Help me learn more about osteoarthritis, its treatment and its associated costs.

February 5, 2007 3:04 PM

My fiancée has just been told by her chiropractor that she has osteoarthritis. I have questions about the condition and, more specifically, how we can mimimise the cost of treating it under Australian Medicare.

My fiancée, who is 23 years old, has long complained of back problems. Late last month we finally managed to get ourselves into a financial position where we were able to afford to go see a chiropractor, who did some tests and subsequently had some x-rays ordered. Yesterday, during the follow up consultation, he told her she has osteoarthritis. He's now telling us she needs to see him 4 times a week to fix the problem.

I've done my googling and wikipedia research and already I've learned much about it. But I'd like to know more, perhaps specifically some personal stories of people who have it and how they've coped with it and treated it.

On the money side of things, we're happy to pay whatever needs to be payed, but the problem is that at $45 a pop, this is going to cost some serious money. One estimate we've come up with puts the total cost around $2000. Now as I've said, it's money we know we have to spend (its for her health, after all) but it's still going to hurt us finacially at a time when we just started to talk about the possibility of saving some money.

I've done my research and found out that chiropractors aren't covered by Australia's Medicare system, so that isn't a possibility. But I wonder if there are any other avenues we, as a couple living in Queensland, Australia, can do to perhaps minimise the cost.

And yes, we've looked into private health insurance but with a minimum 2 month waiting period and a limit of what appears to be around $400 per year on chiro work, that dosen't seem to be something worth persuing.

So my questions therefore are as follows;

1) Are there are other ways that osteoarthritis can be treated by the public health system under Medicare, hopefully in a timely manner (we don't want to wait weeks/months/years to get it fixed) and preferably at a relatively small cost?

2) If not, can any Australian MeFites reccommend any ways we can go about minimising the cost of the treatment?

3) Can you please give me any more general advice about osteoarthritis, its treatment and the likelihood of my fiancée being one day cured of the disease (or at least, I understand it is a disease, so correct me if I'm wrong there too)?

It's all early days yet, and I'm still learning about the whole thing as I go along, but any and all advice you might all be able to provide me would be greatly appreciated.

posted by Effigy2000 to health & fitness (28 comments total)

Have you considered seeing a doctor? Specifically, a rheumatologist?

Leaving aside my personal belief that chiropracty is quackery, if anyone diagnoses you with something serious, and recommends an expensive course of treatment, you owe it to yourselves to get a second opinion.

And I hate to break it to you, but osteoarthritis is a chronic, degenerative condition. You can not "get it fixed". You can alleviate the symptoms and try to prevent it getting worse.
posted by i_am_joe's_spleen at 3:16 PM on February 5, 2007

PS: if health insurers in Australia are anything like health insurers in New Zealand, you will not be able to obtain cover for a pre-existing condition. On the other hand, they are unlikely to take a chiropracter's diagnosis seriously, which again points to the importance of obtaining advice from a specialist.
posted by i_am_joe's_spleen at 3:18 PM on February 5, 2007

I'm pretty sure that there's no way to get osteoarthritis "fixed."

She needs to see a real doctor, pronto.
posted by bshort at 3:19 PM on February 5, 2007

Get a second opinion. If the chiro is claiming he can cure osteoarthritis, I'd be suspicious of anything else he says. Go see a GP, and get a referral to a decent orthopaedist and/or rheumatologist.

PS: if health insurers in Australia are anything like health insurers in New Zealand, you will not be able to obtain cover for a pre-existing condition.
On some funds, the waiting period is extended to 12 months for the pre-existing condition.
posted by zamboni at 3:32 PM on February 5, 2007

Osteoarthritis (OA) is a disease common in elderly folks; when I explain it to my patients, I explain that there's no disease-reason for it to happen, the joints have just "worn out" with aging and time.

OA is a term that was invented to describe this syndrome of loss of cartilage after wear and tear, and to distinguish it from inflammatory joint diseases that actually do have a specific cause. For example, in rheumatoid arthritis and lupus, abnormal activity of the immune system causes damage to the joints. OA is by definition not caused by this kind of immune system activity.

Because of the nature of OA, it can't be 'fixed' or 'cured'. Measures can be taken to slow its progress and treat the pain from it.

It's unusual, though not impossible, to have OA at the age of 23. Unusual enough, though, that I'd want a pretty good opinion from an honest-to-gosh MD before I hung my hat on it.
posted by ikkyu2 at 3:40 PM on February 5, 2007

Whoa - to more directly reiterate what others are gently hinting at: chiro is a sham. Go to a real doctor.
posted by M.C. Lo-Carb! at 3:40 PM on February 5, 2007

I'd asking to see that well framed Nobel Prize in Medicine certificate and then running, or limping off, for a real doctor like that knows about science and stuff, sheesh.
posted by Freedomboy at 3:41 PM on February 5, 2007

See a doctor. Leaving aside the issue of whether a chriopractor can treat other issues, he or she certainly CANNOT treat osteoarthritis. Seriously, osteoarthritis is no laughing matter and you owe it to your fiancee to see that she gets an actual medical evaluation.
posted by Justinian at 3:41 PM on February 5, 2007

Just to add to what's already been said, in the UK it is illegal to claim to be able to cure arthritis - that's how unlikely the chiropractor's claims are... Best of luck to you both.
posted by prentiz at 3:49 PM on February 5, 2007

I should specify that the chiro never said he could cure it. The third question where I ask if it can be cured is simply me asking if it could be. However where I said earlier that he could fix it, I should have been clearer in what he and I meant. While my fiancée never got it spelt out for her, she believes he meant that he could stop the back pain from being an issue. I'm fairly certain he didn't meant to say he could cure the arthritis.

