SO TONIGHT WE’RE GOING TO EXAMINE ARTHRITIS WHICH IS THE LEADING CAUSE OF DISABILITY IN THE UNITED STATES AND HERE TO SHARE THEIR EXPERTISE IS THEIR EXPERT PANEL. DR. REBECCA MUNTEAN WORKS FOR PROVIDENCE INTERNAL MEDICINE. SHE IS A BOARD CERTIFIED RHEUMATOLOGIST AND INTERNAL MEDICINE EXPERT. BRIAN GATES RECEIVED HIS DOCTOR OF PHARMACY AT WASHINGTON STATE UNIVERSITY WHERE HE IS THE ASSOCIATE DEAN FOR PROFESSIONAL EDUCATION AND CLINICAL ASSOCIATE PROFESSOR. AND JOHN LYNCH DOES ADVOCACY WORK FOR THE ARTHRITIS FOUNDATION RIGHT HERE IN SPOKANE. AND I WANT TO WELCOME ALL OF YOU AND THANK YOU SO MUCH FOR BEING HERE. SUCH AN IMPORTANT TOPIC. AND AS WE MENTIONED, ONE THAT AFFECTS SO MANY PEOPLE. DR. MUNTEAN, LET’S FIRST ESTABLISH WHAT WE ARE TALKING ABOUT BECAUSE THERE ARE DIFFERENT TYPES OF ARTHRITIS AND IT IS NOT JUST THOSE ACHES AND PAINS THAT SOME OF US MIGHT FEEL. THIS IS ACTUAL MEDICAL CONDITIONS.>>TRUE. SO ARTHRITIS — WHEN SOMEONE COMES IN FOR ARTHRITIS ACTUALLY CAN BE — IT CAN MEAN MANY, MANY THINGS. IT CAN BE ANYTHING FROM RHEUMATOID ARTHRITIS, ANYTHING FROM GOUT OR PSEUDOGOUT OR PSEUDOARTHRITIS OR EVEN A VIRAL ARTHRITIS. SOMETIMES PEOPLE HAVE ACTUAL MORE SERIOUS CONDITIONS LIKE CANCER CAN HAVE ARTHRITIS SECONDARY TO THAT. PEOPLE THAT HAVE CONNECTIVE TISSUE DISEASE CAN HAVE ARTHRITIS. IT CAN BE MANY, MANY THINGS THAT CAN CAUSE A SYMPTOM SUCH AS ARTHRITIS. SO IT IS DIFFERENT DEPENDING ON WHAT THE PATIENTS — THE PERSON HAS.>>NOW, DOES THE LARGEST PORTION OF THE POPULATION HAVE THE OSTEOARTHRITIS?>>THAT’S THE NUMBER ONE, MOST COMMON CAUSE OF ARTHRITIS IS OSTEOARTHRITIS.>>AND EXPLAIN WHAT THAT IS.>>SO OSTEOARTHRITIS, IT STARTS TO BE A DEGENERATIVE CONDITION. AND THERE ARE A LOT OF RISK FACTORS. THE MOST COMMON ONE IS THOUGHT TO BEING OVERWEIGHT AND HAVING ANY KIND OF TRAUMA TO A JOINT, HAVING ANY KIND OF MALALIGNMENT TO A JOINT, AN INFECTION, HAVING AN INFLAMMATORY ARTHRITIS CAN PREDISPOSE SOMEONE TO OSTEOARTHRITIS MUCH EARLIER. AND IN TODAY’S SOCIETY, WE THINK THAT OBESITY AND MALALIGNMENT SEEM TO BE THE TOP RISK FACTORS OF OSTEOARTHRITIS.>>AND TALK ABOUT RHEUMATOID ARTHRITIS WHICH IS WHAT JOHN HAS AND WE ARE GOING TO TALK TO JOHN ABOUT THAT AND THE WORK THAT HE DOES. BUT WHAT IS THAT CONDITION?>>RHEUMATOID ARTHRITIS IS AN INFLAMMATORY AUTOIMMUNE DISORDER THAT CAN AFFECT CHILDREN AND IT CAN START AT ANY AGE AND ADULTS. AND IT CAN BE PRETTY DISABLING DISEASE IF IT IS NOT TREATED APPROPRIATELY. AND I THINK WE’RE PRETTY LUCKY. IN 2013 WITH THE MEDICATION THAT IS WE HAVE TO TREAT PEOPLE COMPARED TO IN THE MID ’90s WHEN ALL WE HAD WAS STEROIDS PRETTY MUCH.>>AND, JOHN, THAT’S SORT OF PART OF YOUR JOURNEY. YOU ACTUALLY WERE DIAGNOSED AS A CHILD, ALMOST MISDIAGNOSED BECAUSE IT WAS SO MANY YEARS AGO. TALK ABOUT YOUR STORY AND THANKS AGAIN FOR BEING HERE. IT IS VERY RARE THAT WE ACTUALLY GET A CHANCE TO TALK TO A PATIENT AND SOMEONE WHO WORKS ON BEHALF OF THE PATIENTS.>>YOU’RE WELCOME. MY ODYSSEY WITH ARTHRITIS STARTED WHEN I WAS 11 YEARS OLD. AT THAT TIME WAS DIAGNOSED WITH RHEUMATIC FEVER AND WAS TREATED WITH BED REST AND ORAL PENICILLIN. AND BEING AN ACTIVE 11-YEAR-OLD BEING BEDRIDDEN FOR FIVE MONTHS WAS LIKE A LIFE SENTENCE. I COULD HARDLY WAIT TO GET OUT OF BED AND GO BACK TO SCHOOL. BUT IT WASN’T UNTIL I WAS AT THE UNIVERSITY OF WASHINGTON AND WENT TO THE SCHOOL OF MEDICINE IN THE RHEUMATOLOGY DEPARTMENT THAT I WAS DIAGNOSED WITH JUVENILE RHEUMATOID ARTHRITIS. AT THAT TIME THE ONLY MEDICINE THAT WAS PRESCRIBED FOR ME — AND THAT WAS BACK IN THE MID ’60s WAS HIGH DOSES OF ASPIRIN. AS DR. MUNTEAN EXPLAINED, WE HAVE COME A LONG WAY SINCE THEN. ONE OF THE BENEFITS I’VE DERIVED FROM THE ADVANCEMENT IN TREATMENT OF RHEUMATOID ARTHRITIS WAS THE DEVELOPMENT OF DRUGS IN THE EARLY 2,000s WHICH MAKE A SIGNIFICANT IMPROVEMENT IN MY LIFE.>>TALK ABOUT SOME OF THE WORK YOU DO ON BEHALF OF OTHER PATIENTS AND TRYING TO WORK TOWARD FINDING NEW DRUGS, FINDING AN OCCUR EVENTUALLY FOR THIS DISEASE.>>THE ARTHRITIS FOUNDATION HAS BEEN ESTABLISHED IN 1948, HEADQUARTERS IN ATLANTA, GEORGIA. MY ROLE WITH THE ARTHRITIS FOUNDATION SINCE EARLY 2000 SINCE HAS BEEN AS AN ADVOCATE ADVOCATING THAT AGENDA BEFORE CONGRESS. I SPENT A LOT OF TIME IN WASHINGTON, D.C. TALKING TO SENATORS AND REPRESENTATIVES ABOUT LEGISLATIVE MATTERS AND FUNDING MATTERS THAT ARE IMPORTANT TO PATIENTS, NOT ONLY ADULTS BUT ALSO CHILDREN. THAT’S MY PRINCIPLE ROLE FOR ARTHRITIS FOR THE PAST 15 YEARS. I HAVE GOTTEN MY WAY AROUND WASHINGTON, D.C. AND ATTEND A LOT OF STAFF MEETINGS AND SO FORTH. BUT MY FOCUS NOW HAS BEEN IN FUND-RAISING FOR THE FOUNDATION. SO THIS YEAR I SPENT MORE TIME DOING THAT THAN I HAVE ON ADVOCACY MATTERS.>>SO YOU CAN CONTINUE TO DO WHAT YOU DO TO MAKE PROGRESS?>>YES. AND THE ARTHRITIS FOUNDATION DOES DEVOTE A LOT OF THEIR RESOURCES TO RESEARCH AND HELPING TO CREATE IMPROVEMENTS FOR PEOPLE WITH ARTHRITIS OF ALL AGES.>>AND, BRIAN, I WANT TO GET TO YOU. I WANT TO TALK ABOUT THE WORK THAT YOU DO BECAUSE — AND WELCOME BACK TO “HEALTH MATTERS,” BY THE WAY.>>GOOD TO BE BACK.>>BECAUSE YOU DO WORK WITH THE OLDER POPULATION AND SO YOU PROBABLY SEE A LOT OF PATIENTS WITH ARTHRITIS AND WORK WITH THEM. TALK ABOUT THE WORK THAT YOU DO.>>SO I ACTUALLY WORK THROUGH WSU AND WE HAVE STUDENTS AT THE PROVIDENCE VISITING NURSES SO WE ACTUALLY DO HOME HEALTH CARE. AND AS PART OF THAT, WE’LL ACTUALLY SEE PEOPLE IN THEIR HOMES. WE’RE BASICALLY THERE TO TRY TO SORT OUT MEDICATION PROBLEMS. AND FROM THE SIDE OF ARTHRITIS, OF COURSE, THERE IS A LOT OF OVER-THE-COUNTER MEDICATIONS THAT CAN BE USED TO TREAT ARTHRITIS AND SOMETIMES THAT DOES COMPLICATE THINGS A LITTLE BIT MORE BECAUSE THERE ARE AT TIMES CONFUSION BETWEEN PEOPLE TAKING OVER-THE-COUNTER MEDICATIONS THAT MIGHT BE SIMILAR EVEN TO SOME OF THEIR PRESCRIPTION MEDICATIONS AND SOME OF THOSE CAN HAVE A LOT OF SIDE EFFECTS AND PROBLEMS THAT PEOPLE MIGHT OTHERWISE CONSIDER TO BE PRETTY SAFE JUST BECAUSE THEY ARE OVER-THE-COUNTER.>>WELL, THEY ARE JUST TRYING TO HANDLE IT ON THEIR OWN. IS THAT WHAT YOU ARE FINDING?