Don’t let joint pain hold you back

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Brooke Mobley and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Brooke Mobley.

CARMENN MILES
Hello, everyone, and thank you so much for joining us today on the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles, and I'm excited to jump into another great conversation centered around health and wellness topics that really matter, especially for our seniors. If you're listening in for the first time, you can find this podcast on any podcast listening platform. We're also available on the radio in several Texas markets, and each week we share practical health information that hopefully helps all of us live healthier, happier lives. We're thrilled that you're tuning in today. We have a great topic for discussion. Living well with osteoarthritis, understanding and managing joint pain. Before we get started, let me take a moment to introduce my co-host for today, Dr. Brooke Mobley. Dr. Mobley graduated from Xavier University in Louisiana, where she obtained a master's in business administration from Saint Joseph's Hobbs School of Business and Doctrine of Osteopathy from Philadelphia College of Osteopathic Medicine. Dr. Mobley began her nephrology career in Lake City, Florida, where she established a renal disease clinic and served as the medical director of a dialysis clinic for DaVita Kidney Care. Just over 10 years ago, she relocated to Tampa, Florida, where she started her hospitalist career with Optum. Today, she is the medical director of Post Acute Care. Hello, Dr. Mobley, how are you?

DR. BROOKE MOBLEY
Hello. I am doing great as usual. Looking forward to hearing about this topic, considering as we all age, it eventually becomes something that we all deal with.

CARMENN MILES
Absolutely. I'm excited to hear your insight on the topic. Let's introduce our esteemed guests today, Dr. Shelby Valero from WellMed at Division, located in my hometown of San Antonio, Texas. Dr. Valero serves on the board of directors for the Texas chapter of the American College of Sports Medicine as a health professional representative. Dr. Valero's clinical interests include sports medicine, obesity management, and diabetes care. Areas in which she says she is passionate about helping patients achieve healthier, more active lives. She's earned her Doctor of Osteopathic Medicine at the University of the Incarnate Word School of Osteopathic Medicine and completed her residency at the Texas Institute for Graduate Medical Education and Research. Dr. Valero practices osteopathic manipulative treatment, or OMT, which involves diagnoses and treatment of musculoskeletal dysfunctions. OMT can be effective in treating conditions like lower back pain, constipation, and headaches, by reducing pain levels and promoting natural healing processes. I love that. She currently lives in San Antonio with her husband and daughter. Reading fiction, playing guitar, caring for our house plants, and spending quality time with her family and dogs are Dr. Valero's favorite pastimes. Hey Dr. Valero, you'll have to share some tips with me on how to keep plants alive. I quite do the opposite. Welcome to the show.

DR. SHELBY VALERO
Thank you for having me. I'm happy to be here.

CARMENN MILES
Absolutely. Well, as I said, everyone, we have a great health topic for you today. Dr. Valero is going to share her medical insight on how to live well with osteoarthritis, understanding and managing joint pain. This is a condition that affects millions of people worldwide, including myself. If you've ever experienced joint pain stiffness first thing in the morning when getting out of bed or difficulty climbing stairs, osteoarthritis, also referred to as OA, could be the culprit. I have a question, Dr. Valero. Many people describe osteoarthritis in particular as the wear and tear arthritis. I understand that the mechanical stress on your joints absolutely plays a role, but we now know that osteoarthritis is a little bit more complex than just general wear and tear. So, tell us, Dr. Valero, just what is osteoarthritis and how is it diagnosed?

DR. SHELBY VALERO
You're right, it is often referred to as a wear and tear condition or a degenerative condition that occurs over time. Essentially what happens is you have a rubbery cushion inside of your joint called cartilage. This can gradually wear down over time with excessive amounts of force. So, cartilage normally allows bones to glide smoothly against each other, but when it breaks down, bones can rub closer together and that will cause pain, stiffness, swelling, generalized inflammation. It most commonly affects, knees, hips, hands and spine. So, when it comes to diagnosis, it's actually a clinical diagnosis. A lot of patients, think that we need imaging or specialist referrals. When in fact, it's just a matter of taking a good history and physical exam. So, if you have pain that worsens with activity, such as, like you'd mentioned, climbing stairs or walking, improves with rest, and morning stiffness lasting less than 30 minutes, in an asymmetrical distribution, you're over age 50, then boom, you likely have osteoarthritis.

