Dr. Phil Hariram’s Health Blog

Cervical spondylosis is a degenerative condition of the cervical spine.

Thirty five percent of us have had neck pain at some time or other but in most of us the pain was transient and disappeared in time. In some cases, however, this is not the case.

Movement of the neck is a complicated process involving the bones of the cervical spine, ligaments and muscles. It is not surprising that the neck is susceptible to injury and pain.

X-ray confirms the bony problem resulting in pain but a curious finding is that 80% of patients with no symptoms had abnormalities on x-ray, and it is not unusual to see x-ray abnormalities in the neck in the over 30s.

A common cause of neck pain is cervical spondylitis. This is like arthritis of the spine in the neck. Bony growth develops on the vertebral bodies. They are called osteophytes and the moving joints may become involved. There may also be intervertebral disc degeneration.

Progressive arthritis might lead to pressure on the nerves and the artery (the vertebro-basilar artery). This can lead to problems with swallowing, visual problems and vertigo.

With cervical spondylitis, pain is present. There may also be referred pain in the face and chest. There may be restriction of movement, pain on movement of the neck and stiffness.

Cervical spondylosis is more common in the lower cervical vertebrae but can be in the upper spine. In this case a patient can develop headache mainly in the back of the head (Occipital).

Dr. Phil Hariram.

This form of arthritis treatment is increasing in popularity and more health food shops are stocking their shelves with alternative treatment for arthritis. There are many reasons why sufferers are turning to this form of treatment.

Conventional medicine is not providing the expected benefits patients want. Ideally I would expect for arthritis a drug that will work effectively to control pain, stiffness and swelling without any concerns about side effects. In reality the picture is different.

Patients are concerned about the potential side effects. Drugs that work well for pain control for years, are suddenly withdrawn because of serious side effects and makes a sufferer suspicious of conventional drugs. Some drugs are re-introduced on the proviso that the benefits outweigh the risk.

Some analgesics have addictive potentials. NSAIDs can cause gastric bleeds and the newer COX2 inhibitors can cause heart problems.

There is nothing wrong with complimentary medicine but be well informed before you use them.

I have used acupuncture on my patients with pain. The only serious risk from acupuncture is a punctured lung. If your acupuncturist sticks a needle on your chest wall for arthritic pain, then question his credibility.

I have used acupuncture for backache and I have had some amazing results. One day I will post these individual results but I can reassure you that everyone with backache who had acupuncture from me had some improvement.

There are a wide range of complimentary therapies available. They include homeopathy, herbal medicine and Traditional Chinese Medicine. Then there are treatments such as massage, aromatherapy and reflexology.

If you are looking for a way to control pain, stiffness or other problems with arthritis, you could waste a lot of time and money looking for a solution.

Please make an informed decision on what you want to do. My blog will give you information but it is up to you to decide what treatment option to go for.

Dr. Phil Hariram,

Arthritis Guide.

There are many reasons why we feel tired. This is the same in arthritis. In some forms of arthritis, tiredness is part of the illness.

In conditions such as rheumatoid arthritis and fibromyalgia, sufferers are tired irrespective of whether they had a good night’s sleep.

Like pain, fatigue has a strong impact on patients. They feel exhausted and drained. They live their lives at a pace dictated by the level of their tiredness. Day to day chores become major trials.

In rheumatoid arthritis, fatigue is part of the disease process. When rheumatoid arthritis is in remission, fatigue improves but returns when there is a flare up.

Arthritis is associated with pain. Drugs used to control pain may cause tiredness. Analgesics can produce drowsiness especially the codeine based products, and anti-inflammatory drugs have light headedness as a side effect.

Constant unrelenting pain can be overbearing and lead to tiredness. In addition pain can cause disturbed sleep leaving the sufferer tired during the day.

Anaemia results in tiredness and in inflammatory arthritis, anaemia is possible.

Arthritis can lead to inactivity in that particular joint. The muscles associated with that joint can waste and become weak. This contributes to tiredness.

Long standing chronic arthritis has an impact on a person’s general well being. Anxiety may result from severity of arthritis and worry about the ability to cope in the future. Arthritis patients can become depressed. One of the symptoms of depression is tiredness.

So if you are tired, there are many reasons for this. Listed below are potential causes.

Part of the disease process.

Drugs you take could cause drowsiness.

Persistent pain could lead to tiredness.

Disturbed sleep due to pain and stiffness.

Anaemia as part of inflammatory arthritis.

Persistent pain could lead to tiredness.

Depression.

Dr. Phil Hariram,

Arthritis Guide.

Arthritis can affect your ability to drive. With Arthritis your joints can swell and become stiff. This could result in limitation on bending or other movements. It is, therefore, more difficult to apply brakes, turn the steering wheel, use the accelerator pedal, wear or clip seat belts or move your head to have a clear view behind you.

These problems can make driving safely more difficult. In addition getting in and out of your vehicle becomes a problem if you have arthritis of the ankles, knees or hips.