>>PARTLY.>>YEAH.>>AND JUST FROM THE EFFECT OF SOME OF THE MEDICATIONS CAN BE VERY SAFE BUT ESPECIALLY IF THEY’RE USED FREQUENTLY OR IN HIGH DOSES CAN BE AN ISSUE. AND IT’S OFTEN, AS WE CALL THEM NSAIDS OR ANTIINFLAMMATORY MEDICATIONS OR IBUPROFEN OR NAPROXEN, THERE ARE OTHERS, THEY CAN BE HARD ON THE STOMACH SOMETIMES. CAN BE HARD ON THE KIDNEY. CAN BE A PROBLEM WITH HEART FAILURE. THEY CAN BE USED AND BE VERY EFFECTIVE BUT WE ALSO HAVE TO BE CAREFUL WITH THEM. IF THEY ARE NOT WORKING WITH THE PHYSICIAN OR SOMEONE WHO IS FOLLOWING THAT, WE HAVE SEEN PEOPLE END UP IN THE EMERGENCY ROOM AND ISSUES LIKE THAT, TOO.>>I THINK THEY FORGET THAT THOSE CAN BE A DANGEROUS DRUG EVEN IF THEY ARE BUYING IT OVER THE COUNTER.>>THAT’S RIGHT.>>TALK ABOUT SOME OF THE PRESCRIPTION MEDICATIONS NOW WE ARE FINDING FOR THE DIFFERENT FORMS OF ARTHRITIS.>>YEAH, THERE’S ACTUALLY BEEN QUITE A LOT. AS JOHN MENTIONED, IT’S REALLY TAKEN OFF IN THE LAST SEVERAL YEARS. AND WE’VE GONE FROM THINGS INITIALLY THAT WERE MORE JUST FOR PAIN AND SOME INFLAMMATION LIKE ASPIRIN IS OR WHERE THE STEROIDS WOULD DO TO NOW THERE ARE SEVERAL DIFFERENT AGENTS THAT WILL HELP THE BODY FROM ATTACKING THE JOINTS THAT HAPPENS WITH RHEUMATOID ARTHRITIS.>>PUT IT INTO A REMISSION-TYPE STAGE THEN?>>WELL –>>OR DO WE USE THAT TERM?>>WE DO CALL THEM DISEASE MODIFYING IN THE SENSE OF PREVENTING THAT DAMAGE. AND WE HOPE THAT IT COULD ESSENTIALLY INDUCE REMISSION OR KEEP IT FROM GETTING WORSE AND SOMETIMES IT DEPOSIT DO THAT — DOESN’T DO THAT FOR ALL PATIENTS.>>WE ARE HOPEFUL WE GET PATIENTS INTO REMISSION BUT WE HAVEN’T BEEN ABLE TO FULLY PROVE IT. WE HAVE PROVED THAT WE ACTUALLY DECREASE INFLAMMATION AND DECREASE THE AMOUNT OF EROSIONS. PATIENTS FEEL BETTER. THE QUALITY OF LIFE IS BETTER. IF WE LOOK AT THE QUALITY OF LIFE AND THE DISEASE ACTIVITY, IT IS MUCH LESS. SO THE MEDICATION THAT WE HAVE, ESPECIALLY THE BIOLOGICS, WE NOW HAVE MANY CLASSES, NOT JUST ONE, THAT HAVE MADE A DIFFERENCE IN PATIENTS’ LIVES. BUT WE’RE STILL NOT TO THE PLACE WHERE WE’RE WORKING TOWARDS AND WE DO COMBINATION THERAPY SOMETIMES IN ORDER TO ACHIEVE THE GREATEST GOAL OF REMISSION.>>SO TRYING TO FIND THAT BALANCE IN EACH PATIENT IS WHERE THOSE MEDICATIONS WILL EITHER WORK TOGETHER OR INDIVIDUALLY?>>EXACTLY. AND WE’RE STILL TRYING TO FIGURE OUT WHAT REMISSION IS. IS IT NOT SEEING INFLAMMATION PHYSICALLY WHEN WE DO THE EXAM? AND THEN GETTING X-RAYS AND MAKING SURE THERE’S NO EROSIONS, NO PROGRESSION OF DISEASE. IT IS ALWAYS A QUESTION: WHAT IS REMISSION? AND MAKING SURE PATIENTS FEEL GREAT, IT IS ALWAYS QUALITY OF LIFE. AND THAT ALWAYS IS THE MOST IMPORTANT THING ALSO.>>AND, JOHN, I’M SURE YOU CAN SPEAK TO THAT HAVING LIVED WITH RHEUMATOID ARTHRITIS WITH YOUR WHOLE LIFE AND THE CHANGES THAT HAVE TAKEN PLACE AND THE DIFFERENT MEDICATIONS YOU HAVE TAKEN ALONG THE WAY.>>I THINK THE POINT IS WELL-MADE BECAUSE OF THE ADVANCEMENT AND THE TREATMENT, MY PERSONAL SITUATION HAS RESULTED IN NOT STOPPING THE PROGRESSION OF THE DISEASE BUT CERTAINLY MAKING MY LIFE MORE LIVEABLE. ONE OF THE THINGS THAT I FEEL IS IMPORTANT TO STRESS IS THAT ONCE THE CONDITION IS UNDER CONTROL, THE PATIENT ALSO HAS A DUTY TO DO OTHER THINGS, DO SELF-MANAGEMENT OUTSIDE THE FIELD OF MEDICINE WHEREBY THEY CAN, FOR INSTANCE, BE — EXERCISE PROPERLY, EAT PROPERLY, WORK WITH THEIR PHYSICIANS ON THESE THINGS. BUT MAKE IT PART OF THEIR LIVES JUST AS MUCH AS GETTING UP IN THE MORNING AND GOING TO BED AT NIGHT, THEY SHOULD DO THESE THINGS SO THEY CAN HAVE A BETTER QUALITY OF LIFE AND NOT SUFFER THE DISABLING EFFECTS THAT A LOT OF PEOPLE WITH ARTHRITIS SUFFER. AND AS A CONSEQUENCE CANNOT WORK OR CANNOT DO THE WORK THAT THEY REALLY WANT TO DO AND CONSEQUENTLY SUFFER ECONOMIC LOSS AS A RESULT.>>I AGREE. WE ACTUALLY KNOW NOW MORE THAN EVER STAYING PHYSICALLY ACTIVE AND BEING AS CONDITIONED AS POSSIBLE IMPROVES QUALITY OF LIFE MUCH MORE THAN ANYTHING ELSE IN MANY DISEASES NOT JUST ARTHRITIS. IT’S SOMETIMES HARD FOR PATIENTS THAT ARE IN PAIN TO UNDERSTAND AND TO SEE THEMSELVES STARTING AN EXERCISE PROGRAM. BUT ONCE THEY DO IT, ONCE THEY DO IT, I HAVE THEM COME BACK AND BEING THANKFUL THAT THEY’VE MADE THAT CHANGE. BUT IT DOES TAKE A WHILE FOR THEM TO START AND TO SEE THE DIFFERENCE THAT IT MAKES TO ACTUALLY EXERCISE. AND THE WARM WATER EXERCISE, THE WARM WATER THERAPY IS ACTUALLY THE BEST, THE BEST WAY TO START.>>AND, IN FACT, I THINK — THIS WOULD BE A PERFECT TIME TO SHARE WITH EVERYONE THAT STORY BECAUSE WHEN YOU ARE IN PAIN AND SUFFERING FROM ARTHRITIS, THE LAST THING AS DR. MUNTEAN MENTIONED, YOU WANT TO DO IS EXERCISE. BUT IT IS ACTUALLY ONE OF THE VERY BEST THINGS YOU CAN DO FOR YOUR JOINTS. AND WE CAUGHT UP WITH TWO WOMEN WHO RELY ON THE WATER WORKOUT TO KEEP ACTIVE AND THEY SWEAR BY THE POWER OF THE POOL.>>HERE WE GO!>>YOU WOULDN’T KNOW IT BY THE WAY THEY GET AROUND IN THE WATER, BUT BOBBI MASSIE AND SALLY RHODES BOTH SUFFER FROM ARTHRITIS.>>ARTHRITIS IN MY KNEES, MY NECK, MY BACK>>PULL THAT CORD NICE AND TIGHT. KEEP THOSE FEET TOGETHER!>>SEVERAL TIMES A WEEK THEY ATTEND A SPECIAL WATER EXERCISE CLASS AT THE NORTH SPOKANE YMCA. THE CLASS IS DESIGNED FOR PEOPLE WITH ARTHRITIS. AND THESE LADIES SAY THEY WOULDN’T MISS IT.>>IT’S A GREAT TIME. I DO TRY TO COME FOUR DAYS A WEEK AND IT MAKES A BIG DIFFERENCE IN MY LIFE, A BIG DIFFERENCE.>>THE REASON THIS KIND OF WORKOUT WORKS IS THAT IT’S LOW IMPACT. THERE’S LESS STRESS ON THE JOINTS WHILE BUILDING CORE STRENGTH.>>THEY STILL GET THE WALKING MOTION WITH THEIR KNEES THEY STILL STRENGTHEN THOSE MUSCLES IN THEIR KNEES BUT RATHER THAN HAVE THE IMPACT ON THE GROUND, IT IS WEIGHTLESS. THEY CAN MOVE THROUGH THE WATER WITHOUT IT HURTING.>>SALLY SAYS THE CLASS KEEPS HER ACTIVE.>>I NEVER COULD JUST GO FOR A WALK BEFORE BECAUSE IT WOULD HURT MY JOINTS MY BONES SO BAD BUT NOW I CAN GO FOR A WALK AND DO WELL AND MANAGE IT JUST FINE>>INSTRUCTOR ALEX FUHRIMAN HAS SEEN IT FIRST HAND.>>THEY CAN WALK EASIER I HAVE HAD PEOPLE COME AND TELL ME IT RELIEVES THEIR PAIN BECAUSE THEIR MUSCLES ARE NOW SUPPORTING THEIR BODY DO MUCH BETTER.