Sunday, December 18, 2011

Christmas Season in the Philippines: Good weather, Bad joints?


     It’s Christmas time once again, and brrrr…..the nights and early mornings are getting colder. On top of that, rare December showers are being experienced in Metro Manila, even a typhoon is hitting southern Philippines (Let’s all pray for the latest typhoon victims). La Nina phenomenon maybe? 

  In the Philippines, Christmas season is associated with cool weather which most Pinoys like, being hot and humid all-year-round. However, most of my elderly patients don’t. And they claim that they could predict cold weather better than any of the equipment of PAG-ASA. How? By merely rubbing their knees and other joints. During this cold season, arthritic pain is probably the greatest cosmological and eternal significance to them.

     My maternal grandmother, whom we fondly call Grandma, lives in the US. But every Christmas season, she goes back to the Philippines.  Reason?  Umiiwas sa lamig. (She avoids the colder US weather). It has been that way ever since I knew her.  (Although just recently, everyone decided that she should stay here in the Philippines for good, being widowed and in existence in our universe for 89 years already. Yehey for that!)

  Cold, damp weather is well known for aggravating aching bones. It seems like an old wives’ tale, but can it really cause aching joints? Is there really a correlation between bad weather and bad joints?

     Maybe. No studies have yet found conclusive evidence to the above question.

   The American Academy of Orthopaedic Surgeons (AAOS), the umbrella organization of orthopedic surgeons in the US, reported that many people with arthritic knees correlate changes in their pain levels with changes in the weather.  

      RealAge Facebook fans were polled recently to find out what triggers their hip and knee pain, and 42% blamed cold weather -- by far the leading cause. 

Potential Theories
   John Hopkins Medicine lists their potential theories for weather-related changes that cause pain.

     1.Drop in barometric pressure
This drop in barometric pressure is associated with rainy, cold weather which allow inflamed tissue in your joints to expand further, leading to increased levels of pain.

2. Muscle contraction
  The cold weather can cause muscles to   contract, putting more pressure on joints that may already be painful, causing even more pain.

      3.Lack of pain-reducing exercise in cold weather - People tend to be sedentary during colder weather.
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   4. Drops in pain tolerance associated with cold weather. 

   5. Mood alterations associated with rainy, cold weather.

Conflicting Studies
A study done in Argentina showed significant links between rheumatoid arthritis symptoms and high barometric pressure and humidity, as well as significant links between osteoarthritis symptoms and high humidity. On the other hand, a study of osteoarthritis patients conducted in Florida did not show any significant increases in weather-related knee pain. In a third study reported by the Arthritis Foundation, researchers at Tufts University in Boston noted in 2007 that drops in temperature or increases in barometric pressure can worsen arthritis symptoms.

   In my own opinion, cold weather has the tendency to slow things down. Think about metal over heat. As long as the heat is applied, the metal is able to be molded and shaped. When it gets frigid, it’s more likely to break when you attempt to manipulate it.  Same with muscles which stiffen up during cold weather, making it harder even when getting out of bed.

     Also, when it gets cold, blood flow moves away from your extremities and into your body’s main core.  Notice that in cold situations, your hands get whiter looking because there’s not as much blood flow. Someone who has arthritis and relies upon good blood flow to keep those joints warm and the inflammation down, begin to hurt and feel stiff.

Other studies
A Chinese study reported that knee pain is significantly more prevalent in people working in cold stores than in those in normal temperatures.

One study noted 17% of adolescents with anterior knee pain (pain in front of the knee, along the knee cap) report that their pain is associated with cold weather. 

Cold-induced knee pain may also be due to tenosynovitis or inflammation of tendons around the knee, in which cold exposure has a specific role, either as a causative or a contributing factor. Frank arthritis has been reported in children due to frostbite from extreme cold causing direct  chondrocyte injury.

So how do you control your anguish? 

1.      Pain relievers
There’s no question that staying on routine medications like anti-inflammatory pain relievers will help.  We call them NSAIDs and are readily available in our country. However, you may develop side effects with long-term use. 

2. Stay warm – In temperate countries, a way to keep joints warm during cold season is wearing several layers of thin, breathable, non-absorbent clothing. In order to retain body heat outdoors, don’t be afraid to throw on some long johns and heavy socks to protect your joints on a particularly cold day. In the Philippines, the days are usually the same warm weather but the early mornings are those that can cause pain.

If you plan on exercising in cooler weather, perform your warm-up indoors. That way, your muscles are more flexible and prepared to move once you step outside. 

A hot shower and a nice warm room make joints feel better, because both increase the circulation. An increased circulation helps decrease the inflammation in the joint.

Should  patients move to warmer climes just like what my Grandma does? Not necessarily. No climate is arthritis-proof. People in warm climates still struggle with arthritis pain. (I see them almost everyday).  

3.      Cortisone shots –
If you find your pain becoming worse, a trip to the doctor is in order. Cortisone shots may provide immediate relief, although it may only be temporary.

4.      Move It!
People are less likely to work out when it's chilly and damp. A recent study of elderly Chicago-area arthritis patients found people are significantly more sedentary when days are short, wet, and cold. Being a couch potato is bad news for your joints because exercise helps lubricate your joints to prevent pain. 

5.     Try some new therapies – Ask your physician about what you are able to do to manage frigid weather. Intensifying your physical therapy may increase the lubrication in your joints and shrink inflammation.

Summary

Although studies are still conflicting, many individuals feel their joint pain intensifies as the weather turns cooler. Therefore, it’s important to protect yourself against the chill, to stay active and to keep healthy and fit.

Moving to a dry, warm climate may improve your joint pain, as what my Grandma does. However, making such a move will not guarantee you freedom from pain, and distancing yourself from social support systems may stress you significantly in other ways. If you live in a colder or wetter climate, ask your doctor for advice on ways to relieve weather-related pain in your knees or elsewhere in your body.

Have a pain-free joint Christmas season!

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