Oh, those aching bones

One advantage of being stuck in perpetual adolescence is that I have avoided getting any older in the past 30 years – I think like a teenager and therefore must still be one. Some nights, however, an evil alien species takes possession of my lower back; when I get up in the morning that lower back does not want to straighten up. I have to walk around for about 15 minutes with my rear end stuck so far out that all I need is tail feathers to look like a duck.

If I had aged a bit in those 30 years I would recognize that low back pain as the likely result of degenerative arthritis (known to physicians as DJD, which sounds like the name of a rap singer but actually stands for Degenerative Joint Disease). DJD is a kind of arthritis that eventually afflicts all of us (except me) to one degree or another as we age. It is the result of wear and tear on joints over the years, and the more we wear and tear, the more DJD we are likely to suffer. That is why so many ex-pro football players in their 50s look like pretzels and walk like tacos (folded over), and why obesity causes DJD in younger patients.

Why write about DJD in the editorial pages of a newspaper. The answer is that the simple disease of DJD is going to painfully demonstrate how a disease that affects many of us individually as we age can affect an entire nation. While there are many diseases associated with aging, few will affect our behavior and appearance more than DJD. Beyond its impact on our individual backs and knees, DJD is going to put a limp in our national gait.

First, it is changing the popular image of what it is to be American. Like it or not, we are no longer the country of youth with the confident stride – we are a nation getting older and a bit gimpy. Watch people walk by you at the mall – the aging of the American population is producing such an epidemic of DJD that a limping gait from arthritis is becoming a national norm. The evening news shows are heavily sponsored by ads for arthritis medications, and “The Coming Epidemic of Arthritis” was the cover story in last week’s Time magazine. That article could not have been written about countries in the Muslim and Asian worlds, where more than half of the inhabitants of many nations are under the age of 25. While it is unclear how our national aging will affect our international relations, what is clear is this; we are a nation of aging baby boomers in a world of restless youths. We are watching our retirement accounts while most of them are watching MTV.

DJD is going to hit us hard enough in the wallet to give us arthritis in our nation’s financial hip. It is cheap to treat only if you are happy to live with pain that can be progressively severe and disabling. That means treating millions of Americans for DJD is going to cost billions of dollars every year, because this is not a nation of people happy to accept their plight. Few of us are going to limp quietly into the sunset when great drugs and other expensive treatments can keep us dancing the Twist.

Take Celebrex, as an example. Americans are spending more than a billion dollars a year on this new arthritis medication, one $2 pill at a time. We could probably save money if we just put the stuff in the national water supply. More billions are being spent on other drugs for DJD pain. In addition, Americans undergo 400,000-plus knee and hip joint replacement procedures each year because of arthritis, at an average cost of more than $10,000 each. That number will increase rapidly as our population and its joints age.

For American business, DJD is a national whack in both shins. Older joints are more easily injured and may need more time to recover when injured.

That affects productivity – whack! Then, whether old joints and backs get injured on the job, or a worker in his late 50s needs his DJD-ravaged knee replaced, business bears the brunt of the health care costs – whack again! The simple DJD pains which have many of us saying “Ouch” each morning will have American business collectively screaming for relief from our pain, relief that business will only get by shifting health care costs back to employees.

DJD looks like a simple disease that affects only the individual, but the reality is profoundly different. The full effects, on us as individuals and as a nation, have yet to be determined. Some of that destiny is in our own, achy hands; if we commit individually to personal health by way of exercise and healthy weight, and nationally to good health care and new treatments, we stand a chance of standing tall well into our old age. If not, the ‘simple’ disease of DJD is going to make our individual and national aging very painful. Ouch, indeed.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.