Msit Heart&Stroke Health Directory atwww. h ea rta n dstro ked i recto ry. ns. ca

for support on how to lead healthiei lives.

Heart&Stuoke

qazuoFULUuouJVoEFVIozFELUI

===

Health Directory

on the map to viewkey services in your area

or give us a call and we willget you started.

Find out how to live healthier and bemore physically active in your community.Our free online health directory is yourconnection to people, programs andsupport for:

- Physicalactivity- Healthy eating- Heart disease and stroke management- Ouitting tobacco and more...

Working for o heolthier world'^

6fD HffslE\l/ 5:I&lil"P"tFlncllng answers. For life.

Preventing Falls Together

Anybody can fall. But as we get older, we are more at risk offalling. One out of every three Nova Scotian seniors will suffer a

fall this year, and more than half of these seniors will fall morethan once. lnjuries caused by falls result in pain, suffering, and aloss of independence.

Preventing Falls Together, a program of Community Links,funded by Nova Scotia Health Promotion, was developed to helplocal groups and organizations work with seniors to prevent fallsboth at home and in the community.

November 22 is Falls Prevention Day across Nova Scotia!Make this day count by committing to make positive changes inyour home and community to protect yourself, or a senior youlove.

Celebrate Falls Prevention Day by making

positive changes in your home and community!

Personal Changes-for yourself or a senior you care about:. lncrease daily physical activity. Have hearing and vision checked regularly. Wear sturdy footwear such as sneakers. Eat a healthier balanced diet to maintain strength. Consider using a walker or canF-make sure it is rubber-tipped

and the correct height. Use a reaching aid instead of standing on a chair

Changes ln The Home:. Remove scatter rugs. Eliminate clutter in walkways and stairs. Ensure lighting around home is bright and switches are within

reach of doorways. lnstall grab bars near toilets and bathtubs. Use night-lights in the bedroom, hall, and bathroom

Outdoor Changes:. Keep steps, sidewalks and pathways clear of snow, ice and

wet leaves. Replace shaky railings with sturdy ones. Put garden tools away when not in use. Keep your entrances well lit

For more information, or to get involved with a coalition in your area,contact Preventing Falls Together, PO Box 29103 Halifax B3L 4T8( 9 0 2 ) 57 6-2420 or fal lsprevention@eastl i nk.ca

PreventingFolls

TogetherPreventing Falls Together

helps volunteers andorganizations work with

seniors to prevent falls athome and in the

community.

'u-'*lCommunity LinksSeniors . Communiti$ . Action

A program of Community Links,funded by Nova Scotia

Health Promotion and Protection.

Tool KitThe Preventing Falls Together:Population HealthTool Kit is availableto organizations uponcompletion of ourtraining workshop.The tool kit includes fall preventionstrategies and check lists to use athome, the workplace, and in thecommunity. The tool kit is available inCD and print formats.

Commu nity PresentationsPreventing Falls Together coalitionsoffer presentations to interestedcommunity groups about the impact offalls on seniors and falls preventionstrategies. Please contact your localcoalition or our provincial office formore information.

Print ResourcesThe following is a selection of some ofour fact sheets. Please contact us for afree copy:tr Dont Fall this WnterB NeighbourhoodChecklr'sto Fall Proof Yourself Checklisttr Fall Proof Your Place of Worshipa Are You at Risk of Falling?o 12 Steps to Stair Safety

About 33o/o of seniors fall each year.

Anyone can fall, but falls haveserious consequences for seniors:1 in 4 seniors who fall will recover fully1 in 4 will be less mobile after their fall1 in 4 will lose their independence1 in 5 will die within the year

The good news is that manyfalls are preventable!

Preventing Falls TogetherPreventing Falls Together is a program ofCommunity Links, a provincial associationseruing seniors and volunteersthroughout Nova Scotia. The programhas received nationwide recognition forits work.

Our GoalThe goal of Preventing Falls Together isto help prevent falls among seniors.

A Community ApproachPreventing Falls Together coalitions havebeen formed throughout Nova Scotia.Members of these coalitions includecommunity volunteers, seniors' groups,health promotion agencies, businesses,and government.

How we workCoalition members work with individualsand organizations in their communities topromote falls awareness and to conductactions to reduce falls among seniors.Preventing Falls Together staff supportand assist coalitions in their work.

Community ActionsSome fall prevention actions conductedby coalitions include:r presentations and displays at health

fairs and community events. tai chi & exercise classes. painting the edges of stairs in public

buildings. projects focusing on places of worship. advocating for seating for seniors. safer sidewalks and trails, and. publications

WebsiteOur website provides contacts, links,and resources, as well as informationsharing for Preventing Falls Togethercoalitions.

Visit us online atwww. preventi n gfa I lstogether.ca

Contacts

Community LinksP.O. Box 29103

Halifax, NS B3L 4TBPhone: (902) 422-09L4

Fax: (902) 422-9322ad m i n @ o reve nti nqfa I lstoqether. ca

Program Co-ordinatorcoord i nator@ preventi n gfa I lstogether. ca

Western Nova Scotianswest@preventingfa I lstoqether. ca

Central Nova Scotianscentra I @ preventi nqfa I lstogether. ca

Eastern Nova Scotianseast@ preventi n gfa I lstogether. ca

28.02.2007

Preventino Falls Toqether Coalitions

Annapolis/Kingsavh@preventi ngfa I lstogether, ca

Antigonish Countya ntigon ish@preventingfa I lstogether. ca

Cape Breton Regional Municipalitycbrm @preventi ngfa I lstogether.ca

Colchester/East Hantsceh @ p reve nti n gfa I lstog ethe r. ca

Digby and Areadig by@preventingfa I lstogether. ca

First Nations and Inuitchh @preventingfa I lstogether, ca

Guysborough Countyguys@preventingfa I lstogether, ca

Halifax Regional Municipalityhrm @preventingfa I lstogether. ca

or to enquire about a presentation:hrmspea kers@preventingfa I lstogether. ca

Inverness and Victoria Countiescbiv@preventingfal lstogether.ca

Lunenburg/Queen'slqfp@preventingfal lstogether. ca

Pictou Countypictouco@preventingfa I lstogether.ca

West Hants Cobequidwhc@preventingfa I lstogether.ca

fiar tlbshnThe Canadian Red Cross mrssion is to improvethe lives of vulnerable people by mobilizing thepower of humanity in Canada and around thewoild.

0 nt, fnn dane nta( fi' tu cp ko'. Humanity. NeutraliU. Voluntary Seruice. Universality

hontut qoru hca((ed hnss 0/{rce'

. lmpartiality

. Independence

. UniU

Canadian Red Crosswww.tedctoss,ca

Canadian Red CrossCroix-rouge canadienne

| .:.i:.,:4.ti: ;.-.Goi odes.:r.tt. :i:Healthcare Equipment Loan Program

The Red Cross provides healthcareequipment to people recovering fromillness or injury. ltems ranging fromcrutches to wheelchairs are available toimprove the quality of life for our valuedclients. This service is provided free ofcharge.

The Red Cross is dedicated to meetingthe needs of individuals, from ruralcommunities to major centres , withquality healthcare equipment.

How Do I Access The HealthcareEquipment Loan Program?

Our priority is to make equipment aseasily accessible as possible. Contactyour local Red Cross office to find thenearest H.E.L.P location. Pleaseremember that a referral from a healthprofessional is required.

fiSome years ago I broke my

ankle and one fine day a set ofcrutches appeared lent by theRed Cross. lwas pleasantly

surprised that I was able to getthem easily, having enough on

my mind as a result of theaccident. lt is good to be ableto get this kind of help in times

of need. ,,

- Aet SandstromRed Cross Client,

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Please contact your local Red Crossoffice to see what'is available.

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lnterested ln Volunteering?

The Red Cross Healthcare Equipment LoanProgram relies on the generosity ofvolunteers who make this service a reality.Volunteers are an essential link which allowus to make this service available.

Volunteers maintain equipment, loan andtake returns at your local Red Cross H.E.L.Pcentre. To lend your time to a program thatmakes a difference in the lives of many,please call and become part of a wonderfulorganization.

fiI thought the Red Cross wouldbe a great organization to givesome free time to. Everyone isso friendly. I get to meet a lot ofpeople and you can really seethat the Red Cross is making a

difference in the lives of people' ,,

- Yvonne Se//ersRed Cross Volunteer,

How Gan I Help?

There are three ways you can help:

1. Financial donations are used topurchase new equipment, maintainequipment and for the generaloperation of the program. Taxreceipts are issued for financialdonations.

2. We also accept equipmentdonations forthose items thatare part of ourregular inventory.

3. We welcome yourvolunteer time andskills to make ourprogram available.

fiI was very appreciative when I

called the Red Cross for a walker.I was going to buy one, but when

I realized how expensive theywere, I couldn't afford it at thetime. I got the phone number

from the hospital and was glad Iphoned. The girlwas very

helpful. lwas glad I didn't needto look anywhere else. , t

- Pauline ClarkeRed Cross Volunteer,

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ThisDisease Self-ManagementProgram isa provincially

you thetools to live ahealthier life.

How can you get involved?

To take the program or become avolunteer leader, please call us at1-aa8-672-3444 or email us atYou rWay2Wel lness@gov. ns. ca

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Who should attend?

. Any adult who has an ongoing(chronic) health conditionincluding among others:o arthritiso diabeteso high blood pressureo heart diseaseo asthmao fibromyalgiao chronic obstructive

pulmonary disease (COPD)o mental illnesso chronic pain

. Family members, friends andcaregivers of someone with a

chronic condition

t

lifestylechanges. I havenever felt betteror healthier."

'This is thebeginningof my takingcontrol of mycondition. Imoved fromvictim, fromfeeling helpless,to feelingthat I can dosomething toalleviate mycondition."

"l learnedmany practicalskills from theothers in the

i.i-:.ill

,rafitDo you have a chronic (ongoing) health condition? Do you want tobetter support a loved one who has a chronic condition? This freeprogram helps those with chronic conditions overcome some of thedaily challenges they face. Join us for a six-week program to learn howto manage your condition better, develop new skills, and use proventools to help you maintain an active, fulfilling life.

-4.

Learn how to

. Eat healthier

o Become more active

o Manage symptoms

. lmprove self confidence

r Manage fear, anger, and frustration

o Make daily tasks easier

o Talk to your doctor and health care team

. Set goals, learn problem solving, anddevelop action plans

Learn how to take action toward a healthier life!

About the program

o Free

Each session lasts 2 1/2 hours

Six sessions, held once a week

Groups of 6-15 people

Volunteer group leaders, mostwith chronic conditions themselves

Offered in your community atcom m u n ity centers, sen iorscenters, libraries, or recreationalfacilities

For general informationabout programs and servicesavailable for seniors, contact:

Nova Scotia Seniors' Secretariat17 40 Granville Street, 4th FloorPO Box 2065Halifax, Nova ScotiaB3J 7Zr

Phone: (90?,) 424-0065Tbll-free: 1 -800-670-006 5

E-mail: scs@gov.ns.ca

The Secretariat's u'ebsite has a widerange of information about senior abr-rse:

www.gov.ns.ca/scs

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Did you know thatfina ncia I exploitationis the most commonlyreported form of abuseof se n io rs?

Financial exploitation has two mainforms-financial abuse and economiccrime.

This is one form of senior abuse. Otherforms include emotional, physical, sexual,neglect, and violation of rights.

Financial exploitation can happen toanyone. If it happens to you, remember,you are not aloner lou are not to blame.

Economic Crime includes consumer fraud,investment fraud, scams, and identity theft.These crimes can be carried out throughe-mail or the Internet, by door-to-doorsalespeople, or by telemarketers. CallPhoneBusters or your local police if yoususpect that you are being targeted.

Who should youca ll for help?

