Osteoarthritis and a sedentary lifestyle can go hand-in-hand

About 1 in 5 adults in the U.S. suffers from some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia, according to the Centers for Disease Control. Arthritis affects people of all races and ethnicities, but is more prevalent in women. While there are many causes for arthritis, or joint inflammation, research has shown that people with sedentary lifestyles and people who are obese or overweight are more likely to experience one of these types of arthritis.

Dr. Ronald Rush of Highway Healthcare in Texarkana, Texas, says inflammatory arthritis such as rheumatoid arthritis usually runs in families. Though it can affect many joints in the body, joints in the hand suffer more often, especially when not in use. “You might think of it like the fluids in your engine or wheel bearings. On a cold day, the fluids are thick and slow to move but after a few miles the fluids thin out and the engine and bearings run smooth. The fluids in the joints, when not in motion, stiffen the joint.”

Rush says the treatment for inflammatory conditions is movement, which is not always possible for a trucker. He says another option is to discuss with a doctor the possibility of taking a class of drugs called NSAIDS.

Degenerative or osteoarthritis can have an inflammatory component, but it mostly occurs when joints become worn out and bone rubs against bone. Rush says truckers might notice this type of arthritis pain in joints they use often, such as shoulders, lower back, arms, wrist and fingers.

“The role of a sedentary lifestyle is mostly related to the osteo or degenerative arthritis. This is primarily due to weight gain, which stresses joints. A sedentary lifestyle also tends to weaken joint muscles and this leads to more direct stress on the joints,” Rush says.

All about arthritis

• Osteoarthritis is the most common type of arthritis. Symptoms are pain, swelling and stiffness, and the cause is breakdown of joint cartilage.

• Rheumatoid arthritis, an inflammatory disease characterized by pain, swelling, warmth and redness, affects the lining of multiple joints in the body and can affect organs, as well.

• Gout is the most common type of arthritis among men and is caused by being overweight or obese, hypertension, alcohol consumption, diuretics and eating a lot of meats and seafood.

Sources: www.arthritis.org; www.arthritistoday.org; www.cdc.gov

How do you deal with arthritis pain?

Via Facebook:

“Yoga has helped me a lot! I have the Yoga in Bed DVD and it works great! It’s mostly stretches but keeps the body from being so stiff, thereby easing the arthritis pain!” — Zoe W.

“Aspirin when it bothers me to the point that I can’t sleep. Otherwise I’ve lived with it for so long I ignore the pain.” — Dale S.

“When I need to I’ll use some ibuprofen, but I try not to use it all the time as it is tremendously hard on the stomach. Walking seems to help keep the joints worked up by providing lubrication. When I sit too much old Arthur seems to get restless.” — Jacques C.

Dietary changes that can help

• Decrease Omega-6 fatty acids: found in corn, sunflower, soybean, cottonseed oil; prevalent in snack foods, fried foods, margarines, other spreads.

• Increase Omega-3 fatty acids: found in fatty fish such as salmon and tuna.

• Eat more fruits, vegetables, nuts and drink tea. These foods can help reduce enzymes that cause joint inflammation.

Sources: www.arthritis.org;

www.arthritistoday.org; www.cdc.gov

Treatments

(under doctor’s guidance)

• Non-inflammatory arthritis (osteoarthritis): physical therapy, weight loss, pain medications

• Inflammatory arthritis (rheumatoid): exercise, weight loss, pain medications, anti-inflammatory drugs

sources: www.arthritis.org;

www.arthritistoday.org; www.cdc.gov

Be sure to visit www.fit4theroad.com for more information on weight loss, healthy recipes, information on health products and more.

As if life on the road is not tough enough, some of the same chronic health conditions that contribute to truckers’ quality of life may also cause impotence and/or difficulties with erections. The medical term “erectile dysfunction” describes the condition where you may be unable to achieve erection or may only be able to achieve brief erections. According to the National Institutes of Health, an estimated 30 million men in the United States experience chronic erectile dysfunction. Men over the age of 40 with health conditions common to truckers, such as heart disease, obesity or diabetes, are at higher risk than other populations.

