Physical Therapy | Arthritis Information
So I went to the Orthopedist today, because I wanted some input on whether I will ever get ROM back in my hand, and what I could/should be doing to keep what I have for now. I called earlier this week, and would have been fine with scheduling six weeks out, but they offered me today, Friday, at 7:45. Great! I thought. Early in the day, I won't miss too much work.
And, the doctor sees me at 9:15. Enough said. No apology for running late.
Anyway, it was one of those visit where you never get to articulate what you really want out of the visit. I wanted him to examine my hand and give me his opinion whether it was cartlidge or bone issues, and what I should be doing. His first reaction was to offer to inject my wrist and shoulder and send me on my way. Well I have to go work! He was defensive and said they always do it well, but whatever. I guess maybe, but the last time I had an attempted aspiration too, so maybe that made the pain worse.
Long story short he too is content to say, yep, RA in the ankle, in my shoulder, in my wrist, in my hips probably, but not too bad there. He did set me up with PT. Twice a week for 6 weeks to try to get the ROM back in my wrist. I don't know if this will help or just hurt and make me frustrated. We shall see.
Overall it was a good visit but he was one of these docs where he's trying to be kind but just sort of stares you down and I was so tired and cranky and under so much stress (work stuff) that he got me started crying, then I calmed down, then he did the "are you sure you are okay? is there anything else i can do" and you just want to say "make the RA go away" or "be honest about whether or not I will get my ROM back" b/c all he says is we will work on it. And also, please don't keep me waiting for an hour and a half! I bill by the hour too and that is a lot of time wasted! All I could muster though was my main emotion, which is that I'm so frustrated because every time I start to try to exercise or get in shape, suddenly another joint is involved. First my ankle, then my shoulder, then my hips...
So I guess I'll start next week but I haven't cleared this with RD and I don't see him for a month. I don't know. I've heard I should take it easy, but with taking easy I lose more function every day.
He mentioned getting on more than just MTX and I think I'll push my RD for plaq the next time I'm there.
Katie, have you considered an arthritis pool class. i've taken one before and found it helpful in maintaining rom and muscle strengthening. the pool i went to was in rehab facility, the water was comfortably warm and soothing, conducive to relaxing tense muscles. the support of the water makes it easier to do exercises, and the resistance of the water during certain movements or exercise strengthen muscles. in the 30 yrs i've had ra that was one of best things i did. i moved and was no longer able to get to the class, regretfully, i've lost rom and wonder if i had been able to continue the class, if i'd be in better physical condition. Good luck to you, hope the pt or whatever you pursue helps. take care.I am sorry you are so frustrated. It gets that way some times, but like every thing we move on to the next frustration. I have at least one thing a day RA or Fibro wise that frustrates me, but then I just move pass it and hope to tackle it another day.
I hope PT works out for you. Just remember... where there is PT there is pain & torture, well for me anyways.
I hope you can get some where with you next RD appt in a month.
I always take the first or second appointment of the day when I see my rheumatologist. She tends to spend lots of time with each patient and she often falls behind in her schedule. She also works "emergency" cases into her schedule. If I have to have an appointment later in the day, I bring a good book and/or a fully-charged laptop.
^ It is scary at first, isn't it? I've gone from having 5 joints affected in December to 26 joints affected this April, and it just isn't getting any better, but what can you do? I would go hard in PT and see if that does anything. Don't worry about crying in front of the doc. My doctor always seems to do something to frustrate me! Being in pain all the time is not fun. I'm sure my doctor would be bawling like a baby if he woke up one day and couldn't lift himself out of bed, walk to the toilet, or lift a spoon to feed himself. I would perhaps also get a spine xray to see if there is any Undif Spondily going on, or if there is any sign of AS, which can also mimic RA. Also, a combination of Plaquenil, Sulfasalazine and MTX is 40% effective in achieving remission within the first 2 years of RA, so I would ask for a combo, not just Plaquenil (which is mild and rarely works anyway.)
Good luck!
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Thanks for the support (and reading such a dreadfully long post.)
Part of why I am so disappointed is b/c I went swimming about a month ago, thinking, yay, this will be great, and ended up limping from hip pain for the next 2 weeks. I only did about 10 laps, but I guess breaststroke messed them up.
Yeah, PT = pain. But I'm so worried about losing mobility/getting out of shape, I'll try it for a while, I guess....
Katie, Maybe give pool exercises a second chance. There's a lot of different type of exercise you can do besides swimming, the breaststroke and all that kicking. When I took the arthritis pool class we had an instructor that was trained to teach folkks w/arthritis, fibromalgia, etc. So we'd do warm ups, walking forwards, backwards, sideways, its not real vigorous exercise like we're accustomed to doing in our pre-RA days, but moving through the water is resistance against your muscles, so you strengthen and tone them. Then we did a bunch of range of motion exercises, and you went at your own pace, which would vary depending on how you were feeling that particular day. There was a bunch of different "equipment" available: these flotation belts you'd wear around your waist which kept you vertical in the deep end while you did a cross country skiing motion, the faster you did it the more of a cardio workout, but even if you did it at a moderate pace, you were still strengthening muscle. if you can't get to an arthritis pool class, perhaps you can find an instruction video or book. I've done PT out of the water, and exercise in a warm pool, and found pool exercise effective and much more comfortable and soothing. Good luck with whatever you pursue.
