New Hours!

To accommodate our patients, Main Line Rheumatology has increased its hours to better serve you!

LANKENAU MEDICAL CENTER
Monday 9am – 5:30pm
Tuesday and Wednesday 8am- 4pm
Thursday 9am – 4pm
Friday 8am- 4pm

MAIN LINE HEALTH CENTER, Broomall
Tuesday, Wednesday and Friday  9am – 4pm

Don’t Let Arthritis Stop You from Enjoying Sex

This original story, seen here, can now be seen on philly.com 1/4/19 as a Health & Science, Q&A column,  and in the Philadelphia Inquirer, Health & Science, Sunday 1/6/19.

“Doc, I’m having trouble at home. You know…?” Not a great conversation starter in an office visit with a rheumatologist, but common to hear from patients suffering arthritis.

According to health.clevelandclinic.org, patients with various forms of arthritis talk about how it affects their feelings of sexuality and their sex lives. Close intimate, sexual relationships are part of a healthy, quality of life. Working on achieving that might take a little extra work, but the benefits are worth it!

Arthritis sufferers say the following issues affect the quality of their sexual identity and sex lives: pain, exhaustion, fatigue or decreased endurance, loss of self-esteem and feelings of sexual attractiveness, decreased sexual desire and satisfaction, difficulty with sexual arousal, decreased sensation, erectile dysfunction or impotence, vaginal dryness, extreme sensitivity to touch, limitation of movement/flexibility, effects of surgery, depression, and side effects from medication.

Inflammatory arthritis is a group of diseases characterized by inflammation of the joints and tissues, and include rheumatoid arthritis, psoriatic arthritis, lupus and ankylosing spondylitis.

How do these conditions affect sex and relationships? Inflammatory arthritis can cause joints to be tender or painful, and when it hurts to move, sex feels like the last thing on your mind or agenda. Swollen or misshapen joints or weight gain can make you feel older, and less attractive and confident. Offshoot immune disorders like Sjögren’s syndrome, can decrease women’s lubrication. Often men’s’ penile blood vessels are affected, causing arousal and erectile dysfunction. So, who wouldn’t be depressed from all of this, which can then further exacerbate the problems?

There’s hope. We’re bringing sexy back.

Having sex can help your pain and your brain! Pleasurable touching and sex releases those blessed endorphins that bathe your brain in happy feelings, and holistically lubricate parts of your body. We’re not kidding!

There is no sex czar to make arthritis complications disappear, nor one magic bullet. But here are some RECOMMENDATIONS AND OPTIONS that can help.

  • Boost open and honest communication; allow yourself to be more vulnerable about fears, sexual needs, desires and difficulties
  • Accept change; we’re all in process at every age!
  • Plan ahead: Take medication or muscle relaxants beforehand, nap with a heating pad, take a warm shower or relaxing hot bath, use an electric blanket to relieve joint stiffness and add more pillows
  • Connect: Hug, kiss, cuddle, massage
  • Be spontaneous; there are more times than bedtime when you are naturally more tired
  • For improved intimacy – more kissing, and experiment with new positions, oral or manual stimulation, visuals, lubricants and sex aid devices
  • Make sure to stay active with exercise to increase stamina, strengthen muscles and improve range of motion
  • Recognize and address any depression and sadness; seek professional help
  • Following joint replacement surgery, discuss recovery and safe positions for sexual activity, with your doctor

Sex and all forms of arthritis can coexist. It’s the journey and destination to achieve satisfaction, happiness and peace in your life, so GO FOR IT!

Main Line Rheumatology Doctors Awarded 2018 TOP DOCS by Main Line Today Magazine

Main Line Rheumatology is proud to announce Gary Gordon, MD, FACP, FACR, Thomas Harder, MD and Amy Lundholm, DO have been named TOP DOCTORS, Rheumatology, 2018, by Main Line Today Magazine. #rheumatology #topdoctors2018 #topdoctors #mainlinerheumatology #rheumatologist #Lankenau Medical Center #Main Line Health

A Main Line Rheumatology Patient With Rheumatoid Arthritis Runs Her Own Race

Rheumatoid arthritis can be a miserable disease for the millions of people who suffer from it.  Patients live with pain, stiffness and disability which can last for many years.  As rheumatologists, we always rejoice for those who manage to overcome the inherent difficulties living with a chronic illness.  Most of us would probably hang our heads and suffer the outrageous bad fortune, while a few others manage to rise above it.