As prevalent as the condition is and in spite of a barrage of ads promoting drugs designed to cure the problem, men still don’t like to talk to their doctors about ED. It can be an embarrassing subject to bring up, but sometimes it’s a symptom of more serious issues, such as heart disease. Often men go in for one complaint, such as for possible sleep apnea, and end up telling their doctor about their ED during the work-up. Steven Y. Park, author of Sleep, Interrupted, says that in one study, nearly 70 percent of men with sleep apnea were found to also have ED. Diabetic truckers with ED have an eightfold risk of heart disease they didn’t even know they had.

If you are concerned about any aspect of your sex life, the first step should be a thorough checkup by your family doctor. He will determine the cause of your ED and may suggest diet and lifestyle changes along with medications proven to improve sexual function.

It’s important to remember that ED doesn’t happen alone. It’s a symptom of other various problems, which include heart disease, diabetes, hypertension and sleep apnea. It’s important to at least look for or consider all these other conditions when talking with your doctor.

Physical causes

If you are over 50 years old and have chronic health conditions found in the trucking population, your erection problems are most likely caused by your physical conditions. According to the Mayo Clinic, common causes of ED include:

• Conditions such as diabetes, heart disease, high blood pressure, clogged blood vessels (atherosclerosis) and obesity.

• Metabolic syndrome, a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol.

• Diseases such as Parkinson’s disease and multiple sclerosis.

• Hormonal factors such as low testosterone.

• Peyronie’s disease, development of scar tissue inside the penis.

• Prescription medications such as drugs taken for high blood pressure and depression.

• Tobacco, alcohol or illegal drug use.

• Treatments for prostate cancer or enlarged prostate

• Surgeries or injuries that affect the pelvic area or spinal cord.

Psychological causes

Relationship issues, anxiety, stress, fatigue and depression can interfere with normal sexual function. Dr. Park says that arousal (and erection) is activated by the parasympathetic nervous system, whereas orgasm is activated by the sympathetic nervous system. Having too much stress (sympathetic tone — the fight or flight response) from not sleeping effectively, or from any other source of job or relationship stress, can prevent arousal by suppressing the parasympathetics (the relaxation half of your involuntary nervous system). Many patients with ED caused by emotional and relationship issues benefit from counseling. No matter the cause, the good news is that there are effective, available treatment options.

Treatment

The most popular, well-known treatments for ED are prescription oral medications such as Viagra (Sildenafil), Cialis (Tadafil) and Levitra (Vardenafil) that enhance the blood flow to the penis. Some patients experience side effects or adverse reactions, so it’s important to follow your physician’s directions. Other treatments include hormone replacement therapy to replace diminished levels of testosterone, needle injection therapy, intra-urethral therapy (where you give yourself the injection), vacuum pumps, surgery and penile implants. There are also plenty of scams promising to cure your ED with “natural” products. Check with your doctor before taking any herbs or vitamins.

One or two episodes of ED don’t mean you are doomed to a bad sex life or catastrophic health news. Make an appointment with your doctor and have a frank talk about your symptoms.

Preventing Erectile Dysfunction

Steps you can take toward preventing erectile dysfunction and also improving your overall health.

• Stop smoking.

• Exercise regularly.

• Maintain a healthy weight.

• Review your medications with your doctor and ask about possible substitutions for those that may cause or exacerbate ED (never stop or change a medication without first talking to your doctor).

• Take prescribed medications as directed.

• Avoid excessive use of alcohol (more than two drinks a day).

• Avoid the use of illegal drugs.

• If you have a chronic illness such as diabetes or kidney disease, follow your doctor’s guidelines to keep these conditions in control.

Stroke warning signs include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden, severe headache with no known cause.

Stroke is a disease that affects the blood vessels that supply blood to the brain. The effects of a severe stroke are often permanent, so it is best to be aware of the causes of a stroke, the warning signs of a stroke and ways to reduce the risks of a stroke.

