27 years young. That was the age I was diagnosed with grade 4 osteoarthritis in my hips.
Below are my deep dive notes and action plan on how to treat arthritis.
Takeaways
- Stop consuming a few alcoholic drinks casually.
- Sign up for a Movati gym membership.
- Sauna, pool aqua fitness, Yin Yoga, Tai chi, meditation, weight room
Goals
Short Term
- Regain full ROM and strength after hip surgery. Maybe increase it from the baseline.
- Bike to work after the Christmas break pain-free.
- Build a team of health professionals
- Naturopath: Rachelle
- 550$/year with 80$/appointment
- Comprehensive blood panel for general health
- Food sensitivity testing (if scientifically validated)
- Supplement recommendations
- Nutrition advice
- Personal trainer: Movati?
- Psychotherapist: Bara
- 2000$/year with 200$/appointment
- Acupuncture specialist:
- 550$/year with 80$/appointment
- Medical acupuncture for osteoarthritis
- Ergotherapy:
- 550$/year with 80$/appointment
- Maybe custom-made equipment
- Osteopath:
- 550$/year with 80$/appointment
- Podiatrist:
- Orthodics
- Custom made shoes
- Massage therapist: Michael
- 550$/year with 80$/appointment
- Arthritis specialist:
- Family doctor: Archie
- Surgeon: Dr. G.
- Physiotherapist: Dhiya & Leo
- 3000$/year with 100$/appointment
- Chiropractor: Dimitri & Jonathan & Beechwood
- 550$/year with 80$/appointment
- Naturopath: Rachelle
Long Term
- Play with children in old age.
- Delay hip replacement till 55 if not prevent the need for it completely.
- Live a happy, relatively pain-free, rich life full of friends, yoga, meditation, board games, poker, racket sports, fitness classes, biking and walking to work, teaching, writing, a family, coaching sports etc.
Notes
FAI & Osteoarthritis
- “Repeated abnormal contact due to FAI can damage the cartilage, leading to a condition called hip osteoarthritis. Osteoarthritis is the degeneration of joint cartilage and the underlying bone, causing pain, stiffness, and reduced joint mobility. If left untreated, the damage caused by FAI can contribute to the development of osteoarthritis in the hip joint.”
- “In general, we think there are many potential causes of hip arthritis. First, increased age and weight are the leading causes. Other possible causes include traumatic injuries to the hip joint and abnormally shaped joints such as hip impingement or hip dysplasia. Finally, there may be a genetic influence, meaning osteoarthritis runs in the family.” (Source)
Dietary Modifications
- Reducing:
- Alcohol
- Processed foods
- Sugar
- Red meat
- Emphasizing
- Vegetables
- whole grains
- Fruits
- May restrict eating between 7 am and 7 pm.
Supplements
- Glucosamine and Chondroitin are popular choices (effectiveness is debated) (Costco)
Hot & Cold Therapy
- Sauna at Movati Gym
- Ice pack
Movement
- We allow an exercise if the pain during or after the exercise is low-level and lasts less than 24 hours.
- Regular low-impact exercises like:
- Physical therapy
- Swimming
- Cycling
- Yoga
- Tai Chi
- Resistance exercises
- Aerobic exercises
- Balance exercises
- Walking is not recommended when the arthritis is severe.
- Maintaining a healthy weight can reduce stress on your hips.
- My weight hovered around 180 +- 5 lbs last decade.
- Physical therapy can provide tailored exercises to improve mobility, and balance, and reduce pain.
- “Over 12 high-level studies show that a formal exercise program consisting of a combination of aerobic, resistance, and balance training improves hip symptoms. Occasionally, flare-ups of pain occur within the first six weeks of starting a new program. But don’t be put off by episodes of short-lived low-level pain.” (Source)
Environmental Changes
- “For people with autoimmune forms of arthritis like rheumatoid arthritis (RA), environmental factors, including allergens, could potentially trigger or worsen flare-ups. While the exact relationship between allergens and arthritis is not fully understood, some research suggests that the immune response triggered by allergens might contribute to inflammation, which could aggravate arthritis symptoms.” Chat GPT
- Buy an air purifier for our apartment with two cats. (Costco)
Injections
We recommend a cortisone injection for good short-term relief for severe and excruciating pain. However, for your long-standing grumbly pain, we advise a high molecular-weight hyaluronic acid such as Durolane.
Injections for Hip Arthritis: Which One Is Best?
- Cortisone Shots:
- “For example, one study in the UK found that a cortisone shot into the hip joint directed by ultrasound improved pain for four months compared to simple education. Also, cortisone injections were relatively safe if done with good hands. On the contrary, another study found that 50% of patients with hip arthritis derived short-term benefits only (about two weeks), while 30% obtained medium-term relief and 20% had no relief.
