An interview with spine and joint specialist, Dr. Dalton-Bethea
Dr. Venita Bland | 7/17/2013, 10:08 p.m.
I recently had the pleasure of interviewing Dr. Shawn Dalton-Bethea. She is a spine and joint pain management physician.
What symptoms should you look for when you feel you are being visited by arthritis?
Do you cringe when the winter months draw near? Do your knees, shoulders, hips, wrists, elbows, or ankles ache, throb, or feel like a toothache? Do you find that applying pressure to the affected smaller joints eases the annoying symptoms? If you answered yes to any or all of these questions, you’ve been visited by Old Uncle Arthur.
Old Uncle Arthur afflicts many more persons than rheumatoid arthritis. Degenerative osteoarthritis is the “wear and tear” type of arthritis. Spongy cushioning cartilage over the bone grows thinner as the fluid leaves it and is worn away from use and aging. This results in the bones of our joints touching and rubbing against each other with various movements.
Genetics can play a role in early onset osteoarthritis symptoms. Obesity also wreaks havoc on knees and hips.
Even absolutely healthy activities such as marathon running over years can affect the joints. (I am not advocating discontinuing running).
Dr. Dalton-Bethea, what can a person who wants to remain active do?
Cross training with for example- swimming, can offset much of the load on the joints that occurs from running. Useful topical medications include: Flector patches (Diclofenac 1.3 percent solution) twice daily; Voltaren gel (Diclofenac 1 percent solution) 2-4 grams up to four times daily, and PENNSAID (Diclofenac 1 percent solution) 40 drops 4 times daily to each affected joint .
Custom topical solutions are available which involves mixtures of topical agents which target bone, muscle, and nerve pain in a single application. You can apply these and still be out in public without fear of unacceptable odors (unlike some liniments we all know).
I am glad to see that you are suggesting using topicals for care of our joints. What are your suggestions for those who require oral medications?
Oral NSAIDS (non-steroidal anti-inflammatories) such as Ibuprofen, Motrin, Aleve, Meloxicam (Mobic), Relafen, Celebrex, Diclofenac, Ketoprofen, Naprosen, Indomethacin, Zipsor, or Sulindac may be useful (If no contraindications exist (heart, lung, stomach, intestines, liver, and kidney)). Some afflicted patients still find Tylenol (maximum dose is 3 grams daily) or aspirin 325mg daily (no ceiling dose, but recommend to stay low with it) to be effective pain control.
What are your views on injectables?
Steroid (Celestone, Depo Medrol, Dexamethasone, and Kenalog) injections into the arthritic joint(s) are useful treatments for some patients. This can delay the need for joint replacements.
Hyaluronic acid is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.
An injectable synthetic example of hyaluronic acid (some of our Reidsville patients refer to it fondly as the “chicken oil or the rooster grease.”) is Orthovisc. Just one series of injections (total of three) may yield six months or more of knee pain relief and restoration of function.