>>IF I MISS A CLASS I NOTICE THE NEXT DAY IT’S VERY HARD FOR ME TO WALK AND GET UP THE DOWN THE STAIRS WITHOUT, WITHOUT PAIN.>>BESIDES THE PHYSICAL BENEFITS THESE LADIES SAY THE CLASS GIVES THEM A CHANCE TO CONNECT.>>THERE’S A GREAT CAMARADERIE BETWEEN THE MEMBERS THAT ARE IN THE POOL.>>AN HOUR OF SPLASHING AND SMILES THAT IS BUILDING NOT ONLY MUSCLE BUT MEMORIES.>>IT’S A GOOD GROUP OF PEOPLE , WE HAVE A REALLY GOOD TIME. ♪ YMCA ♪♪ [ LAUGHTER ]>>THAT WATER EXERCISE THAT BOB BY AND SALLY TAKE IS OFFERED AT ALL THREE OF THE YMCAs IN SPOKANE. WE HAVE POSTED A LINK TO THE Y’S WEB SITE. GO TO KSPS.ORG AND CLICK ON “HEALTH MATTERS.” AND I THINK WHAT I ALSO TAKE AWAY FROM THAT IS THAT THE CAMARADERIE, HOW MUCH IT HELPS THEM TO GET TOGETHER WITH OTHER PEOPLE AND GET IN THE POOL AND DO THAT EXERCISE.>>YOU CAN SEE THAT EVERYBODY HAS A LITTLE BIT OF PAIN AND THEY STILL DO IT AND IT ACTUALLY HELPS THEM.>>IT IS GREAT SUPPORT SYSTEM.>>YEAH.>>TALK ABOUT AGAIN HOW IMPORTANT THAT EXERCISE IS TO RELIEVING SOME OF THE SYMPTOMS OF ARTHRITIS.>>IT IS VERY IMPORTANT BECAUSE YOU ALREADY HAVE A JOINT THAT’S ILL EITHER BECAUSE YOU HAVE OSTEOARTHRITIS OR RHEUMATOID ARTHRITIS OR WHATEVER ARTHRITIS YOU HAVE THAT’S CAUSING THE PAIN. NOW YOU HAVE A DECONDITIONED MUSCLE AND LIGAMENT THAT’S NOT REALLY SUPPORTING THAT JOINT. BUT IF YOU GET STRONG MUSCLES AND LIGAMENTS, YOU’RE NOT USING YOUR JOINTS THE SAME WAY. YOU ARE GETTING SOME SUPPORT FROM STRONGER MUSCLES AND LIGAMENTS SO IT MAKES A HUGE DIFFERENCE TO BE MORE CONDITIONED. SO PATIENTS DON’T THINK ABOUT IT. THEY THINK THE MORE THEY USE THEIR JOINTS, IF THEY GO AND EXERCISE, THEY’RE GOING TO BE MORE IN PAIN BUT IT IS THE OPPOSITE. THEY’RE MORE CONDITIONED AND THE STRONGER YOU ARE IS BETTER FOR YOUR JOINTS. I’M NOT TELLING THEM TO GO GET READY FOR A MARATHON AND I THINK THAT’S WHAT SOMETIMES PEOPLE WHEN THEY ARE IN PAIN THEY CAN’T QUITE HEAR THAT I’M ASKING THEM TO DO GENTLE STUFF, NOT HEAVY-DUTY WORKOUTS.>>THAT’S WHY THE WATER EXERCISE IS SO PERFECT.>>IT IS PERFECT.>>WHAT ABOUT SOMETHING LIKE YOGA?>>THE OVERSTRETCHING SOMETIMES CAN BE TOO MUCH.>>OKAY.>>FOR OSTEOARTHRITIS, ESPECIALLY THE HYPEREXTENSION OF THE KNEES. SO FOR YOUNGER PEOPLE, IT’S OKAY.>>IS IT SORT OF ONE OF THOSE, AGAIN, TRIAL AN ERROR?>>CORRECT.>>WHATEVER FEELS GOOD FOR YOU?>>EXACTLY. I WOULD RECOMMEND IT FOR SOME BUT NOT SO MUCH FOR OLDER PEOPLE, NOT SO MUCH. I WOULDN’T WANT THEM TO HYPEREXTEND THEIR JOINTS TOO MUCH.>>I WANT TO TAKE A LOOK AT AN ILLUSTRATION THAT WE HAVE ON THE DIFFERENT TYPES. IT SORT OF GIVES US AN IDEA WHAT’S GOING ON. THIS IS A KNEE JOINT, I ASSUME. AND WHAT’S GOING ON WITH THESE TYPES OF ARTHRITIS. AND DR. MUNTEAN, SPEAK TO EACH ONE OF THESE.>>SO WE HAVE A HEALTHY JOINT. AND THEN THE NEXT ONE IS THE OSTEOARTHRITIS WHERE WE SEE THE GENERATION OF THE CARTILAGE. AND SO — AND THERE’S NO MORE LIQUID. THE BLUE LIQUID THAT’S MISSING IS THE NORMAL SYNOVIAL FLUID THAT’S MISSING.>>SO THAT’S BONE ON BONE?>>THAT’S CORRECT.>>THAT’S WHAT HAPPENS THERE?>>AND NO MORE CARTILAGE IN THE OSTEOARTHRITIS. NOW, IN THE RHEUMATOID ARTHRITIS WE ALSO HAVE EROSIONS. THE SPIKEYNESS OF THE BONE, WE HAVE EROSIONS INTO THE BONES AND THE HYPERTROPHY OF THE SYNOVIAL SO NOT ONLY DO WE GET EROSIONS, WE GET SOMETHING WE CALLED TENIS FROM THE CHRONIC INFLAMMATION WE GET AN OVERGROWTH OF THE SYNOVIAL FLUID AND TISSUE INTO THE JOINT THAT CAN DAMAGE THE BONES EVEN MORE, THE JOINT EVEN MORE.>>AND OVER TIME JUST BECOMES WORSE?>>EXACTLY. THE JOINT GETS DESTROYED.>>ALL RIGHT. JOHN, I WANT TO TALK ABOUT SOME OF THE ROAD BLOCKS THAT YOU’VE COME UP AGAINST AS YOU DO YOUR WORK AS AN ADVOCATE AND THE FIGHTS YOU HAVE FOUGHT AND TALK ABOUT SOME OF THE WORK YOU’VE DONE IN THAT REGARD AND WHAT YOU COME UP AGAINST.>>WELL, AS I SAID — AS I MENTIONED EARLIER TO YOU, TERESA, MY FIRST FORAY INTO THE FIELD ON THE LEGISLATIVE AGENDA ON SEPTEMBER 11th, 2001 I WAS IN WASHINGTON, D.C. WITH THE ARTHRITIS FOUNDATION. AND OTHER PATIENTS THROUGHOUT THE COUNTRY TRYING TO LOBBY CONGRESS FOR MEDICARE COVERAGE TO SELF-INJECT BIOLOGICAL MEDICINES, ONE OF WHICH I’M ON WHICH HAD MADE A BIG DIFFERENCE IN MY LIFE AND THE LIVES OF OTHER PATIENTS. BECAUSE OF WHAT HAPPENED THAT DAY, NOTHING CAME ABOUT AS A RESULT. BUT EVENTUALLY, THROUGH TIME AND EFFORT AND ENROLLING MORE PEOPLE AS ADVOCATES, WE DID ACCOMPLISH GETTING MEDICARE COVERAGE TO SELF-INJECTED BIOLOGICALS. THAT PARTICULAR DAY HAD A REALLY ADVERSE EFFECT ON FUNDING OUTSIDE OF THE AREA OF HOMELAND SECURITY AND DEFENSE SPENDING. THERE WAS JUST SO MUCH MONEY IN THE PIE. SO OUR BATTLES BECAME MUCH HARDER TO FIGHT AND GETTING FUNDING FOR RESEARCH AND THINGS OF THAT NATURE. BUT IT REQUIRES PERSISTENCE. IT REQUIRES ESTABLISHING RELATIONSHIPS WITH PEOPLE WHO ARE MEMBERS OF CONGRESS. AND I THINK JUST THE TIME AND EFFORT PUT INTO IT, WHICH I WAS ABLE TO GET BECAUSE OF THE ADVANCEMENTS IN THE TREATMENT OF ARTHRITIS, I WOULD NEVER HAVE BEEN ABLE TO HAVE DONE IT EXCEPT FOR THE ADVANCEMENTS IN THE TREATMENT OF ARTHRITIS. OVER THE YEARS, WE HAVE MADE SOME INROADS. I THINK WE WILL HAVE BETTER OUTCOMES AS TIME GOES ON. BUT, YES, IT IS A STRUGGLE. IT IS JUST LIKE DEALING WITH ARTHRITIS ON A DAILY BASIS IS TRYING TO CONVINCE ENOUGH PEOPLE TO SUPPORT WHAT WE NEED AS ARTHRITIS PATIENTS.>>OKAY. ALSO, WE ENCOURAGE YOUR PHONE CALLS AND EMAILS TONIGHT IF YOU HAVE QUESTIONS FOR OUR PANEL. PLEASE TAKE ADVANTAGE OF THIS EXCELLENT OPPORTUNITY TO ASK YOUR QUESTIONS. AND WE DO HAVE AN EMAIL THAT WE WANT TO ADDRESS RIGHT NOW FROM JEN WHO SAYS:>>WE SORT OF STARTED TO TALK ABOUT THIS, BRIAN, BUT IT IS AN EXCELLENT QUESTION.>>IT IS A VERY GOOD QUESTION. AND ON A SIMPLE ANSWER IS THE NUMBER ONE THING WE HAVE OVER-THE-COUNTER IS ACETAMINOPHEN WHICH IS WHAT’S IN TYLENOL WHICH IS WHAT MOST PEOPLE KNOW. IT IS NOT AN ANTIINFLAMMATORY, THAT’S OFTEN WHERE SOMEBODY WILL START IF THEY ARE JUST STARTING TO GET ARTHRITIS. IT IS PRETTY SAFE. PEOPLE KNOW IF SOMEBODY TAKES ENOUGH OF IT, IT CAN DAMAGE THE LIVER.