The interview subject of the following narrative has granted permission for this content to be shared; the individual has also granted permission for her name to be used.
Lilian, a mother of four, teacher, seamstress, and businesswoman, known for her ability to lead a fast-paced life as she balanced multiple duties such as motherhood and a profession with ease. She was a superhero. As she approached her old age, those labels that encompassed her identity fell apart as her agility diminished resulting from her Osteoarthritis (OA). With this condition, she has grown envious of her youth and somewhat angry at her once youthful self for not cherishing the mundane tasks such as climbing up the steps or performing a set of squats with ease. For Lilian, living with OA has been a journey of self-discovery and acceptance of limitations set by those conditions. The goal of this research, in its entirety, is to discover how osteoarthritis affects livelihood and if it is responsible for depression within patients, specifically Lilian.
To understand Lilian’s condition, it is vital to define Osteoarthritis (OA). Osteoarthritis, the most common form of arthritis, occurs when the cartilage separating the bones within one’s joints wears down; therefore, the bones begin to rub against one another causing pain for an individual. As the bones rub together, degradation of connective tissues occurs between the joints, also destroying the muscles surrounding the bone. The symptoms of OA include pain at the affected joints, stiffness, tenderness, grating sensation when joints are in use and swelling. The pain can get very severe making everyday tasks difficult. Furthermore, studies have indeed proven that those dealing with OA are also likely to develop depression and cases of insomnia (Mayo Clinic 2021).
An average day for Lilian back in Nigeria includes: long miles of walking, carrying groceries from the market and walking back home, and standing for hours on end teaching classes throughout the day. Around the age of 45, the first stage of OA became prevalent. “I noticed back then that my joints would hurt whenever I bent and straightened them to get in my car, climb stairs, or even to pick up objects.” During this stage of Osteoarthritis, bone spurs can occur but are not necessarily large enough to be noticed just yet. (McCray 2020). Over time she noticed that whenever she’d come home from work, which on some days consisted of miles of trekking, she would complain about her aching joints. “Most of the time after work I needed to just sit and rest, but I couldn’t due to my other obligations such as feeding my children and tending to my clients.” As I spoke with Lilian, it was evident that with her busy lifestyle she never took a step back to assess or care for her worsening condition. Like many with her condition, due to the hectic demands of adulthood, fail to take the time to listen to their bodies as deterioration progresses over the years.
Upon coming to the United States, she had a career change, something more time-consuming. She became a nurse. Lilian was still able to keep up with the fast-paced lifestyle she once had in Nigeria. On multiple occasions, she would pick up extra shifts and sometimes work a second job at a nursing home for extra income. At the nursing home, she would perform tasks such as lifting patients and putting them into wheelchairs or leading them to the bathroom repeatedly. Movements such as these performed repetitively can fasten the process of cartilage deterioration. “I always came home with aching joints, but at this point, I just never thought any different of it. It was normal to me now. It was my body. My life was just constantly on the go,” she said as she smiled to alleviate how painful this topic is for her.
As Lilian moved into her 50s, the third stage of OA was finally a raise for concern. “The pain was unbearable on certain days. I’ve even had to call out from work several times because of how much pain I was in.” In stage 3, the aches turn into fleeting pains as the joints are moved. In this stage, there is cartilage loss, and the bones are rubbing against one another. Fluid may build up as well and lead to swelling in the joints. (McCray, 2020). “It was the morning I came home from a nightshift, and the pain I was feeling was not like any other. I came home, and I fought with myself as I attempted to climb up the stairs. I felt weak and I wanted to cry as I realized that I was getting old. As much as it hurt, I had to come to terms with it. There was no more neglecting the issue.” A doctor’s visit confirmed that she had osteoarthritis, and sadly the treatment options sounded a lot less like treatment and a bit more like “deal with it.”
Life after receiving her devastating diagnosis led to depression, “I felt like my life was over. There was no part of living the rest of my life with pain that was appealing,” she said with a shaking voice. The correlation between osteoarthritis and depression is very common due to the physical limitations it places on people’s lives (Chandrasekaran 2021). For Lilian, her depression lay with the fact that her agility and mobility to a certain degree is not what it once was. She received several treatments. A shot of corticosteroids in the knee to help ease the inflammation, heat, and swelling in her joints. The relief usually lasts for weeks to several months meaning that it isn’t a cure, but a means to manage the condition. As her condition began to move into stage four, she complained of intense pain when moving her joints. This was due to the bones and bone spurs grating against one another. The pains were so intense that she felt as if the corticosteroid injections were a joke. “I spoke with my doctor again about other methods to stop this terrible pain, and he said that all he can do for me is prescribe arthroplasty, surgery which I can’t afford to do right now.”
Treatment options for osteoarthritis are mostly not cures, but management methods and momentary pain relief. Treatments include constant medicating with topical pain medicines, exercising, losing weight, physical therapy, which are extremely difficult to do due to constant pain, and lastly surgery. “I have been taking all sorts of pills for the past two years, and I honestly cannot tell if it is helping in any way. There is one that I choose not to take because it makes me sluggish throughout the day.” As Lilian stated her treatment methods, it became evident that all doctors can do is prescribe ways to manage this unstoppable bone degeneration. Lilian believes that surgery was out of the question for her due to how expensive it was. “there are other things I have to do with money currently.”
Additionally, many that are affected by osteoarthritis are women and people of color. Recent studies have proven that pain and functional limitations are more prevalent for African Americans than Caucasians with knee osteoarthritis. More studies are needed to discover why these underlying factors affect some racial or ethnic groups more than others. (Allen, 2010). One could infer that greater pain and functional limitations are most evident with African Americans due to other factors such as inability to consult with a healthcare provider, or even inability to cover expenses for the best treatment option which is surgery. For many like Lilian, money is
Allen, Kelli D. “Racial and Ethnic Disparities in Osteoarthritis Phenotypes.” Current Opinion in
Rheumatology, vol. 22, no. 5, September 2010, pp. 528-532. doi: 10.1097/BOR.0b013e32833b1b6f. Accessed 3 Nov. 2021.
Chandrasekarn, Anita. “Osteoarthritis and Depression.” Verywell Health, Sep. 2021. Verywell
Mayo Clinic. “Osteoarthritis.” Mayo Clinic, June 2021. https://www.mayoclinic.org/diseases-
conditions/osteoarthritis/diagnosis-treatment/drc-20351930?p=1. Accessed 3 Nov. 2021.
McCray, Alexandra. “Stages of Knee Arthritis.” WebMD, Aug. 2020. WebMD,
Ogidi, Lilian. Interview. Conducted by John Ogidi, 14 Nov. 2021.
Google Images, Creative Commons license.