This Issue

Exercise key
to slowing common painful condition

With more options today, surgery not the only recourse

Best remedy for osteoarthritis? Get up and go

Q & A

A closer look

Signs and Symptoms

• Pain during or after joint movement

• Limited range of motion or flexibility

• Cracking noise during joint movement

• Stiffness, especially after long periods of inactivity
• Swelling or tenderness in afflicted joints

• Bone spurs — extra pieces of bone that form around affected joint

• Muscle weakness

• Joint deformity

Signs and Symptoms

Risk Factors

A lifeline

The umbilical cord is the baby’s lifeline, but once clamped and cut after the baby is born, it can be the lifeline for someone else. Cord blood — once considered medical waste — is rich in stem cells, which can be used in transplants. But time is limited. You have to complete enrollment to donate cord blood by the end of the 32nd or 34th week of pregnancy depending on the blood bank used.

• Call the Be The Match Registry at 800-507-5427 to find out which hospitals in your state participate.

In Massachusetts, Brigham and Women’s Hospital and University of Massachusetts Memorial Medical Center take part.

• If your hospital is not listed you can still donate. Contact the Carolinas Cord Blood Bank at 919-668-2071 or Lifeforce Cryobanks at 800-869-8608

There is no cost to you and no harm to you or the baby.
If you don’t donate, the blood is thrown away.
A closer look

KNEES are commonly afflicted by osteoarthritis causing pain, stiffness and difficulty in walking and performing normal day-to-day activities. The cartilage, a smooth tissue covering the surface of joints, begins to wear away, which can lead to bone rubbing against bone, muscle weakness and malalignment of the knee.

Copyright 2011 American College of Rheumatology

THE HAND is another common site of osteoarthritis. Bony prominences called Heberden’s nodes may develop near the joint closest to the nail, while Bouchard’s nodes are bony enlargements of the middle joints. Heberden’s nodes are more common in women and may have a genetic link.

A weighty situation

Relief from pain

Initiative to Eliminate Cancer Disparities
2011 National Minority Cancer Awareness

April 17 - April 23

Boston Public Library Cancer
Awareness Display

• Codman Square Branch Library
690 Washington Street

• Mattapan Branch Library
1350 Blue Hill Avenue

• Brighton Branch Library
40 Academy Hill Road

April 28: 12 - 1 p.m.

Secondhand Smoke Exposure
Harvard Street Neighborhood
Health Center
632 Blue Hill Avenue

May 16: 11 a.m. - 1 p.m.
Skin Cancer Prevention
Roxbury YMCA
285 Martin Luther King Boulevard

April 21:
9 a.m. – 4 p.m.

Reducing Cancer Disparities & Promoting Health Equity Among Socioeconomically Disadvantaged Populations
Beth Israel Deaconess Medical Center
Riesman Lecture Hall, 330 Brookline Avenue

Registration is required:

All events are open to the public
For any additional information contact
Athene Wilson Glover at 617-632-4860

Another good reason to visit the dentist

“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance

The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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Risk Factors

• Age — the incidence increases with age

• Gender — women are afflicted more than men after age 45

• Continued overuse of or trauma to joints

• Overweight and obesity

• Fractures and other joint injuries or infections

• Congenital defect or weakness in a joint

• Occupations that include tasks that place repetitive stress on a particular joint

• Other types of arthritis, such as gout and rheumatoid arthritis

• A genetic defect in joint cartilage

With more options today, surgery
not the only recourse

Joint replacement surgery four years ago for osteoarthritis in her left knee has not slowed down Alveta Haynes, 56. Haynes plays tennis regularly at the Sportsmen’s Tennis Club in Dorchester. (Ernesto Arroyo photo)
Alveta Haynes is living proof that osteoarthritis doesn’t trouble only the old.

Back in the early seventies, Haynes was in her teens, ripping and running on the courts until she seriously injured her left knee playing basketball. She needed an operation, but arthroscopic surgery, then in its infancy, was a far cry from what it is now.