That said, it has been something of an eye-opener to learn most people here think chiropracty is a sham. While I have always known that it wasn't exactly 'mainstream', I had always believed that it was considered to be a legitimate form of treatment for something like the back pain from which she suffers.

At any rate, we've taken your advice on board. She has an appointment with the chiro tomorrow where she'll get her x-rays from him. Then a few hours after that she's seeing a doctor to get a second opinion.

We both appreciate the advice so far. But just in case the doctor confirms that she has OA, I'd still aprreciate advice from you all on at least the first two questions.
posted by Effigy2000 at 3:56 PM on February 5, 2007

What they all said. Osteoarthritis can't be "fixed", so if your fiancee's chiropractor says she "needs to see him 4 times a week" at $45 a pop "to fix the problem", some skepticism may be in order. And a visit to an actual doctor.

My stepmother has had osteoarthritis for many years, and has undergone various procedures to help her deal with it, including arthroscopy on both knees and both shoulders (to trim damaged cartilage). Ultimately, she's had both hips and both shoulders replaced at various times. It's been really difficult for her, and her mobility has been badly affected. (She is bionic, though, which is sort of cool.)

The only good part of all that is: I'm pretty sure all the procedures and surgery were free on Medicare (they live in Perth).

On preview: I'm so glad to hear that she's going to a doctor. That's a great first step. I'm also glad to hear that the chiropractor didn't claim to be able to perform miracles.
posted by hot soup girl at 4:08 PM on February 5, 2007

People were mostly reacting to the suggestion that the chiropractor could cure osteoarthritis, I think. There are different schools of chiropractic, and they have different claims as to what chiro can accomplish. Studying the efficacy of chiro vs conventional medicine is hard, but there are studies that suggest that manipulation plays a role in pain management. I think your main decision criterion should be that Medicare will mostly cover the GP/specialist route, and it won't cover the chiropractic.

On the bright side, a quick squizz at PubMed shows that conventional medicine is doing some interesting stuff with tissue engineering and injections these days, but they're mostly in the trial phase (rat testing). Maybe in a couple of years?
posted by zamboni at 4:45 PM on February 5, 2007

It is good to hear that you are visiting an actual doctor. Since you seem to be into alternative treatments you may want to look into your diet in addition to whatever your doctor recommends.
posted by davar at 4:51 PM on February 5, 2007

Effigy2000, I think that some of the theoretical grounding of chiropractic is questionable, and some of the high velocity neck manipulations are known to me to be dangerous in certain patients; but I would stop well short of dismissing the entire practice of chiropractic as a sham.

It's been my experience to have treated many patients who explained to me the real benefits they got from their chiropractors, and that makes me think that there must be something to it. My suspicion is that, like in any field, there are good practitioners and bad ones, and that the good ones can probably find a way to help their patients within the framework of their training. I'm quite certain that this is true in mainstream medicine, for what that's worth.
posted by ikkyu2 at 4:52 PM on February 5, 2007

Oh, by the way, I wasn't implying that your fiancee was headed down the same route as my stepmother in terms of serious joint replacement surgery, etc (I was just using her as a reference point in terms of Medicare costs). Hope I didn't spook you, Effigy2000. Good luck to you both.
posted by hot soup girl at 5:22 PM on February 5, 2007

I had "arthritic changes" in my spine in my mid 20s per MRI and xrays too. According to my doctor that isn't unusual in athletes in my sport(s). However he also told me that my chronic back pain was far, far, more likely related to muscle weaknesses and generally being a tall skinny person with suboptimal connective tissue. He told me I could do my choice of Pilates, yoga or PT but to do it faithfully every day, follow his anti inflammatory and icing regime and and to come back in 4 months if it still hurt. It didn't. I do get the occasional deep tissue massage done if I feel a twinge coming on.

I did see a chiroprator for about a year when I was younger after a bad fall. He did a great job of resolving the shronic muscle spasms and pinched nerves but never claimed to be able to do anything with arthritis, including his own (ex pro athlete). My totally non professional opinion is to be wary and to go to a good sports doc, preferably one who is/was an athlete themselves.
posted by fshgrl at 5:31 PM on February 5, 2007

Jesus Christ. Get an opinion from someone with less of an ulterior motive. A 23 y/o with osteoarthritis is an oxymoron. A chiropracter who is a dumbass, not so much. The worst things I see coming out of chiros is not injury as much as a patient being fed the notion that their pain is a result of some intrinsic spinal defect, which they then internalize into a self-image of "I'm broken". Scientific American and the Mayo Clinic both hold periodic forums on the origins of back pain and it's treatment. The reality is most pain cannot be isolated to a specific tissue anomaly, and the presence of actual finding on xray or MRI rarely correlates with the source of the pain. The other Universal is that anyone with chronic back pain has got to become used to more activity.