According to the American Heart Association, a stroke occurs when a blood vessel that brings oxygen and nutrients to the brain either bursts, which causes a hemorrhagic stroke, or is clogged by a blood clot, which causes an ischemic stroke. When either of these takes occur, parts of the brain do not get the blood and oxygen they need. Without oxygen, nerve cells in the affected area of the brain cannot work properly, and die usually within three to four minutes. When nerve cells cannot work, the part of the body they control can’t work either.

If you or anyone you know has complained of these symptoms, the AHA advises to take immediate action by calling your emergency response number.

The best natural way to help prevent a stroke is to know the risk factors contributing to stroke and taking steps to reduce those factors. Factors that contribute to stroke risk include:

• High blood pressure
• Cigarette smoking
• Diabetes mellitus
• Carotid or other artery disease
• Atrial fibrillation (heart rhythm disorder)
• Other heart disease (heart failure or coronary heart disease)
• Sickle cell anemia
• High blood cholesterol
• Poor diet (diet high in saturated fat, trans fat and cholesterol)
• Physical inactivity and obesity

If concerned about your risks of having a stroke, it is best to contact your doctor to find out your risk level and measures to take to reduce your risk level.

Information from the American Heart Association.

The average death rate in the United States for cardiovascular disease is around one death every 38 seconds, according to the most recent report from the American Heart Association. More than one in six deaths in the U.S. in 2006 were from coronary heart disease.

Dr. Alan Gass, medical director of heart transplantation and mechanical circulatory support at Westchester Medical Center in New York, says obesity is a prime factor in this. “In the U.S., 66 percent of the population is overweight and over a third is obese,” he says. “Now they are predicting that by 2012 50 percent of the U.S. population is going to be obese. Obesity is directly related to high blood pressure, diabetes, heart attacks, arthritis and cancer. Therefore obesity is directly related to the majority of health problems in this country and probably represents the single biggest reversible expenditure for the U.S. government.”

Dr. Hunter Myers, a cardiologist in Rome, Ga., says the first risk factor he suggests changing is smoking. “That may be the hardest thing to do but the most quick return as far as risk factors,” he says. “[Smoking] speeds up your risk of heart disease.” He says nicotine patches and a prescription medicine called Chantix often work best, but a visit to the doctor can determine the best method for individuals. Next in line on Myers’ list of changes to lower risk of heart problems would be “things that affect your cholesterol” — meaning diet, he says.

Both Gass and Myers suggest that while eating healthy and exercising may be a struggle for some truck drivers, these things aren’t impossible to do on the road. Gass suggests finding ways to work in exercise, whether it be at a truckstop or at a gym chain with nationwide locations — make it “something that you have to fit in your life,” he says.

Talking to those who argue they don’t have time for exercise, Gass advises they imagine the problem as a little angel and little devil on either shoulder. “Most of the time the little devil on their shoulder is telling them they don’t have time to exercise. So I just tell them to take a minute and have a conversation with that little devil. Tell him, ‘I know you’re just screwing with my head.’ You can find a million excuses not to exercise, but most of those excuses are not founded in reality.” Gass says he also has his patients keep a food and exercise diary, which he suggests might be helpful for truckers.

“Another thing I preach is to live in the moment,” Gass says. “You can’t be hard on yourself for how you got to where you are because you’re unhealthy, nor can you say, ‘I weigh 350, and I have to weigh 200 — there’s no way I can do that.’ … Try not to look backwards, but to look forward. Guilt and blame, those are bad concepts. People should not feel bad about themselves, they should feel good about themselves.”

Gass says limiting or decreasing alcohol intake and smoking are other lifestyle changes that can help lower the risk of heart disease.

Myers says motivation is key to being healthy and preventing heart disease. “Most people get motivated by having something bad happen to them and getting a second chance,” he says. “Or they have another event that makes them want to live forever because something so good happened to them, like having a grandchild.”

A new lease

Randy Freels (before)

Averitt driver Randy Freels knew he was getting heavier as the years went by, and at 40 he decided to do something about it.

