Side Project Podcast 10: Pain with Naureen Alim

Ruthie Miller (00:13.446)

Our topic today is something a little bit interesting. We’re talking about pain. And the reason we’re talking about pain is that Leyla and I’ve had two very different journeys with pain. And we’re not just talking about pain like, ouch I stubbed my toe. We’re talking about chronic pain, physical pain, debilitating pain. So Leyla, why don’t you tell us about your experience a little bit?

Leyla Seka (00:39.448)

Yep. So, about six years ago, my hips started hurting and I went to the doctor and they said, you have arthritis in your hip and, you’re way too young for a hip replacement. So suck it up and do PT and lose weight and all these things. So for like six years, I’ve been sucking it up. And last year it got real bad. It got super acute. I was on a cane for six months. I couldn’t really sleep. 

Ruthie Miller (01:08.634)

And you’re 50 years old, right? You’re not… 

Leyla Seka (01:10.318)

I’m 50 years old, yeah. I mean, I’m not like a spring chicken, but I’m not grandma, you know. I’m not 75. But here’s the thing, lots of 50 year olds have hip replacements, lots of 40 year olds have hip replacements. There’s this story that hip replacements are for your grandma. Well, I’m your grandma then because I have fucking hip replacement. But just the general, I mean, I think the thing for me was I had never been in pain like that and I’d hurt my knee. I’ve had surgeries, like I’ve been hurt before, but I had never been in pain that started to change my personality and change the way I felt about living and like, cause it hurt all the time. And I was talking to you that whole time, Ruthie, and you and I were chatting earlier. Tell us a little bit about your experience. Like you were listening to me and then what happened to you?

Ruthie Miller (01:57.144)

Yeah. So my pain experience was totally different from Leyla’s. I have heard her for years talk about how much pain she was in and it was like, wow, Leyla is really in a lot of pain, but I couldn’t really empathize with her because I had never been through something like that myself. Now rewind to last fall when I started going through debilitating pain, and I couldn’t, I couldn’t do anything. It was hard to dress myself. Some days I couldn’t get out of bed. It hurt to lift a cup of coffee. It hurt to pull a hanger off the shelf. I didn’t feel safe driving because it hurt to turn the steering wheel. And I was eventually diagnosed with an autoimmune disease. So I’m working on it now. But I similarly had some very dark days when you’re dealing with pain and you just don’t know if there’s an end in sight. So well, to that end, I’m excited because today we have with us Dr. Noreen Alim, who is a rheumatologist and immunologist here in Houston, Texas. Thank you so much, Dr. Alim, for joining us.

Naureen Alim (03:03.52)

Thank you for having me, I’m excited.

Leyla Seka (03:06.414)

Listen, pain is a big topic, right? Because pain happens to everyone in all different kinds of ways and people react to pain differently, some better than others. But I think generally we can all say that as we move into midlife, pain seems to be more of a rider than she was, say, in our 20s. And why? OK, body’s getting older, things are breaking down. But like, why do things ache?

and get creaky and like why does my knee like snap crackle and pop every time I kick in the swimming pool and like what why

Naureen Alim (03:43.591)

So yeah, so that’s the more common type of arthritis. And I always try to explain to patients, there’s many different types of arthritis, but the one that you’re talking about is the most common, that’s osteoarthritis. And what’s happening is that that cushion, that cartilage that is sort of in between the joint space is sort of wearing down, most likely as a result of age and normal degradation, but then that ongoing friction basically leads to pain, stiffness, and swelling. And that could be, like you said, due to age, but also genetics. You may be predisposed in certain families, obesity, wear and tear. You mentioned, you know, some people are getting hip replacements earlier. Well, that may be because they were engaged in activities that just put a lot of stress on that particular joint. So even though they were younger. And one of the things that I think, because your podcast is sort of focused on middle-aged women, people in general tend to lose muscle mass as we get older, right? And so now you’ve lost that stability around the joint. Again, another source of stress on that joint. And then because of the way, and that’s the main sort of arthritis, 

But the type that Ruthie shared is a little bit more autoimmune inflammatory. And again, you have a joint and that’s less common, but you have a joint that’s now compromised as a result of inflammation. And again, you know, it’s going to be more susceptible to that degradation and wear and tear as well, just like if you had an injury to a certain area. So that’s it. And just a little fun fact is that, you know, we’re not in this alone because there was a, there was a study maybe like a decade ago where they looked at the number one, like the top reasons why someone would go to their healthcare provider for an office visit and the top three are sort of number one is skin, number two is just musculoskeletal joints, and number three is back pain. So, you know, so it’s common.