Senior Abuse Line: 1.877.833.3377Call the Senior Abuse Line for information orto talk about a situation of abuse. Your call willbe kept confidential.

Legal Information Society ofNova Scotia: 455.31351,900.6 65.97 7 g

The Legal Information Society is a not.for-profit organization that provides informationon legal issues and lawyer referral.

Police: 911 for emergencies only

Abuse may be a crime and fall under theCriminal Code. Callyour local police stationfor information or to report abuse. If thesituation is an emergency or if it could bedangerous, call 911.

PhoneBusters: 1 ,888-495 -85 0 1

www.phonebusters.caReport scams and fraud to PhoneBusters.

Adult Protection: 1 .800.225.7225If you know of a senior in need of protection,call Adult Protection Services at theDepartment of Health. If financial abuseoccurs at the same time as other forms of abuse,Adult Protection workers may be able tointervene and offer services to help those inneed of protection.

Financial Abuse is aviolation of trust.Someone you know and trust-a familymember, friend, or care provider-triesto take what belongs to you, such as yourmoney, your property, or other assets.

Financial abuse is unethical. Sometimesit is also illegal.

Examples of financial abuse:

. Someone puts pressure on you to gainaccess to your money or property.

. Someone misuses a power of attorneyto take your money.

. Someone forces or tricks you intosigning a contract or a will.

Financial abuse often goes hand in handwith emotional abuse. The person maymanipulate you, bully you, or threaten youto get your money or other valuables.

Remember... it's your money.

What should you do?

Prevent it!. Conduct your own financial matters as

much as possible.

. Plan ahead and make your wishes known.

Say "no" when someone pressures youfor money-even family members.

Make sure you understand everydocument you sign.

Report it!Thlk to someone you trust.

Call your local police. They willinvestigate to determine if the abuseis a crime and will recommend howto proceed.

Get legal information and advice!

Talk with a lawyer when making planssuch as creating a power of attorney.

Good legal information and advice is

an important investment.

Abuse can happen to anyone.

a

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ARTHRITIS FIGHT IT!

To getthe best results,you need to form closeties with your healthcare team and become a

full partner in your healthcare treatment.

Learning daily living strategies to manageyour arthritis gives you a greater feeling of

control and a more positive outlook.

To suppart arthritis research or i:contactThe Arthritis Sc . ..

1.800.321.1433

www.arthritis.ca

rhef,lft1i1i5Society

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rhrArthritisSociety

Osteoarthntis

ARTHRITIS FIGHT IT!

SIIRTIhis publiertion has hccn cndr,rsucl br rh.'t-

ri'ltose nrissirrn is to rrprcs{ut Crnatli.rn lihciirrol erccllence in ,,\rtltrirrs t-rn F.

Osteoarthlili-s - Knou., lilti. O|ri,,r.s : .r-rnrestricte d eclucatlonal grant 1r,l:', ).1

Healthcare, thc ntlrkers ..i l'r .

Thc An lrilti5 Socielv grrrrcllllr rel.lo* lirltc- t. . -:

Assistrutt ProLessortr{ irlcrlicinc l ltr..r.:1.. .-; .'. -:-(J\lr(Lil1fir ilis - l(nnr lbirr t)i xi(rri. t)r. K.rIr :l',,, .,:: .r '

fhtrlrps,u lJScl'T, oLLr \Jctlicirl,\chr:rrrr ( frlrir: : -

contt'nt rrrrtl Dr. NlrniclLrc (-antcrltrn i,'r irr: :: -

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Osteoarthritis

DID YOU KNOW?

. Ostcorrrthnti-s ,t1.1) is the most common type ofarthritis. rt iiicels I in ltr Crrnrtdian aduits.

.It affc-cts \\'r)nrct.r rlnL] I'..i: .'cu,rlh'tpasr 60).

. An)'rtne ciln qct t)-\. b'.:'.:: -.s,.-:.-'. ::-..::s:t-i thc

tO iOS and is nt.rr.' .t\ll-.r-;r.:] ,-.S .,.: -. :-.-.:--'-:a '-i

There is no cure for OA, bst when you arediagnosed early and start the right treatment,you can take control of your disease and avoid

severe damage to your joints.

Most people with OA can lead active andproductive lives with the help of fte right

medication, surgery (in some cases), exercise,

rest and joint protection tedrnQues"

WHAT rS OSTEOARTHRTTTS (OA)?

Can you beliei'e that thcre .i:. !- ..: - -'-- --.--::.'n: tr-pes

olanhritis? To keep thrnqs sir',1r.: .,..'.,,.., ;.'.-.:iarthritis inio twc.r general tvFrai - .::-..:-.:-.:: :. :nddegeneratir,e. The root CJUSc' t i j.:i. -..-:--,:..: :::r,ritis is

the breakdolin of cartil;rqc \\' i.. :..:.: : :.:1.-. :-. :-.., :...n .r Ithe lining (svnor-ium\ trl rhc- ,r'::'. :-. ::a :.-.-'- :-r'-,sc olinfl ammatory' arth ritis.

Cartilage is the t,-rugh eilsir: :r,ric:iJi thilr colers and

protects the ends tri btrnc-S. 1n healthr'.]oints, cartilage

acts as :r shock rrbsr-rrber u-hen vr-ru put weight on thejoint. The slippen' surlirce o[ the cartiiage al]ows the

.joints to rnrrre smorrthh'.

When a loint "degenerates", the cartilage graduallybecomes rt'rugh, begins to wear away, and the bone

underneath thickens. This is typlcally how osterrarthritis

starts. Most people notice OA as they get into thcir40's or 50s, however, in some people it can strri-t .-arlier.

2 Anf,HnmS re llGHTn!

-10 -.

It rends to aflect the joint at the base of the thumb, the

end.joints or middle joints of the fingers, the hips, the

knees, and the joints at the base of the big toe (bunion).

OA will usuaily cause the affected joints to become

stifl in the mornrng but the stiflness usually lasts about

15-20 minutes. However, as the day progresses andjoints are used the pain and discomlort usually gets

worse. Resting the joints tends to provide relief.

Movement of the joint can sometimes cause a "creaking"

sound or leeling (crepitus). Painless cracking of loints(like when you crack your knuckles) or painless

snapping sounds (1ike your ankles when you walkdown stairs) is not a leature oI OA.

The joint may become inflamed with pain, warmth,and swelling. Although we see signs ol inllammationin degenerating joints it is usually not a major part ofthe problem. Naturally, all of the pain and stiflness

causes the joints to be used less often and the muscles

surrounding the .joint weaken.

Over time, as the cartilage wears down, the.jointsmay slowly become bigger (boney) as the body tries to

heal rtself, With severe OA, the cartila€le may wear away

entlrclx and the bones may rub together ("bone-on-bone")

When this happens the joints become more painlul.

.irl I ntt :q,,i\.ff ,*,i1,rr4$ h W {,}&

. End joints of fingers

. Middle joints o[ lingers

o Joint at base ofthumb

. Hips

. Knees

o Joints at base

ol big toe

Neck (cervical spine)

Low back (h-rmbar spine)

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WWW.ARTHRITIS.CA 3

WHAT ARE THE WARNING SIGNS OF OA?

Remember that OA usualll' progresses sLr\rl\. lrver a

period of months to years.

. You start to leel the gradual onset of pain in.lointstypically aflected by OA.

. This pain is usually worse alrer you use rhe joint andimproves as you rest it. The joint may be still afteryou rest it or when you wake in the morning but thisstlffness is usually short-lived lasting only I5-20minutes.

. The pain can be with you (ro some degree) most ofthe day even causing discomfort while you rry rc)

sleep at night.

. You may notice some swelling in the joinrs and aloss of flexibility or strength. The joinrs ma;' have a

"creaking" sound when you move rhem.

WHAT TO DO IF YOUR FAMILY

DOCTOR THINKS YOU HAVE OA?

If your iamily doctor belier.es thar 1.'ou har.'e OA, iris important to educaie yoursell abour the disease.

Your lamily doctor may ask you ro see allied health

pro[essionals such as physiotheraprsts, occuparlonal

therapists, and dieticians to provrde y'ou lr'rrh tools tobetrer manage your osteoarthriiis. 1l vc'rur lamiiy doctoris unsure about the diagnosis or rs uncomfortable withsome aspects of the management a relerral to a

rheumatologist may be made. A rheumatologist is a

doctor who is an expert in arrhriris. lf your arrhritisgets to the point where your lamlly doctor leels

surgery is needed then you will be relerred ro an

orthopedic surgeon.

HOW DOES THE DOCTOR DIAGNOSE OA?

There is no single test for osteoarthriris. lfyou have

signs and s)rynptoms of osteoarthntis, your doctor r.vill

likely discuss your q./rnptoms, examine vour.joints, andperform x-rays to help with the diagnosis.

4 ARTHNMS M flGHTfi!

WHY IS TREATMENT FOR OA SO

IMPORTANT?

Unlortunately, osteoarthritis is a disease that tends to get

worse over time as the cartilage continues to wear away.

Although there is no cure ior OA, with the right treatment

you can take control ol your disease and keep yourjolntsas healthl'as possible for as long as possible. The main

goals o[ treatment include:

. Controlhng your pain

. Improving your abiiity to function

. Slowing down the progression of the disease.

WHY DO PEOPLE GET OA?

It is importan t to realize that there are two types ofosteoarthritis: primary and secondary Primaryosteoarthritis occurs when there is no obvious reason

for the arthritis, although you may have risk factors

(see below and page 6). Generally, primary osteoarthritis

occurs in many joints such as the fingers, base of the

thumbs, spine and bunions. It is often inherited so

parents and siblings may have some feaiures of it with

various degrees o[ severity

Secondary osteoarthritis occurs when there is a likelycause for the OA. The most common cause of second-

ary OA is a prior injury to the joint although there stillmay be other rlsk factors (see below and page 6).

Secondary OA is very common in professional athletes(footbali and hockey players) but can occur in anyone.

The risk factors for developing OA include the following:

Age: As we get older so do our chances of developing

osteoarthritis. As OA is a degenerative condition, the

naturai "wear and tear" on the joints does play a part

in the development. If we live long enough, most of us

will experience osteoarthritis, but age alone doesn't

mean that OA is inevitable.

tvwwJf,rlnrF.(fi 5

Family History: 1r is becoming clear rl-rat geneties

plays a role in the dei'elopment of osreoarthriris. Thisseems to be more ol a lactor with arthriLis affecting thesmall .joints rn the hands (nodai OA). Researchers are

not sure how genetics plays a role but it may be due rcr

the shape o1'your bones and the way rhey lit rogerheror your ability to make and repair cartilage.

Excess Weight: lf yor-r r,veigh roo rnuch, your leer,knees and hips have ro carry rnore weight rhan theyshould. The good nelvs is losing r,veight, even just 10

pounds (4.5 krlograms), can help pr.event osteoarrhritisin your knees. Even ifyou have osteoarthritis in yourknees, losing weight can mal<e you leel betrer andprevent the need lor surgery in the lurure. Less bodywciglit mcans lcss stress on y,our.joints.

Joint lnjury: Osreoarrhriris can occr-rr in joints whichhave been "damaged" by a previc'rus injr-rr1i The inirialinlury may have damaged the carrilage or alfectecl the

wely the.joint moves resuhing in secondary OA.

Complications of Other Types of Arthritis:Ost-eoarthritis can occllr in joints which hal'e been"damaged" by oLher rypes ol arthritis. For example,peopie wjth rheumatoid arthritis or gour can developsecondary osteoarthlitis in lhose joints in which theinflammation has caused damage.

Wear and Tear: Wear and rear on rhe joinrs can playa role in the development of OA but it cloesn't explalneverything. For example, why clo some people, wirhsimilar.jobs and lilesryles, develop OA in rhe small .joinrsof the lrands and others not? Rcsc,trch ntlu shotps tlutlnormal we ar does noL acluttlly causc thc joints to dcganeratc.