You can still drive safely but get help, advise and reassurance from your family doctor. Check also that the medication you take for your arthritis does not affect your alertness and ability to drive effectively. Make sure your arthritis treatment does not make you drowsy.
If you are not sure what to do contact the Arthritis Foundation at 1-800-283-7800.

If you have been driving for some time before you develop arthritis, then you need to make note of two things. Is your arthritis affecting your ability to drive? Has it lasted more than three months? You need to notify the licensing authority. You also need to notify your insurance company. It is true that since the Disability Discrimination Act in UK, your insurance premium will not go up, but your Insurance Company will need to know of any changes in your health.

If you are thinking of learning to drive, and you are applying for a provisional license, make sure you include information about your arthritis on the form. Your driving test will be just as stringent as for anyone else. The driving inspector is more interested in your ability to drive correctly and how safe you are on the road.

Sometimes seat belts can be real bother for someone with arthritis. You may be tempted to request an exemption from wearing seat belts. If you are inclined to do this, please remember that should you have an accident, not wearing a seat belt leaves you open to further injury to your joints.

Dr. Phil Hariram.

Arthritis Guide.

Glucosamine and chondroitin are widely advertised as remedies for osteoarthritis. The benefits, however, are not clear.

A qualitative assessment of various trials were done by T.E. McAlindon et al. to evaluate the benefits of glucosamine and chondroitin products for osteoarthritis of the knee and/or hip.

The studies were randomised, double blind, placebo controlled of four weeks duration. Fifteen studies reached the criteria and were included in the analysis.

Conclusions: Trials of glucosamine and chondroitin products for osteoarthritis of the knee and hip showed moderate to higher effects but there were quality issues and possible bias suggesting that benefits were exaggerated.

They concluded, however, that some degree of benefits appear probable.

A trial by H.Muller-Fassbender et al. in 1994 compared glucosamine sulfate to ibuprofen in osteoarthritis of the knee. The result showed that glucosamine was as effective as ibuprofen but without the potential serious side effects.

Dr. Phil Hariram,

Arthritis Guide.

Glucosamine is an amino acid sugar produced by the body and present in cartilage. It has been widely promoted as a treatment for osteoarthritis.

There is no conclusive evidence that this drug is effective. It is up to you to make your own mind up on it. There are individuals who swear by it and others who have no benefit.

Promoters of glucosamine claim it repairs damaged cartilage. It is derived from shells of shellfish. It is classified as dietary supplement just like chondroitin and its manufacture is not subjected to regulation. Make sure you purchase from a reputable company and check the ingredients.

There are no serious side effects with glucosamine. It is extracted from shells of shellfish so if you are allergic to shellfish be aware of this. If you are a diabetic, remember that glucosamine is an amino acid sugar and can impact on your blood sugar level.

Your family doctor is not likely to recommend glucosamine or chondroitin as an arthritis treatment because there is no clear evidence that they confer greater benefits over placebo in arthritis treatment.

It is, however, a safe medication. If you are on this drug or you are considering taking it, use it for three months before making your evaluation. If you are convinced there is improvement, continue using it as a treatment of arthritis.

Dr. Phil Hariram,

Arthritis Guide.

Chondroitin is a carbohydrate compound and is present in cartilage. It gives the cartilage elasticity. Articular surface of joints are protected by cartilage (articular cartilage) and this cartilage is a tough smooth gristle that reduces friction and protects the underlying bone from wear. Damage and wear of the cartilage is seen on an x-ray as loss of joint space. Cartilage contains both glucosamine and chondroitin.

The rationale for the use of chondroitin and glucosamine as treatment of arthritis is that these two drugs, according to some, will improve the health of affected articular cartilage. Both chondroitin and glucosamine are manufactured by the body.

Chondroitin is considered a dietary supplement and as such the manufacture is not regulated. The quality of products available will vary.

It is available as chondriotin sulphate, obtained from cows’ cartilage. Make sure you purchase a recognised brand from a reputable company and check the label for ingredients. If you are not sure, ask, or consult your doctor. Do not discontinue your on going medication.

According to studies, patients with mild to moderate osteoarthritis had relief on par with NSAIDs such as ibuprofen. Trials, however, are inconclusive and a large placebo controlled trial will one day throw light on whether this drug should be an acceptable arthritis treatment.

There are no serious side effects. Reported side effects are increased intestinal gas and loose stools. It should not be given to children or taken by women considering pregnancy or who are pregnant. It may potentiate the effects of anti-coagulants.

If you are taking this drug or considering taking it in future, make your assessment on its effeciacy after three month. If you feel it is doing you some good, continue.

Dr. Phil Hariram,

Arthritis Guide.

Apart from gout, diet does not have a significant direct impact on arthritis. Diets, vitamins and supplements will not cure your arthritis but altering your diet to maintain or attain the right weight is an important step to reduce the burden of arthritis.

For weight loss, dietary change and the amount you consume is important. Your diet must contain basic nutrients such as minerals and vitamins. Poor diet will impact on your general health and subsequently on your arthritis.