Ruthie Miller (05:30.202)

That’s like the stereotypical thing: you throw your back out when you’re middle-aged, when you hit old-age. It’s just so, it’s like, you turn 45 and it’s like, I threw my back out. I mean, it’s just, it’s all downhill. It’s pretty crazy.

Leyla Seka (05:45.23)

So, I mean, with pain being so prevalent, right? And as you said, I think everyone I know has some kind of arthritis sprinkled in somewhere at this point, right? My sister had a knee replacement, my mom had two hips, so it’s genetic, and all that kind of stuff. But the pain component, right? Because often the doctor will be like, take some Advil, take some Tylenol. You know, I get it. So I took Tylenol PM every night for two and a half years. Because I was like, okay, yeah, it hurts and I’m tired. And so, and then only in like the last, I don’t know, six months with someone like, yeah, maybe don’t do that, Leyla.

Ruthie Miller (06:26.586)

Yeah, let’s talk about that for a second. Why is that? Can you take over-the-counter pain medicine, you know, ad nauseum? I feel like that’s bad. I mean, we should not be taking pain medicine every day.

Naureen Alim (06:40.522)

I agree, I do agree. I don’t think people should take pain medicine all the time. I think it’s helpful if you, like you said, you mowed the yard or you were in the gym, you felt something, you’re gonna take it easy, take something over the counter for a few days, that’s fine. But if it’s ongoing, severe, it’s the worst thing you’ve ever felt, or you’re just finding, like you said, Leyla, that you’re just taking this all the time.

And why? Because it’s affecting your functionality, it’s affecting your quality of life, then maybe we need to investigate or at least find some alternatives. Because again, not everything is perfectly safe long term.

Ruthie Miller (07:17.294)

But what happens? Is it like your liver? Doesn’t it affect your liver?

Naureen Alim (07:20.774)

Yeah, so let me talk about the safety sort of thing first, because one of the sort of misconceptions that I deal with all the time is people think if it’s over the counter, it’s safe. But then let’s talk about non-steroidal anti-inflammatory. So that’s going to be your ibuprofen or naproxen, the other names for it, like Advil Aleve Motrin. And people are like, it’s over the counter. So they’re taking it instead of maybe discussing things with their doctor. But guess what? Long-term use of those can actually damage your kidneys. It can raise your blood pressure. So now you’re dealing with a cardiovascular issue. And then it can irritate your stomach lining. So then that leads to ulcers and GI bleeds. So that’s pretty significant. As physicians, a lot of us have seen sort of the effects of people just sort of, even young people just popping this stuff and then, you know, ending up with a bad outcome. Tylenol is a little bit safer in my books, but again, a lot of times people say it doesn’t work. That’s one thing, but even if it does, if you’re using it chronically and at higher doses than recommended, then you might end up with liver issues. There’s just organ involvement there, even though they’re over the counter.

Ruthie Miller (08:22.842)

So you’ve really got to get to the root cause then of the pain. So that’s how you know when you need to see a doctor is if it’s like debilitating or if you’ve been on over-the-counter medication too long, it’s like, okay, buddy, come on.

Naureen Alim (08:28.093)

Exactly. If it’s severe, it’s debilitating, it’s affecting the quality of your life, it’s different from anything you’ve experienced. And then I would mention again, because you brought up the autoimmune issue, and this is not going to be as common, but you know, if you have red flags because there are many other causes of pain, right? So if you have fever or rashes or weight loss, that might be something else going on. Or a common one is, you know, my back hurts or my neck hurts, but now my arm’s going to sleep or my leg’s going to sleep or I have numbness and tingling. Now you may be dealing with a pinched nerve and how serious that is needs to be investigated. So there’s lots of little nuances there that, you know, you want to think about when you’re talking about pain.

