Other than Medicines,What else can i do?

by Dr. Arvind Chopra

This is a very common scenario with patients suffering from different kinds of rheumatism (also called arthritis). Mostly, people hate to take medicines for prolonged periods. But sometimes, there is no other option. The situation is certainly more demanding when the ailment becomes chronic and threatens livelihood and living. The number of tablets often increases with time and age. Besides physical suffering, the mind also begins to suffer and complain. Frustration, anxiety and depression are commonly seen with chronic ailments. Such is also the case, when somebody continues to suffer from painful joints and body aches and pains.

Nobody wants 'pain'. But pain is an important symptom and warning bell of so many diseases. Irrespective of the cause, pain is an extremely troublesome and it influences both body and mind. Pain must be treated on priority. If pain persists, all other treatment measure are unlikely to be accepted by the patient. In fact, the success and failure of therapy is often judged by the relief of pain. And pain is an extremely challenging target in treating arthritis especially in a chronic situation. Also, the challenge becomes more serious if the patient is elderly and suffering from other co-existing ailments like heart problems, diabetes, stomach ulcers, liver disorders and kidney failure. Arthritis cannot be treated without using pain killers but there are several methods and precautions to be observed to escape serious side effects.

There are several important 'protective mechanisms' to make medicines safe in patients with chronic arthritis and rheumatism and protect joints from further damage. Some of the measures can also improve joints and overall health. We will focus on general issues that could be followed by one and all. For specific query, one needs to discuss in detail with an expert.

Diet:
A healthy balanced diet with enough fiber (daily seasonal fruits) and properly divided into 2-3 meals is required. In the large majority of patients with arthritis, there is no individual diet or its component that causes or aggravates arthritis. There is no good food and bad foods but avoid junk and fast food and food not cooked under hygienic conditions.

Vegetarian diet with pulses (dal) and cereals (rice, wheat, bhakri etc) is easier to digest. There is nothing wrong with non vegetarian food but its preparation should be friendly to health rather than just good taste. Fish has a special advantage for providing substances that reduce inflammation and arthritis, and further help correcting blood lipids. Ensure a daily intake of seasonal vegetables and fruits. Green leafy vegetables and jaggery are a great source of iron and other minerals and vitamins and will help in maintaining normal blood hemoglobin. Also, a glass of milk (about 400 ml) is a good source of calcium and vitamin D and should be consumed daily by one and all.

Spicy and oily food can easily upset the stomach and digestive system. Don't get stomach infections or else you may have problems with the tolerability and side effect of medicines.

The amount of food should be consistent with a correct body weight. Do not over eat. A light breakfast and one adequate meal is good enough. One meal (lunch or dinner) can be substituted by soup or salad (no dressings) and fresh fruit. Be conscious of calories and remember that all that excess body weight has to be carried by your spine, hips, knees, ankles and feet. So don't overload joints and more so if they are already suffering from arthritis.

A balanced healthy diet provides several minerals and substances that are anti-oxidants and help body fight some of the side effects of chronic therapy.

Water:
At least 2 liters of water, properly measured, should be consumed over 24 hours. Don't drink water only when you feel thirsty. It is a practical suggestion to prepare 2 bottles of water, each of one liter capacity, every day in the morning and finish drinking by next day morning. You may like to drink more but not less.

Water is essential for so many body functions. Importantly, many drugs are excreted in urine and kidneys need enough water to perform this task properly. This will also safeguard you from side effects of drugs including kidney damage. Enough water also facilitate proper bowel function and smooth defecation.

Exercise:
Joints need to be moved. Routine work whether in the house or office is not equivalent to exercise. Exercise should be well planned with a clear aim to improve health of bones and joints and overall health. Exercise should begin with an exercise prescription similar to a drug prescription.. Patients must be explained all the 'dos' and 'don't'. Exercise also improves mental fitness and energy level. In arthritis, it is better to begin arthritis under supervision of a physiotherapist. Once the arthritis is well controlled, the level of exercise can be gradually increased under supervision. This is also important when going to the gym or health club but the physical training instructor must consult the rheumatologist prior to beginning exercises.

Swollen joints should not be exercised vigorously, and neither should be loaded with weights used in gym. Even during acute arthritis, joints should be moved passively through a full range of motion. If the knees are swollen, do not sit in any position on the floor. Similarly, walking (and treadmill) as an exercise should be avoided if knees are painful and swollen. Excessive body weight bearing or loading can damage the knee cartilage further. A cycle or a health cycle is a good way to increase the knee strength and fitness and preferred in patients with chronic knee arthritis. In fact, patients with bad knees should not insist on sitting on floor or sitting cross legged or using Indian type of floor level toilet. Patients with bad knees should avoid climbing steps. Swimming or exercises in water are very beneficial to patients with spine and joint ailments.

Mental Health and Fitness:
Several forms of arthritis are also called psychosomatic disorders which means that mind plays an important role in cause, aggravation and treatment of arthritis. Learn to look after the mind. Reduce stress. Several techniques are available. Yoga (pranayam with focus on controlling breathing) and meditation are excellent methods. It is advisable to learn and practice Yoga in the beginning under the supervision of a learned teacher. Do not stretch painful swollen joints as in some of the Yoga asanas because stretching can worsen inflammation.

Summary:
I have tried to describe some of the practical aspects of advice on issues other than medicines that I invariable give to all patients. This is not an exhaustive list. Don't be afraid of asking queries and questions.. Above all, learn to get rid of fear. Be a learned patient but don't fall prey to false beliefs or myths. Try to ascertain the truth. Arthritis is also a life style disorder. It is important to remember that much more than medicines is required to get rid of pain and arthritis. By following some of the advice above, you will actually contribute to proper management of your disease. Many forms of arthritis are lifelong ailments. By learning to combine good life style and other healthy measures to the drug management, you will be able to lead a healthy and relatively pain free life. Follow the advise provided by the doctor and actively participate in the monitoring of your ailment and treatment response. All drugs have side effects but it is the benefit that should be fully realized. Drugs must be taken properly and monitored at regular intervals.