I did not see this coming. I’d always thought that it would be heart disease that would do me in. A year ago, when I noticed a deep pain at the base of each thumb, I figured I must have somehow injured (both) hands at the same time. When the pain got so bad I could no longer push-and-twist open the child-proof caps on the bottles of my cardiac meds, I asked my pharmacist to use easy-open caps for my drug prescriptions from now on. It took a while before the gnarled finger joints of both hands began to swell until they now resemble those of the Wicked Witch of the West.
I remember looking at my outstretched fingers one morning and wondering, “Whose hands ARE these?” .
I should have expected the results of my hand x-rays: arthritis in the joints of my fingers, the same arthritis that had been diagnosed in the x-ray of my left knee, the cause of breathtaking new pain with each step during the past few months.
So when my family doctor recently asked about my ongoing cardiac symptoms (during our first in-person appointment since pre-COVID), I flicked my deformed fingers at her dismissively. “Cardiac!? That’s the LEAST of my problems right now!”
You know it’s bad when heart disease – our #1 killer! – begins to take second place to a new diagnosis. How can scary chest pain (in my case, caused by coronary microvascular disease) that’s been so pervasively overwhelming over the past 14 years of my daily life suddenly now seem hardly worth mentioning? Well, my dear heart sisters, everything is relative. And distraction is powerful. As my late mother used to joke: “Any problem in life will fade away by wearing shoes at least one size too small!”
Over the years, I’ve gradually learned how to manage my daily cardiac symptoms, but I’m a rank amateur at coping with painful arthritis symptoms. It has occurred to me, however, that feeling overwhelmed by new pain is actually pretty normal. The dismay of learning that yet another body part is now in trouble really sucks.
Our doctors call this state of having more than one serious chronic diagnosis at the same time “co-morbidity” or “multi-morbidity” – or as I prefer to call it, “a living hell”. And in a cruel twist of fate, painful arthritis is surprisingly common among people with other chronic conditions.
According to the CDC, for example, while about 20 per cent of adults have arthritis, it’s even more common among adults already living with chronic conditions like diabetes or heart disease. In fact, about half of heart patients will develop arthritis. There is no cure for arthritis, but I’m told that, like many chronic conditions, it can be “managed”. I think this means that one day, I will no longer feel the urge to poke out my own eyes with a stick. . .
Researchers have studied people living with more than one chronic illness, and as researchers like to do, they have come up with distinct categories of patients, along with clever names for each group. One often-cited study (Reeve & Cooper) on those living with“co-morbidities” identified three key categories based on how such patients viewed their personal experience of multiple chronic illnesses, and specifically how the daily presence of pain affected their quality of life:(1)
1. The “gliding swan” group (basically, the absence of significant health-related disruption; “resilience” was the keyword among these patients)
2. The “stormy seas” group (significant health-related disruption; health care was the dominant narrative theme; “vulnerability” was the keyword here)
3. The “stuck adrift” group (daily life narrative was completely interrupted by illness or treatment burden, feeling bad was the dominant theme; the keyword was “disruption”)
I’m a reluctant newbie to this arthritis world. Both “stormy” and “stuck” would be appropriate descriptors of the painful upheaval that this arthritis diagnosis has brought me. But my longterm chest pain of refractory angina? Ironically, it’s now the “resilience” of that gliding swan category!
I’ve learned so far that there are two main types of arthritis. The kind I have is osteoarthritis (OA), the most common form, usually affecting the joints of the hands, feet, hips, knees or spine. As Canada’s Public Health Agency explains, it’s usually blamed on inflammation, genes, aging or sex. (Women are significantly more likely than men to develop osteoarthritis, most before the age of 65). Pain is caused by the break down of the joint cartilage (the tough material that covers the bones) or the underlying bone. I also learned that previous injuries or joint surgery (like the operation I had decades ago to repair a torn meniscus in my left knee, for example) can increase the risk of later osteoarthritis in that joint.
The other main type of arthritis is rheumatoid arthritis (RA), which unlike OA is an autoimmune disease.
I’ve spent the past few months trying to avoid putting weight on my left knee to help minimize the extreme pain of each step. This has meant some remarkable changes to daily life.These include using a cane, no longer walking my darling Baby Zack around the neighbourhood in his stroller for morning naps, avoiding stairs or standing, and not being able to join my walking buddies for our regular weekly walks. Instead, I’ve usually been collapsed on my red LaZBoy recliner, left leg elevated, ice packs alternating with my heating pad, my extra pillows, blankie and Extra-Strength Tylenol close at hand.* So far, I’ve also finished off several binge-worthy NetFlix series in this position (which I acknowledge has also been a common pastime even among my non-arthritic friends and family during COVID).
BUT what’s this? Now I’m learning that what will help to reduce my arthritis pain is EXERCISE, not rest! In fact, when I saw an orthopedic surgeon this past week to discuss my knee pain, the first option on his suggested treatment plan list was to have me fitted for a leg brace, “so we can help get you back to your walking group as soon as possible!”
UPDATE: Consider the “Classical Stretch” 30-minute Full Body Pain Relief workout as seen on PBS. This was the first organized online ‘class’ I’d done in months; it’s carefully led by an excellent instructor specifically for those living with chronic pain. And I can do these stretches without hurting my knee or any other body part. As the reader who initially recommended this gentle movement class to address my arthritis pain says, “When I miss a day, I can really tell the difference!”
Orthopedic surgeon Dr. Howard Luks reinforces that plan in his very helpful blog:
“Far too many people believe that arthritis is caused by mechanical wear and tear. Osteoarthritis appears to be caused by low-grade chronic inflammation. This is the same chronic inflammation held as a cause of other chronic diseases such as Type 2 diabetes, heart disease and fatty liver.
“It’s only natural that you might assume that your arthritic knee pain will worsen with exercise. Too many healthcare professionals counsel their patients to stop running, speed walking, elliptical, treadmill, etc. to ‘save’ their joints. Most of the time, you need to do just the opposite. The research over the years has been unequivocal.”
* IMPORTANT WARNING re PAIN MEDICATIONS FOR HEART PATIENTS
You may have read that the pain medication routinely recommended to address arthritis pain or any pain associated with inflammation, swelling or acute injury is the family of drugs called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). But according to Mayo Clinic cardiologist Dr. Rekha Mankad and many other experts, studies now suggest that this type of pain-relieving drug can increase the risk of a heart attack, stroke and high blood pressure – whether you already have heart disease or not, although the risk is greatest among those who already have heart disease.
NSAIDs are available over-the-counter or with a prescription. They include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox DS, others), diclofenac sodium (Voltaren, Solaraze, others), acetylsalicylic acid (Bayer, aspirin, others) and celecoxib (Celebrex).
If you need to take an NSAID, take the smallest dose for as short a time as possible to limit the risk of heart attack or stroke. Consider the topical form of the drug (cream, ointment, gel) which are reported to have fewer cardiovascular risks than the oral (pill) form of NSAIDs. Dr. Mankad warns that although NSAIDs are probably safe to take once in a while, serious side effects can occur as early as the first weeks of continuously using an NSAID and the risk can increase the longer you take it. If you are a heart patient, please discuss alternative pain meds e.g. acetaminophen (Tylenol) with your own doctor before taking any NSAIDs.
Learn more from Mayo Clinic about the NSAIDs warning here.
1. Reeve, J, Cooper, L. “Rethinking how we understand individual healthcare needs for people living with long-term conditions: a qualitative study.” Health Soc Care Commun 2016; 24(1): 27–38.
NOTE FROM CAROLYN: I wrote more about women’s co-morbidities in my book “A Woman’s Guide to Living with Heart Disease“. You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).