- However, there are increasing concerns that cortisone can worsen arthritis.
- Also, you should be cautious about having a cortisone injection just before a hip replacement. Recent research suggests an increased risk of infection if a replacement is done within three months of injection. Also, multiple cortisone injections increase the risk of worse hip joint arthritis. As a hip replacement infection can be devastating, we must avoid injecting cortisone before surgery.” (Source)
- Hyaluronic Acid:
- “Hyaluronic acid is a natural substance in joints, bones, and tendons.
- Injecting hyaluronic acid into a diseased joint reduces inflammation and improves the function of the joint. We suspect it works by enhancing the synovial fluid in the joint. However, unlike cortisone, it is not harmful to the joint surface.
- Recent studies suggest a small effect, which may be no different from other drugs. One reason for the smaller effect is the type of hyaluronic acid used. Using a high molecular weight and high cross-linked hyaluronic acid is better. An example of a high molecular weight hyaluronic acid is Durolane.” (Source)
- PRP:
- “While there is good evidence for PRP in knee arthritis, the data is lacking for hip arthritis.” (Source)
- Stem Cells:
- “Unfortunately, there has been no strong evidence to support stem cells for hip arthritis.” (Source)
- “Some studies and clinical trials have explored the use of stem cells in the treatment of hip arthritis, aiming to promote tissue repair and reduce inflammation. These studies have shown varying degrees of success, but more research is needed to determine the long-term safety and efficacy of stem cell therapy for hip arthritis.” Chat GPT
Surgical Procedures
- “Options for surgery include:
- Hip arthroscopy: Keyhole surgery is generally NOT recommended to treat hip arthritis. If we do keyhole surgery for hip arthritis, we know these people do worse and often go on to replacement surgery earlier than those who do not.
- Total hip replacement:* This is still the gold standard treatment for hip replacement. It has an over 90% success rate. We remove and replace cartilage with a metal and plastic implant in this surgery.
- Hip resurfacing:* Some younger patients opt for a resurfacing rather than a total replacement. There are advantages to resurfacing, including less dislocation risk and a more straightforward revision procedure. However, over 60 years, women and those with inflammatory arthritis should consider a standard hip replacement.” (Source)
Potential Treatments
- “While there is some preclinical and animal research suggesting that CBD may have anti-inflammatory and pain-relieving properties, large-scale clinical trials specifically focused on CBD for arthritis are limited. More research is needed to establish its safety and effectiveness for arthritis in humans.” Chat GPT
Massage Therapy
Acupuncture
- Medical acupuncture for osteoarthritis
- Weak evidence so only go if it’s covered and feels good.
Pain & Emotions
- “Although it may feel like it’s coming from your joints, pain – particularly the chronic pain common to arthritis – is also an expression of your state of mind.” (Source)
- “Chronic pain and emotions are so intertwined, in fact, says psychiatrist and palliative medicine physician David Buxton, MD, that’s it’s often hard to tell where one ends and the other begins. People with depression, for example, have about three times the risk of those without it of developing chronic pain. And, those with chronic pain have about the same increase in risk for winding up with clinical depression.” (Source)
- “Multiple studies of osteoarthritis, rheumatoid arthritis, lupus and fibromyalgia show that people who experience more negative emotions also report more pain. Not surprisingly, people with these conditions also have substantially higher rates of depression and other mood problems compared with those without arthritis and related conditions.” (Source)
- ““Our level of fear of pain and the narrative we tell ourselves about pain can influence how our brain learns to deal with it across time,” explains Wager.” (Source)
- “Many studies show that patients who have a strong sense of control experience less pain, fatigue and disability than those who feel powerless.” (Source)
- Connects with Paul Conti Agency and Gratitude.
- Connects with Lisa Feldman Barrett’s constructivist view of pain.
- “Positive and negative expectations and beliefs change brain chemistry, explains Lauren Atlas, PhD, who heads the section on affective neuroscience and pain at the National Institutes of Health. Positive beliefs stimulate the production of pain-blocking chemicals like endogenous opioids and dopamine. Negative beliefs trigger the release of an anxiety-provoking hormone called cholecystokinin (CCK). Not only does CCK make you feel bad, it also blocks the effectiveness of pain treatments, creating a downward spiral.” (Source)
- “There’s the story of a young man who was a serious rock climber. After his PsA diagnosis, he stopped climbing because he lost some of the grip strength in his hands. So, he took up surfing instead. That’s what taking control is all about — remembering that you are not your disease and there are different ways to continue having a fulfilling and productive life.” (Source)