To help your arthritis, ensure your diet is balanced and varied and incorporates vitamins, minerals, anti-oxidants and other essential nutrients. Reduce animal fats and eat more fish. Take plenty of fruit and vegetables.

Omega-3 polyunsaturated fats found in fish oil has been shown to be beneficial in inflammatory arthritis. It is also useful in gout but it has high quantity of purines which in broken down in the body to produce urates and therefore should be avoided in gout.

A balanced and varied diet with more fish, fruit and vegetables is beneficial in all forms of arthritis. Nutritional supplements are available over the counter and are usually costly. Most of the ingredients are present in a balanced diet.

Your weight is important. So what should your weight be? You should use the Body Mass Index (BMI) as a guide to assess whether your weight is acceptable or not. To find out your BMI, first measure your height in metres,(i.e. say 2metres) then multiply it by itself (2×2=4). Check your weight in kilograms (say 80Kg). Now divide your weight in Kg by the first figure (80 divided by 4 =20). That is your Body Mass Index (20). Recommended BMI for most people is between 20 and 25. For your arthritis aim to be within this range if you can.

From childhood I have been told that calcium is good for my bones. Lack of calcium may lead to osteoporosis especially in arthritic patients. Vitamin D is also important for bone formation. The commonest source of calcium is in milk. If you are on skimmed milk as part of your low fat and calorie controlled diet be assured that skimmed milk has more calcium in it that full fat milk. Daily recommended intake of calcium in under 60s is 1000mg and over 60s -1500mg.

During the summer your body manufactures vitamin D through the sunlight on your skin and you do not need to worry about Vitamin D intake. You, therefore, need to be more vigilant in winter. Older arthritic patients may need supplements.

In case of gout, you should be careful with certain foods. Foods high in purines such as meat and fish should be consumed with care. Avoid or reduce alcohol.

Fish liver oil contains both omega-3 fatty acids and Vitamin D. it is a useful supplement but care should be taken in women thinking of starting a family or already pregnant. It also contain Vitamin A and is not recommended in pregnancy because of potential harm to the foetus. Avoid fish liver oil or vitamin A supplements. It is better to take pure fish oil (high in omega-3 but has no Vitamin A) rather than fish liver oil.

Dr. Phil Hariram
Arthritis Guide.

Exercise is good for arthritic joints. Exercise keeps the joint flexible and the muscles strong. Inactive muscles tend to waste and become thin. Make sure you know what to do and do not overdo it. Exercise also makes you feel generally better.

Resting an inflamed joint will help it to improve and prevent further damage. If you are not sure ask a professional. Resting a joint is fine as long as you do not rest it too long. Combine it with some stretching exercise after some time.

If you are overweight, losing weight will help your arthritic joint. By losing weight you are putting less pressure on the joint. With arthritis a person may be inclined to reduce activity or in some case cut down considerably. This could end with weight gain if the calorie intake remains the same. It is best to aim for your ideal weight.

It is not clear whether special diets have any effect on arthritis. I feel it does not. However, fish oils and vegetables are supposed to reduce slightly joint inflammation. Alcohol does not affect arthritis but be aware that it could interact with over the counter treatment or prescribed medications. Make sure you are aware of this. If in doubt ask you doctor.

Arthritis that causes persistent pain and discomfort could lead to anxiety and depression. Get professional help if this happens. These conditions can increase your perception of pain and increase the intensity. Learn relaxation techniques and get help if you cannot control your anxiety. Any treatment that will create a positive attitude to your arthritis will impact very well on your general well being.

I strongly believe that a positive mental attitude will help you enormously in coming to terms and living with arthritis.

Dr. Phil Hariram

Arthritis Treatment.

There are certain arthritic conditions that we know a specific cause for. Gout, for example, we know is caused by a lack of an enzyme, xanthine oxidase, and as a result the level of uric acid in the blood is higher than normal. This high level results in crystals separating out and being deposited in joints and other areas of the body.

In most cases of arthritis there are more than one factors involved. Some people have a genetic risk that leaves them susceptible to arthritis. Some arthritis runs in families but the precise genetic link is not yet clear.

Environmental factors contribute to arthritis. Individuals involved in repetitive high physical demand in a particular joint will be prone to arthritis. Injury can cause damage or mis-alignment of the joint leading to undue wear.

Infections in the joint (septic arthritis) can lead to arthritis. Some general infections can cause joint pains but this goes away when the infection subsides.

There is no clear evidence that climate contributes to arthritis. These joint problems are worldwide. I know a lady with osteoarthritis. She could tell with reasonable accuracy the weather outside when she wakes up in the morning by the level of stiffness and pain.

Another patient who endures regular winter aches and pain in UK, was remarkably pain free during a winter spent in the Spain where the weather in mild and the sky is blue. Pain is subjective and the intensity does not necessarily depend on the severity of arthritis. Of course, winters in UK are cold, damp and gloomy and the sky usually grey.

Dr. Phil Hariram.

Arthritis Guide.

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