Osteoarthritis

[CEJM]

Does anybody have any experience with Osteoarthritis and flying? My doctor is of the opinion that I suffer from osteoarthritis in one of my feet. Initially it started as having a stiff and painfull foot in the morning but it has gotten worse over the last year. To such an extent that the foot hurts after a longer period of inactivity.

At the moment this does not affect my work but it does worry me when looking towards the future. I am only end thirties so still a long career ahead of me. Now wondering if I should start preparing for the inevitable and start looking at another career.

[goudie]

I’m not a pilot but I had osteoarthritis of my left knee last year. After 4-5weeks or so treating with iboprufen it disappeared and hasn’t returned, so don’t give up hope

[BoeingBoy]

I have an Osteoarthritic left knee that came on almost overnight after mowing the lawn too enthusiastically. I am now told I need a replacement and nothing can be done to alleviate the pain of walking. Apparently I've lost most of the cartilage on the inner side of the joint and nothing is really available to provide relief long term. That said, I have good integrity and mobility in the joint, it's just painful to walk on. I manage pain relief with over the counter products (Ibuprofen and Paracetomol) if needed and have some neoprene braces for dog walking etc but I have no discomfort when sitting or flying.

You don't say where you're from but the UK CAA (EASA) take the view that so long as the joint has integrity in strength and won't fold on you then you can still operate. I suspect a class one might be provided with an OML clause but I have my class 2 without any restriction.

As my AME said "If you can climb in and push the pedals, you're good enough to go".

Here's the official protocol from the CAA website.

Musculoskeletal conditions (http://www.caa.co.uk/Aeromedical-Examiners/Medical-standards/Pilots-(EASA)/Conditions/Musculoskeletal/Musculoskeletal-conditions/)

[abgd]

Whole foot or just a bit of the foot? Any other joints infected? Any injuries in the past? Any family history? Any X-rays? Do you jog?

I certainly wouldn't throw in the career at this stage unless you had very good specialist advice. My guess if it's just one joint that is affected is that it relates to an injury - possibly even an old one that you've completely forgotten about. There are other possibilities such as stress fractures as well. And there are treatments for various conditions - heck, you can even get joint replacements on toes if needs be. If it's causing you this much grief at your age and has lasted that long, I think you need to see a specialist and get a firm diagnosis.

If you're taking medications, also consider topical ibuprofen or diclofenac gel (don't you need to consult with your AME even if on paracetamol?). Everything has its side effects and whilst it's reasonably safe, Ibuprofen will put your blood pressure up a bit and can give you stomach upsets and set off asthma attacks (if you have asthma). If you can make do with less, all the better.

[CEJM]

Thank you for the replies. They are very much appreciated.

BOEINGBOY,my apologies I was going to include my national authority but completely forgot. It will be the UK CAA that I have to deal with so it doesn’t seem as bad at the moment. It doesn’t affect my work at all, walking after a TFS and back might be a bit painfull but no issues using the rudder. Thank you for the link to the CAA protocol. I will have a read of this. Hopefully your knee can be sorted out with a replacement, however that has its own challenges.

ABGD, it is just the front part (toes, excluding the big toe) which plays up. As far as I am aware no other joints are infected and no other joints are stiff or cause me grief. I don’t jog and never had any injuries on that foot. The problem started during the build of our garage. I did all the work myself and I wonder if carrying heavy weight concrete blocks over uneven ground might have put uneven strain on that particular foot. At the moment I am not taking any medication as the pain is bad for about 10 minutes when I wake up and after that it is more manageable.

You are right and I need to start putting some pressure on my Doctor to send me to a specialist.

[421dog]

At the risk of providing advice without the benefit of examination, I would strongly suggest a brief (2 week) course of Nsaids (like Ibuprofen, 600 mg every 6 hours whether you have pain or not) Drink a bunch of fluids, and be sure to eat with the pills when you can.

If it gets better, welcome to being out of your 20's. If it doesn't, maybe you should pursue things further.

From an FAA standpoint, there is nothing about this that would raise anything beyond passing interest as an AME.

[abgd]

By the toes do you mean the actual toes, or the end of the foot before the toes attach? If you type 'metatarsals' into Google you'll see what I'm getting at. In a way the toes extend into the foot a bit so I hope I'm not being stupid.

There's a particular injury often affects the second or third toes, just inside the foot, which is related to overuse. I would certainly seek out an X-ray (which a GP can order) as if it's arthritis, you should see some changes, and if it's a stress fracture, ditto.

