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Advancing Care - June 2022

advancing care

 

5 signs you may have osteoarthritis

As you get older, you may find yourself coping with aches and pains on occasion, especially if you participate in physical activities. However, if you start experiencing aching, pain and stiffness on a routine basis —particularly if the pain is at the joint — you may be developing osteoarthritis. 

Arthritis describes more than 100 different conditions that affect joints and the surrounding tissue. Osteoarthritis is the most common. It can develop after trauma or from age-related wear and tear on your joints over time, according to Cristina M. Brunet, MD, a rheumatologist at Yale New Haven Hospital and Yale Medicine. 

Wear and tear on the joint leads to the breakdown of cartilage, the rubber-like padding that covers and cushions the ends of the bones, allowing them to easily move against each other. As the cartilage breaks down, bone becomes more exposed. Eventually one bone starts to rub against another, causing pain, damage, swelling and problems with motion. 

“Anyone may develop osteoarthritis and the risk gets higher as we age,” said Dr. Brunet, who serves as site director of the rheumatology clinics at YNHH’s Interventional Immunology Center. “It develops in some people when they reach their 60s, although certain individuals may be at risk for osteoarthritis at younger ages due to prior injury or a familial tendency. At times, it develops after a sports injury, with repeated stress, or after surgery.” 

Excess weight may also contribute to developing osteoarthritis in weight-bearing joints, such as the hips or knees, said Dr. Brunet. The disease may also be associated with certain metabolic diseases such as iron overload or diabetes. 

What are the early signs of arthritis?

  • Pain in a joint. Pain or aching in a joint that gradually becomes worse over time is a classic symptom of arthritis. The pain may be triggered by activity, or it may arise after activity or at the end of the day. Osteoarthritis is most likely to affect weight-bearing joints such as the knees, hip, lower spine or big toe, but it can also cause pain and stiffness in your thumb or finger joints. 
  • Joint swelling and tenderness. As arthritis gets worse, it can cause joints to be swollen and tender. “Over time, it may become increasingly difficult to move the joint, or to bear weight on the joint,” said Dr. Brunet. 
  • Pain in a joint that was previously injured. Many cases of osteoarthritis occur in a part of the body that suffered a prior injury or trauma. “It’s worth seeking evaluation for persistent joint symptoms,” Dr Brunet said. 
  • Grating sound or sensation. Grinding or grating as a joint moves is a sign the cartilage in your joint has worn down and can indicate arthritis. It’s most common in the knee and hip but can affect other joints as well. 
  • Groin pain. Many people don’t realize pain from hip arthritis radiates to the groin, not the outside of the hip. Hip arthritis can also cause pain in your thigh or buttocks. 

What can I do to help ease my pain?  

There is no cure for osteoarthritis – but if the disease is diagnosed early, you may be able to slow its progression. Exercise can be one of the best treatments. “Osteoarthritis pain is best managed by staying active through exercise,” Dr. Brunet said. 

Walking – as long as it does not cause pain – is a good exercise; however, it is best to avoid running. You may want to consider a low-impact exercise, such as bicycling or swimming, to reduce the wear and tear on your weight-bearing joints. Studies have shown that regular yoga practice can decrease pain and improve joint flexibility for people with osteoarthritis.

Other treatments may include:

  • Medications: Topical pain relievers such as lidocaine creams and over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDS) can be helpful, said Dr. Brunet. More severe persistent pain is often managed with injections of steroids.
  • Ice packs and/or heating pads
  • Physical therapy to improve flexibility, strength and range of motion

Your doctor may also suggest that you lose weight. Being overweight puts you at a higher risk of developing osteoarthritis because carrying too much weight over time puts unhealthy pressure on the joints, causing the cartilage that supports that weight to break down faster. 

If your pain is getting worse, it’s best to talk to a doctor. “Consultation with a physiatrist, a specialist in physical medicine and rehabilitation, may be helpful in non-surgical management of mechanical causes of arthritis,” Dr. Brunet said. “Any symptoms that are progressive may need to be evaluated by orthopedics for consideration of surgical intervention.”

Spot the symptoms of tick-borne diseases 

Summer is here – and so are the ticks. If you or your pets spend time outdoors, you need to beware of ticks that can transmit diseases to people and animals. What can you do to keep your family safe from tick-borne illnesses?

Lyme disease

Here in Connecticut and most of the Northeast, the summer and early fall are prime times for deer ticks to spread Lyme disease. 

Lyme disease, named for the town in Connecticut where it was first detected, is a bacterial infection that can cause flu-like symptoms. Left untreated, it can cause severe long-term medical problems – but if caught early, it can be treated and cured with antibiotics.

One of the most common symptoms of Lyme disease is joint or muscle pain. Other symptoms can include fever, chills, swollen glands, heart palpitations, facial weakness and the classic bull’s-eye rash. While classic, that rash isn’t as common as you might think. Matthew Grant, MD, an infectious disease specialist with Yale New Haven Health and Yale Medicine, said that the rash only looks like a bull’s-eye in about one out of 10 patients. 

It can be a long time before some people develop any symptoms at all. Untreated Lyme disease can produce a range of symptoms, depending on the stage of infection. About 10 percent of people continue to have symptoms that linger, including difficulty concentrating, aches and fatigue.

“Lyme is typically broken down into three stages of infection and the last stage is called late or late disseminated Lyme -- and that can actually show up years after you get the initial tick bite,” Dr. Grant said. 

Learn more about Lyme disease.

Powassan virus

Another rare but potentially dangerous tick-borne illness has been in the news lately. Powassan virus is transmitted through the bite of an infected black-legged or deer tick. The virus can be transmitted in as little as 15 minutes after the tick first attaches. Symptoms start to appear a week to one month after the bite from an infected tick. While cases of Powassan virus are rare in the United States, several have been reported in Connecticut this year. 