Normal activily ancl exercisc is good rathe r than bad.fitr

.jttints ancl tlocs not ctwse osteourthrllis.

Just to conluse the issue, there is a rare type ol OA thatis called 'inflammatory OA. This is a more severe, rap-idly progressive, nrultiple joint OA thar is associated

wiLh more stiflness in the nrorning and swelling in thejoints witl"r warmrh and redness. This type o[ OA is

6 AffiHRITIS:, flGHTlT!

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more diflicult to diagnose because it ls olten conlused

with Rher-rmatoid Arthriris. A rheumatologist can helpmake the correct diagnosis and suggest treatment forinflammatory OA.

We do not yet know the causes or the cure lorosteoarthritis, but researchers in Canada and around

the world are tryrrng [o learn why cartilage starts to wear

away In fact, The Arthritis Society ftinds many leadingedge research projects that bring vital new insights and

lead to new and better treatments lor osteoarthriiis. For

example, Canadian researchers have identilied some ofthe enzymes that damage the cartilage in osteoarthritis.

Blocking ihese enzymes may be one way to slow downthe ploglessirrn of the disease.

HOW CAN I MANAGE OA?

Once ;'6111 diagnosis is conlirmed there are many

treatments that can help decrease your pain and increase

yoLlr mo\?ement. Non-medication therapies such as

physiotherapy', occupational ther"apy', education, exercise,

and rclaxation techniques are e very rmporLant part o[ the

tr€atment of OA. Howelrr, the typical treatment plan is

usually made up ol several components including:

. Medication

. Healthcare support(physiotherapy, occupational therapy etc.)

. Daily-lir,ing adjustments

WWW"ARTHRIIIS.CA /

A WORD ABOUT PAIN

Pain lrorn osteoarthritis can be so intense and constant

that it dominates your every waking moment (and can

cause many sleepless nights). Due to pain, you may

be unable to continue with your routlne daily activities

and you may become less active in an attempt to keep

your joints as comfortable as possible. Unfortunately,this inactivity can then have negative effects on yourmuscles and joints. This can then lead to a loss olstrength, reduced flexibility, and more pain. Therefore,

good pain control is essential in the treatment of arthritis.

Persistentiy severe pain from arthritis requlres a

combination of therapies as no single management

technique is powerlul enough to provide non-stoppain relief. You need to discover what works lor you.This olten means trying many dif{erent therapies or

combinations ol therapies lor prolonged pain reliel.

ln order to decrease your pain and maintain movement

and function, it is essential that you become actively

involved in developing your prescribed treatment plan.

NON-MEDICATION THERAPIES

Non-medication therapies are a very important part

of the treatment ol osteoarthritis.

ffxerr:tsm

When done properly, exercise can help to decrease OA

ryrrnptoms and make you feel better overail. If done

improperly, exercise can "flare" your arthritis. Therefore,

an exercise program should be done under the guidance

of a trained physiotherapist. There are different types ofexercises that you can do to lessen your pain and stiffness;

. Range of motion exercises reduce pain and stiflness

and keep your joints moving. To achieve the most

benefit these exercises should be done daily.

. Strengthening exercises maintain or increase muscle

tone and protect your.ioints.

8 AT'HN|IF M,fIGilIM

. Moderate stretching exercises help to relieve the

pain and keep the muscles and tendons around

an afiected joint flexible. Your physiotherapist can

guide you on whai strengthening and stretching

exercises are best and when they are appropriate.

. Endurance exer(iseg strengthen your heart, give you

energy, control your weight and help you feel better

overall. These exercises include things like walking,

swimming and cycling. It is best to avoid high impacL

exercises like step aerobics,.jogging or kick boxing.

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Heat is one of the oldest treatments to provide relieI

from muscle and joint pain. When heat therapy is used

it can reduce joint pain, stilfness and muscle spasm.

Heat promotes blood circuiation, which nourishes and

detoxifies muscle fibers. You can purchase "hot packs"

made ol silicate gel, beans, or corn (i.e. magrc bags) or

nse a hot water boltle. Place a damp towel on the skin

to improve heat conduction and apply the "hot pack"

lor l0-15 minutes. Heat should be comfortably warm.

The heat should not feel like it is burning your skin. Ilheat is too hot, add one or two towels between the heat

source and body part, or remove heat. Continuously

inspect the area that is berng heated. The area wiil appear

red and possibly sweaty If, however, the heat has caused

pain in the area, it should be removed and discontinued

until you consult with your physiotherapist. Heat can be

re-applied alter leaving it olf for the same period of time

for which it was applied. All redness should be gone belore

re-applying. In order to avoid making s)rnptorns worse,

heat shouid not be applied to an already inflamed.joint.

Cold applied to inflamed.joints reduces pain and

sweliing by constricting blood flow. Gel packs, a bag olfrozen vegetables, or crushed ice in a bagare good "cold

packs". Place a moist towel between the pack and the skin

to improve conduction o[ cold and apply the cold pack

for l0-15 minutes. The skin underlying the cold pack

will redden; check the skin frequently for signs of over-

cooling (blanched, white skin). Leave at least two hours

between cold applications. You should not use ice if you

have circulatory problems such as Raynaud"s disease.

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You should always use your joints in ways that avoidexcess stress. This allows you to experience less pain,perform tasks more easily, and protect your joints lromdamage. Techniqr-res to protect your joints include:

. Pacing by alternating heary or repeated tasks withiighter tasks. Breaks or frequently changing posirionsreduces lhe stress on painful joints and conserves

energy by allowing weakened muscles to rest.

. Positioning joints wisely promores properalignment and decreases excess stress. For exampiesquatting and kneeling may put extra stress on yourhips or knees. When lifting or carrying hearli iterns,

keep ltems at waisr height and avoid carrying rhemup and down stairs.

. Adapting your daily activities and using helpfuldevices can help to conserye energy and make dailytasks easier. Raise seat levels to decrease stress onhip and knee joints. Use a reacher to pick up itemsfrorn the ground. Use a cane to decrease stress onhip and knee joints. Enlarge grips on u[ensi]s suchas spoons or peelers t.o decrease stress on delicatehand joints. Other devices to consider include cartsfor carrying objects, and jarltap openers.

. Talk to your doctor about seeing an occupationaltherapist or physiotherapist who may prescribe '

splints, braces, or orthotics (shoe inserts), to helpalign and support yourjoinrs.

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Developing good relaxation and coping skills can helpyou maintain balance in your iile giving you a greaterfeeling of control over your arthritis and a more positiveoutlook. Relaxing the muscles around a sore jointreduces pain. There are many ways to relax. Tiy deep

breathing exerclses. Listen to music or relaxation tapes.Meditate or pray Another way to relax is to imagine, orvisualize, a pieasant activity such as lpng on the beach,

or sitting in front of a fireplace. For more informarionon these skills, you can parricipare in the ArthritisSelf-Management Program or see a psychologist, socialworker or arthritis therapisr.

IO ARTHRITIS 5E FrcHT|I!

l)l lrThere are many claims about diets which help or "cure"

arthritis. Most of the information is confusing and claimsmade are usualll' not. supported by scientiflc evidence.Simply put, there is no dier that has been proven rosignificantly improve osreoarthritis. Until there is moreconclusive evidence, use a common sense

approach by eating a well-balanced diet .laimed at mainraining a healthy weight.

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Massage is widely used for pain relief, butrts results are open to question. At best, massage mayreiieve muscle ache or tension b), increasing blood flow,but that benefit is relativeiy shorr-lived. Massage shouldbe avoided when joints are especially render or inflamed,since it can actually worsen your condition at such times.If you're har,'ing a massage done by a professional, makesure he or she understands that, because o[ your afthritis,you want only the gentlest procedure.

WHAT MEDICATIONS ARE USED FOR OA?

The general approach ro rrearing OA with medicarionsis to reduce your pain, increase your function, andslow down the progression of the disease. Unfortunately,there is no medication that has been shown to consistentlyslow down the progression of OA. For the most part,the goal of medications in OA is to reduce pain.

NON-PRESCRIPTION MEDICATIONS

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Acetaminophen is an elfective medication for pain reliefwhich can be used for borh shorr and long-term paincontrol. if your pain is present most of the time, yourdoctor raay recommend that your take acetaminophen(Tylenol') regularly - every four ro six hours. When thepain is there all oi rhe time, there is no point in waiting forit to become unbearable belore taking your medicatron.Then you have to walt for the ellects ol the acetaminophento "catch up" to the pain.

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Although acetaminophen is sale, it does have its limits:

you can take two regular strength tablets (325 mg each)

to a maximum of l2 tablets in one 24-hour period, or

two extra-strength tablets (500 mg each) every six hours

up to a maximum of eight tablets in a24-hour period, or

two extended-release tablets (650 mg each) every eight

hours up to a maximum ol six tables in a24-hour period.

Acetaminophen is found in other over-the-counter

preparations such as cough and cold formulations.

You must be careful to look at the ingredients of ail of the

over-the-counter medications you are taking to ensure

that you are not taking too much acetaminophen. The

maximum daily recommended dose is 4 grams (a000 mg).

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Acetylsalicylic Acid (ASA, Aspirin.') and lbuprofen(Advif', Motrino) are Non-Steroidal Anti-lnflammatory

Drugs (NSAlDs) which can be purchased over-the-counter.

You can learn more about NSAIDs in the section below

You must be careful to avoid taking ibuprofen withother NSAIDs your doctor may prescribe as it increases

your nsk of developing stomach problems.

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There are a number of over-the-counter creams and

rubs available to help with the s),'rnptoms o[ arthritis.

Some of these products contain salicylate (ASA) as the

active ingredient whereas others contain capsaicin or

menthol. Salicylates work by decreasing pain and

inflammation while products containing capsaicin or

menthol are able to relieve pain by tricking the body to

leel the coolness or heat o[ these agents.

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PRESCRIPTION MEDICATIONS

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Non-Steroidal Anti-lnflammatory Drugs (NSAIDs)

are a class of medications used to treat the pain and

inflammation of arthritis. They do not contain steroids,

hence the name "Non-Steroidal". NSAIDs are a very

large category of medications, some of which you can

obtain without a prescription, such as ASA (Aspirin,,

Entrophen'u, Novasen*) and ibuprolen (Advilu, orMotrinu'). The list of NSAIDs is long with over 20

currently available today.

It is importanr to remember that NSAIDs work toimprove symptoms and have no proven long termbenelits in OA. As such, these medicarions can be

taken on an as needed basis and do not need to be

taken regularly That being said, some parlenrs find ithelpful to take their NSAID on a regular basis ro

control their symptoms.

lndigestion, heartburn, stomach cramps, and nausea

are the most common side elfects oi NSAlDs. NSAIDscan alfect the protective lining of the stomach makingyou more susceptible to ulcers and bleeding. Il you

develop signs of stomach bleeding, such as vomit that

looks like it has "coffee grounds" in it, vomiring blood,or black, tarry bowel movements, while taking NSAlDs,

stop the NSAID and see a doctor immediately. COXIBsare NSAIDs that have been custom-designed to reduce

the risk ol stomach side effects.

Health Canada has reviewed all of the available srudies

on NSAIDs and COXIBs and lound r.hat NSAIDs andCOXIBs are both associated with an increased riskof cardiovascular events (angina, heart attacks, 6s

strokes). The risk is great.est in those patients who use

these medications for long periods ol time and have

risk factors [or, or a history o[, cardiovascular disease.