CARMENN MILES
Very good definition. That's well stated. Let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. Our podcasts are available wherever you listen to your favorite podcast. We're also available on the radio in several Texas markets. I'm Carmenn Miles alongside co-host Dr. Brooke Mobley and our guest today, Dr. Shelby Valero. Today we're discussing osteoarthritis and how to best manage the condition. Dr. Mobley, did you want to add on to what Dr. Valero shared with us regarding just what osteoarthritis is and how it's diagnosed?

DR. BROOKE MOBLEY
I think she did an amazing job of describing what it is and giving patients typical symptoms to look for. You think of osteoarthritis as something that occurs older and age, but understanding that it's a wear and tear, people who have wear and tear on their joints prematurely from sports, professional athletes, dancers, things of that nature. People who hiked starting at a very young age. If you are doing those things, you're putting wear and tear on your joints sooner than, say, the average person. So, sometimes in that patient population, they can expect symptoms earlier than the average patient. So, they may start seeing signs of osteoarthritis like myself early on, causing for different treatments at a young age of 30 or 40 rather than something that affects you at 60 or 70 years old.

DR. SHELBY VALERO
That's absolutely right. If you are a professional athlete or doing much more rigorous activity for a prolonged period of time, you might experience symptoms sooner. If you have any sort of anatomical abnormalities like hip dysplasia or a shallow hip socket, that also puts you at risk for experiencing it earlier in life.

DR. BROOKE MOBLEY
Dr. Valero, I have a question. It's something that came up for me recently. I had some back issues and was diagnosed late in life for hyperextension mobility disorder, or in layman's terms, double jointed. A lot of times people look at those things as not necessarily bad, but my rheumatologist let me know that it did predisposes me for osteoarthritis and other joint issues. Can you speak to any of that for that very small patient population?

DR. SHELBY VALERO
Yeah. Again, anything that's going to affect biomechanics or the mechanical load on your joint. So, whether that be excess laxity in or around your joints from diseases that affect the cartilage, that can result in abnormal mechanics that can unfortunately place a little more pressure on joints kind of everywhere in the body, the spine, the knees, the hips, and predispose you to that cartilage wearing down faster. So, that's kind of how that disease process plays into your potential development of osteoarthritis. It's not definitive for anybody, but it could happen.

CARMENN MILES
All right. Good. You mentioned the most common sights include your knees, hips, hands and lower back. I'm curious to know, especially for myself. Obviously, these the symptoms usually develop gradually over time. Is this something that is that could affect the younger individuals? Is there any type of genetic scenario that plays into this? I also want to know, these are not even related, why is the stiffness seemingly at its peak, at least for me, first thing in the morning when I wake up? Those are the two questions that I have or have.

DR. SHELBY VALERO
Good questions. I'm happy to answer those. As far as risk factors, you have modifiable and non-modifiable risk factors. That goes for any disease process, but for OA, some of the things that can't be changed are age. Like we discussed, just due to prolonged wear and tear. Women are at higher risk than men particularly for knee osteoarthritis. We don't really understand why. It could be due to joint alignment, body composition, but there you have it. Genetics do contribute to OA. There's about a 40 to 80% genetic influence in hand and hip OA, rather than knee OA. Knee OA tends to be less genetically predisposed. As we had discussed, any sort of joint shape abnormalities like hip dysplasia can also predispose you to osteoarthritis. A very important modifiable risk factor is body weight. It's actually the most impactful modifiable risk factor. Being obese will increase your risk of osteoarthritis more than three times. So, that is something that can absolutely be adjusted with lifestyle changes. It is important to address if you are experiencing osteoarthritis and experiencing pain from that condition. So, hopefully that answers that part of the question.

CARMENN MILES
It does.

DR. SHELBY VALERO
You mentioned the morning stiffness. Why does that happen? I usually tell patients to think of a joint like a door hinge. The smooth cartilage cushions the joint, wears down over time, and it can produce an amount of lubricating fluid or synovial fluid similar to oil in a hinge. So, when the joint stays still for a long time overnight, that fluid can settle and it can thicken. During your sleep, your joints arenÕt moving around. The lubricating fluid inside isn't being circulated so it can become thicker and make the joint feel stuck or stiff when you're first trying to move, and you can have some swelling that accumulates. You're not moving and pumping that fluid away, so small amounts of swelling can build up around the joint.

CARMENN MILES
Very good. We need to take just a quick break, but please stay with us as we continue this great discussion on osteoarthritis or OA. You're listening to Docs in a Pod presented by WellMed. We'll be right back.

AD
For over 35 years, WellMed has redefined health care for older adults and people on Medicare. We're physician led and nationally recognized as an Age-Friendly Health System. Our doctors take time to listen and support your unique needs, working with Medicare and select Medicare Advantage plans to keep you healthy and independent. With 24/7 nurse support, telemedicine, in-home, and office visits, care is always within reach. WellMed. Compassionate care, proven results. Visit wellmedhealthcare.com to learn more.