Instead of repairing the cartilage between her thigh and lower leg bones, surgeons removed the entire meniscus, reducing the cushioning in the knee — a perfect scenario for osteoarthritis (OA). Haynes needed time to recover but eventually regained use of her knee without limitations.

Haynes said the surgery did not slow her down. “I lived with it,” she said. “You figure out how to manage.”

For her managing meant icing, over-the-counter pain killers and leg elevation. Though Haynes could ease the pain, she could not prevent the structural damage that worsened over time. By the time she turned 35, she said, “my X-ray looked like an X-ray of an 80-year-old.”

The medical term is valgus but most know it as being knock-kneed, a condition in which the leg bones are not aligned straight. She needed reconstructive knee surgery, but she reasoned that she would wait until it became a day surgery.

Nearly 20 years later, after chronic pain and constant swelling took its toll, she finally relented.

And not a moment too soon.

Dr. John Wright, an assistant professor at Harvard Medical School and an orthopedic surgeon at Brigham and Women’s Hospital, has helped patients overcome misperceptions about knee replacement surgery. He also understands the human proclivity of delaying the inevitable. But he also knows the consequences.

“Waiting because you’re afraid is not a good idea,” he explained. “If you wait too long the results will not be as good.”

Timing is everything and Wright has heard most of the excuses. Some might say they will have surgery once they retire. Others will say they’ll have the procedure when the pain disturbs their sleep.

“Ten years later they are no longer active because of pain and disability,” he said. “They are not going out of the house, to church, and engaging in normal activities because of the pain.”

John Wright, M.D.
Orthopedic Surgeon
Brigham and Women’s Hospital
Assistant Professor
Harvard Medical School
Women have even more excuses for procrastination. “Women wait because they’re caregivers. They tend to put others before them,” he said. But that’s not a good idea, Wright stresses. Women tend to get OA earlier than men; they get it in middle age. They have had too many years of wear and tear by the time they seek care.

He understands the misperceptions. Years ago the results for knee surgery were not as good as desired, but, according to Wright, surgical techniques have markedly improved since then.

Wright readily admits that obesity is a contributing factor to OA, but he cautions that obesity does not preclude the surgery. Losing weight “is not necessary to fix the problem,” Wright said. “If someone’s knees are worn out, the time is then. If you come back later and you are bigger, you are a worse surgical problem.”

Wright is among the first to say that knee or hip replacement surgery is not the only recourse. Many things can be done before surgery is recommended. Exercise, muscle strengthening and physical therapy are a few. “Get going,” he recommended. “Patients return and admit they did get better with exercise.”

But when pain is severe and non-responsive to medications and physical therapy, surgery may be warranted, particularly when reduced function is involved. Loose pieces of cartilage or torn menisci can be repaired through arthroscopy, an out-patient minimally invasive surgery. Often joint surfaces can be smoothed out. When a joint is destroyed beyond repair, joint replacement using a prosthesis may be required.

Haynes was 52 years old when she had her second knee surgery. By all accounts, it went well.

She said she was the best patient a surgeon could have. “If they told me to do five repetitions, I did 10,” she said.

Her hard work paid off. Even today — four years after her surgery — she experiences very little pain. When she does, she knows the drill so well that she gets a jump start. “I take ibuprofen and ice my knee,” she says. “If I don’t, I know the pain will start.”

Haynes got much more from her surgery than relief from pain. “I had no idea of the cosmetic impact,” she said. “That’s huge.” Her knock-knee had caused a change in her posture, gait and appearance. She now marvels at her straight left leg.

Haynes, 56, continues to exercise. At her home gym, she uses the recumbent bike and treadmill, but tennis is her passion.

“I don’t push it as much as I used to,” she said, noting she might not run flat out to chase an errant ball. “I don’t do things as aggressively as I once did. I limit myself. But I’m not worried about it. I have a lot of life ahead of me.”