Please discuss this with vour docror.

slvw.ARfHnllE.fl 13

ln Canacla, cliclolenac (1.5%) is avaiLable in a topical

NSATD preparation sold ttndel the brand-nanre olPcnnsarcl'''. When appliecl as clirecLed to Lhe skin or,e r ajoint, r'e ry little ol this medication rs absot-becl into the

body which signilicantly recluces the usuaI side e fl'ecLs

associirtecl ri,iLh NSAIDs. The common sidc-eflects olPcnnsaicl '' incLude cl11,5p;'', ancl rash at the srte olapplication Please note that Pennsaicl" is incliczrtecl lirr

Llse on OA ol'the knee onll:

Ste roic'l injections, also re lerrecl to as cortisone

injt'ctions. r.rrc nsecl to hclp the pain ancl sri'e lling nilhman)/ types oi arthritic c:onclltions. Injecting a steroici

ir.r or art.rLrnd tlre .joint is an e llective r.va1' to local[1'

reduce pain ancl su'cl[ing.

Most injections typrcally takc 24-48 holu-s to take fi-rll

effect. Il local ancstheLic ("heezing'') r'i.'as given with the

injectior-r yoLr nlay lecl inrprove nrent c1t-tiie qr-rickLy Altcr

the injection it is r-rormirl to lee I a transient iucreasc in

cliscomfort in the joir.rt r,r,hich shoulcl resoive r.r,LLhitr

24 hours. You can treat this by applyine a cold pacl<

or b1, r,rsing me clications such as acetamrnophe n

(},'lenol'') or Non-Steroiclal Anti-lnflammatoty Drugs

(checl< u'ith your doctor). 11'possible , it is best to rest

Lhe lortrt lor 24 hor-rrs alier an inlection :rs str-rdies havc

shor,vn this may improve tbe ellect ol the injection.

Hou'el'er, the length ol tinie an injectlon w'ill last is

variable with some llatients repr)rting months ol relie I

while oLhers f ind only a felv da1's ol re [iel.

Il:r signilicant benelit is achievecl alter the lirst inlcction

thcn an argunlenl can be tnade for a repeat n-rjection.

Thcr-e is some colltroversy that too many iniections nral'

r,veal<e n tendons, liganents, ancl carlilage but olher

stnclies have for-rnd that injections can slor,v.ioinL dama€ie.

As a general rule a rcasc'rnable appro:rch js to lin-rit tl-re

lreque ncy ol injections to 3-4 to each.joint per year.

Most joint iniections resr-rlt in no side-cf{.ects. C)ne olthc very rare (1 in l5,il00) risks ola lotni lnjectiL)n LS

14 ARTHRITI' FIGHIII!

inlection. ll tht- itrjectccl .joir-rt becomcs ve r), painlul,rccl, ol sq,ollen secl< nredical Ltttcntion intn.rediate[1'as

the joint mav bc infecLcd.

\riscosr-tppleurcntation is tl-rc rn jection oI a cleal gcl,likesubstance callcd h;'alur"onan inLo rhc knce . H;,aluronanis a nomal part ol healLhl' carrilage. Irr.jecring it inro rhe

joint is thotrglrL to lultricate the cartrlzrge (muclr like oillublicirtes an e ngirre), rcclucing pain, ancl allowtnggreaLcr lrovcmcrlt ol ihe linee .

r\lthor-rgh thesc nreclications can be pr,rrchased rvithoutir prescription, rt is necessary to see a ph),sicran lbl thcinjeclions. For moul inlrrnlatictn on viscrrtsupltlementill-ion,

speak n,iLh vour cloctor'.

Sonretimcs srnrplc painkillcrs ancl NSAIDs are nor

strong enoLtgh lor Iour pain or )rou tna),not lte ablc Lcr

take NSAIDs \bur cLrcior c:rn help by prescdbingsLrorlge r ltain meclicaLions sLrch as Opioicls. Opioids ar.c

a class ol pain meclicaLion lvhich inclucles codeine ,

lnorphine , ancl trar.naclol. These meclications shor-rld be

takcn r-rnder thc clirect super-rrrsion ol yor-tr physician Ltr

monitor srcle eI'lects. Common side-e I'lects o1'crltioids

inclr-rcle nausea, cotlslipation, clizzrness, clrowsiness, and

a drl, mouth. Becausc these medications slorn' clou,n

cligcsLron (constipation), be sure to cirink six to eighttall glasses ol r.r'atcr througholrt the dayr

t/l,wwARTHRrilS.(A rs

COMPLEMENTARY THERAPY

ll'-s irlportatrt to t'emcmber that altei-native allllro:rches

ro manerge OA ar-en't. mcant lo replace your lreaiment

pl;rn, br-rt rathcr complement tl.tclx. You shoulcl alrva,vs

discuss t'our se lection ol supplements ancl

cornpletlenlzrry' the rapres rvith your cloctor.

Glucosauine sullzrte rs a nortrtal componenl of crlrlilage

and a r,ctJ pc'rpular: sLtpplemenL takcn by paiie nts \\'ith

Or\. AtthoLrgh nrany people n'ith OA Llse this meclicaLion

ther-e is conflicting evjclence irs ttt n'hether it actualll'

rvorks. As it is r;'picalll' macle flotn the shells oi shclllish

snch as shnmp, lobster, ancl cr:rb, an)'one wjth a shelllish

alle rgy' shor,rlcl be carefurl ttsing tlris supple nrent 1-he

t1'picai closc ol glr-rcosamine usecl in nreclical research

is 50tl nrg three times per cla;r 1l your don't lcel iin,r'

ilcnclit altet- tl-rree nlonths it pr-obably isrr't gtling to

lvor-l< ancl ycir-r shor-rld stitp ustng gllicosamine.

C.hondroiLin is irnother popular sullpLctnent arlcl

anolher c(){.}rilonent o[ humarr cartllage , bone, nncl

rendon. Choncir"oitin is r-rsualll' ftlund combinecl rvjth

gLucosanrine in a single tahlet There is conlliciing

evLclorce as to ri'hether chonclroitin actr-ral11' u'tlrks ttl

recluce p:rin in OA. The usual cltlse is'100 mg Lhrcc Lirncs

per clarr lf y'or-t clon't fcel any benelit a[ter three months it

probabli' isn't going to r'vork and 1'or-r should stoll Ltsing

chondroitin.

J' ARIHRITIS TIGHIIT!

A WORD ABOUT MEDICATION SAFETY-fhc

neccl to e llcctively' r.nonitor ner.v drLrss once the]'havc becn approved ancl introdr-rcccl inttl the ntarket

h:rs becn a l<cr., :.rdr.'ocacl' issLre for The Arthritls Socie ty

for scvcral ;.'ears. This aclvocacl' he lps t..r cnsllrc that

unlavourablc side e lfects iue reported. dtrclrnrented, and

rclclressecl. For regular updates on medications available

in Canada, visit www.arthritis. ca,/tips/medications.

Ali nrcclications havc potcntiirl side ellects vu.l.rclhe r

Lhel' are take n bv the mselves or in conrbinatiorl \\'ithotl-rcr hcrbal, Lrve r-the -cL)Lrnte r- and prescriptionmeclicrrlions. It is LhcrcIore impoltant ior paticnts tocliscuss the benclrts ancl pote ntial sicle cllecLs oI rll t]re irmechcirtions r.r,ith iheir clt ct.rr.

Herrlth Cnnacla's N"lrirl<cteci Hcalth Proclr-rcts

l)irectr)rate operiite s the itlcdElfeci program, rvhrch

provicles centralrzecl aecess to neri salet;' inlornr;rtjon

about health proc-|-rcts in an easy to hncl. easv to

reme nrirer location. MedEllcct lvas clevelopecl to help

bnild rrlr.areness abolrt the inrporlurnce ol subnrittingrrdlerse reirctiou reJlorts to idenLif ,r and communicetcpotcrltiLll risl<s irssociatecl w.ith ce rturin dr-ugs or health

pr-odncts. N,'tedElJccL aims to r-nake it as simple and

e lircicnt ers possible for he alLh prole ssionals ar-rd

corlsLrmel's to conrplete and sr-rbmit aclve rse reactir)ll

reporis. lo iind L)Llt nlore or to reporl an ach.crse

rc;rcti on i is it : rvr'vll: heal thcarr-r ad ii. gc. ca/rnecle llecL o r'

cirll toll-lr-ee 1.866 23+.231-.

\\'hcn osteoarthritis beconres severe irnd medical

the rapies are noL uorking. slugerv ma1 be consiclered.-['he

most conllron surgical proceclures for OA include

hip and knee replacements. Horvever. othei surgical

treaLrrents are n'aiiable . It is impoltant ter remember

that there is no age lirnit ior surger)/ - )'oll can't be too

olcl or tott )'otlng. The decision io ttnclergo surger;' rea[1;'

clepencls Lrn i-he amount of pirin ancl dlsabilrtl' ,vourrrthritjs is car-rsing conrbined with the nsks and bene hts

o[ the surgerl. This shor-rld be discussecl lr-rrther u'ith

r.our doctor.

www.ARTl{RtTts.0 il

WHAT QUESTIONS SHOULD I ASK MY

DOCTOR?

A recent study found that patients who

learned more about their treatment and talked

to their doctor about it had fewer symptoms,including less pain, and greater mobility.

You can really help yourself by gettinginvolved in managing your OA.The more you

learn about the disease and your treatmentoptions, the better off you will be now and in

the future.lt's important to get all theinformation you need to make an informeddecision about the right treatment for you.

Be sure to talk with yor-rr doctor about your OA, and

ask questions about the disease and the different kinds

o[ treatments. Before making a decision, your should

understand what you can expect. lrom a medication,

what its possible side efiects are and other important

information. AIso, ask what steps you can take to get

your disease under control.

To help you get started, het'e are some common questions

you may want to ask your doctor about OA treatment:

. What local resources are available so i can better

educate mysell about OA?

. Should I be rel'er-red to a rheumatologist, physiotherapist,

occupational therapist or orthopedic surgeon?

ln regards to my medications:

. What are the possible side effects and how often do

they occur?

. What should I do to minimize the chances of side elfects?

. How will I know if the drr-rg is working, and how long

will this take?

Who do i contact if I hai'e concerns about the

medication?

Will this interact with my other drugs?

Are there dmgs that I should stop taking now that

I am beginning this new treatment?

18 ARTHN|IE !T]IGHTIT!

HOW CAN I LEARN MORE?

The Arthritis Society offers a number o[ services designed

to help you live with arthritis.

Arthritis lnformation Line - 1.800.321.1433Dial The Arthritis Society's toll-free number to connect

with staff or trained volunteers in your province or

territory, You can request free information about different

lorms olanhritis or programs and services that are available.

Ycru can also get the names of health professionals in ;,ourarea who specialize in arthritis.

Website - www.arthritis.caRegularly updated educational materials, inlormative

articles,'ask the expert,' authotitative, expert-rer.iewed

resources and a virtual communitf in our "Open

Forums" of people with arthritis are just a mouse-cllck

away aL the official website lor The Arthritis Societyr

Free Arthritis Registry - www.arthritis.ca/registryThe Arthritis Society can help you understand your

disease and what's happening to your body By joiningthe free Arthritis Registry you wiil receive the specilic

information you need to manage your arthritis and

improve your quality oI life.

Arthritis Self-Management Program (ASMP)

Managing arthritis means more than iust visiting your

doctor and taking the right medications. The Arrhritis

Society's six-week program of two hours per week willhelp you understand your t)?e o[ arthritis, its treatments

and teach you ways to cope with chronic pain. ASMP

also offers a forum to share your personal experiences

and chailenges of living with arthritis.

Arthritis Friendly ProductsThe Arthritis Society is proud to be able

to recognize rnanufacturers that have

designed products that are easy to use

lor people living with arthntis. There is

quite a list of products that have been commended by

The Arthritis Society zrnd deemed ''Arthntis Friendly".

A full list and more inftirmation is available onlinc at

www. arthritis.ca./arthritislnendh:

www^lnilRrfls.(n ]9

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ARTHRITIS FIGHT IT!