Get the hell away from whoever you are currently seeing and choose someone, anyone, else.
posted by docpops at 7:01 PM on February 5, 2007

Umpteenth-ing the be-aware-of-the-chiro-quack, with a helping of but-some-of-them-are-good. My (Brisbane) chiro* never told me I had arthritis, and was key in helping me get my spine back into some sort of order (years of cello-playing and various sports had taken their toll).

That being said, it seems that by itself chiro will not 'fix' anything -- without the addition of some sort of muscle-conditioning, you'll be visiting that chiro once a month or so for the rest of your life*. I've heard good things about osteopaths, who seem to combine the muscle-centric physio stuff, with the bone-cracking chiro stuff, to good effect.


*Email in profile if you want a recommendation
**The visits typically taper down from the 4 /week to something more reasonable and sustainable, as the muscles become 'trained' to the correct spinal alignment. Or something.
posted by coriolisdave at 7:05 PM on February 5, 2007

See a doctor, see a doctor, see a doctor. I have friends who have problems, and see chiropractors. The back massage and flexing makes them feel better for a few days, but I have asked `how long until it's fixed?' and been told `oh, it can't be, I have to keep going back indefinitely'.

Uh huh.

Homer: Less yackin,' more crackin.'

Dr. Steve: We don't actually crack backs. It's merely an adjustment...OK, you're going to hear a loud cracking sound.

Homer: Hey, it feels a little better.

Dr. Steve: I thought it might. Now I need to see you three times a week for ...many years.
posted by tomble at 7:34 PM on February 5, 2007

+1 quackery

FUCK chiropraxis
posted by unSane at 9:13 PM on February 5, 2007

I'm an Australian - currently there is a lot of competition amongst the Private Health cover providers - HCF and HBA are currently offering extras cover (which will cover some of the costs of Osteopaths, Physio, etc) with no waiting period. If you choose to go down this path - get completely reassessed by a GP, after you take out the cover.

Medicare doesn't cover physiotherapy, chiropractors, etc.

However, you may have a claim under Work Cover - if the condition can be related to your girlfriend's job.

I think surrendering yourselves to the public system is probably your best bet - ask your GP about options there (there will be some range of services that you'll be able to access through the public system) - however, take out a cover note (it doesn't cost anything) with a private insurer FIRST - just so you hedge your bets and have options once a proper diagnosis is undertaken.

Get her into Yoga or Pilates in the meantime.
posted by strawberryviagra at 11:02 PM on February 5, 2007

My very recent askme question seems relevant here.
posted by handee at 2:15 AM on February 6, 2007

chiropractors are terrible and are only on the medical board (or whatever it's called) because of a discrimination law. not saying he doesn't have osteoporosis, but see a proper doctor about any thing medical, not a chiropractor.

chiropractor theory is flawed for starters and they are no where near trained as well as a doctor.

see http://skepdic.com/chiro.html for more info.

in short chiropractors are frauds, see a doctor.
posted by randomizer at 7:34 AM on February 6, 2007

also i'd be very surprised if he has osteoporosis because he's young and male. it's much more uncommon for males to develop osteoporosis.
posted by randomizer at 7:37 AM on February 6, 2007

oopas osteoarthititis, im stupidda[pdsia

house falling down bye
posted by randomizer at 7:41 AM on February 6, 2007

My girlfriend saw an actual doctor this morning who looked at her x-rays and confirmed that she has OA.

She's referred her to an exercise physiotherapist and has said that if she feels that the chiro is doing her some good (she does) then she should keep going to that too.
posted by Effigy2000 at 8:00 PM on February 6, 2007

Good luck ... hope it all works out for you both.
posted by strawberryviagra at 9:25 PM on February 6, 2007

OK, I already posted this in the legal thread concerning worker's compensation for the gf - but I figured I'd drop a duplicate in here as well since somebody may be searching these threads later and might need the info.

-------------
Please do get a second doctor's opinion. People get second opinions all the time for important medical conditions, and this is important. I know you don't have a lot of money, but this is really worth it. If it is RA, then early treatment is crucial.

Info about the differences between RA and OA here and here.

Assuming it is OA, consider glucosamine and chondroitin. It's been studied and does seem to relieve symptoms, build up the cartilage in the joints, and prevent worsening symptoms.

Here are some products. Basically what you want is 500 mg of glucosamine 3 times a day (for 1500 mg/day) plus 400 mg of chondroitin 3 times/day (for 1200 mg/day). Those are the doses that were studied.

Also, weight loss is shockingly effective in keeping the symptoms from worsening. Losing 1 kg cuts your risk of developing further OA in your knees by something like 50%. You don't even have to be really overweight for weight loss to make a difference.
posted by selfmedicating at 1:59 PM on May 21, 2007