While most people infected with Powassan virus likely experience no symptoms or a mild flu-like illness, some people may develop severe illness affecting the central nervous system. 

Severe cases may begin with fever, vomiting, headache, or weakness and rapidly progress to confusion, loss of coordination, difficulty speaking or seizures. People who experience these symptoms should go to the emergency department. There is no vaccine nor a specific treatment for POWV-associated illness. Severe illness is treated by supportive therapy which may include hospitalization, respiratory support and hydration. 

Learn more about Powassan virus and other tick-borne illnesses.

Prevention is key

To prevent tick-borne illnesses like Lyme disease and Powassan virus, you will need to protect yourself from tick bites. “The best way for people to prevent tick-borne diseases is to not be exposed to tick bites as much as possible,” Dr. Grant said.

To help protect yourself and your family:

  • Use a chemical repellent with DEET, permethrin or picaridin. Dr. Grant recommends using a bug repellent with 30 to 40 percent DEET. You can also get your lawn treated, or treat your clothing using permethrin, an insecticide that stays on fabrics through several washes.
  • Wear light-colored protective clothing. If you’re spending a lot of time outdoors, wear long sleeves and pants. Tuck pant legs into socks.
  • Avoid high-risk areas such as leaf piles or wood chips.
  • Check yourself, your children and your pets daily for ticks. Carefully remove any ticks you find. Sometimes ticks will attach in places that are hard to see. Pay particular attention to the armpits, belt line or groin area.
  • Take a bath, which can also help wash off ticks.

Dr. Grant adds that it can be very difficult to self-diagnose Lyme disease or other tick-borne illnesses as tick bites can be hard to find. Fever and chills, which could be warning signs for Lyme, might lead people to believe they’re suffering from another illness like COVID-19.

“If you’re concerned, especially about Lyme disease, go and talk to either your primary care doctor or infectious disease doctor,” Dr. Grant said.

Yale New Haven launches hospital-at-home program

Yale New Haven Health (YNHHS) has launched a program to provide high-acuity, hospital-level care to patients in their homes. The Home Hospital program serves Medicare patients meeting certain clinical and social stability criteria who live within 25 miles of Yale New Haven and Bridgeport hospitals. Yale New Haven Health is partnering with a private company, Medically Home, to provide the program, which is expected to expand to other YNHHS hospitals in the future.

The Home Hospital program provides acute care to patients who would otherwise need to be in the hospital. Patients are in the program for two to six days, on average, then transition back into the care of their primary care physician. Through a combination of in-person visits and telehealth technology, the program brings a range of hospital services to the homes of patients with heart failure, pneumonia, chronic obstructive pulmonary disease, cellulitis and other conditions.

“Many patients prefer to be cared for in their homes,” said Olukemi Akande, MD, physician executive director, Post-Acute Care, and Home Hospital program physician co-lead with Scott Sussman, MD, physician executive director, Telehealth. “With the growth of telehealth and other mobile health technologies, we can provide a high level of care and 24/7 accessibility to these patients.”

Each patient receives a physician video visit once a day through a WiFi-enabled tablet, in-person visits from a nurse twice a day, plus additional nurse home visits as needed. Other healthcare professionals provide in-home infusion therapy; physical, occupational and speech therapies; phlebotomy; mobile diagnostic services such as X-rays and echocardiograms; behavioral health care; and nutrition services. Immediate laboratory tests, imaging and IV services are available for urgent situations.

A Home Hospital “mission control,” staffed by nursing and physicians, remotely monitors all program patients. The team is available 24/7 to handle patient and family member questions or concerns. Each patient also has a personal emergency response device.

The number of home hospital programs has grown dramatically nationwide since 2020, when the COVID-19 pandemic prompted the federal Centers for Medicare and Medicaid Services to launch its Acute Hospital Care at Home waiver program. That program was designed to give hospitals greater flexibility to care for patients in their homes, freeing up hospital beds for COVID-19 patients.

Home hospital programs can also help reduce hospital overcrowding. YNHHS’ hospitals, like many others across the country, face significant capacity issues as they treat more and sicker patients who delayed care during the pandemic’s height.

“Just as telehealth has transformed outpatient care, it is helping us rethink the way we provide inpatient care,” Dr. Sussman said. “We can provide the same high-quality care in patients’ homes, reduce the risk of hospital-related complications and enhance our patients’ experience by caring for them in familiar surroundings.”

ER, urgent care or video visit? How to decide where to go

Need care right away? We can help with everything from allergies and sprains to emergency symptoms for heart attack and stroke. While emergency departments provide care for life-threatening injuries or illnesses, walk-in/urgent care centers offer convenient, professional medical attention for non-life threatening conditions including the flu and common cold to broken bones, sprains, cuts, allergic reactions, and minor burns, and hundreds of other conditions. Avoid long wait times at the emergency department and get the care you need at one of our walk-in or urgent care centers (https://www.ynhhs.org/patient-care/urgent-care) located throughout Connecticut and New York.

For minor medical concerns, you can receive care online using Video Care OnDemand

Not sure where to go? Explore your treatment options: Emergency department, urgent care or video visit?

Make a lasting impact at YNHH

Help support the mission of Yale New Haven Hospital with a donation! Your contributions support vital programs, services and facilities within the hospital and help keep Yale New Haven at the forefront of innovative treatment. When you make a gift to YNHH, you are part of the advanced medicine and compassionate commitment that touch so many lives in our community. 

Find a Doc at YNHH

Are you looking for a physician? Call 888-700-6543 or visit our website’s Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience. 

Billing questions?

Yale New Haven Hospital offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.