“I was at my heaviest, and I was just miserable and figured I’d better do something,” the Lenoir City, Tenn., resident says. “Heart disease runs in my family. So I figured it was time to turn it around and try to take care of myself.”

Freels found out at Averitt’s annual free health screening that he was at extremely high risk for a heart attack and possibly a stroke. “Those numbers were alarming,” he says, and he went almost immediately to see his family doctor. “He started to write me a prescription, but I asked if there was anything I could do medically. So he prescribed the South Beach Diet.” The South Beach Diet, originally designed partially by a cardiologist, is an alternative to other low-fat diets that revolves around the ideas of “good carbs” versus “bad carbs” and “good fats” versus “bad fats.”

By following the South Beach Diet, Freels was able to lose 30 pounds in 90 days. “I feel wonderful,” he says. “Got all kinds of energy, and I look forward to exercising each day. I weigh less than I did when I graduated high school — that’s always a good thing when you’re 40.”

Randy Freels (after)

Freels’ wife has also been following the diet, which he says helps tremendously. He says his back and joints no longer hurt as they did when he carried around the extra pounds. When he’s on the road, he packs his own meals and keeps snacks in his truck to help him stick to his weight-loss plan. “Don’t wait till you get starving to death and get in a truckstop with aisles and aisles of candy and quarter-pound hot dogs and all that stuff,” he advises. “Alcoholics don’t go to bars, and as a food addict, I just don’t go around where I could fall and make bad decisions.”

The motivation to prevent heart problems has provided great incentive for Freels to make the lifestyle changes necessary to lose weight and get healthy.

“I’ve got a new lease on life, and I’m going to stick with it,” he says.

FMCSA heart guidelines

The Federal Motor Carrier Safety Administration has multiple heart-related medical guidelines that determine the status of a driver’s CDL. The guidelines include the following:

A driver must not have a current clinical diagnosis of myocardial infarction (heart attack), angina pectoris (chest pain), coronary insufficiency (insufficient blood flow through one or more coronary arteries, or the arteries encircling the heart), thrombosis (blood clots) or any other type of cardiovascular disease that may be accompanied by loss of consciousness, breathlessness, collapse or congestive cardiac failure.

The driver can’t have a clinical diagnosis of high blood pressure likely to interfere with his or her ability to operate a commercial motor vehicle safely. Typically this means if the driver’s blood pressure is higher than 140/90 he or she likely will be granted a temporary medical certification of up to one year with periodic check-ups. With a blood pressure greater than 180/110, the driver cannot be qualified until his or her blood pressure is demonstrated to be below 140/90 with treatment well tolerated.

Additionally, FMCSA requires that the driver not have any established medical history or clinical diagnosis of vascular disease that interferes with his or her ability to operate a CMV safely. Vascular disease includes disorders that affect the integrity of blood vessels and arteries away from the heart; the disorders include peripheral artery disease, renal artery disease, Raynaud’s Disease, Buerger’s disease, peripheral venous disease, varicose veins and venous blood clots.

The key to these regulations is the qualifier that they interfere with an individual’s ability to safely operate a CMV. With some exceptions, such as the specific guidelines for blood pressure levels, many of these guidelines are left to the discretion of the doctor performing the CDL medical exam.

Be sure to visit www.fit4theroad.com for more information on weight loss, healthy recipes, information on health products and more.

CPAP is a common treatment for obstructive sleep apnea.

Are you afraid you may have sleep apnea but hesitant to get tested? While seeking a medical professional’s opinion is best, here are five signs that you may have the disorder:

Loud, chronic snoring

This is one of the most common signs of obstructive sleep apnea. The snoring may include pauses and choking or gasping. It is, however, important to remember that not everyone who snores has sleep apnea.

Louder snoring when you sleep on your back

It may ease off when you sleep on your side, and it may not happen every night.

You are unable to judge the severity of the problem yourself

Because this happens when you’re asleep, you likely will not realize that it’s happening or how bad it is. Family members or bed partners often recognize the signs first.

Daytime sleepiness

This can be especially tough while driving. If you find yourself falling asleep at the wheel even after eight to ten hours of sleep, it may be a sign that your sleep is not as restful as it should be.