>>WE HAVE SEEN ALL SORTS OF WARNINGS ABOUT THAT.>>RIGHT. FOR THE MOST PART, THAT IS GETTING TOO MUCH. THAT IS SOMETHING WE CERTAINLY WANT PEOPLE TO ASK NURSE, DOCTOR, PHARMACIST IF THEY HAVE GOT ANY QUESTIONS ABOUT THE DOSING, IT CAN BE A LITTLE CONFUSING. ONE THING THAT HAS COME UP WITH THAT IS IT MAY BE MORE LIKELY IF SOMEBODY IS DRINKING ALCOHOL WITH IT IN TERMS OF DAMAGING THE LIVER. SO YOU DO HAVE TO BE –>>DO YOU SUGGEST WITH ANY KIND OF MEDICATION TO CHECK WITH YOUR PHYSICIAN FIRST?>>WELL, FOR THE MOST PART, YES, ESPECIALLY OBVIOUSLY THE OVER-THE-COUNTERS ARE THERE AND PEOPLE CAN SELF-TREAT. IF IT IS SOMETHING THAT WILL BE CHRONIC.>>YOU ARE FEELING THAT ACHE AND PAIN EVERY DAY?>>RIGHT. PERIODICALLY HAVE IT CHECKED. ONE THING WITH SOMETHING LIKE THE ACETAMINOPHEN, MAKE SURE THE DOSE IS CORRECT.>>LET’S TAKE A PHONE CALL. WE HAVE PENNY FROM SPOKANE ON THE LINE. GOOD EVENING, PENNY.>>I APPRECIATE YOU HAVING THIS SHOW. WHAT I WAS CALLING ABOUT IS I WAS WONDERING IF THEY CAN SPEAK TO THE FACT OF SORIATIC ARTHRITIS WHICH IS THE ONE THAT I HAVE WHICH IS CRIPPLING. YOU HAVE THE OUTBREAK OF PSORIASIS FOR MANY, MANY YEARS AND THEN ALL OF A SUDDEN YOU END UP WITH ARTHRITIS ON TOP OF IT. BUT A LOT OF PEOPLE DON’T REALIZE THAT THEY MAY BE ELIGIBLE FOR THAT. AND I FOUND OUT THAT I SHOULD HAVE GONE TO THE DOCTOR SOONER ABOUT MY ARTHRITIS TO HAVE PREVENTED MORE DAMAGE. AND SO I LIKE TO TELL PSORIATIC PATIENTS JUST TO BE AWARE.>>THAT IS EXCELLENT, AN EXCELLENT POINT. THANKS SO MUCH, PENNY. TALK ABOUT THE TYPE OF ARTHRITIS THAT PENNY IS DEALING WITH.>>I AGREE, PSORIATIC ARTHRITIS, IT IS A HUGE SPECTRUM. IT CAN BE QUITE DISABLING AND MUTILATING. I’M NOT SURE, PENNY, IF YOURS IS THAT SEVERE. THERE IS A TYPE CALLED PSORIATIC ARTHRITIS MUTALENS THAT CAN GIVE YOU SHORTENING OF YOUR FINGERS AND THEN THERE’S SOME THAT’S NOT AS DEFORMING THAT NEEDS TO BE TREATED VERY AGGRESSIVELY. AND SOME THAT ARE ALMOST RHEUMATOID ARTHRITIS-LIKE, DIFFERENT FORMS OF PSORIATIC ARTHRITIS. SO VERY IMPORTANT FOR PEOPLE THAT HAVE ARTHRITIS.>>IS THE ONSET DIFFERENT THAN THE GARDEN VARIETY OF ARTHRITIS? OR IS IT THE SAME TYPE OF SYMPTOMS?>>SAME TYPES OF SYMPTOMS BUT USUALLY A RHEUMATOLOGIST OR PHYSICIAN SHOULD BE ABLE TO PICK UP ON THE DIFFERENCE.>>HOW IS THAT TREATED?>>USUALLY MORE AGGRESSIVE, EITHER DEPENDING ON IF IT’S JUST PERIPHERAL WITH MEDICATIONS SUCH AS METHOTREXATE. BUT SOMETIMES WE HAVE CERTAIN FEATURES THAT WE CALL DACTILITIS WHEN YOUR FINGERS ARE RED AND SWOLLEN AND LOOKING LIKE A SAUSAGE AND YOUR NAILS ARE VERY INVOLVED, THEN WE USE A MEDICATION SUCH AS ENBRIL, HUMEIRA, ANY OF THOSE MEDICATIONS.>>LET’S TAKE ANOTHER PHONE CALL. WE HAVE FRAN FROM CALLGARY.>>GOOD EVENING, A LITTLE SNOWED IN HERE. THANK YOU FOR PUTTING ON THIS PROGRAM. I HAD ORIGINALLY PHONED BACK WHEN YOU DID THIS IN THE SPRING AFTER I HAD ARTHROSCOPY. I HAD BEEN TOLD THAT I NEED A PARTIAL KNEE REPLACEMENT. HOWEVER, I HAVE FIBROMYALGIA. SO I REACT TO THE DRUGS A LOT AND TO PAIN. AND IT TOOK ABOUT TEN WEEKS UNTIL I FINALLY GOT A CORTISONE SHOT WHICH HELPED A LITTLE BUT THEN I WEAR A REMOVABLE KNEE BRACE. IT IS VERY DIFFICULT WHEN YOU HAVE BEEN TOLD “WE CAN ONLY DO THE SURGERY FOR YOU IF YOU CAN DO THE DRUGS AND IF YOU CAN, YOU KNOW, HANDLE THE PAIN.” SO I’M WONDERING IF THERE’S ANY SUGGESTIONS FROM THE PANEL.>>OKAY, FRAN. DR. MUNTEAN?>>AS FAR AS I KNOW, I DON’T THINK THERE’S ANY WAY TO DO EVEN THE PROCEDURE WITHOUT ANESTHETICS. SO NOT AS FAR AS I KNOW. DOING A PARTIAL REPLACEMENT WITHOUT ANESTHETICS, NOT THAT I KNOW OF.>>FRAN, ARE YOU STILL THERE? NO, I THINK WE HAVE LOST FRAN.>>I’M NOT SURE IF SHE’S TRIED JUST — IT SOUNDS LIKE SHE TRIED STEROID INJECTIONS WITHOUT MUCH HELP. SO NOT MUCH ELSE.>>BRIAN, ANYTHING TO ADD?>>WELL, AND DEPENDING ON ASSUMING ANESTHETICS, TOO, BECAUSE SOMETIMES — IF IT WAS MEDS AFTER THE SURGERY A LITTLE BIT, TOO, BECAUSE SOMETIMES –>>SHE HAS A UNIQUE CASE DEALING WITH BOTH OF THOSE CONDITIONS.>>RIGHT. SO SOMETIMES THERE MAY BE — IF IT’S AFTER THE FACT, SOMETIMES WE DO FIND THAT IF IT’S THE POST-OP TREATMENT, THAT SOME OF THOSE — SOME MAY BE BETTER THAN THE OTHERS. WE HAVE HAD SOME LOCK WITH TRAMODOL WHICH HAS BEEN BETTER THAN MORPHINE AND SOME OF THOSE IN SOME CASES. IT DEPENDS ON WHAT SOMEBODY HAS TAKEN.>>THAT’S A TRICKY ONE. SHE SHOULD JUST CONTINUE TO WORK WITH HER DOCTOR.>>OR GET A SECOND OPINION, MAYBE ANOTHER CENTER, THEY MIGHT HAVE OTHER THINGS TO OFFER. I DON’T KNOW.>>OKAY. WELL, FRAN, WE WISH YOU BEST OF LUCK WITH THAT. THIS MIGHT BE A GOOD PLACE TO TALK ABOUT A ROBOTIC PROCEDURE HERE IN SPOKANE. DR. PETERSON WHO HAS BEEN A GUEST ON THIS PROGRAM IS STARTING TO PRACTICE THIS PROCEDURE. I WANT TO TAKE A LOOK AT SOME OF THE VIDEO OF HIM ACTUALLY DOING THIS. IT’S FOR A PARTIAL KNEE REPLACEMENT. AND DR. MUNTEAN, YOU WERE ACTUALLY IN THE ROOM WHEN HE WAS PRACTICEING THIS ROBOTIC PROCEDURE.>>I WAS. HERE HE IS STARTING TO SHAVE THE CONDYLE TO GET IT READY FOR THE PROSTHESIS.>>WE DO SEE A LOT OF PATIENTS THAT WILL NEED THIS PROCEDURE.>>CORRECT. HE IS VERY IMPRESSED WITH THE RESULTS. AND HE’S BEEN DOING IT NOW WITH PROVIDENCE.>>WHAT ARE THE ADVANTAGES OF DOING IT THIS WAY THAN THE TRADITIONAL KNEE REPLACEMENT WITH THE ROBOTICS?>>SO HE WOULD BE A BETTER PERSON TO GO INTO THIS. BUT FROM HIS PERSPECTIVE, IT SEEMS THAT ONCE YOU GET TRAINED, ROBOT DOES THE WORK AND IT DOES IT RIGHT EVERY TIME AND THE ORTHOPEDIC SURGEON, IT SEEMS LIKE YOU HAVE TO DO A LOT OF PROCEDURES TO BE REALLY GOOD AT THE PARTIAL REPLACEMENT. WITH THIS, YOU ONLY HAVE TO GET TRAINED ON HOW TO USE THE ROBOT AND THEN YOU WOULD BE ABLE TO DO IT RIGHT EVERY TIME.>>AND DR. PETERSON ACTUALLY EXPLAINS A LITTLE BIT MORE ABOUT THE PROCEDURE THAT HE’S PRACTICING IN THIS VIDEO.