NSAIDs are anti-inflammatories. If you have an angry joint, use can make it angrier and more inflamed and you end up with a vicious circle which you may be able to break with anti-inflammatories. If it's a toe I would try a topical gel first. But you have to use them regularly as 421dog states - they're not just for pain.

And I'd still get it looked at again.

[CEJM]

421dog, thank you. I will have a look at these and discuss it with the doctor.

ABGD, you are spot on. It is the joint between the metatarsals and the toes. After living in the UK for 14+ years the medical terms are still not very well known to me. In my case it affects the outside toes more then the inner toes. I will pester my doctor for an x-ray. Reading various bits of information on the internet I would expect that it is overuse and maybe not walking correctly.

[gingernut]

I think if this problem is worrying you about your future functionality, you probably need to investigate things further.

Not sure of your age or location from your profile on here, but I think a reasonable stert would be for your doc to try and differentiate between an inflammatory condition, and a "wear and tear" condition.

The stiffness and pain in the morning should perhaps spurn some further work up (bloods and an x-ray at the very least I would have thought.)

[CEJM]

Gingernut, the Doctor is more inclined to go along the ‘wear and tear’ route as there doesn’t seem to be any inflamation of the joints. I am in my late thirties and live in the UK. It worried me with regards to my career and if this was a career limiting condition. However reading the replies it seems that it doesn’t have to be career limiting. My biggest worry is the fact that it got worse over the last year. With my age I have a lot longer left as a pilot. If it would ultimately lead to me not being able to perform my duties then I rather find out now. At least now I would have time on my side to prepare for a new career in case it is required at a later date.

Back to the Doctor it is.

[Radgirl]

I am afraid you will get nowhere without a diagnosis. You need an X ray, possibly weight bearing and non weight bearing. You not only need a view of the joint (s) but also an assessment of the arches and your gait. Pain can be a symptom of poor gait, and OA is normally an issue in later life
There are a number of podiatrists who specialise in gait and they can also diagnose the problem if it is a particular joint, organising not only X rays but also some blood tests. I would suggest you ask your GP to refer you. I doubt however it will stop you flying.

[gingernut]

I think Radgirl has hit the nail on the head.

[RatherBeFlying]

To add to the previous good advice, GENTLE usage can be powerfully rehabilitative. Sharp pain is of course a signal to back off.

Build up to walking a couple kilometers a day, preferably off hard surfaces.

[abgd]

Best to know what you're actually treating first though.

[Centaurus]

Two years ago I had open heart surgery as a precaution since my mitral valve was leaking. I was then age 85 and always fit. The operation was successful with no complications. At the time, and during rehabilitation which included supervised walking at normal pace for two kilometres around the hospital block, my left knee was playing up. Not seriously painful but slowed up my walking pace. Been like that for a year before my operation and it didn't go away. As a simulator instructor I had to demonstrate various sequences to students and the left knee pain restricted my movement . One of my students was a doctor who owned a farm with horses. He noticed me limping because of the inside of my left knee was a bit painful at times. On our next sim session he gave me a large tube of horse liniment under the trade name Rapigel. At least that is the trade name in Australia. It specifically states for animals only. Nevertheless my student says it is widely used on humans and so did my own doctor and chemist.
I rubbed the liniment on the inside of my knee twice a day for a month and very soon the knee pain vanished. I could not believe how effective the Rapigel was. That was two years ago and so far so good. No re-occurrence of the ailment and I discontinued use of the Rapigel about a month after the knee pain disappeared. My medical doctor attended a conference where Rapigel was discussed and many doctors swore by its effectiveness. Even though it is labelled for legal reasons, only to be used on animals who have sore limbs.

[CEJM]

Thank you all for your opinions and advice, it is greatly appreciated. I have got a diagnosis of Osteoarthritis but not a lot of research has been done by my family doctor. This week I have my medical and will discuss it with my AME.

[CEJM]

Just to give a quick update where we currently are.

I had an x-ray and blood test so far. All is coming back negative with no abnormalities found. When he told me the results he asked me what I wanted him to do, as all the results were negative. He then got a bit upset when he asked me if I take paracetamol and I told him that I wasn’t. He told me to go away and take the max dosage of paracetamol for the next three weeks and if there was no change to come back.

Obviously he must have had another thought as he examined my foot and then said that I should have a scan done of my foot. I am now waiting for the hospital to contact me so we can select a suitable date.

I have the distinct feeling that my GP does not really believe my symptoms.

[gingernut]

How old are you, and what is your BMI ?