Mood swings

Another common sign of sleep apnea is mood swings and feeling irritable or depressed.

People with sleep apnea may suffer from one, several or all of these symptoms. If you think you could have the disorder, best get checked out by your doctor, who can help you come up with a way to overcome it.

Information from the National Heart, Lung & Blood Institute.

Industry coming to grips with long-term health consequences of sleep apnea

Randy Grider

Tony Guzman, an owner-operator leased to Prime Inc., was having a hard time making it through most driving shifts without a nap, despite often sleeping through and beyond the end of the required 10-hour rest.

“I was always exhausted,” Guzman says. “I couldn’t get through the day. I would sleep 10 or 12 hours, and it wouldn’t be enough. I would have to pull over 200 or 300 miles down the road and sleep some more and keep going that way.”

Fellow Prime driver James Stitt of Charlotte, N.C., has a similar story. He would wake up feeling tired, moody and suffering from headaches. “I would wake up aching and just didn’t feel good at all,” Stitt says.

Last year Prime screened both drivers and set them up for a sleep study at the Springfield, Mo., company’s offsite sleep lab. Neither driver was happy about it.

“The drivers sometimes get angry when we tell them they have to be tested,” says John Hancock, director of driver training at Prime. “We get them to talk to other drivers who have been diagnosed and are being treated.”

“Some guys quit,” adds Don Lacy, Prime safety director, who also suffers from sleep apnea. “What makes up for it is when a driver comes to you and says, ‘You saved my life.’”

The attitude changes almost immediately when a driver with sleep apnea begins treatment using a continuous positive airway pressure (CPAP) device.

“Every time I use the machine, I wake up with a lot more energy,” Guzman says. “It just makes it a better day. Now I get my job done quicker without all the quirks of having to stop to sleep for four or five hours during the day.”

What is sleep apnea?

Apnea is a Greek word that means “without breath.” There are three kinds of sleep apnea: obstructive, central and mixed.

Obstructive sleep apnea (OSA), the most common form, is caused by a blockage of the airway that usually occurs when the soft tissue in the rear of the throat collapses and closes during sleep. Symptoms often include loud snoring, restless sleep and sleepiness during the day.

Central sleep apnea (CSA) is not caused by a blocked airway but when the brain temporarily fails to signal the muscles to breathe.

You’ve heard the rumors. The Federal Motor Carrier Safety Administration is soon going to require testing for sleep apnea if your body mass index (BMI) and/or neck size is [fill in the blank].

From all indications, it does appear that FMCSA plans to address sleep apnea sometime and will require some kind of action to screen/test for and treat those drivers who are diagnosed. Many medical experts and trucking company officials think FMSCA may initiate a process that deals with sleep apnea later this year.

Sleep apnea is a combination of the two.

With each apnea event, which can happen hundreds of times in a single night in severe cases, the brain finally arouses you to breathe again. This means the restorative sleep your body needs to function properly is fragmented and of poor quality.

“For a person who has moderate to severe sleep apnea, it is very much like someone poking you every 30 to 45 seconds to wake you,” says Duke Naipohn, president and CEO of Sleep Pointe, which partnered with Prime to run its sleep lab.

Untreated sleep apnea can have serious and deadly consequences. According to the American Sleep Apnea Association, sleep apnea can contribute to high blood pressure and other cardiovascular disease, diabetes, memory problems and weight gain. People with untreated sleep apnea also may complain of headaches, depression, reflux, nocturia (the need to go to the bathroom frequently in the night) and impotency.

Studies have shown sleep apnea can lead to job impairment and motor vehicle crashes.

How big is the problem?

According to Dr. Mark Berger, president and chief medical officer for Precision Pulmonary Diagnostics, approximately 20 million Americans have OSA. Of those, 17 million are undiagnosed. The risks for sleep apnea increase with age and weight gain.

Among truckers, a 2002 study commissioned by the Federal Motor Carrier Safety Administration found that approximately 28 percent of drivers on the road suffer from sleep apnea. Some medical experts think the actual number is higher and is growing due to the upward trend in average age of the driver population, coupled with contributing health factors.

