How to End Joint Pain

Intro: We’re talking wellness at MemorialCare Health System. It’s time for Weekly Dose of Wellness. Here’s Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I am Deborah Howell, and today we'll have two guests to help us talk about how to end joint pain and get back to living an active lifestyle pain-free. Dr. Daniel Duggan is a board-certified orthopedic surgeon specializing in arthroscopic and reconstructive surgery of the knee, shoulder, hip, and ankle. Dr. Sharoun Porat is a board-certified orthopedic surgeon at MemorialCare Saddleback Medical Center and OC Sports and Orthopedics, with fellowship training in sports medicine and arthroscopy. Welcome, Dr. Duggan and Dr. Porat.

Sharoun Porat, MD: Thank you.

Daniel Duggan, DO: Good morning.

Deborah Howell (Host): Dr. Duggan, let's begin with you. What are the first signs of a joint problem?

Daniel Duggan, DO: A few signs of a joint problem, often times people present with pain, sometimes altered function, and in certain circumstances even deformity.

Deborah Howell (Host): And can joint problems affect people at any age?

Daniel Duggan, DO: Yeah, they sure can. And oftentimes they're related to different reasons.

Deborah Howell (Host): Okay, and what are some common causes of joint pain?

Daniel Duggan, DO: Well, oftentimes we consider things like wear and tear, which we call osteoarthritis, causing pain. But it can also be related to prior injuries or traumas, which we can classify as post-traumatic arthritis. Or even related to a body's attacking its own cell linings, and in those circumstances we call that rheumatoid arthritis. And really, arthritis is damage to cartilage inside the body.

Deborah Howell (Host): Okay, never a good thing, right?

Daniel Duggan, DO: No.

Deborah Howell (Host): At what point should someone really, you know, get down to business and see an orthopedic specialist for joint pain?

Daniel Duggan, DO: Well, I oftentimes tell people if they're experiencing pain, specifically progressing pain, or pain that alters their function, or maybe they're unable to participate in certain activities or their quality of life is declining, then it's really time to probably do something about it and maybe see an orthopedic surgeon.

Deborah Howell (Host): Okay, and this is something that you would do after you see your own doctor?

Daniel Duggan, DO: Yeah, you could. A lot of that depends on, you know, your comfort level. You could be referred from a primary care physician, or your general medicine doctor, or in some instances people will come directly to their orthopedic surgeon.

Deborah Howell (Host): Okay, great. Dr. Porat, now I have some questions for you if I may. What can someone expect at their very first appointment with a specialist?

Sharoun Porat, MD: Well, your specialist should sit down and actually listen to you in terms of what your goals are, what kind of symptoms you're experiencing, and we call that basically a history. And they should listen to what the patient is experiencing. And then you should expect a good physical examination, going over body parts that are affected and all the associated body parts, and to go over your imaging data. And then to provide a detailed plan giving you options and suggestions to what to do next.

Deborah Howell (Host): Perfect. And I know every case is so different, but in general, when is surgery necessary to relieve joint pain?

Sharoun Porat, MD: This is actually a good question. Surgery is necessary usually when you've exhausted all of the non-surgery techniques. Surgery oftentimes is one of these things that's irreversible. So once you take this step to go to surgery, you can't go back and undo the surgery. So we'd like to do other things as much as we can before we proceed with that step. However, of course, there are some stages where someone comes to the office and surgery is the first thing that we offer because things have progressed past the point where we expect non-surgical things to actually have much benefit.

Deborah Howell (Host): And that's based on an examination of the patient and their scans and their images?

Sharoun Porat, MD: Absolutely. You have to tailor everything to the individual.

Deborah Howell (Host): Okay. Now since we're living in the year 2019, are there some alternatives to surgery for joint pain, depending on how severe someone's problem may be?

Sharoun Porat, MD: There are alternatives. I get this question a lot in the office. The first thing that I want to caution people for is there have always been and there continue to be snake oil salesmen. And people who will try to take your money to do something for you that is either unproven or doesn't have scientific backing. So the first caution that I would give is just because somebody is offering something to you, don't necessarily take that as the final answer. Make sure you've done your research. Generally, if insurance is not covering it, I would be very wary about those kinds of things. There's a couple of new procedures that people are charging cash, large sums of money, and there really isn't science to back it up, I'm not going to mention those by name. But there are alternatives to surgery that are helpful. There's medications that we can use, physical therapy can be very helpful. There are some injections that have been proven repeatedly, including gel injections as well as steroid injections that can give some temporary improvement, and those do have scientific backing to support their use.