Leyla Seka (09:13.326)

Sometimes with the pain, Naureen, you can’t figure out what’s wrong. I mean, my hip hurt and they did a thing and they’re like, yeah, you have terrible arthritis and it’s gonna get worse, suck it up. But with Ruthie’s, there was a period of time with Ruthie where she was like, I don’t know what’s wrong, Leyla. We talked to each other all the time and she’d be like, feel terrible. So in those situations where you’re trying to discover what’s going on, but you’re still in terrible pain…

Wait, I realize you can’t give medical advice and no one’s gonna like do anything. Don’t do anything! We’re just having a chat. Talk to your normal doctor. All caveats aside, all disclaimers. I mean, I guess it’s a little hard to know what to do, right? Because it hurts. And I’m stuck and I can’t think, like with my doctor, was like, I won’t fix it. You’re too young. And I was like, come on. Like I’d go on family vacations and I’d have to stay in the hotel while everyone went walking around because it hurt too much to walk. I don’t know how to think through that kind of pain when the medical profession doesn’t necessarily have the answer you need right then. 

Naureen Alim (10:27.84)

Well, I would say that, you know, okay, it sounds like you maybe ended up with a specialist who specifically, you know, made the diagnosis and said, hey, I’m not going to do anything at this point because of your age or whatever reason. So there’s that group of patients who are undiagnosed. And we sort of talked about those red flags where they may need to go and see somebody seek medical attention, whether that’s with their primary care doctor or orthopedics or rheumatology or whatever. So that’s one group. And then you are sort of in this group where you know what’s going on.

But maybe you’re not a candidate for the definitive treatment. But then there’s other things exactly like you said, and in terms of medications. So there may be, we talked about the over-the-counter stuff, the anti-inflammatories and Tylenol. But then, for example, in my practice, we may use things that, and I’m not even talking about narcotic pain medications, right? Because those, again, they’re difficult, they’re prescribed by a certain group of physicians and they’re habit forming. But even before that, there are certain strategies we can use, medications included. there’s Cymbalta, for example, is an antidepressant, but it’s been shown to work for chronic pain. So muscular skeletal pain, back pain. So again, sort of in the appropriate patient, you might use something like that, or there’s a variety of nerve pain medicines, which you can use for the sort of sciatica type pain. And even in arthritis, I’ll use it sometimes because again, I’m thinking, well, if someone needs pain medication long-term, what can I use that might be a little bit safer than Tylenol or Advil Aleve? 

Again, that decision sort of depends on the specific patient, but those are things that are worth discussing. And then for you, we’ll just use you as a specific example, right? Physical therapy, that’s a great option, right? You can get injections into the joint. And then there’s, I know we’re gonna do natural things, but just let’s just think. 

Leyla Seka (12:15.032)

Does that work? Did that injection in the joint thing work? I mean, it just feels like a big needle. Does it work? I didn’t do it. I was scared of it. I’m not gonna lie. 

Naureen Alim (12:22.3)

The injections? It’s worth a try is what I say, right? Everything’s worth a try at least once because you always hear the horror stories, right, for people for whom it didn’t work. But for all of that, there’s plenty of people who do really well and it serves as a bridge for you till maybe your doctor determines that you’re appropriate for the replacement.

Ruthie Miller (12:41.402)

So on that note, let’s talk about some of the more proactive things that you can do. You know, think Leyla and I have very specific instances of acute pain, but a lot of people have sort of long-term joint pain. So what about things like supplements? You know, now I’ve been doing collagen and creatine to try to build muscle mass and loosen up my joints a little. Do these things work? Omega-3s, fish oil, all those things that you read about.

Naureen Alim (13:09.298)

So in talking about supplements, you know, and I think you guys had like a weight loss doctor on and, you know, supplements are tricky, right? Cause they’re not FDA approved, they’re not regulated. So you don’t know what you’re getting from company to company and from batch to batch. So there’s it. So for, for the medical community, it’s very difficult to do studies and give you an evidence-based answer as to whether or not something will work.

That being said, sort of I look at the flip side. I say, you know, if it’s safe, why not? So as long as it’s safe, it’s not interacting with anything that you’re doing, I’m a proponent of trying something maybe once. Because again, these things aren’t cheap either.

So you might want to try one at a time and see what benefit you get. And I don’t know if you’d like me to give you some specific examples. It’s not like you mentioned several, Ruthie, but one of the things I’ll recommend is turmeric, which is essentially the active ingredient is curcumin. It’s a spice. It’s a natural substance. They formulate it with black pepper. It improves the absorption.

And it works, which is a really great natural anti-inflammatory. But again, some people may experience GI side effects with the medication. And then I have to look at the patient’s medication list too, because I’m saying, OK, if you’re on a blood thinner for your heart or something like that, I’m not going to prescribe this or I’m not going to recommend this because it can actually thin your blood further. So that’s an example of something that works really well but might not be appropriate for everybody. And you mentioned collagen. Again, same sort of thing.