A hero in rheumatology, and his face graces the cover of a standard text book of rheumatology, is the famous French painter, Pierre Auguste Renoir.  Renoir, as most know, had a unique impressionistic painting style beloved around the world.  His luscious paintings of his female models might suggest that the painter was some kind of Don Juan with a paintbrush.  The reality is that Renoir suffered, and was crippled by rheumatoid arthritis (RA).  He had to be physically carried on a chair, transferred from room to room.  Paintbrushes were either pushed into his hand and fingers, or taped to the back of his hands.  Renoir lived at a time when there was precious little medication to take for his pain and inflammation, other than narcotics, yet he managed to find the determination and will to overcome the enormous difficulties he suffered.

Every rheumatology practice has their own “Renoirs” and the doctors at Main Line Rheumatology are privileged to have a few.  One such patient is Susan M. She is a   52-year-old nurse who has rheumatoid arthritis (RA) that required ankle fusion, and elbows that do not bend much, which is a major factor as she enjoys running as a hobby and sport.  Her life has been further complicated by breast cancer.  In spite of these significant physical roadblocks, Susan M. runs marathons!  Not only does she run marathons, but she runs fast enough to have qualified for the Boston Marathon in April, 2019.  Given the number of runners to attempt to qualify for this 26-mile race, this was no small accomplishment.

Susan M. comes to Main Line Rheumatology for infusions of the drug, rituximab, under the care of our outstanding nurse practitioner, Cheryl Wieczorek.  Under Cheryl’s attentive care, Susan M. continues to do reasonably well controlling the inflammatory part of her RA.  The mechanical issues, including her elbow and fused ankle, cannot be helped by any medication, but Susan M. perseveres, nonetheless. Grit and determination come from deep within her determined, athletic and competitive spirit; she is a role model for many, and a marvel to observe and experience.  As her health partners and advocates, we are proud of her accomplishments.  Good luck in April, Susan M.!  In our estimation, you’ve already won the race.

Men and Osteoporosis. It’s Real, and Might Affect You!

To all men over age 50: At your next annual physical checkup visit, ask your doctor to check your height. If you have lost about one inch or more in the past year, you may have male osteoporosis, and is a very noticeable sign.

Osteoporosis is not just a “woman’s disease”. Although osteoporosis is typically associated with women, it is also diagnosed in men who account for an estimated one in five Americans who have osteoporosis. It is the major cause of fractures in the older population, where bones become thin and brittle, and as a result become weaker and more fragile. Women traditionally experience bone and spine issues after menopause and receive a confirmed diagnosis with a Dexa (bone) scan. However, men are normally not screened for osteoporosis, and don’t learn they have the condition until they experience a fracture. People who have rheumatoid arthritis or who smoke, consume more than three alcoholic drinks a day, have had prolonged prednisone treatment or previously experienced a fracture from only minimal impact should talk to their doctor about starting screening earlier.

Be proactive and don’t wait until you experience pain or height loss, before seeking help. Here are some questions to ask yourself.

  • Have I broken a bone since age 50?
  • Do I have a family history (female or male) of osteoporosis?
  • Do I appear shorter, or have a change in posture?
  • Do I have low levels of testosterone?
  • Do I consume more than three alcoholic drinks every day?
  • Have I had any prolonged steroid treatment?

According to a recent article published by the National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center, here is important osteoporosis information for men.

Risk factors linked to osteoporosis in men:

  • Chronic diseases affecting the lungs, kidneys, stomach and intestines, or altered hormone levels
  • Undiagnosed low levels of testosterone
  • Unhealthy lifestyle habits including smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
  • Age: Risk increases with age
  • Heredity: A son is almost four times as likely to have low bone mineral density (BMD) if his father has low BMD; nearly 8 times as likely if both parents have it
  • Race: All men can develop the disease but Caucasian men at high risk

Osteoporosis can be effectively treated if detected before significant bone loss has occurred. A medical work-up to diagnose osteoporosis includes a complete medical history, x-rays, and urine and blood tests. The doctor may also order a BMD (bone mineral density of DEXA scan) test, which can be used to detect low bone density, predict the risk for future fractures, diagnose osteoporosis and monitor the effectiveness of treatments.

Primary and Secondary Osteoporosis
There are two types of osteoporosis: primary and secondary. Primary osteoporosis is either caused by age-related bone loss (men age 70, and over), or have an unknown cause.

At least half of men with osteoporosis have at least one secondary cause (sometimes more). In cases of secondary osteoporosis, the loss of bone mass is caused by lifestyle behaviors, diseases or medications. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid medication, hypogonadism (low levels of testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria and immobilization.