>>I THINK IF YOU’RE A CANDIDATE FOR A PARTIAL KNEE REPLACEMENT WHICH IS A SMALL PERCENTAGE OF PATIENTS, MAYBE 10% OF ALL THE PATIENTS THAT ARE IF THE HAVE A KNEE REPLACEMENT ARE CANDIDATES FOR THIS. BUT IF YOU HAVE THIS REPLACEMENT, THEN YOU SAVE BOTH LIGAMENTS, YOUR ANTERIOR AND POSTERIOR CRUCIATE AND YOUR PATELLOFEMORAL JOINT AND YOUR LATERAL JOINT AND YOUR MENISCUS. ALL YOU LOSE IS YOUR DISEASED PART OF THE JOINT. YOU ARE REALIGNED AND BALANCED SO YOU HAVE A MUCH BETTER FUNCTION THAN A TOTAL KNEE REPLACEMENT.>>THAT’S AMAZING. AND PROBABLY A LOT LESS INVASIVE SO YOUR RECOVERY TIME WILL BE A LOT QUICKER THAN TRADITIONAL METHODS.>>EXACTLY.>>PRETTY NEAT TO SEE THOSE ADVANCEMENTS MADE FOR QUALITY OF LIFE. AND BECAUSE WE HAVE AN AGING POPULATION, WE’RE PROBABLY GOING TO SEE MORE OF THAT?>>CORRECT.>>LET’S TAKE ANOTHER PHONE CALL. WE HAVE SUSAN CALLING IN FROM IDAHO.>>Caller: GOOD EVENING. I HAVE A QUESTION REGARDING INJURY, LIKE A WINDOW CAME DOWN ON MY FINGER AND ARTHRITIS HAS JUST SET IN THERE AND I DROPPED A BIG ROCK ON MY TOE. MY QUESTION, THIS IS ARTHRITIS FROM INFLAMMATION THERE BUT I DON’T BELIEVE IT WOULD SPREAD ELSEWHERE BECAUSE IT IS AN ISOLATED CASE. IS THAT A CORRECT ASSUMPTION OR NOT?>>DR. MUNTEAN?>>IT SOUNDS LIKE A TRAUMATIC INFLAMMATORY ARTHRITIS. AND SOMETIMES THAT’S TRUE. SO IT’S — ONLY TIME WILL TELL. IT SOUNDS LIKE IF YOU ONLY HAVE IT IN THOSE TWO LOCATIONS, THAT IT IS ONLY RELATED TO THE TRAUMA. BUT IN TIME, IF YOU DEVELOP IT ANYWHERE ELSE, THEN IT COULD BE A SYSTEMIC DISEASE.>>SUSAN, ARE YOU SEEKING TREATMENT?>>Caller: I BEG YOUR PARDON?>>ARE YOU SEEING A DOCTOR?>>Caller: NO, NO. I NEVER HAD OSTEOARTHRITIS. I’M IN MY 60s. BUT I RUN. I DO MARATHONS, I’M UNDERWEIGHT AND I NEVER EAT SUGAR. IT HASN’T SPREAD ANYWHERE BUT IT IS KIND OF UNCOMFORTABLE BECAUSE WHEN THE ROCK DROPPED ON MY TOE, YOU DON’T SET BIG TOES USUALLY. I JUST IGNORED IT. AND IT SEEMS TO BE GETTING A LITTLE BETTER. THE FINGERS WERE DAMAGED. THE WINDOW BROKE ALL OF MY FINGERS. MY FRIEND SAID IT COULD GO INTO THE WHOLE SYSTEM. IF IT IS PECULIAR TO A PARTICULAR AREA, IT WON’T SPREAD.>>SOUNDS LIKE DR. MUNTEAN AGREES WITH YOU. THANK YOU FOR YOUR CALL, SUSAN. SHE ALSO BROUGHT UP A POINT WHERE SHE TALKED ABOUT HER OVERALL HEALTH BEING VERY GOOD AND SHE EXERCISED. WE HAVEN’T TALKED ABOUT THE DIET ASPECT OF THIS. CAN YOU HELP WITH ANY OF THE SYMPTOMS BY CONTROLLING WHAT YOU EAT? ARE WE FINDING ANY SORT OF FOOD COMBINATIONS OR THINGS THAT PEOPLE SHOULD AVOID?>>PRETTY MUCH. I DON’T THINK THERE IS A SPECIFIC DIET. I HAVE SEEN — THROUGH THE YEARS, I HAVE OFFERED DIFFERENT DIETS TO PATIENTS AND I HAVE SEEN PATIENTS DO DIFFERENT DIETS THROUGH THE YEARS, ANYTHING FROM GLUTEN-FREE DIETS, DAIRY-FREE DIETS, VEGAN DIETS, AVOIDING NITRATES, DIFFERENT — HIGH ALKALINE DIETS, SO DIFFERENT TYPES OF DIETS. THESE PEOPLE — I HAVE HAD PATIENTS THAT HAD READ DIFFERENT THINGS ON THE INTERNET AND THEY’VE DONE IT THAT PROMISED TO OCCUR THEM OF ARTHRITIS. BUT I THINK AT THE END OF THE DAY, WHAT I RECOMMEND, IT IS A WHOLE FOODS DIET, AVOIDING AS MUCH AS POSSIBLE SATURATED FATS, INCORPORATING AS MANY VEGETABLES AND FRUITS AND AVOIDING PROCESSED FOODS AS MUCH AS POSSIBLE. AND I THINK THAT IS GOING TO BENEFIT SOMEONE MUCH MORE THAN ANYTHING ELSE. SO AVOIDING A PROCESSED DIET AND A UNHEALTHY DIET.>>JOHN, HAVE YOU FOUND OVER THE YEARS THAT A CERTAIN DIET HELPS YOU? OR CAN ACTUALLY CAUSE A FLAREUP WITH YOUR RHEUMATOID ARTHRITIS?>>NO, I HAVE NOT FOUND THAT. BUT I HAVE FOUND THAT WATCHING MY WEIGHT ENABLES ME TO DO MY EXERCISE MORE OFTEN AND MORE EASILY. SO I DO WATCH WHAT I DO TAKE IN AS DR. MUNTEAN SAYS, THE KINDS OF FOODS THAT WILL GO INTO MY SYSTEM. I NEED TO HAVE A PROPER EXERCISE REGIMEN. I THINK THEY GO HAND IN HAND. ANOTHER ASPECT MIGHT BE — AND MAYBE DR. MUNTEAN CAN TALK ABOUT THIS, ARE NATURAL ANTIINFLAMMATORIES, SUCH AS I BELIEVE FISH OIL THAT CAN BE INCORPORATED INTO A PERSON’S DIET WITHOUT ANY — TOO MUCH DISCOMFORT AND HAVE SOME BENEFITS FROM IT.>>OKAY. LET’S TAKE ANOTHER PHONE CALL. WE HAVE JOHN CALLING IN FROM ALBERTA. GOOD EVENING, JOHN.>>Caller: GOOD EVENING. I WOULD LIKE TO KNOW IF MEDICAL MARIJUANA HAS RELIEF ON ARTHRITIS?>>WE NOW IN THE STATE OF WASHINGTON HAVE LEGAL MARIJUANA AND, OF COURSE, HAVE HAD MEDICAL MARIJUANA. HAVE WE FOUND ANY RELATIONSHIP BETWEEN THE TWO?>>SO I LOOKED AT IT JUST BECAUSE IT’S CONSIDERED A MEDICATION. THERE IS SOME DATA WHEN IT COMES TO PAIN. SO I DO AGREE THAT IT DOES HAVE SOME PAIN PROPERTIES. I DO NOT PRESCRIBE IT. AND SO I THINK THAT’S AS MUCH AS I WILL SAY. AND I THINK I WILL PASS IT ON TO YOU.>>SHE’S PASSING THE BALL.>>WELL, IT IS AN INTERESTING QUESTION. AND AS TERESA BROUGHT UP, IT WILL BE INTERESTING HOW HERE IN WASHINGTON THAT WORKS OUT. I CERTAINLY RUN INTO PEOPLE WHO HAVE USED IT BEFORE AND, SAY, FOR DIFFERENT PAINFUL CONDITIONS WE’LL SAY IT IS HELPFUL. AND, OF COURSE, THERE ARE SOME POSSIBLE HEALTH EFFECTS. PART OF THAT CERTAINLY IS JUST LIKE ANY OTHER MEDICATION, MAKING SURE IT IS THE RIGHT DOSE, TOO, AND BEING CAREFUL WITH THAT AND NOT ALWAYS THINKING THAT IF A LITTLE IS GOOD, MORE IS GOING TO BE BETTER. SO I WOULD, EVEN THOUGH PEOPLE DON’T ALWAYS LIKE TO, TO LET THE HEALTH CARE PROVIDERS KNOW IF THEY ARE TAKING THAT BECAUSE, AGAIN, THE IDEA THAT YOU CAN GET IT, THAT IT MIGHT BE ENTIRELY SAFE — EVEN THOUGH SOME PEOPLE MAYBE DO WELL. WE CERTAINLY SEE SOME PEOPLE WHO HAVE SOME PROBLEMS WITH IT, TOO, AND HAVE TO BE CAREFUL WITH THAT.>>AGAIN, LIKE ANYTHING, IT IS IMPORTANT TO SHARE THAT INFORMATION WITH YOUR PHYSICIAN. WE TALKED AT THE BEGINNING OF THE SHOW THAT 300,000 KIDS IN THIS COUNTRY HAVE ARTHRITIS AND WE HAVE A QUESTION PERTAINING FROM BILL AND CAROL THAT ARE EMAILING US.>>AN EXCELLENT QUESTION FROM BILL AND CAROL. TALK ABOUT THE KIDS.>>I’M GLAD TO HEAR. I DO SEE CHILDREN. AND I’M NOT A BOARD CERTIFIED PEDIATRICIAN. BUT I HAVE BEEN TRAINED, I TRAINED AT THE CHILDREN’S HOSPITAL OF ORANGE COUNTY SO I DO SEE CHILDREN. AND IT’S VERY IMPORTANT THAT CHILDREN GET ATTENTION RIGHT AWAY AND WE TREAT THEM AS HARD AS WE CAN AS SOON AS WE CAN SO WE PREVENT DISABILITIES AND DEFORMITIES AND GROSS ABNORMALITIES BECAUSE ARTHRITIS IN CHILDREN AFFECTS THEM AT EVERY, EVERY LEVEL. SO WHENEVER I TREAT A CHILD, I TRY TO WORK WITH PARENTS VERY, VERY HARD TO MAKE THEM UNDERSTAND IT IS VERY IMPORTANT THAT WE GET VERY AGGRESSIVE TREATING THE CHILDREN.