Deborah Howell (Host): Okay, so the injections, the physical therapy, and the medications are, would be the ones that you would recommend looking into and not the snake oil stuff?

Sharoun Porat, MD: Absolutely.

Deborah Howell (Host): Now, is there anything people can do to try and prevent joint problems?

Sharoun Porat, MD: There are. Again, unfortunately a lot of joint problems can be genetic, and you don't really have much control over your gene pool, so that is what it is. But what you can control is basically how you live your life. Multiple studies have shown that being involved in a vigorous and regular exercise program that strengthens and adds flexibility to your core and your lower extremities can help prevent joint problems, and even if you do develop joint problems, it can help decrease the pain and increase function. So that's something that is consistently something that can be helpful. Another thing, for a lot of people weight loss can be helpful as well. Other than that, we come back to the snake oil ideas, there are things that are being sold over the counter that don't have scientific support, and you can try some of those things, I don't recommend spending a whole lot of money on those things or expecting huge improvements. But they're out there, in terms of vitamins and the like.

Deborah Howell (Host): Dr. Duggan, let's go back to you for a moment. What about those drinks that you see in the grocery stores for, you know, joint juice and things like that? What would you say to that?

Daniel Duggan, DO: Yeah, I get that question quite a bit as well, and I think Dr. Porat just really mentioned that a lot of the stuff doesn't have any scientific backing. However, people are willing to try it, and at a low cost, something like a drink, I really probably don't have a problem with someone trying it, it's just the reality is as often times as that arthritis becomes more and more problematic, the thought of taking a drink that's going to restore your cartilage has just been completely disproven. I mean, there's no science behind that. That being said though, I do have a few people who try different types of drinks and they tell me that they think they're feeling better. And my response to that is, well, keep using it if it's making you feel better, I have no problems with it. The reality is a lot of it may just be kind of placebo or because you think you're getting better you are getting better, and if that makes people feel better, I'm okay with that as well.

Deborah Howell (Host): Not a problem. And what's the first thing you tell somebody going into a joint surgery?

Daniel Duggan, DO: So I think there's a long discussion before, because as Dr. Porat alluded to, this is a decision that's made on an individual basis with between a patient and a surgeon. I think expectations are very important. A lot of these surgeries can really restore function, restore activity levels, but at the same time we've got to remember these aren't the joints that God gave ya, they're mechanical man-made joints and they also have some limitations. And I think the expectations of kind of what patients or people are hoping to get out of this is very important, and that's often an early conversation I have with a patient.

Deborah Howell (Host): Absolutely. I'm sitting here with a big plate in my shoulder and nine screws, and you know, I'm not exactly the same as I was before surgery, but without the surgery, boy, I'd be in a world of trouble.

Daniel Duggan, DO: Yeah, just like we said, those expectations sometimes need just to be reminded.

Deborah Howell (Host): Absolutely. Dr. Porat, this is a good time to be a patient for joint surgery, is it not?

Sharoun Porat, MD: It is. There have been several advancements in the way that we handle patients, both before, during, and after surgery. So people do consistently do better, they're more functional, they're able to progress. And we've got more data to support what we do, so that helps patients improve their outcomes.

Deborah Howell (Host): Data is good. My final question to you is, how important is that rehab?

Sharoun Porat, MD: It's critical. A lot of times we break it down and we say 50% of the outcome, if we're talking about a joint replacement for example, 50% of the outcome is the actual surgery and 50% of it is the rehab. So you definitely want to spend the time to do the physical therapy and the home rehab and the exercises that go along afterwards because that really determines to a great extent how your final outcome is.

Deborah Howell (Host): Do your PT folks. Dr. Duggan and Dr. Porat, I want to thank you so much for your time today, it's been very enlightening. To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell, thanks for listening and have yourself a wonderful day.