To get the best results,you need to form closeties with your healthcare team and become a

full partner in your healthcare treatment.

Learning daily living strategies to manageyour arthritis gives you a greater feeling of

control and a more positive outlook.

To support arthritrs research or to ie:co n ta ct Th e Arth riti s S oci ei,. .

1.800.321 .1433

www.arthritis.ca

rhrArthritisSociety

RheumatoidAnhritis

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'J-his pulllicirLion has bt-cn cndorsccl ltv thc Canacliln Rh.-u;l.i:... :ulrose mjssion is to rcprcscnL Cittraciian Rheumatok,gists,rnc'l :tir::'.--..

oI cxccllence in ,\rthritis Cirrt'. L:c]ucation irnil Re....:r:::

Rhttntatoid Arthtitis - I{rror,r, Yrrur Optirrrrs ts spr.r:,an unrestricLed edr-rcational grant. fi-clm .{nrqcr C...::

ancl Wveth I-aboratorit:s

Ihe Arthritis Soclctv grrtciullv acknorvlcdgrs Dr. .\ndr 'lltlr:::

.tssisLut l\rrfessor of N{cdicine. L.lnivcrsirv o[\\'cstt:Ln ()nL.ur,. :,.:

r\r'thrjtis * linov lirtrr ()ptiors, l)r. Karl Shojarrir. [)r. ]rrrle ]j,::-lhompson

BScPl. our N{eclical .\clris()ry'(-(rulnriltce l,,r tltit :...,

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Rheumatoid ArthritisDID YOU KNOW?. .{nhritis is the most common cause of disability

in Canada.

. About one out o[ even' lt]tl Canadians has

rheumatoid anhntrs (or R{. lor shon). That's

about Stlo.tlt\l Canadians!

. .{n)'one can get R{ at anv age. but it mc-rst oftenappearc bets'een the ages oi 2j and ltl.

. R{ affects \\'omen three times more often than men.

WHAT IS RHEUMATOID ARTHRITIS (RA}?

Can you belier,,e that there are over 100 dilferent types

of arthritis? To keep thingp simple we will divide arthritisinto two general t)"pes - inflammatory and degenerative.

The root cause of degenerative anhriris is the breakdown

o[ cartilage u'hereas inJlammation t-rf the lining (syncn'ium)

of the joint is the rocrt cause of inflamn'raton' arthritis.

Rheurnatoid Anhritis (R{) is a tvpe trf inflammatorl'

anhritis and an autoimmune disease. .{n autcrimmune

disease is one n'here the bodvs immune s)-stem becc'rmes

confused and begins to "attack- the bodl: In R{, the

joints are the target o[ the immune attack causing

sr,r'elling, pain, and n-armrh (inflammation) in the joints

resulting in inflan, matory arthritis.

R{ usualll' begins slorvll', staning in a few joints

and then spreading. over a few weeks to a feu,months,to involve other joints; rarellt does RA begin almc-rst

2 ilnrmMFlqllm

overnight. As time goes on, M involves more and more

joints on both sides of the body in a "symmetrical" pattern

This means if joints in your right hand are swollen thenjoints in your left hand will probably be swollen.

The symptoms of RA vary from person to person.

Some people have only a few joints involved or mildinflammatlon whereas others have many joints involved

or they are severely inflamed. The symptoms o[ RA also

vary from times when the joints feel good to other times(often for no reason at all) when the joints become stilfer,

sorer, and more srvollen. We call this a "flare".

Remember back when we said that RA was an auto-

immune disease where the immune system gets confused

and attacks the joints? Well, that isn't the whole storyWhen the imrnune system is confused, it can also attack

other parts of the body such as the ey'es, lungs, or heart.

Fortunately this ls rare.

WHAT ARE THE WARNING SIGNS OF RA?

Remember that M usually starts over a period of weeks

to months slowly adding joints over time? These are thewarning signs! If any of the following s1'rnptoms lastfor more than two weeks, see your doctor.

. You start to feel unusual pain and stiffness in joints(look lor new pain and stiffness in the knuckles in the

hands and the balls ol the lee|.

. This pain and stiffness is worse inthe moming, typically lasting more

than 30-60 minutes before you"ioosen up" and start feeling better

. However, the pain and stlflnes

can be with you (to some

degree) most of the day even

causing discomfort while you

try to sleep at night.

. Some people notice that

they feel more tired whenRA starts and occasionaily some

iose weight or develop a low-grade

fever. (Although, most people will say

they gain a little weight because

they haven't been as active).

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There is nocur€for RA,butwhen you aledhgnosed early and start the dght treatmen!,you can take control of your disease and avoid

swele damage to your joints

llost people wtth RA can lead aclive andproductive liws with the help of the right

medication, suryery (in some casesf, exercise,rest and joint protection tedlniques.

WHAT TO DO IF YOUR FAMILYDOCTOR THINKS YOU HAVE RA?

Ii r onr i;rn.rih' docror believes that yor-r have RA, iL is

in.rpr..;1;i111 ro see it rher-rmatologlst and to begin treatmentriqhr as'.rr. -{ rhr-umiltrrlogist is a doctor who is an

e\pc-rt in irrthritls. \br.r nrr-rst get a referral lrom your[tmi]r- dtrcttrr- to Sc.e :r rheumatologist.

The Arthnris Srrcierl mrrintirins a list ol r-heumatologistsacross Canirda.Trr find out ti'hich rheur.natologist is ncarestto )'ou, call our toll-lree Anhritis Inlormarion Line ar

r.800.32i.1433.

HOW DOES THE DOCTOR DIAGNOSE RA?

There is no single test for rheumatoid arthritis. If youhave signs and symproms of rheumatoid arrhritis, your.doctor will llkely examine your joints and perfonnblood tests and x-rays ro help wlth the dlagnosis.

Your doctor may order blood tests such as the ESR(Erythrocyte Sedimenrarion Rate) and the CRp (C-Reactive Proteln) ro look for inflammation in the blood.

Another blood rest, called the rheumatoid facrorcan be helpful but ir is nor possible ro rule our RA withthls simple blood test. Here are a few points you shouldremember about the rheumatoid factor:

. Il you have a positive (abnormal) rheumatoid factor, itdoes not always mean you have rheumatoid arthritls.Rheumatoid facror can be posirive in iots of otherconditions and low levels can sometimes be found inotherwise healthy people.

. The rheumatoid factor is usually negarive (normal) inmost (50 to 70o/o) parienrs wirh new onsel rheumatoidarthritis.

4 ARTHRITI9 rFtKHrlfl

. The rhenmatord lactor is positive in most (70 to 80o/o)

oI patients rn'ith long-standing rheumatoid arthritis.

At thls time, there is no cure for rheumatoid arthritis.

Therelore establishing the correct diagnosis is very

important because there are many treatment options

to manage the symptoms of rheumatoid arthritis.

WHY IS EARLY TREATMENT SO

IMPORTANT?

Remember that RA causes inllammation (swelling,

pain, & warmth) in the aflected joints. You can thinkof this inflammalion like a "fire" burning in the loints.If we leave the fire of inflarnmation "buming" it can

pemanently damage the iolnt. Once a joint is damaged,

it can't. be lixed with mediclne.

Imaglne you come home from a long day at work,

kick off your shoes, and relax on the couch. Ycru then

notice that there is a small fire burnlng in the kitchen.

You aren't iikely to sit on the couch and wonder, "Gee,

that's a nice fire. I think I'11 wait and see what it does."

<No, that wouldbe crqzy>. You're more likely to jump

up, get the fire extinguisher and call the 1oca1 fire

department to get the lire put out as quickly as posslble

belore it causes damage to your house.

You should think of RA in the same way, like a

"fire" in your.joints. You don't wanl to sit around and

"watch" this fire (inflammation) burning. Instead, withthe help of youl rheumatologist, you want to get that fire

put out as quickly and as safely as possible. Sometimes

it can take up to three medicatlons in combination(triple therapy) to settle the joints down. This is a very

common approach to ireating early RA.

To emphasize. RA can cause permanent jointdamage quickly when it is not treated and controlled.

This damage can occur even when the pain is not severe.

Once damage occurs it is not reversibie and can cause

signi.licant pain and disability. Fortunately, we knowthat treating RA early and aggressively improves the

long-term outcome and significantly reduces damage.

WWW.ARTHRITIS.il 5

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WHY DO PEOPLE GET RA?

No one knows lvhat causes RA. To simpiify rhings, let's

again th:ink oi the inflammation of RA like a fire. Thrstime, imagine you're out camping and want to start a

campfire. The lirst thing to do is to garher and arrarr1e

enough wood and paper lor the campfire. If you gatherlots ol dry wood and newspaper, chances are the firewill light. Il you gather soaking wer wood chances are

you won't be able to get the lire started. Peopie whodevelop RA have genes (DNA) [har "ser rhem up" to ger

the dlsease. They have the nice dry wood and paper all"set-up" to light the fire o1'RAl If they had genes (DNA)llke the "wei wood" the fire of RA would never be ableto light.

+k=$ATrigger

Ok, lust because someone has the right genes (the

dry wood) doesn't mean they'il go on ro develop RA.They need something to light the fire - we call this a"trigger". Just iike many things can be used to light a

fire (matches, flint, lightning etc) there are many"triggers" that could starr RA. Unfortunately, we dontknow what the "trigger" is rhat sraris RA but somebelieve it may be a viral infeciion or somerhing eise inour environment. There may be more than one trigger.Many dedicated scienrists are looklng for the "trigger",and many clues have been lound (such as an increased

risk of developing RA il you smoke), bur nobody has

been successful yet. The Arthritis Soclety funds manyleading edge research projecrs that bring viral newinsights, resulting in new and better treatments for RA.

6 ANTilRIIIS ftcltT tT!

Beliere it or not, most people who develop RA have

no history of RA in the family. As we said rhe genes are

only one part of the story, the orher is the "trigger".

Howeveq if a relative has RA you are at a small increased

risk. It is unusual to see RA in many family members,

but we oecasionally do see ir.

HOW CAN I MANAGE RA?

Once your diagnosis is confirmed there are manytreatments ihat can help decrease your pain andstiflness, and inclease yclur movement.

The typical treatment plan is usualiy made up ofsever-al components:

. Medication

. Other healthcare support.(ph1,sio,6..oOy, occupational therapy etc)

. Daily-living adiustments

Being actively invr:lved in developing your prescribedtreatment plan is essential to decrease your pain, andmaintain yolrr movement and lunction.

Hwlfiflnms.(t 7

The Fire of RAThe Right Genes

WHAT MEDICATIONS ARE USED FOR RA?

The general approach to treating RA is to reduce thejoint inflammatlon to prevent long-term damage to the

joints (put out the fire!). The cornerstone ol therapy is

rhe Disease-ModifpngAntl-Rheumatlc Drugs (DMARDs

pronounced DEE-mardz ). You can think o[ the DMARDs

llke yor-rr local fire trucks with their hoses on the fire.

In general, everyone with RA should be on a DMARD -they are the anchor therapy. DMARDs will suppress the

inflammation and prevent long-term damage to the joints.

DMARDs are often used in combination withNon-Steroidal Anti-lnflammatory Drugs (NSAIDs)

and Corticosteroids (steroids). Although NSAIDs and

steroids slow down the day-to-day inflammation they

don't allect the long-term outcome ol the disease.

A relatively new class ol medications (biologics) has

revolutionized the treatment ol RA or.er the past few

years. These medications, olten used in combination withDMARDs, also suppress inllammation and help prevent

damage to the joint.

ir: r.". .i

DMARDs are a class o[ medications used to treat

inflammatory types of arthritis such as rheumatoid

arthritis. DMARDs slow down the biologic processes

that are the driving lorce behind the persistent

inflammation (pain, swelling and stlffness) in the.loints.