>>JOHN, YOU’VE CERTAINLY LIVED THIS.>>YES, I HAVE AND I’M VERY SYMPATHETIC TO CHILDREN WHO DO SUFFER FROM ARTHRITIS AND ALSO THEIR FAMILIES, THEIR PARENTS, THEIR SIBLINGS AND SO FORTH WHO SUFFER WITH THEM, TOO, IN DIFFERENT WAYS. AND I’M GLAD WE’RE TOUCHING ON THIS POINT BECAUSE THERE IS LEGISLATION THAT WILL RE-AUTHORIZE THE PEDIATRIC LOAN REPAYMENT PROGRAM TO ALLOW PHYSICIANS TO GO INTO PEDIATRIC RHEUMATOLOGY AND HAVE PEOPLE AVAILABLE IN THE COMMUNITY. ONE OF THE GREAT THINGS THAT I SEE COMING IN AS A RESULT OF WSU COLLABORATING AT THE MEDICAL SCHOOL IS PROVIDING INCENTIVES FOR THOSE CANDIDATES, FELL FELLOWS, TO COME OVER HERE AND MAYBE ESTABLISH A PRACTICE IN PEDIATRIC RHEUMATOLOGY. I’M IN FAVOR OF HAVING THAT HAPPEN AND I I THINK IT WILL OFFER HOPE TO BOB AND CAROL TO GET THE RIGHT TREATMENT FOR THEIR 9-YEAR-OLD AND GET IT AS SOON AS POSSIBLE SO THEY DON’T SUFFER THE EFFECTS I SUFFERED FROM MY DISEASE.>>ABSOLUTELY. WELL SAID. HOW DIFFERENT ARE THE SYMPTOMS IN KIDS FROM ADULTS? BECAUSE THEY ARE QUITE DIFFERENT.>>THEY ARE DIFFERENT. I WOULD SAY THE PAIN IS DIFFERENT. CHILDREN DON’T REALLY COMPLAIN OF PAIN AS MUCH. THEY — THEIR MAIN SYMPTOMS ARE LIMPING. THE SWELLING IS VERY OBVIOUS. AND SOMETIMES DEFORMITIES. SO IF THEY HAVE SWELLING IN THEIR HANDS, SOMETIMES THEY ALREADY — THEY GET CONTRACTIONS IN THEIR FINGERS MUCH FASTER. SO THEY WILL HAVE THEIR HAND IN THIS POSITION. IF THEY HAVE SWELLING IN THEIR KNEES, DEPENDING ON THEIR AGE, THEY WILL END UP HAVING A LONGER LEG OR A SHORTER LEG. SO IT IS PRETTY OBVIOUS AND THAT’S WHAT IS CAUSING THE LIMPING. IT IS NOT THE PAIN. IT IS USUALLY THE SHORTER LEG OR THE LONGER LEG. SO THE SYMPTOMS THAT WAY ARE DIFFERENT. AND AS THEY GROW, IF THE ARTHRITIS IS NOT CONTROLLED ALSO THEY END UP HAVING A SMALLER JAW. THEY END UP BEING SHORTER. SO IT IS VERY IMPORTANT THAT THE ARTHRITIS IS TREATED AGGRESSIVELY AS SOON AS POSSIBLE IN A CHILD.>>OKAY. LET’S TAKE ANOTHER PHONE CALL. WE HAVE MORRIS CALLING IN FROM LEFTBRING. GOOD EVENING, MORRIS.>>Caller: GOOD EVENING, HOW ARE YOU?>>VERY WELL. THANK YOU.>>Caller: THANK YOU FOR TAKING MY CALL. I’M 68 YEARS OLD. I’M AN OLD DINOSAUR.>>YOU ARE NOT THAT OLD, MORRIS. [ LAUGHTER ]>>Caller: ANYWAYS, I HAVE TYPE 1 DIABETES AND AS WELL AHAVE RHEUMATOID ARTHRITIS. IN 2009, THEY STARTED TREATING ME WITH METRATREXATE. I WAS ON IT FOR A LITTLE OVER TWO YEARS AND I HAD A LOT OF BAD SIDE EFFECTS SO I QUID. THE STRANGE THING AFTER I STOPPED TAKING IT. I FELL OFF A ROOF 17 FEET AND I LANDED AND NEVER BROKE NOTHING. NOTHING HAPPENED TO ME. BUT IT WAS JUST AS IF MY RHEUMATOID ARTHRITIS WENT INTO REMISSION. NOTHING BOTHERED ME. DOCTORS COULDN’T EXPLAIN IT.>>REALLY?>>Caller: HONEST. THAT’S THE HONEST, ABSOLUTE GOD TRUTH.>>THAT IS QUITE A STORY.>>Caller: YEAH.>>IT IS.>>Caller: ANYWAYS, AFTER THAT, I WAS JUST, OH, MAYBE ABOUT 13, 14 MONTHS, STARTED TO FEEL THE PAIN AGAIN. SO TALKED IT OVER WITH MY DOCTOR AND WENT ON — NOT METHOT REXATE SO I WENT ON HUMEIRA. I HAD LOTS OF PROBLEMS SO THEY INSTRUCT IMMEDIATE TO STOP. IT REALLY BOTHERED MY NERVES BAD. I WAS VERY AGITATED, COULDN’T SLEEP. A LOT OF THINGS WERE COMING UP. AND I HAVEN’T BEEN ON IT VERY LONG. SO I WOULD LIKE TO DIRECT THE QUESTION FIRST TO JOHN. HAS HE EXPERIENCED ANY OF THESE THINGS?>>WELL, I HAVE NEVER FALLEN OFF A LADDER 17 FEET, I CAN SAY THAT FOR SURE. BUT ONE OF THE IMPORTANT THINGS YOU BROUGHT UP IS THE RISKS AND BENEFITS OF TREATMENT AND EITHER GETTING THE TREATMENT OR NOT GETTING THE TREATMENT. AND ONE HAS TO WEIGH THOSE PARTICULARLY WITH DRUGS LIKE HUMEIRA AND OTHER BIOLOGICAL RESPONSE MODIFIERS. THERE ARE RISKS AND THEY SHOULD BE DISCUSSED CANDIDLY WITH A PHYSICIAN PARTICULARLY IN THE CASE OF CHILDREN WHEN THEY ARE PUT ON TO THOSE AND NEXT WAS A BIG ISSUE, STILL IS. CERTAINLY INCREASES RISK MUCH TUBERCULOSIS, LYMPHOMA AND EVEN DEATH. THESE ARE DECISIONS NOT LIGHTLY ENTERED INTO FOR YOURSELF OR FOR YOUR CHILDREN. BUT IT HAS TO BE — IT SHOULD BE DONE WITH A DOCTOR WHO IS TREATING SO THE PATIENT CAN MAKE THE RIGHT DECISIONS AND SO HUMIRA MAY NOT WORK FOR THIS CALLER BUT SOMETHING ELSE MAY AND THE MAIN THING WITH RHEUMATOID ARTHRITIS IS TO STOP THE PROGRESSION OF THE DISEASE AND LIVING A BETTER LIFE. SO IF THAT’S NOT WORKING, MAYBE SOMETHING ELSE WILL.>>SOMETHING ELSE COULD AND SOMETHING COULD BE WORKING FOR A WHILE AND THEN SORT OF TURN ON YOU, TOO.>>YES.>>MEDICATIONS NEED TO BE ADJUSTED AND CORRECTED.>>CORRECT. EVEN MEDICATIONS FROM THE SAME CLASS YOU MIGHT HAVE A SIDE EFFECT FROM HUMIRA BUT HE MAY BE OKAY WITH ANOTHER ONE. IT SOUNDS LIKE HE HAS A RHEUMATOLOGIST AND THEY SHOULD MOVE ON TO SOMETHING ELSE.>>OKAY. LET’S TAKE ANOTHER EMAIL. THIS ONE FROM JAMES.>>THAT COMING FROM JAMES THIS EVENING. AND DR. MUNTEAN, EXCELLENT QUESTION.>>I AGREE. I THINK THE MOST IMPORTANT THING IS HOW OLD JAMES IS BECAUSE THAT WOULD PLAY A ROLE. IN SOMEONE THAT’S OLDER, THEY COULD CONTINUE WITH INJECTIONS EVERY THREE MONTHS FOR AS LONG AS IT HELPS. AND THEY SHOULDN’T –>>SO THERE IS NO WORRY ABOUT HOW LONG YOU USE CORTISONE.>>NO, NOT IN A SMALL JOINT LIKE THE THUMB.>>AND WHAT — WHAT TYPE OF SURGERY WOULD HE BE A CANDIDATE FOR THEN?>>HE WOULD HAVE TO SEE A HAND SURGEON, BUT THERE’S NOT MANY HAND SURGEONS THAT DO ANY KIND OF — HE COULD PROBABLY GET A FUSION OF THE JOINT BUT THAT’S PROBABLY IT.>>BUT MAYBE STICKING WITH THE CORTISONE IS THE BEST AT THIS POINT?>>IF HE IS AN OLDER GENTLEMAN, STICKING WITH A STEROID SHOT FOR AS LONG AS IT HELPS HIM IS PROBABLY GOOD.>>OKAY. LET’S TAKE ANOTHER PHONE CALL. WE HAVE NANCY CALLING IN FROM CALGARY. GOOD EVENING, NANCY.