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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Severe Arthritis

he first problem is an Ischial Tuberosity (torn upper hamstring tendon) in my left hip. There is actually a tear in the tendon where it attaches to the bone. The pain associated with this is debilitating. To this point I have not been able to find any relief. I have had more than twenty physical therapy sessions including heat and ultra sound treatments. At this point I have received little or no relief from the continuous pain. The second issue I have is I have been diagnosed with arthritis in my left hip and told that I am a good candidate for a hip replacement. The level of pain that I have from this is somewhat questionable in that it is masked by the amount of pain due to the torn tendon. In my mind, this issue is secondary since it is not much of a concern when I do not feel the pain associated with lt. The 3rd factor in making my issue unique is that three years ago last November I had a minor stroke leaving me with only about 30% feeling in the lower left quarter of my body. This is permanent and has not changed since the diagnosis. On issue with this is that even though I don t feel the level of pain that my body is experiences the connecting muscles do experience the full brunt of the pain and from time to time the muscle (left leg) will know the limits of what it can stand and it will just go limp and not allow me to use the muscle. The reason that I am contacting you is that I have not been able to find a physician that is willing to look at my issues as a whole. I have a surgeon that wants to replace my hip for the arthritis problem and I have an orthopedist that sent me for physical therapy for the torn tendon. Neither of these is going to make it possible to have a normal life.
Mon, 27 Aug 2018
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General & Family Physician 's  Response
HI. Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you.

Medications:

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

1. Analgesics. These medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram, Ultracet, others) and narcotics containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Norco, Vicoprofen, others).

2. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.

3. Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.
Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

4. Biologic response modifiers. Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).

5. Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.

Therapy:

Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.

Surgery:

If conservative measures don't help, your doctor may suggest surgery, such as:

1. Joint repair. In some instances, joint surfaces can be smoothed or realigned to reduce pain and improve function. These types of procedures can often be performed arthroscopically — through small incisions over the joint.

2. Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.

3. Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit

Hope I have answered your query. Let me know if I can assist you further.
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Suggest Treatment For Severe Arthritis

HI. Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you. Medications: The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include: 1. Analgesics. These medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram, Ultracet, others) and narcotics containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Norco, Vicoprofen, others). 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints. 3. Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself. Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil). 4. Biologic response modifiers. Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade). 5. Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint. Therapy: Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted. Surgery: If conservative measures don t help, your doctor may suggest surgery, such as: 1. Joint repair. In some instances, joint surfaces can be smoothed or realigned to reduce pain and improve function. These types of procedures can often be performed arthroscopically — through small incisions over the joint. 2. Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees. 3. Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit Hope I have answered your query. Let me know if I can assist you further.