[Loose rivets]

Life has been pretty tough just lately, and recently I had to fight depression to make myself investigate some soap allergies. Finally, I picked up that phone and within a week had seen a psychiatrist and got put to the top of the list at the Royal Brompton for finding out just what the hell it is I'm allergic to. Soap mostly, but it's subtle, but can elevate itself to a blue-light job in just two minutes. The body can be a pain, though it's only been life threatening twice in 20 years.**************Foot:
It doesn't sound gout-like, so I assume there's no uric acid factor. It is easily detected as I expect you'll know by now. *************Many years ago Time magazine ran a front page article on inflammation. It seems the body's immune system can be its worst enemy. I have a close friend who was going to have the bones in his feet fused to take away the pain - one at a time of course, so over a year with very reduced mobility.

As it happened, his (nurse) daughter bought him a copper thing to put in his shoe. He walked miles shortly after, and it transformed his very depressed mind-state. There is a huge probability that there was a psychosomatic factor. I kept uncharacteristically silent about that.

This man had served in a job that made flying seem a yawn. He was way over six foot, and very, very strong. Slowly, other arthritic symptoms started to show. What was incredible was his reluctance to diet. When I said, why don't you just follow my routine and see what happens. I can't touch wheat, and possibly gluten, though I'm not Celiac. If I cheat, I suffer. He said, 'I don't think I could do that'. He so enjoys his meals, and his enviable energy burns up enough to leave him slim-ish, but he's never made a sustained attempt to stop his body attacking itself. When he gave up his beloved sailing, I knew he was in real trouble.

Everything one does to ameliorate symptoms will mask any deep probing into the process of elimination of cause. Easy to say, when one is not hurting.

I once taped up the cold air unit in a BAC 1-11's foot well because of pain. Probably gout, despite only being 30. It went away.

Back to immune reactions. Just prior to having back surgery, I was told of a local man that needed to lie down several times a day. So bad was his back pain that he'd do this in client's houses if necessary. Quite by chance, he was diagnosed as Celiac, and when dieting for that, the back pain went away. My (consultant) back surgeon showed me my MRI and the proximity of the descending colon and my duff disc. He said, If this is inflamed, of course this area of your spine will hurt. It was very tempting to delay the surgery, but I didn't. I did however stop cheating on the wheat/gluten diet, and together, it transformed a rotten few years.

Your body should not be letting you down at your age. It should take one hell of a hammering. Something is wrong; something is causal, though finding it is not easy or there wouldn't be the world-wide battle with arthritic issues.

When I was in my 30's, I took stressing my body to insane levels. However, time over, I'd not even dream of messing up my bones to that degree. I've really suffered in the long term with spinal spurs growing in protest. Moderation, but when the body keeps delivering, it's all too tempting to carry on. Perhaps some issues are a timely warning, but kind of useless if they spoil one's life.

Knees. At 33, I was really working for my black belt - which I failed to get - but the effort of running up hill for a protracted period left one knee feeling 'wrong'. It was, and could be tricky for a month, and then okay for a year. This went on until I was 59, and persuaded a surgeon to take out a bit that obviously moved from time to time and forced the joint apart. Not far, but the knee is a close tolerance joint. I was totally $%^%$ after, and he said I'd been unlucky. The inner 'knuckle's' articular cartilage folded over and more than doubled the thickness. I could get it back again, but not reliably. Whey the surgeon did was to cut the flappy bit off and rough up the bone surface. It was some months before I tried to run again, and really, never could get back to where I'd been. I was touching 60, and training on the ATR with it's huge un-powered rudder. By the most extraordinary chance, I was expressing my concerns about my ability to handle the aircraft during gusty taxiing and engine failures, when a new colleague, said, Oh, don't worry. I had exactly the same op. You'll be fine. And I was. The ATR turned out to be the best medicine.

So, what happens if it's inflamed, and generally roughed up? The idea is that the scar tissue acts as a makeshift cartilage. I have no idea how the surface would react to inflammation after that procedure.
I don't push my luck, but almost every day power-walk a couple of miles and take in two accents of our 73' cliffs. 167 steps. There is an element of bloody-mindedness in my battle against old age. I know that if I want, hip, knees and back to hurt, I eat wheat.

More and more of my friends are reporting allergies. And not just the old ones. A pilot pal has recently added another food, a British mainstay, to his list of NO-NO's

Is it the product, or the bizarre stuff they spray on them these days? Maybe I'll find out at the Royal Brompton. The charming young psychiatrist should have been looking for a psychosomatic link to my reactions, but seemed to enjoy my pilot's tales and extended the visit to and hour and a half. He however told me to reduce my wine by 75% . . . so I guess I'll change my doctor.