>>Caller: GOOD EVENING. I WAS VERY INTERESTED IN YOUR PRESENTATION TONIGHT. I’M 62 YEARS OLD, A RETIRED NURSE. AND WHEN I COULD NO LONGER GET UP FROM EMPTYING CATHETER BAGS, I DECIDED IT WAS TIME TO PACK IT IN. I’VE HAD 20 YEARS OF OSTEOARTHRITIS AND 13 YEARS OF RHEUMATOID ARTHRITIS. AND MY QUESTION IS — BECAUSE I HEAR THE BIOLOGICS BEING MENTIONED AS WELL AS THE METHOTREXATE. AND THEN I WAS ON ANOTHER DRUG THAT DIDN’T DO TOO MUCH FOR ME. AND THEN I WAS ON METHOTREXATE, AND THEN I HAD ULCERATIONS IN MY NOSE AND I WAS NOT ATTENDED TO PROPERLY, IN MY OPINION, SO I MYSELF TOOK OFF METHOTREXATE. IN ALBERTA, YOU HAVE TO HAVE FAILED METHOTREXATE AND/OR IRAVA OR HAVE BEEN ABLE TO TAKE ONE OR THE OTHER IN ORDER TO BE STARTED ON BIOLOGICS. SO I CAN’T ESCAPE THE NEXT TRIAL BEING IRAVA BEFORE I GET THE CHANCE TO TRY THE BIOLOGICS. I HAVE HAD ARTHROPLASTY OF MY LEFT HAND AND FIRST, SECOND, THIRD METATARSAL FUSION RIGHT LEFT AND I’M HEADED FOR THE LEFT FOOT IN JANUARY. I’M ACTUALLY QUITE MOBILE BUT I HAVE DONE AQUACISE. BUT THE WATER HAS STOPPED ME FROM GOING TO THAT PARTICULAR PROGRAM. BUT I WAS JUST INTERESTED IN WHAT YOU MIGHT HAVE RELATIVE — WHAT YOUR THOUGHT IS RELATIVE TO THE MEDICATIONS HOW THAT DIFFERS WITH THE AMERICAN SYSTEM. IS IT NECESSARY FOR SOMEONE TO BE ON EITHER IRAVA, METHOTREXATE , ALSO TO BE ON THE BUY BYE-BYE — BIOLOGICS.>>BOY, A LOT GOING ON THERE. LET’S BREAK IT DOWN. OBVIOUSLY THE SYSTEM IN CANADA, DIFFERENT FROM THE SYSTEM IN THE UNITED STATES.>>I WOULD SAY IN A LOT OF CASES USUALLY THEY WILL REQUIRE TRYING SOME OTHER MEDICATIONS AT LEAST FIRST IN MANY CASES. AND CERTAINLY I CAN SPEAK TO THAT A LITTLE MORE, TOO. BUT THERE ARE, AS WE BROUGHT UP, THE DIFFERENT OPTIONS, TOO, BOTH FROM HOW THEY WORK AND SOME OF THE DIFFERENT SIDE EFFECTS ALSO AND EVEN IRAVA CAN HAVE ITS SIDE EFFECTS. SOMETIMES IT, WOULDS WELL, AT LEAST SOME OF THE PATIENTS I’VE HAD, TOO. SOMETIMES IT CAN BE WORTH — THE TRY HAS SOME TOXICITIES TO IT CERTAINLY AND THAT’S WHERE THEY HAVE GONE TO THE BIOLOGICS, HAS SOME ADVANTAGES. CERTAINLY FROM YOUR PERSPECTIVE BECAUSE YOU ARE DEALING WITH IT ON A DAY-TO-DAY BASIS.>>SHE’S TRYING TO TREAT ARTHRITIS ALSO.>>SHE SHOULD SAY INJECTABLE METHOTREXATE FIRST. THAT DOES NOT CAUSE MUCOCUTANEOUS SIDE EFFECTS.>>THAT’S WHERE THE ULCERS IN NOSE CAME FROM.>>CORRECT. THAT’S MIGHT BE APPROPRIATE. AND HERE IN THE UNITED STATES DEPENDING ON PATIENTS’ INSURANCE, SOMETIMES WE CAN BYPASS MEDICATIONS — SOME OF THE DEMARS AND GO TO SOME OF THE THERAPY WITH BUY LOGICS. SOMETIMES WE CANNOT. IT IS ALSO A LITTLE BIT OF A GAME AND IT DEPENDS ON THE PATIENT’S CASE. SOMETIMES IF THEY’RE NOT A CANDIDATE FOR METHOTREXATE BECAUSE THEY HAVE LUNG FIBROSIS AND I WOULDN’T BE ABLE TO START THE METHOTREXATE — EACH PATIENT IS DIFFERENT. SO SOMETIMES YOU HAVE TO START WITH THE BIOLOGIC BECAUSE THEY CAN’T TAKE ANYTHING ELSE. SOMETIMES THE INSURANCE IS NOT AN ISSUE. YOU JUST NEVER KNOW.>>MAYBE THAT’S SOMETHING YOU CAN TALK ABOUT, ALSO, JOHN, IS THOSE COMPLICATIONS THAT CAN COME INTO PLAY WHEN PATIENTS ARE JUST WANTING RELIEF AND THEN THEY RUN INTO THESE STUMBLING BLOCKS.>>YES. THIS COLLEGE EXPERIENCE IS SOMETHING I HAVE BEEN THROUGH. I TRIED EVERYTHING. AND I HAD REACHED THE END OF MY ROPE AND METHOTREXATE, PREDNISONE, VIRTUALLY EVERYTHING EXCEPT GOLD SHOTS. AND I HAVE NEVER HAD THOSE BUT THAT WAS THE STANDARD REMEDY AND MAY STILL BE USED AS FAR AS I KNOW. IT WASN’T UNTIL I WAS ABLE TO GET ON TO THE BIOLOGICS THAT MY LIFE TURNED 180 DEGREES. BUT THE BIG THING WAS THE EXPENSE. AND I THINK THAT’S A STUMBLING BLOCK. I THINK THAT’S WHY INSURANCE COMPANIES AND OTHERS FORCE YOU TO GO THROUGH THIS PROGRESSIVE TREATMENT. AND SOMETIMES IT’S A GOOD THING, I SUPPOSE. BUT IN OTHER RESPECTS, IT CAN BE A STUMBLING BLOCK TO HAVING ADEQUATE TREATMENT BECAUSE OF THE COST. THEY ARE VERY EXPENSIVE DRUGS. THEY CAN RUN $20,000 A YEAR EASILY. AND A PERSON’S INSURANCE DOESN’T COVER THAT OR THE COPAY IS A PERCENTAGE AS OPPOSED TO A FLAT DOLLAR, IT CAN BE COST PROHIBITIVE. SO BEING PUT THROUGH THE HOOPS MAY BE THE ONLY WAY TO GET TO THIS. AND IT IS DIFFICULT TO KNOW THAT SOMEONE IS SUFFERING BUT SOMETIMES IT IS JUST SOMETHING THAT WE GO THROUGH TO GET THE TO NEXT PHASE. MAYBE SHE CAN BYPASS THAT IN CANADA. I THINK HERE IN THE UNITED STATES, WE’RE CONFRONTING IT IN CONGRESS RIGHT NOW. PATIENT ACCESS TO TREATMENT ACT WHEREBY WE’RE TRYING TO TAKE DRUGS OUT OF A CERTAIN TIER TO MAKE THEM MORE AFFORDABLE TO THE PATIENT. SO COST IS A BIG ISSUE IN THE TREATMENT WITH BIOLOGICS. THAT I KNOW.>>ANOTHER PHONE CALL COMING IN. THIS ONE FROM JOHN HERE IN SPOKANE. HI, JOHN.>>Caller: HI. MY PROBLEM — I HAVE ARTHRITIS, ALSO, IN MY KNEES AND MY HANDS AND MY BACK. I’M FINDING A LOT OF RELIEF WITH HEAT, JACUZZI HEAT, WATER THERAPY. MY INSURANCE COMPANY WILL COVER FOR ME FOR A RAMP. THEY WILL GIVE ME A WHEELCHAIR. THEY WILL GIVE ME CANES. THEY WILL MODIFY MY BATHROOMS AND EVERYTHING. BUT FOR SOME REASON THEY DON’T BELIEVE — I GUESS THEY DON’T BELIEVE THAT THE HEAT THERAPY FOR, LIKE, THOSE NEW WALK-IN TUBS WITH THE JACUZZI JETS AND THE HEAT OR EVEN A JACUZZI IS, TO ME, SEEMS AT MY POINT, AT MY AGE, IS VERY COMFORTABLE FOR ME AND IT IS AN EVERYDAY THERAPY FOR ME AT HOME. BUT THEY DON’T SEEM TO WANT TO COVER THAT EXPENSE. I HEAR THEY WILL COVER THE BIOLOGICAL DRUGS AND EVERYTHING ELSE AT MAJOR COST. BUT FOR AN EVERYDAY PERSON WHO JUST WANTS RELIEF, I’M FINDING, LIKE I SAID, THE JACUZZI HEAT, THE WATER THERAPY — I’M THINKING ABOUT BUYING ONE OF THOSE NEW WALK-IN, SIT-DOWN WATER TUB THINGS JUST BECAUSE I WANT THE EVERYDAY RELIEF. AND I HAVE A PROBLEM THAT THE INSURANCE COMPANIES WILL NOT COVER THAT. THEY THINK IT IS MORE ENTERTAINMENT THAN THEY THINK IT IS THERAPEUTIC. AND I HAVE TROUBLE WITH THAT.>>YEAH, IT CERTAINLY IS A BATTLE. YOU NEED TO KEEP FIGHTING, JOHN. THANKS SO MUCH FOR YOUR COMMENTS TONIGHT. AGAIN, THAT’S WHAT’S WORKING FOR JOHN. AND WE DO FIND — AND WE MENTIONED THE WATER THERAPY AND THE HEAT AND THE WARMth HELPED THAT OUT. DOES THAT HELP YOU, JOHN?>>ABSOLUTELY. IN FACT, I DO HAVE A JACUZZI OUTDOOR SPA. I HAVE HAD ONE FOR MANY, MANY YEARS. AND I USE IT AT LEAST ONCE A DAY, TWICE MORE OFTEN THAN NOT. IT IS PALLIATIVE THERAPY, NOT CURATIVE BUT IT PROVIDES RELIEF. I UNDERSTAND USING A JACUZZI SPA OR LONG DISTANCE SWIMMING, WATER THERAPY IS ONE OF THE BETTER WAYS TO DEAL WITH A CHRONIC DISEASE DAY IN AND DAY OUT. ALSO HEAT THERAPY IS BENEFICIAL. SO YOU CAN PUT THE HEAT AND WATER TOGETHER. YOU CAN DERIVE A LOT OF BENEFIT JUST FROM THAT.