CARMENN MILES
We're back on Docs in a Pod. I'm your host, Carmenn Miles, with co-host Dr. Brooke Mobley and our guest today, Dr. Shelby Valero from WellMed at Division in San Antonio, Texas. Dr. Valero practices osteopathic manipulative treatment, or OMT, which involves diagnoses and treatment of musculoskeletal dysfunctions. OMT can be effective in treating conditions like lower back pain, constipation, headaches, by reducing pain and promoting natural healing processes. I'm curious, Dr. Valero, on the natural healing process and remedies. How do you incorporate that into your approach in regard to osteoarthritis?

DR. SHELBY VALERO
OMT can be very helpful in managing pain in osteoarthritis. It's a form of manipulative therapy working on the musculoskeletal system, but we can also work on lymphatics in soft tissue. Basically, any time you have pain anywhere in the body, your body tries to compensate for it without you even knowing. So, maybe you have osteoarthritis in your knee. Well, your quadricep, your lower leg, everything surrounding that joint is going to be affected and kind of try to make up for that pain so that you don't feel it as much. Well, what does that do? That causes pain elsewhere and dysfunction elsewhere. So, you might get a tight hip flexor in the leg that you have a knee osteoarthritis in. Osteopaths who practice OMT can kind of do an assessment and see where you might have tight muscles in the body that we can loosen up to allow for you to ambulate better or just kind of feel better in general and take some of the stress off of the surrounding areas of that affected joint from osteoarthritis. Sometimes patients say it feels like a massage and they're like, keep going. It's and it's a nice alternative to prescription medications or over-the-counter, especially because a lot of the times we use NSAIDs or anti-inflammatories that patients are concerned about affecting their kidneys, and rightfully so, especially after prolonged use. So, that's kind of how we can use OMT to help with joint pain and surrounding muscular issues.

CARMENN MILES
Dr. Mobley, any thoughts on that?

DR. BROOKE MOBLEY
No, I think that's amazing education to what OMT is and how it can definitely help with numerous acute and chronic conditions to help us decrease the usage of oral pain medication or pain patches and things that have a lot of side effects. So, being able to offer that to your patients I think is an amazing alternative to medication and other treatment modalities. You spoke on the NSAIDs, what are some other treatment modalities for osteoarthritis outside of the NSAIDs that you were talking about and OMT.

DR. SHELBY VALERO
If there's one takeaway from this episode, it's that exercise is the single most important intervention for osteoarthritis for pain management and treatment. That can look like aerobic exercise. So, walking programs, cycling, aquatic therapy, strengthening with resistance bands, weight training, particularly targeting the surrounding muscles. So, quadriceps and hip abductors. If you have hip osteoarthritis or knee osteoarthritis, you could also do Tai Chi. That's shown similar improvement as physical therapy does within about 12 weeks. It's got this mind body connection so it can help with other things like depression and just increasing quality of life. Then sometimes balance training can be helpful, especially for patients who feel kind of unstable or fall risk due to their osteoarthritis. Physical therapy is a biggie. I mean, us PCPs love to refer for that. Patients oftentimes think, I don't want to move. I'm in pain. Well, it's addressing the surrounding issues that I kind of mentioned earlier when talking about OMT. Some of the muscle tightness that can occur around the affected joints, loosening those things up, and allowing yourself to offload some of that excess stress on the joint. Patients are kind of blown away regarding how much improvement they see once they complete physical therapy. So, exercise modalities and physical therapy, that's kind of my first go to and my preferred treatment option over any medication for osteoarthritis.

CARMENN MILES
It's so true. The last thing anyone wants to do and experience experiencing joint pain is move. I've heard a term recently, motion is lotion, meaning that movement is the key to alleviating a lot of that joint pain.

DR. SHELBY VALERO
I like it.

CARMENN MILES
Anything else you want to add to that? I've heard Tai chi. Yeah, I think you mentioned that.