DMARDs are important because they help to prevent

darnage to the.joint. Doctors know that prescribing a

DMARD early on is important to slow or even stop the

progression of joint damage .... but a DMARD cannot

fix joint damage that has already occurred.

The fastest acting, best tolerated, and most commonlyprescribed DMARD is met.hotrexate (MTX). MTX isgiven either as tablets or injection; the choice will be up

to you and your doctor. The most important thing toremember is that MTX is only taken once a week. Choose

a day that places ihe ieast demands on you, since some

people feel unwell (tired, sick to ihe stomach, loss olappetite, or headache) lor ar day or two after they take MTX.

8 ARIHR|TF i,;, ]lGHIll!

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Rheumatologists use DMARDs like MTX on rheir

I o*n or in combination. Many studies have shown that

I the outcome ol two or three of these medrcations usedII in combtnation is more effective at managing the

disease. DMARDs used on their own or in combination

with MTX are found in the table below.

Commonly Prescribed DMARDS for RA

Arava

lmuran

Methotrexate

Myochrisine

Plaquenil

Salazopyrin

Leflunomide

Azathioprine

Methotrexate

Gold (Sodium

aurothiomalate)

Hydroxychloroquine

5ulfasalazine

10-20 mg per dayor every other day

50-150 mgper day

7.5 to 25 mgonce weekly

50 mg onceeverv week toeverir month

200-400 mgper day

1000-1500 mgtwice per day

Tablets

Tablets

Tablets or injectionunder the skin

lnjection intothe muscle

Tablets

Tablets

Side effects and blood monitoringAll DMARDs have potential side effects. Each one is

dillerent and you must learn from your doctor what toexpect from each drug you try. In most cases, DMARDs

require regular blood tests to monitor side effects. Some

people require an adjustment to their dosage or a change

to a dilfercnr type ol medication.

ww-lffiHnfTts.ct I

N o rr-St e roi clal An ti -In tl:rmmatory Drugs iNSAlDs)r,ire tr class ol medications nsed to treai the pain ancl

iuf'lamnration ol art]-rritis. They do noL contain steroids,

hence the name "Non-Sterordal". NSAIDs are a ver)'

large caLegory ol medications, some ol which you can

obtain rvithout a prescription, sr-rch as ASA (Aspirin'i,

Entlophen', Novasen') and ibuplolen (Advil'" orIVL:trini').

-Ihe list of NSAIDs is long with over 20

cllrre tltl)/ available toda)r

It rs impcxtarnt to remember that NSAIDs r,vork to

iurprove s\'1r1ptoms :rncl lrave no proven long term

bene{its in RA. As such. tlrese nredications can be Laken

on r1n as rreeclecl basis ancl do not neecl to be taken

legularly That being said, some patienrs lind it helpiulto tal<e tlreir NSATD on a regular basis tr-r control thcrir

sylnptoms. Incligestion, heartburn, stomach cramps,

and nanse;l are the mLrsl common side ellects olNSAIDs. NSAIDs can aflect the protective lining ol the

stomach mirking ),ttll more susceptibLe Lo urlcers and

1:rleecling. ll y'ou der,elop signs ol stomach bleedirrg,

snch urs r,omit that iooks like it has "coffee grounds" rn

rt, r'omiting bloocl, or black, tarrry bor,vel movements,

n'hile tirking NSAlDs, stop the NSAID and see a doctorimmecllately COXIBs are NSAIDs that have been custom-

clesigned to reduce the risk of sLomach sicle eflects.

Health Canacla has reviervecl

irll o1 Lhe available studies on

NSAIDs and COXIBs and iound

that NSAIDs and COXIBs are

both associated with an

incrcasecl risk ol cardiovascular

events (angrna, heart attacks

and strokes). The risk is greatest

in tlrosc patients who nse these

medications lbr long periocls

o{'turre and have risk lactors lor",

or a history of, carc{iovascular

disease . Please discuss rhis with

I'our cloctor.

i{r ARTHRIIIS TIGHTII!

Coltisone is a hormone produced natr,rrally by thebodys adrenal glands. In the 19501s physicians loundthat giving extra cortisone to patienrs with rheumatoidarthrills dramaticalll' rmproved their symptoms. Fron.r

this discor,'er1', corticosteroids, also known as sleroids,r,vere dereloped and are some ol the oldest, most effective,

and fastest-working medrcations lor RA. Stercids czrn

be taken orally. (pr"ednisone), injected into the joint,

injected into a muscle, or through an intravenor-rs drip.

Corticosteroids olten callse an increased appetite

and result in rveight gain. Therefore it is important tolollorv a healthy diet and exerclse (as best as possible).

They can also increase your risk of inlectjcln so see yourdoctor il you develop a lever, chilis, or other symptorrsol infectron. When used lor long periods o[ time, sreroids

can thin yor.rr bones (osteoporosis) increasing your risl<

ol lractr.rre, thin the skin causing easy bruising, and cause

cataracts. A very rarre srde eflect ol corticosteroids,

osteonecrosis, results in lclss of blood supply to the end

ol a long bone. The most common place for this tcr

happen is in the hip bone (femr,rr) bur occasionally rhe

knee or shoulcler coulcl be involr,'ed. lI you develop

suclclen severe pain in one o[ the groins, conlac]t yourcloctor immediately.

WWW.ARTHRITIS.CA 1]

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ir ;,1il1"r,q1i;;, i'r.]ili rli i,iil rrr

The biologlcs are a class of medications specially

designed to treat rheumatoid arthritis. There are a

number of biologics available which work by dilferentmechanisms. Like DMARDs, biologics are used to

suppress inflammation and help prevent damage to

the joint.

In some people with arthritis, a protein called

Tumour Necrosis Factor (TNF) is present in the bloodand.joints in excessive amounts where it increases

inflammation (pain & swelling). Adalimumab (Humira'),Etanercept (Enbrelo'), and Infliximab (Remicade') are

proteins specially designed to block the action of TNFAnakinra (Kinerett) is designed to interfere with another

protein, interleukin-l (IL-t), which also plays a role inthe inflammation o[ RA. Abatacept (Orencia@) is aprotein designed to inierfere w-ith the ability o[ the

body's immune T:cells to talk to each other. By blockingthis lnteraction, the production of TNF is reduced.

Rituximab (Rituxanu') is a protein designed to attach to

and destroy some of the bodys immune B-cells whichplay a part in the pain and swelling caused by arthritis.

By blocking TNf; interfering with T-cell communicaiion,

and by eliminating B-cells, biologics work to suppress

the bodys immune system. Although this suppression

can make it slightly harder to fight ofl infections, iralso helps to stabilize an overactive immune system.

Depending on the biologic prescribed, they are

either given by injection at home or by an intravenousinfusion at a clinic or at home. Side elfects occasionally

seen with these medications include mild skin reactions

at the injection site, headaches or dizziness, colds

or sinus infections, and nausea or diarrhea. Your

doctor will discuss all of the other side effects o[ these

medications before he or she prescribes them.

12 tRrHRmS M.flGHTft!

Commonly Prescribed Biologics for RA

Enbrel Etanercept 50 mg injection once a week 0r25 mg injection twice a week

Humira Adalimumab 40 mg injection every other week

Kineret Anakinra 100 mg injection every day

Orencia Abatacept 500t0 1000 mg intravenous (lV)

infusion every month

Remicade lnfliximab lntravenous (lV) infusion at 0,2,6and then every 8 weeks

Rituxan Rituximab 1000 mq intravenous (lV)infu-sion given twice two weeks apart

What else should I know about Biologics?

Precaution

Biologics work by suppressing

your lmmune system wh.ich can

make it slightly harder for you rolight ofl infections. Piease inlormyour doctor i[ you are prone tolrequent infections. It is advisable

to stop your medication and call

your doctor i[ you develop afever, if you have or think youhave an infection, or if you have

been prescribed antibiotics. Belore

starting biologics, your doctorshould check for other infections,such as tuberculosis with a skintest and a chest x-ray

Cost

Biologic treatments are costly, and can range anylvhere

from $15,000 to over $25,000 per year. Depending on

the type of insurance coverage you have, treatments

may be lully covered or you may be required to share

the cost. Generally, provincial plans or private

insurance companies will require patients [o attempt

other treatments belore they will cover biologics.

www-[RTHntil5.0 13

A WORD ABOUT MEDICATION SAFETY

The need to eflectivell'monitor neu, drug,s once thev have

been apJrroved and introduced inro the markei has been

a ke,v advocacv issue for The Anhritis Socierl' lcrr several

y"ears. This advocacv helps tt'r ensure that unlar-c'rur:rbie

side ef{ects are repofied. documented. ar-rd addressed.

For regular updates on medications available inCanada. visit u'w-rv.arthritis.ca./tips/medications.

All mediczrtions hirve perenri:rl side e[Iecrs.,r-hether ther'

are taken bv themselr.es or in combination lvith otherherbal. oyer-Lhe-counter and i:rescription rnedications.

It is therefrrre imponanr for patients to discuss the benefits

and potential side e flecis of all their nredicarir-'rns riir]rtheir doctor.

Health C-anada's \tirrketed Health Producrs

Dir-ectorate operates the iv{edElfect program. ri-hich

prolides centrali:ed access to nerv salety inlomrationabout health products in an easy- to llnd. easv r.o

rrmember location. \leclE{i'ect 11,35 dsygloped ro help

build a*'areness about the impr-rrtance o[ subn'iittingadversr reaction reporls to identilv and ctrmmunieatepotential risks associated t-ith cer-rain chugs or health

prLrducts. \,tedEflect irims to make ir as simple and

efficient as perssible ftrr health prolessionals and

cor-lsutners tt-r crimplete and subnrit adverse reaction

leporls. nl lincl olrl mLrre Lrr ro rcpon an adverse

r-eaction risit : ullll'. healthcanad a. gc. ca./medellect orcall toll-free 1.866.23+.23+-.

ii mnnrls fK$In!

WHAT ELSE CAN I DO TO TI,IANAGE

MY DISEASE?

\\'hen done properll, erercise can help to lessenslmptoms ol R{ and make 1,ou feei better overall.Ii done improperil'. exercise can "flare"

)'our arthriris.Therefore. an exercise profyam should be doneunder the guidance of a rrained physiotherapist.

There are dilferent ty'pes oi exercises that vou cando to lessen ,vour pain and stiffness_

. Range of motion exercises reduce pain and stilfnessand keep,vour loints mor.ing. To achier.e the mostbenelit these exercises should be done daill:.

. Strengthening exercises maintain or increa-se

muscle tonc ancl protect vour-i(rints.

. Moderate stretching exercises help to reiieve rhepain and keep the muscles and tendons arcund anaflected.joint flexible. \bur physiotherapist can guideyou on what strengthening and siretching exercisesarc best arrd uhen thcl, arc apprL)pnalc.

. Endurance exercises srrenflthen your heart, give I,ouener!l)'. control your iveighr and help I'ou leel betteroverall. These exercises include rhings like walking,swimming and c1'cling. Ir is best to avold high unpaerexercises like step aerobics. jogging or kick boxrng.

Heat applied ro an arrhritic area can help relax achingmuscles, and reduce pain and soreness. lt promotesblood circularicln, which nourishes and deroxilies musclefibers. Taking a hot shcllver is a greztt w-av ro help reducepain and stilfness. To avojd making s)rmproms worse,heat should not be applied ro an already' inllamecl 1oint.

Cold applied rcl ir-rflamed joinrs reduces pain andswelling by cor-rsrricting blood llow Applying ice orcold packs appears to decrease inflarnrnarion and isrecommended r.l'hen.ioints are inflamed. you shouldnot use ice if you have circulatorl' problems such as

Ra;,n2u4t disease.