>>DO YOU FIND THEN THIS TIME OF YEAR, JOHN, WHERE OUR TEMPERATURES ARE SO COLD TO BE MORE DIFFICULT FOR YOU?>>NO. IT MAY BE TRUE FOR OSTEOARTHRITIS PATIENTS, BUT I HAVE NOT NOTICED THAT. I CERTAINLY TRIED OVER THE COURSE OF THE TIME I HAVE HAD THIS, WHICH HAS BEEN A LONG TIME, FIND CORRELATIONS, TWEAKING THIS, DOING THAT. I HAVE NOT FOUND THAT WEATHER IS A FACTOR IN MY OWN PERSONAL DAILY ROUTINE. BUT I THINK THE THING THIS CALLER HAS POINTED OUT IS SOMETHING THAT I WISH INSURANCE COMPANIES WOULD COVER BECAUSE I THINK IT DOES PROVIDE RELIEF. SO UNTIL THERE IS A CURE FOR NOT ONLY RHEUMATOID ARTHRITIS BUT OTHER FORMS WE WILL HAVE TO DEAL WITH IT WITH MEDICINES, WITH HYDROTHERAPY AND THINGS LIKE THAT TO HAVE A QUALITY OF LIFE LIKE DR. MUNTEAN SAID.>>OKAY. LET’S TAKE ANOTHER PHONE CALL. WE HAVE RENEE IN SPOKANE. GOOD EVENING, RENEE.>>Caller: HI.>>DO YOU HAVE A QUESTION FOR OUR PANEL?>>Caller: I DO. I WANT TO KNOW IF ARTHRITIS — IF SOME KINDS OF ARTHRITIS ARE NOT DETECTED IN BLOOD — YOU KNOW, WHEN THEY DO A BLOOD TEST TO SEE? BECAUSE I HAVE BEEN TESTED FOR ARTHRITIS AND, OF COURSE, WITH A BLOOD TEST AND I’M NEGATIVE BUT YET I HAVE ARTHRITIS. I KNOW I DO. AND MY OTHER QUESTION IS: WHAT ELSE CAN THE DOCTORS DO? CAN I SEE A — I SEE A DOCTOR REGULARLY. WHAT ELSE CAN THE DOCTORS DO TO FIND OUT IF I HAVE ARTHRITIS?>>THAT’S A VERY INTERESTING QUESTION BECAUSE HOW IS IT DIAGNOSED IF NOT THROUGH A BLOOD TEST.>>IT IS CLINICAL. THIS IS A VERY COMMON COMPLAINT. THIS IS — I GET PATIENTS LIKE RENEE EVERY DAY. THEY HURT. THEY ARE IN PAIN. AND THEIR SYMPTOMS ARE REAL. THE DIFFERENCE IS ARTHRITIS STANDS FOR SWOLLEN JOINTS. PAIN, IT IS A DIFFERENT SYMPTOM. SWOLLEN JOINTS CAN CAUSE PAIN. BUT WHAT WE’RE LOOKING FOR IN ORDER FOR ME TO SAY THAT SOMEONE HAS ARTHRITIS, I’M LOOKING FOR SWOLLEN JOINTS. IF I DON’T SEE SWOLLEN JOINTS, WHEN I DO THE EXAM AND WHEN I TAKE THE HISTORY, I’M ASKING THEM HOW MUCH MORNING STIFFNESS THEY HAVE, I’M LOOKING FOR A CERTAIN HISTORY, I’M ASKING THEM CERTAIN THINGS. IF I DON’T HEAR THAT, I’M ACTUALLY REALLY NOT LOOKING AT BLOOD TESTS FOR THAT. I DON’T REALLY DIAGNOSE MOST OF THE DISEASES BY BLOOD TESTS. IT IS HISTORY AND PHYSICAL EXAM. SO I DEPEND ON QUESTIONS AND LOOKING AT MY PATIENT AND ALL MY PATIENTS ARE IN SHORTS AND I LOOK AT THEM AND I FEEL EVERY SINGLE JOINT. AND THAT’S HOW I DIAGNOSE THEM. SO IF SHE’S IN PAIN, SOMETIMES IF THERE’S NO SWOLLEN JOINTS, THE PAIN CAN BE BECAUSE SHE HAS OSTEOARTHRITIS. SHE COULD HAVE FRIDAY BRIE — FIBROMYALGIA OR A DIFFERENT UNDERLYING SIS — DISEASE. ARTHRITIS STANDS FOR SWOLLEN JOINTS EXCEPT IN OSTEOARTHRITIS. WE REALLY DON’T KNOW HOW THAT ONE SNUCK IN THERE. [ LAUGHTER ] IT HAS ARTHRITIS AT THE END BUT MOST OF THE TIME IT IS NOT AN INFLAMMATORY DISEASE.>>HOW IS THAT ONE DIAGNOSED THEN?>>USUALLY WE SEE NO SWELLING AND IT HAS CERTAIN FEATURES TO IT. AND IT IS IN A CERTAIN POPULATION SO IT IS USUALLY AN OLDER PERSON, USUALLY IN THEIR 60s. AND WE’RE LOOKING FOR CERTAIN FEATURES, CERTAIN DEFORMITIES AND CERTAIN JOINTS, USUALLY THE KNEES, HIPS AND CERTAIN JOINTS IN THE HANDS. IT IS USUALLY THE BASE OF THE THUMB AND USUALLY THE TIPS OF THE FINGERS. SO IT IS CERTAIN JOINTS. SO WE LOOK AT THE DISTRIBUTION OF THE JOINTS.>>ALL RIGHT. WELL, WE HAVE TALKED A LOT ABOUT ARTHRITIS. WE ALSO WANT THIS EVENING TO GIVE YOU AN UPDATE ON WHAT’S GOING ON WITH THE AFFORDABLE CARE ACT BECAUSE HERE AT “HEALTH MATTERS” WE ARE COMMITTED TO LETTING YOU KNOW WHAT IS GOING ON WITH THE AFFORDABLE CARE ACT. AND THERE ARE A FEW UPDATES THAT WE CAN APPRISE YOU OF. A FIVE-WEEK TECH SURGE HAS GREATLY IMPROVED. WE KNOW THE CAPACITY OF THE ONLINE INSURANCE PORTAL WHICH IS CRUCIAL TO HELPING MILLIONS OF PEOPLE SHOP FOR INSURANCE PLANS, NOW WE HAVE A COUPLE OF KEY DATES THAT ARE COMING UP. THESE ARE IMPORTANT. IN ORDER TO HAVE INSURANCE ON JANUARY 1st, THE DEADLINE TO SIGN UP FOR COVERAGE ON THE FEDERAL SITE IS DECEMBER 23rd. THERE IS EXPECTED TO BE A SURGE OF USERS ON THAT SITE AS THAT DEADLINE APPROACHES, POSSIBLY CAUSING SOME DELAYS. SO YOU NEED TO BE PATIENT. IF YOU’RE USING THE WASHINGTON HEALTH PLAN FINDER WEB SITE OR ARE APPLYING OVER THE PHONE OR IN PERSON, YOU DO HAVE SOME EXTRA TIME NOW. THIS IS BRAND-NEW. ANYONE WHO BEGINS AN APPLICATION BEFORE DECEMBER 23rd WILL GET AS MUCH HELP AS THEY NEED TO FINISH AND WILL NOT FACE A REAL DEADLINE UNTIL JANUARY 1st. SO IF YOU ARE NOT SIGNED UP BY THE DECEMBER 23rd DEADLINE, YOU STILL HAVE TIME TO ENROLL. YOU JUST WILL NOT HAVE COVERAGE ON JANUARY 1st. AND THE OPEN ENROLLMENT, OF COURSE, WILL CONTINUE UNTIL MARCH 31st OF 2014. SO THAT IS OUR UPDATE ON THE AFFORDABLE CARE ACT. AND AS FAR AS OUR DISCUSSION ON ARTHRITIS, I WANT TO THANK OUR PANEL SO MUCH FOR BEING HERE. LOTS OF INFORMATION AND A LOT OF GREAT CALLS THIS EVENING. SO, AGAIN, THANK YOU SO MUCH FOR BEING HERE FOR OUR DISCUSSION. AND THAT WILL DO IT FOR THIS SHOW. WE ARE BACK ON JANUARY 16th WHEN OUR TOPIC WILL BE MENTAL HEALTH, A VERY IMPORTANT ONE RIGHT NOW. SO UNTIL THEN, THANK YOU FOR WATCHING “HEALTH MATTERS.” I’M TERESA LUKENS. GOOD NIGHT. “HEALTH MATTERS” IS MADE POSSIBLE BY OUR VIEWERS, THE FRIENDS OF KSPS AND BY PROVIDENCE HEALTHCARE.>>I’M ARNIE PETERSON, I’M AN ORTHOPEDIC SURGEON. AND I WORK IN THE SACRED HEART PROVIDENCE MEDICAL GROUP. WHEN I NEEDED MY HIP REPLACED, I CHOSE PROVIDENCE BECAUSE OF THE PROFESSIONALLALLISM AND THE CARE I KNEW I WOULD RECEIVE. I NEVER THOUGHT TWICE ABOUT GOING ANYWHERE ELSE.>>I’M GREG FRIESEN AND I WORK AT HOLY FAMILY HOSPITAL SURGICAL MEDICAL ADMIT UNIT. WHEN I NEEDED HERNIA SURGERY, I CHOSE PROVIDENCE. I TRUSTED THE DOCTORS. I TRUSTED THE NURSES. I WORKED WITH THEM AND HAD FULL CONFIDENCE I’D BE TAKEN CARE OF. CLOSED CAPTION PRODUCTIONS
– www.ccproductions.com –

Leave a Reply

Your email address will not be published. Required fields are marked *