DR. SHELBY VALERO
Yeah, Tai Chi is great because of that mind body connection. I tell patients, the main thing is do something you enjoy because that's something that you're going to be more likely to keep up with. If the pain is significant, it's affecting the way you're walking, your biomechanics, then you should probably start with physical therapy for rehabilitation and strengthening. Then from there, the options are endless. Cycling is a low impact exercise, low impact on the joints. Just whatever it is that you enjoy. There are pharmacologic options as well. We talked about NSAIDs. So, anti-inflammatories like ibuprofen, Advil, there are also prescription anti-inflammatories that are a little safer to use long term. Less side effects such as gastric ulcers, things of that nature. There's topical NSAIDs, so diclofenac gel or Voltaren is one of my favorite things. It's over the counter, and you can apply it to the area of pain or the joint that's affected and it can help reduce inflammation. It doesn't affect the kidneys quite as much because it's not absorbed systemically as much as a pill is. Tylenol is another great option. Duloxetine is a medication that your doctor might talk to you about. It's particularly helpful for widespread osteoarthritis pain because it acts on your pain pathways. Some patients with osteoarthritis can develop what's called central sensitization or they have altered pain processing and lower pain thresholds. This medication can be helpful for that.

DR. BROOKE MOBLEY
Dr. Valero, what kind of symptoms should patients be aware of when they suspect something a little more serious than osteoarthritis? Sometimes people like to self-diagnose, but what kind of symptoms should they look for that will prompt them to get a more urgent evaluation if these particular symptoms you can tell us about is more concerning for something more serious or more acute?

DR. SHELBY VALERO
That's a great question. You said that you suffer from RA, correct?

DR. BROOKE MOBLEY
Yes.

DR. SHELBY VALERO
So, there's a lot of misunderstandings about what's RA and what's OA. OA, we talked about morning stiffness less than 30 minutes, gets better with movement, that OA. Now, if you're having symptoms of swelling, warmth and redness around your joints, especially if it's symmetric, like in both of your wrists or hands, and you have prolonged morning stiffness, so that it's defined as more than 30 minutes, or you don't quite fit the picture. You're younger, maybe in your 30s or to 50s, then that's when it might be time for some lab work, looking into some other causes of joint pain, such as, rheumatoid arthritis, which is an autoimmune condition which absolutely requires a little bit more diagnostic investigation and a vastly different treatment plan. So, any of those symptoms, that's where we think more along the lines of RA. Gout is something else that can cause joint pain, but usually that's going to be sudden, it's going to be super severe pain that occurs. It'll peak within like 12 to 24 hours of onset. It usually can affect places like the big toe can sometimes affect the knee. It's associated with diet. Any of those other symptoms, you should probably mention to your doctor, and they can work you up because that's not typical of osteoarthritis.

CARMENN MILES
Now, you mentioned some lifestyle factors that can play a major role in osteoarthritis management, one of which being weight loss for anyone who's overweight, even losing 5 to 10% of body weight can meaningfully improve the symptoms. What are some other lifestyle factors that come into play that we could look at to better manage osteoarthritis?

DR. SHELBY VALERO
Weight loss is a biggie. Activity, as we mentioned before, I'm going to harp on that movement is medicine. I think you said motion is lotion. I like to say movement is medicine. Same thing. Also, ensuring that if you are going to participate in physical activity, that you're doing it safely. Stretching is really important. After I hit 30, I realized I have to stretch before I workout because otherwise, I'm going to be tight and in pain. And that predisposes you to joint injury. Joint injury is something you want to avoid because joint injury does predispose you to OA long term. So, warming up before physical activity, making sure that you're using proper technique and proper equipment, and then strengthening those muscles around vulnerable joints. Like we had discussed, the quadriceps for knee osteoarthritis and hip flexors for hip osteoarthritis. You also want to avoid any sudden increase in exercise intensity. Slow and steady. At work too, if you have a physically demanding job that involves maybe repetitive kneeling or squatting, heavy lifting, you want to make sure that you're taking regular breaks, that you're using assistive devices for heavy lifting, that you're doing it the right way, and you can even talk to your employer about certain ergonomic modifications at work for your workplace. Just overall, avoiding a sedentary lifestyle. As much as the joint pain makes us want to want to sit, don't do it. I promise it's better to just keep moving.

CARMENN MILES
We're just about out of time. Quick question. No specific diet, I imagine, cures osteoarthritis, but what are some things that you can eat that may help with that?

DR. SHELBY VALERO
Anti-inflammatories. Turmeric is a well-known anti-inflammatory. High fiber is another way to decrease inflammation in your diet. Avoid fatty, greasy fried foods at all costs just for your health in general, but those are some things you can you can do.

CARMENN MILES
Wonderful. We are out of time. Thank you both for joining us today to share your expertise. Listeners, don't be a stranger. Subscribe to this podcast so you never miss an episode. If today's show helped you, sharing is caring. Tell your friends and family where to find us on any podcast platform. You can also find us on the radio and several Texas markets. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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