What is hydrotherapy, and how does it differ from swimming?
Swimming
itself has many health benefits. It is enjoyable and it particularly
helps people with arthritis and other musculoskeletal disorders because
the water supports their joints while they are exercising. Some
swimming pools reserve special entry times for people with joint
problems.
Hydrotherapy is the use of water in the treatment
of a range of conditions, including arthritis and other musculoskeletal
disorders. Hydrotherapy differs from swimming because it involves
special exercises which take place in a warm-water pool, usually within
a hospital physiotherapy department. The water temperature is usually
33–37ºC, which is warmer than normal swimming pools.
People
who might benefit from hydrotherapy are referred by their doctor or
rheumatology nurse specialist to a physiotherapist, who then decides if
hydrotherapy is a suitable treatment. Not all physiotherapy departments
have a hydrotherapy pool, so you may have to travel to another hospital
for treatment.
What are the benefits of hydrotherapy?
The
warm temperature of the water allows your muscles to relax and eases
the pain in your joints. This makes it easier to exercise.
The
water supports your weight. This helps to relieve pain in your joints
and can also increase the range of movement of your joints. By pushing
your arms and legs against the water you can also improve your muscle
strength.
Who benefits most from hydrotherapy?
Usually
people who have arthritis in several joints find most benefit from
hydrotherapy. This is because all the joints can be exercised easily in
the warm supportive water. Hydrotherapy also helps people who feel pain
when walking, since the water provides extra support.
Hydrotherapy is sometimes used after joint replacement surgery and for people with back pain or ankylosing spondylitis.
What happens on my first appointment?
You will be seen by a physiotherapist, either in the physiotherapy department or on the hospital ward.
The
physiotherapist will ask you about your general health and about your
arthritis and the problems resulting from it. Using this information
and the information provided by the doctor, the physiotherapist will
then decide whether hydrotherapy is appropriate for you. The initial
meeting will take approximately 30–45 minutes. If a course of
hydrotherapy is agreed, you will probably have five or six sessions of
about 30 minutes each. You might not go in the water on your first
appointment.
What will I need?
You will usually need to take your own swimming costume and towel.
What if I can't swim?
You
do not have to be able to swim to have hydrotherapy. The pool is quite
shallow, so you can exercise well within your depth. Buoyancy aids are
also available, and there will always be a physiotherapist in the pool
and an assistant on the side of the pool. Even if you are worried about
water, you should try hydrotherapy if it has been recommended by your
physiotherapist. Most people find the warm water very soothing and
enjoyable.
How do I get into the pool?
To get
into the pool you need to climb down a few steps. For people who cannot
manage steps there will be a mechanical hoist to lower you into the
water. Most pools have different depths, varying from waist height to
chest height. There is also a rail around the edge of the pool for
extra support.
What happens at the end of a course of hydrotherapy?
Exercise
helps almost all forms of arthritis, so after your course of
hydrotherapy you will probably be advised to continue your exercises in
your local swimming pool. It is worth investigating your local
facilities, as some swimming pools have special sessions when the water
temperature may be increased. Some sports centres may organise classes
for exercise in water. You should speak to your physiotherapist or
doctor before joining these. In some areas local arthritis support
groups (such as Arthritis Care and the National Ankylosing Spondylitis
Society) may hire a hospital pool or health-club pool for regular
hydrotherapy sessions.
Gentle swimming might also help, but again speak to a health professional first.
What are the side-effects of hydrotherapy?
Hydrotherapy
is one of the safest treatments for arthritis and back pain. The warmth
of the water and the exercise may make you feel tired after treatment.
This is normal.
When is hydrotherapy not appropriate?
With certain medical conditions hydrotherapy may not be suitable. These include:
- wound or skin infections
- viruses/stomach upset
- a raised temperature
- high or low blood pressure
- severe breathing difficulties
- people on renal dialysis programmes
- angina/heart problems
- incontinence
- chest infections
You
must tell the physiotherapist if you have any of the above conditions.
If you have any questions or doubts you should also discuss these with
your physiotherapist. If you feel unwell on the day of your
hydrotherapy appointment you should contact the physiotherapy or
hydrotherapy department.
What is spa therapy?
A
spa is a place where the local spring water is said to have special
health-giving properties. Some people believe that the mineral content
of the spa water gives it advantages over tap water for bathing and (in
some cases) for drinking. Hydrotherapy in spa water, or spa therapy, is
commonly used in mainland Europe. One reason it is so popular there is
the many naturally-occurring hot springs found in Germany, Poland,
Hungary, Switzerland and Italy.
Some recent research from
Israel supports the suggestion that the mineral content of spa water
does make a difference. However, research from Bath in the UK suggests
that hydrotherapy using just ordinary tap water will have significant
benefits.
forgot to say this took ages to type out ...
Boney, My what a good typist you are -- not one mistyped word!
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