WWW.ARTHRIIIS.CA ]5

[;'i:{.}'[ff']:ii lrttl 1l{;ix[.i f .lftf li ft t!

You shouid always use your joints in ways that avoid

excess stress. This aliows you to experience less pain,

perform tasks more easily, and protect your joints from

damage. Techniques to protect your joints include:

. Pacing by alternating heaq' or repeated tasks with

lighter tasks or breaks or frequently changing positions

reduces the stress on painful ioints and conserves

energy by allowing weakened muscles to rest.

. Positioning joints wisely promotes proper alignment

and decreases excess stress. Do this by maintaining

proper posture and carqnng hear,y obiects close to you.

Use larger, stronger joints to carry loads. For example,

use a shoulder bag instead of a hand-held one.

. Adapting your daily activities and using helpfuldevices can help to consewe energy and make daily

tasks easier. Avoid positions that may cause excess

stress, such as squatting or kneeling. instead, raise

seat levels to decrease stress on hip and knee joints.

Enlarge grips on utensils such as spoons or peelers

to decrease stress on delicate hand joints. Other

devices to consider include canes, t:eaching aids,

carts for carrylng objects, or 1ailtap openers.

**t**+j-:iil:r""'$*ilorthotics (shoe inserts), to help align /and support yourjoints. I

,l

]6 AffiHRITIS W TIGHIII!

r.';i,r

There are many claims aboutdiets which help or "cure"

althritis. Most o[ the informationis confusing and claims made are usually not supportedby scientilic evidence. Simply put, there is no diet thathas been proven to significantly improve rheumatoidarthritis. Some studies sholv that a dier low in animalproteins and dairy and higher in cold warer fish (i e.

salmon) may reduce inflammation of RA to a smalldegree, but these have not been well proven. Despite

this, many patients manipulate their dlets as ir gives

them a sense ol control over their disease. Until there is

more conclusive evidence, most rheumatologists wouldrecommend a common sense approach by eating a well-balanced diet aimed at maintaining a healthy weight.

l;i, rui,ir 1,. rii r\i i r.r i i it,, 1,-,:i 6i l,lt rq :i $* [ fi I s

Stress and over-activity can sometimes trlgger a "flare"

of your arthritis. Developing good relaxation and copingskills can help you mainr.ain balance in your llle givingyou a greater leeling of conrrol over your arthritis and a

more positive outlook. Relaxing the muscles around an

inflamed joint reduces pain. There are many ways torelax. Try deep breathing exercises. Listen to music orrelaxation tapes. Meditate or pra)z Another way to relaxis to imagine, or visualize, a pleasant activity such as

lying on the beach, or sitting in lront of a fireplace.For more information on these skills see a psychologist,social worker or arthdtis therapist.

li)uyflErlt lrl

Surgery is something that you and your doctor mayconsider il one of your joints becomes badly damaged,

or if the pain is too inrense. Some people with severe,

advanced RA that have not responded to conservativemanagement may benefit lrom surgerll Benefits includeless pain, better movement and function, and in some

cases, bet.ter physical appeararlce. There are a numberof different kinds of surgery for RA ranging from minorprocedures to complete jolnt reconstruction.

www.ARTHRtTlS.(A 17

WHAT QUESTIONS SHOULD I ASK MY

RHEUMATOLOGIST?

ri ir T,n i, Ai;\lr|lri r:,- rritil- Aflr ;:jit{tfilr Li9r,1flSfi*!'t&Bi{Sr1rl

A recent study found that patients wholearned more about their treatment and talkedto their doctor about it had fewer symptoms,

including less pain, and greater mobility.

It's important to get all the information youneed to make an informed decision about the

right treatment for you. il

{i illr t llf .! r1[ti1{ii}{#1!iiLi{il r'il ] il!tsllrlttt,l4{r911Cj liBi Si ft:ir$qi':1}]Hg{Mel{MitrifwfaMff[{ffiS${l,

Be sure to talk with your doctor about your RA, and

ask questions about the disease and the different kinds

of treatments. Belore rnaking a decision, you shouldunderstand what you can expect from a medication,

what its possible side eflects are and other importantinformation. Also, ask what steps you can take to get

your disease under control.

To help you get started, here are some common questions

you may want to ask your doctor about RA treatment:

. What local resources are avaiiable so I can bettereducate myself about RA?

. Should I be referred to a physiotherapist or

occupational therapist?

In regards to my medLcations:

. What are the possible side effects and how often dothey occur?

. What should I do to minimize the chances o[ side effects?

. How can I keep track o{ the blood test results used to

monitor me?

. How wiil I know il the drug is working, and how long

will this take?

. Who do I contact il I have concerns about the

medication?

. Will this lnteract with my other drugs?

. Are there drugs that I shouid stop taking now that

I am beginning this new treatment?

18 ARTI{RIIIS if ]IGHTIT!

HOW CAN I LEARN MORE?

The Arthritis Society offers a number ol services

designed to help you live with arthritis.

Arthritis lnformation Line - I .800.321 .1433

Dial The Arthritis Society's toil-free number to connect

with staff or trained volunteers in your province orterritory. You can request free information about diflerent

forms of arthritis or programs and senices ihat are available.

You can also get the names of health prolessionals inyour area who specialize in arthritis.

Website - www.arthritis.caRegularly updated educationai materials, informativeanicles,'ask the expert,' authoritative, expert-revlewed

resources and a virtual communitv in our "Open

Forums" o[ people with arthritis are just a mouse-clickaway at the official website for The Arthritis Society.

Free Arthritis Registry - www.arthritis.ca/registryThe Arthritis Society can help you understand yourdisease and r,r,'hat's happening to ).our body By joiningthe free Arthritis Registry'y'ou will receive the specific

information you need to manage your arthritis and

improve your quality ol lile.

Arthritis Self-Management Program (ASMP)

Managing arthritis means more than just visiting yourdoctor and taking the right medications. The ArthritisSocietyb slt-week proEfam of two hours per week willhelp you understand your t)?e ol arthritis, its treatments

and teach you ways to cope with chronic pain. ASMP

also offers a lorum to share your personal experiences

:rnd challenges of living with arthritis.

Arthritis Friendly Products

,..fG;d> The Arthritis Societ,v is proud to be able

/rt r\ ir) reeL)gni:e manulacturers that have

\t ..{,' desrurred products that zrre e!1sv to use\a$9 ftrr pecrple living n irh arrhriris. There is

quite a list c-tf prt.'ducls that hi1\'e been cr-rntntended byThe Anhritis Sr)ciet)' arnd deemed "Arthritis Friendly".A full list and m,.rre infLrrnlirtiL)n is irvirilirble online at

wwrid.anhritis.cr,/arthntis friendh:

wrrrnilnma(t 19

Mrhl ii#ffi :i[:*u,H Jxil';u.:'J ".,.Reality: Although genetics play arole in the disease,

only about seven per cent ofcases are associatedwith genes that cause the early onset inheritedfamfial form of the disease (FAD).The majority ofcases are of the late onset "sporadic Alzheimer'sdisease" form, in which genes may also play a role.A person who has a parent or a sibling who has orhad sporadic Alzheimer's disease has a very slightlyincreased risk of getting the disease.

Mvth? Alzheimer's disease is only an old' Z person's disease.

Reality: While age is the most significant knownrisk factor for Alzheimer's disease, most people infact do not develop the disease as they age.

Moreover, even with the late onset form of the

disease people have been diagnosed with it in their40s and 50s. What's most important to understandis that Alzheimer's disease is not a normal part ofaging.

Mvth? There is a cure for Alzheimer's disease.' J Reality: At present there is no cure for

Alzheimer's disease, but there are medications andother approaches that can successfrrlly help withsome of the symptoms and improve quallty of life,in some people. The good news is that researchershave made great strides and there are a number ofdrugs in clinical trials that act directly against thedisease process.

nayilr{ x:il::HJ:;il::trReality: Many people have troublewith their memory as they getolder, but that in itself does notmean they have Alzheimer'sdisease. When memory loss af;fects

day-to-day function, and iscoupled with lack of judgment andreasoning, or changes incommunication abilities, it's bestto visit a doctor to determine thecause of the symptoms.

MvthE Aluminum causes Alzheimer's disease.' J Reality: Although there's been much

research into the connection between aluminumand Alzheimer's disease, there's no conclusiveevidence to show a link. The disease appears todevelop when the combined effects of many riskfactors, including age, genetics, lifestyle andenvironmental factors, overwhelm the naturalcapacity of the brain to deal with them.

^. -, ? Alzheimer's disease is preventable.MythO Reality: There is no treatment that can

prevent Alzheimer's disease. There is, however, agrowing amount of evidence that lifestyle choices

that keep mind and body fit mayhelp reduce the risk. Thesechoices include being physicallyactive; eating healthy foodsincluding fresh fruits, vegetablesand fish; keeping your brain

challenged; reducing stress, keeping an eye onyour blood pressure, blood sugar andcholesterol levels; avoiding traumatic braininjury; and keeping socially active.

MvthT Vitamins, supplements and' t memory boosters can prevent

Alzheimer's disease.

Reality: Many studies have been done to test theeffectiveness of products such as vitamins E, B,and C, gingko biloba, folate, and selenium inpreventing Alzheimer's disease. The findings aremixed and inconclusive. However, research inthis area is ongoing.

M\rthQ lf l'm diagnosed with Alzheimer's' lJ disease, my life is over.

Reality: Manypeople with the disease livemeaningful, active lives. Theyhave a sense ofpurpose and do not feel their lives are over.Earlier diagnosis and medications are helping.It is also important to provide appropriatesurroundings, services, support and activitiesto people with the disease to help enrich theirquality of life throughout the progression ofthe disease.

MvthO All people who have' J Alzheimer's disease become

violent and aggressive.

Reality: Alzheimer's disease affects each persondifferently, and certainly not all becomeaggressive. For the person with Alzheimer'sdisease, the loss of memory and the resultingconfusion is often frustrating or evenfrightening. By learning about the disease,adapting the person's surroundings andchanging the waywe communicate with theperson, aggressive responses may bepreventable.

Mvthl 0 Hll: fi'ffi'.'liTTi.1l'"""going on around them.Reality: Some people with Alzheimer's diseaseunderstand what is going on around them;others have difficulty. The disease does affect apersont ability to communicate and makesense of the world around them, although itaffects each person differently. When weassume someone does not understand, feelingscan be hurt unintentionally. The fact is aperson with Alzheimer's disease is still thesame person as before and needs to be treatedwith dignity and respect.

An end to the mythsThe Alzheimer Society would like to put an endto the myths surroundingAlzheimer's disease.

Get the Facts:.learn about the disease. seekhelp. treat people with the disease with respect.

The Alzheimer Society is a national not-for-profit health organization dedicated to helpingpeople affected byAlzheimer's disease. TheSociety has numerous resources and supportprograms for people with the disease and theircaregivers. The Society funds research intofinding a cure for the disease, and into improvedmethods of caregiving.

Contact your local Alzheimer Society,visit our website at www.alzheimer.ca orcall l-800-616-8816.

t )lts0"

Alzheimer-$r ri*fyAlzheimer Society of Canada

20 Eglinton Avenue West, Suite 1200, Toronto, Ontario, M4R lKgTel: (416) 488-8772 1-800-616-8816 Fax (416) 488-3778E-mail: info@alzheimer.ca Web site: www.alzheimer.ca

Charitable registration number: I t BTB 4925 RR000l

Made possible through an educational grant from:

fi tvtanulife Financial

8300-'t4E 2007

The Alzheimer Society is a national not-for-profit health

organization dedicated to helping people affected by Alzheimer

Disease. The Society has numerous resources and support

programs for people with the disease and their caregivers.

The Society also funds research into finding the cause and cure

ofthe disease, and into improved methods ofcaregiving.

For more information, contact your local Alzheimer Society

or visit our Web site at www.alzheimer.ca.