Causes of Secondary Osteoporosis in Men

  • Glucocorticoid excess (Asthma and rheumatoid arthritis medications)
  • Immunosuppressive drugs
  • Hypogonadism (Low testosterone levels)
  • Alcohol abuse
  • Smoking
  • Chronic obstructive pulmonary disease and asthma (COPD)
  • Cystic fibrosis
  • Gastrointestinal disease
  • Hypercalciuria (Loss of too much calcium)
  • Anticonvulsant medications
  • Thyrotoxicosis (Excess thyroid hormone)
  • Hyperparathyroidism (Enlarged parathyroid glands)
  • Immobilization (Prolonged bed rest or immobilization)
  • Osteogenesis imperfecta (Genetic disorder called “Brittle bone disease”)
  • Homocystinuria (Metabolism disorder)
  • Neoplastic disease (Benign or malignant tumor growth)
  • Ankylosing spondylitis and rheumatoid arthritis
  • Systemic mastocytosis (Accumulated mast cells in organs)

What You Can Do!
Make an appointment with your rheumatologist or endocrinologist for an evaluation and diagnosis. It’s your continued committed partnership in treating your osteoporosis.

Osteoporosis management includes eating foods high in calcium (i.e. dairy products) and taking vitamin D (1,000 mg daily for men age 50-70; 1,200 mg over age 71), regular weight-bearing exercise, no smoking, limitation of alcohol and caffeine consumption, and fall-prevention.

 

Main Line Rheumatology News

Main Line Rheumatology is more mobile! Our improved mobile website now makes it easier for you to be well informed, every day! Read all about our doctors, get office information, learn more about diseases we treat, read about us in the News, and catch up on daily social media posts ~ all in one place. Come visit!

Can Stem Cells Regenerate Damaged Cartilage in Osteoporosis?

If you have arthritis, you know about the term “bone on bone”. We tell patients that you cannot grow new cartilage once it is destroyed, whether from over or repetitive use, the natural aging process, or injury. Stories about stem therapy being used to treat osteoarthritis, an aggressive degenerative form of arthritis, are popular on the internet. But, can stem cells regenerate damaged cartilage with this disease? Maybe one day we can be cautiously optimistic, but for today, I am still skeptical.

Our understanding is that stem cells are the building blocks of all human tissue. Arthritis, or joint degeneration, is due to loss of the cartilage that cushions bones and the stem cell goal is to treat arthritis to regrow cartilage.

Stem cells that come from your own body and are harvested through a medical scientific procedure, are then injected back into your body (stem cell therapy) in a desired location, addressing a specific medical condition, movement or pain problem. A newborn baby’s umbilical cord is rich in natural stem cells, and there has been a movement over the last 5-10 years to freeze and save these stem cells for that baby’s (or natural family member) possible health needs.

The human body is a remarkable repair machine. Skin can regenerate, and a small piece of liver transplanted in a human body, grows miraculously to accommodate the body’s needs. But damaged cartilage causing osteoarthritis, does not naturally regenerate. Making degenerated and damaged bones and joints “almost good as new” is more often than not, only the outcome of surgery.

Dr. Shane Shapiro, at the Mayo Clinic Orthopedic Surgery and Center for Regenerative Medicine, published an article in May, 2018 describing how efforts and studies in stem cell regenerative medicine could treat degenerative conditions such as osteoarthritis, changing the course of orthopedic surgery over the coming years. Although research and studies show promise, stem cell treatment for arthritis is not widely available at this time, as is still being researched.

When discussing stem cell therapy, it’s important to understand that pure stem cells are not currently available to U.S. patients outside of a clinical research study. Stem cell therapies currently used outside clinical studies do not contain pure stem cells; they are a mix of a variety of cells with only a very small percentage, stem cells.

A handful of clinical research trials, monitored by the U.S. Food and Drug Administration (FDA), are ongoing at this time to study stem cell treatment for arthritis. The early findings are encouraging for the future. Many stem cell therapies now marketed to patients are conducted without a required FDA biologics license. Also, some forms of stem cell therapies are mislabeled, and do not contain actual living stem cells. These practices cause concern among rheumatologists as these treatments may mislead, or even harm the public.

Research into stem cells and arthritis shows that there are opportunities for stem cell treatment resulting mostly in pain relief and improvement in function, or quality of life. But only a few limited early studies have demonstrated improvement in new cartilage   or bone formation needed to cure arthritis, so I am skeptical. Exactly how that cartilage regrowth occurs, or even how pain relief is achieved, is still unknown.

To conclude, here is my opinion. Stem cell therapy, particularly with fetal stem cells, offers great promise for many diseases, including regenerating the damaged cartilage of osteoarthritis. Free standing stem cell clinics that offer treatment, giving you back a few of your mature stem cells for a high cost. As a cautionary tale, The New York Times reported, October 15, 2018, that Harvard University is retracting data that had implied that stem cells had improved cardiac function, when stem cells were placed in the heart. The odds of success currently are minimal, and insurance does not cover this expensive procedure. The “Religious Right” has prevailed upon the last three administrations to toss umbilical cords into the trash instead of utilizing them to save or improve lives. We hope this will change one day, or maybe other countries can lead the way.