Diagnosis and treatment

The most accepted form of sleep apnea diagnosis starts with a questionnaire screening. If it is determined that a person exhibits symptoms related to a possible sleep disorder, the next step is an overnight sleep study. This is done in a controlled environment where certified sleep technicians hook monitoring sensors to the patient to record and study apnea events. Depending on the number of apnea events the patient has during each hour of sleep, the patient will be diagnosed as either not having a disorder or as having mild, moderate or severe sleep apnea.

Treatments range from lifestyle changes, including weight loss, smoking cessation, exercise and different sleeping positions, to specialized devices like a CPAP or auto-titrating positive airway pressure (APAP) systems to dental devices to surgery.

While CPAP and APAP are most commonly used to treat moderate and severe sleep apnea, oral appliances are prescribed by many dentists to reduce the number of apnea events. Some patients go this route when they find they can’t adjust to wearing the mask required to use CPAP systems.

Dr. William Adams, who specializes in sleep disorders at his Albertville, Ala., dentistry practice, advocates oral devices as the best alternative for CPAP haters. In fact, he is a member of a national campaign called I Hate CPAP to bring awareness to dental devices offered for sleep apnea sufferers.

While he admits CPAP is a more effective treatment when properly used — especially among severe sleep apnea patients — real-world evidence suggests that many people simply quit using them.

“We found that 35 to 50 percent of patients given CPAP machines quit using them after six months,” Adams says. “With oral devices, 90 percent are still using them after one year.”

But other medical experts say CPAP machines offer accountability that the device is being used with downloadable data cards. Oral appliances do not. “In the trucking industry, it’s about accountability, especially with facing stricter federal regulations,” says Berger, who provides a comprehensive sleep apnea program to fleets like ­Schneider National and Swift.

Several kinds of surgeries can help in some sleep apnea cases. These include trimming throat tissue, removing tonsils and adenoids, gastric bypass, restructuring the jaw, repairing a deviated septum and tracheotomy. These procedures are done in the more extreme cases and have varying degrees of success for curing sleep apnea permanently.

CPAP, oral devices and surgery are all acceptable treatments recognized by the American Academy of Sleep Medicine.

Sleep apnea rule coming soon

But at the Healthy Trucking Association of America’s February Healthy Trucking Summit in Atlanta, FMCSA Office of Medical Programs Director Dr. Maggi Gunnels was vague on the timeframe and nature of a potential rule.

While some type of sleep apnea regulation may be on the horizon, Gunnels said due to the nature of the process, it’ll likely be at least a couple of years. Even if that does happen in the future, “are we going to mandate screening and testing?” Gunnels asked. “I don’t think we know yet. I think we’re going to propose that it probably will be screened for. … But I don’t know how detailed we’ll get in terms of regulation or mandates.”

Last year, the FMCSA Medical Review Board made a recommendation that the agency require screening for obstructive sleep apnea for all drivers with a BMI greater than 30. More recently, the National Transportation Safety Board urged the FMCSA to begin a program to identify commercial drivers at high risk for obstructive sleep apnea, and if treatment is required, show that it is has been conducted.

— Misty Bell contributed to this report.

Conference and Webinar

The American Sleep Apnea Association will hold its first “Sleep Apnea & Trucking Conference” May 11-12 in Baltimore. The conference’s focus is creating greater awareness about sleep apnea and its dangers.

The conference is cosponsored by the American Trucking Associations and the Federal Motor Carrier Safety Administration.

Panel discussions include:

• Body mass index (BMI) guidelines

• Interstate medical exams and enforcement

• Affordability of diagnosis and treatment

• Future research needs on prevalence and impact

For more information, visit: www.satc2010.org.

Truckers News held a webinar titled “Sleep Apnea: A Wakeup Call” in February. The guest speaker was Dr. Mark Berger, CEO and chief medical officer of Precision Pulmonary Diagnostics. You can download and listen to the recorded webinar in the archives at www.truckerwebinars.com