Tlrc Nzlwimer Swrnty wouldliketo thnnkboth Chris and Ann

for agreeing to be part ofthis brochure andfor lulpin4 raise

awareness of ll.Izhpimer Disewe. Chris was dingnosed with

Nzfuimer Di,sease in 1998.

Alzheimer "$

* r{* f vAlzheimer Society of Canada

20 Eghnton Avenue West Suite 1200, Toronto, Ontario, M4R 1K8

TeL (416) 48&872 1-800-6168816 Fax (416) 488-378

E-mail inlo@alzheimerca Web site: www.alzheimer.ca

Claitable regstration numbu:11878 4925 RRlffil

Is[adn possibl,e through an educatinnal grant hy:

fi Manulife Financial

For Those Recently

Diagnosed With

Alzheimer Disease

Alzheimer-$* rf *fy8300-09E 2005

I'irct Steps tr nffiil:*Jlffi' soins tt*ou$

You have likely been worried and anxious

about the changes you are seeing in yourself.

I(nowing you have Alzheimer Disease may be

upsetting. You may be concerned about the

future. However, you have already taken an

important first step in caring for yourself:

getting a diagnosis.

Changes to expect

The changes you are experiencing are because

ofAlzheimer Disease. You may have trouble

finding words, completing thoughts, following

directions or remembering information. Later

you may feel confused and have fficulty with

familiar tasks, such as driving a car. These

changes are related to the disease as it affects

memory thinking and behaviour. Other people

may notice changes in your behaviour or

personality. The effects of the disease willchange how you Iive day to day.

The information in this brochure can help you

cope with the changes you are experiencing

and plan for futwe changes so you can

continue living your life to its firllest every day.

You may respond to the news of the diagnosis

and the changes caused by the disease with avariety of emotions. You might feel angrry,

embarrassed, frustrated, afraid or sad.

These emotions are very normal and may

come and go. Let those close to you know how

you are feeling.

It will also be helpfrrl to be aware that

members of your family may also be

experiencing the same types of emotions.

Often people withAlzheimer Disease get

depressed. If your feelings are overwhelming

and won't g0 away, talk to your doctor.

fhlpeopteLet the people closest to you know that you

are living with Alzheimer Disease. Explain

what the disease is and how it is affecting you.

Sharing this information will help them bknow that the difficulties you are having are a

result of the disease. Sharing the ffirmationwill also allow you to tell them how they might

be able to support you.

tr Inam as much as you feel you can

Find out what you can about the disease

and how it will progress. Learn about tips

and strategies that might help you day to

day. TheAlzheimer Society has many

useful resources to help people with the

disease, such as Shared Experi,ences,the

Web site (www.alzheimer.ca) and

support groups.

tr Explore treatnent options

While there is no flre forAlzheimer

Disease, currently there are medications

that can help some people with some of the

symptoms. Read about the treatments that

are available. Discuss their risks and

benefits with your doctor. You may wish to

particrpate in a research study. Your local

Alzheimer Society will have information

on treatment options and research studies

in your area.

tl Recognize that you have a disease

f that affect"s your abilities. Focus on what you can do, not what

you can't.

. Find ways that might help you cope with

the changes. For example, writing down

important things in a memory book,

labelling cupboards or marking a calendar

might help with memory problems.

. Simplfi your life wherever you can.

o Reduce the number of presswes you face.

. Follow a routine.

People who have the disease say you should:

o Learn to be patient.

. T$ not to be hard on yourself.

o Keep in mind that you have a disease

that affects your abilities.

tr Seekouthelp

There are community agencies, services

and resoruces to help you and your family.

Some offer practical services like helping

with your shopping, preparing meals or

providing support such as talking to a

leader from your house of worship. Call

your localAlzheimer Society to find out

what is available in your area.

E Inokforsupport

Find people you are comfortable with to

share your feelings and emotions. It may

be a member of your family, a good friend,

another person with Alzheimer Disease

or a support group. No matter who it is -

the important thing is to share your

experiences and how you are feeling.

Some people also find writing their

thoughts, feelings and experiences in

a journal helpful.

Plan forthe future

Starb planning now for the future.

o If you are working, it is important to

prepare for your future retirement.. If you own a business, you will need to

make plans for when you can no longer

do things on your own.

r Ifthere are decisions about your personal

life that you have been puthing 0ff, make

them now.

o Put yow paper work in order, including

legal and estate planning, if it is

not already.

I Ensure that you have chosen someone to

make financial and health-care decisions

for you when you are unable to do so.

Talk to the person about yow wishes and

write them down in an advance directive.

This will ensure that your requests are

followed when you are unable to

communicate them yourself.

tr liveeachday

Enjoy life t0 the fullest. You will continue to

have abilities...focus on them. Do the things

you enjoy and that bringyou meaning and

fulfilment. Some days may be better than

others, but strive to create those times each

day that are satisfying and worthwhile.

Maintain your physical health, exercise

and eat a healthy diet.

tr ilTJJfffl',imersocietvThe Society can help by:

. Giving you the ffirmation you need to

learn more about the disease and

coping strategies.

. koviding support whether with a

telephone counsellor or a support group.

o Registeringyou with the Safely HomerM -

Alzheimer Wandering Regstry program

to ensure that if you get lost, there is help

at hand to get you home.

. Iocating services in your community.

The Alzheimer Society is a national not-for-profit health

organization dedicated to helping people affected byAlzheimer

Disease. The Society has numerous resources and support

programs for people with the disease and their caregivers.

The Society also funds research into finding the cause and cure

of the disease, and intn improved methods of cuegiving.

For more hformation, contact your iocal Alzheimer Society

or nsit our Web site at www.alzheimer.ca.

Alzh e i m e r,5'* dr r. #f lj

Alzheimer Society of Canada

20 EglintonAvenue West Suite 1200 Toronto, Gtado, M4R 1K8

Tel (416) 488-8772 1-800-616-8816 Fax: (416) 488-3778

E-mail info@alzheimerca Web site: www.alzheimer.ca

Claritable registration number: 1187 8 4925 RR0001

Madn possibln through an educational grant by:

fi Manulife Financial8300-t1E 2006

Alzheimer$rrrrsv

Anger2,

Taking care of someone with Alzheimpr Disease

requires timn and energy. It can be a demandingand stressfitl nsk. Knowing and recognizing signs

of stress in yourself or sotneone you care about is

the first step towards tahing action.

If the following symptoms occur on a regular basis,

call your d,octor or contact your Local AlzheimerSociety for help.

1. Denial...about the disease and its effect on the

person with the disease.

"I know Mom will get better. They must have

made a mistake."

...at the person withAlzheimer Disease

and others.

"If he asks me that question once more

I will scream!"

3, Withdrawing socially...you no longer want to stay in touch with friends

or participate in activities you once enjoyed.

"I don't care about getting together with theneighbours an5rmore."

4, Arxiety...about facing another day and what the

future holds.

"I'm worried about what will happen when I can

no longer provide care."

5, Depression...you feel sad and hopeless much of the time.

"I don't care anSrmore."

6. Exhaustion...you barely have the energy to complete your

daily tasks.

"I don't have the enerry to do anything an5rmore."

7. Sleeplessness

...you wake up in the middle of the night or havenightmares and stressfirl dreams.

"I rarely sleep through the night, listening to hearif Dad is out of bed."

8, Emotional reactions...you cry at minor upsets;you are

often irritable.

"I cried when there was no milk for my coffee thismorning. Then I yelled at my son."

9, Lack of concentration...you have trouble focusing and you find it

fficult to complete complex tasks.

"I used to do the daily crossword. Now I am luckyif I can solve half of it."

10. Health problems...you may lose or gain weight, get sick more often

(colds, flu), or develop chronic health problems(backaches, high blood pressure).

"Since the spring, I have had either a cold or theflu. I just can't seem to shake them."

As a caregiuer, you need to take care ofyourself. You are the most important person inthc life of someone with Alzheimer Disease.

There are things you can do to help maintainyour health and well-being.

Learn about the disease

Ifuowing as much as you can about thedisease and care strategies wili prepare you

for the Alzheimer journey. Understanding howthe disease affects the person will help you

comprehend and adapt to the changes.

Be realistic...about the disease

It is important, though difficult, to be

realistic about the disease and how it willaffect the person over time. Once you are

realistic, it will be easier for you to adjustyour expectations.

Be realistic,,,about yoffselfYou need to be realistic about how much you

can do. What do you value most?Awalk withthe person you are caring for, time by yourself,

or a tidy house? There is no "right" answer;

only you know what matters most to you and

how much you can do.

Accept your feelingsWhen caring for a person withAlzheimerDisease, you will have many mixed feelings.

In a single day, you may feel contented, ffigry,guilty, happy, sad, embarrassed, aflaid andhelpless. These feelings may be confusing. Butthey are normal. Recognize that you are doingthe best you can.

Share information and

feelings with othersSharing information about the disease withfamily and friends will help them understandwhat is happening and better prepare them toprovide the help and support you need.

It is also important to share your feelings.

Find someone with whom you feel comfortable

talking about your feelings. This may be a

close friend or family member, someone you

met at anAlzheimer support group, a member

of your religious community, or a healthcare professional.

Be positiveYour attitude can make a difference to theway you feel. l}y to look at the positive side ofthings. Focusing on rvhat the person can do,

as opposed to the abilities lost. can make

things easier. Tly to make every day count.

There can still be times that are special

and rewarding.

Inok for humowWhileAlzheimer Disease is serious, you may

find certain situations have a bright side.

Maintaining a sense of humour can be a good

coping strategy.

Take care of yourselfYour health is important. Do not €nore it. Eatproper meals and exercise regularly, Findways to relax and try to get the rest you need.

Make regular appointrnents with your doctor

for checkups. You also need to take regularbreaks from caregiving. Do not wait until you

are too exhausted to plan this. Take time to

maintain interests and hobbies. Keep in touch

with friends and family so you will not feei

lonely and isolated. These thinp will grve you

strength to continue providing care.

Get helpSupport: You will need the support that comes

from sharing thoughts and feelings withothers. This could be individually, with aprofessional or as part of anAlzheimersupport group. Choose the form ofsupporb

with which you are most comfortable.

Practical help: It can be hard to ask for and

accept help. But asking for help is not a sign

ofinadequate caregiving. You cannot care fora person withAlzheimer Disease alone. Askfamily and friends for help. Most people are

wiiling to assist you. There are also programs

in your community that offer assistance withhousehold chores or caregiving tasks.

Your local Alzheimer Society can help

you access these.

Plan for the futruePlanning for the future can help relieve stress.

While the person withAlzheimer Disease is

still capable, review his or her financialsituation and plan accordingly. Choices

relating to future health and personai care

decisions should be considered and recorded.

Legal and estate planning should also be

discussed. As well, think about an alternatecaregiving plan in the event that you are

unable to provide care in the future.

HeartSrnart'm Physica I

r*d/-+-;F

J,;-**ifl

H EART&STRO KEFOUNDATIONOF NOVA SCOTIA

Finding qnswers. For life.

PHOTOSCOURTESYOFCAAWS MARLENE H ELEMAPHOTOGRAPHY&HRM RECREATON

then iustNloveMore!

Sign up for Move More,an B-week program on physical

activity basics. Sample FUN

activities in your community,meet new people, and learn

how to set goa ls.

" l learned that I can have f un

[and be active]!"

Move More parlicrpant from Halifax

For more information on programs inyour area, contact the Heart and Stroke

Foundation of Nova Scotia

(9021 423-7530 . 1-800-423-4432

www.heart"llrtroke. ns.ca

I_==,/neieatnoiiltflliR i0i0ii! rr,t,tirlraRanrcl

'\*,2Nov{'s'bbrn

Health Promotionand Protection

q2;*niiffFinding 0nswers. For liJe