Limited data, but it suggests that it may be because it’s sort of like, you know, trying to replace that cushion. So collagen, fish oil, all of these things have either been shown to help with arthritis pain or reduction of inflammation. Another one is glucosamine chondroitin. You may have heard of that, you know, like osteobiflex is a common brand that people talk about.

Naureen Alim (15:00.478)

But essentially, again, it’s the same thing. And they’ve looked at it in various studies for knee pain and da, da, da. And it’s like, it doesn’t work. But it is so safe and so free of side effects that I think it’s worth trying. Because I think everybody wants to see if there’s something out there that’s not a medication. So I think it’s fair.

Leyla Seka (15:18.094)

What about like topical things like, you know, icy hot and bio therm and they, every, I think I have every brand possible in my bottom drawer. Cause I tried every single thing.

Naureen Alim (15:29.746)

Yes, Arnacare, capsaicin, you name it, rubbing a little spice on your leg. It’s the same thing. Again, no data, but they’re all safe. And so it’s definitely worth trying. And since we’re talking about topicals, we can even foray into non-medication things, Like massage and physical therapy I mentioned, even acupuncture. Not great data out there, but there’s no harm in trying to see if it alleviates your symptoms.

Ruthie Miller (16:00.248)

It is funny as we’ve been going through this whole thing and we ask everybody about supplements just because who doesn’t want to just take a pill and suddenly be better, and a pill that’s not even medicine. But my sister-in-law texted and she said, I feel a little like a science experiment these days. Cause it’s like, take this, take this, take this. It’s like, I’ve got my 20 supplements that I’m taking every morning now. It can be a little disconcerting.

Naureen Alim (16:23.653)

Exactly, and there’s a pill burden associated with that, right? Like you’re trying to do all of these things to sort of quote unquote help yourself. You don’t have great data and then you’re taking a handful of pills, which you know, what are they doing? Like how do you know, how does that make you feel to take all of that medication? So yeah, I try to simplify things for people and it’s totally up to the patient, right? Like because we don’t know how beneficial this is, if you’re motivated, you’re more likely to go through that trial and error process.

Ruthie Miller (16:51.406)

Yeah, I’ve paired way back. Like I was taking all the supplements and now really kind of taking none because it’s like, who knows? I mean, and who knows if they’re working or not? So if I’m taking 20, then how can you tell which one is actually working?

Naureen Alim (17:02.842)

Exactly. I would do one at a time. Definitely.

Leyla Seka (17:05.509)

It does seem like inflammation is our new enemy. Inflammation and trying to eat as much protein as a full cow daily, which is outside of my forte. I like a hamburger. No way I can eat that many hamburgers. Ruthie and I were chatting about this earlier, like, are there foods that are anti-inflammatory? Like, you know, what should we be doing to deflame?

Ruthie Miller (17:34.148)

Yes. I would like to know how I can deflame my body. Yes.

Naureen Alim (17:34.592)

That’s a new word. Okay, we’re going to de-flame.

Leyla Seka (17:39.54)

I’d like to deflame my body a little bit. How do I do that?

Naureen Alim (17:41.887)

So that’s a question I get asked a lot. And it’s a little tricky because there is a lot of information out there. There’s a lot of diets out there. And it’s sort of akin to the supplement conversation, right? Not a ton of data. And it’s just hard to do studies on diet or food specifically. I would answer this the way I would sort of explain it to my patients. So of all the things that are out there, if they’re really motivated, if the person in front of me is really trying, and I think that’s a great idea because, you I think taking a holistic approach to your health is very important, it’s very empowering.

but I also don’t like to be too restrictive. So I’ll normally suggest, hey, why don’t you start with gluten and like refined carbohydrates and refined sugars. So natural stuff is okay, but try to avoid the gluten and sugar as much as you can, because in terms of just the sort of whatever little evidence we have, that seems to be the most implicated in terms of inflammation.

And then depending on the patient, if they’re super motivated, they may go and then experiment with, you know, there’s lists out there, right? So they may experiment with dairy, red meat, nightshade vegetables. So that’s going to be like your eggplant and tomatoes and things like that. And they may come back and give me some feedback on how they did. But it’s hard for me to really tell them to not eat all of these things because I think that’s just really hard to do. And also even with things like the Whole30 or an autoimmune protocol, all that stuff that’s out there.

I do believe that when you do it, because it’s essentially healthy living, that people feel better. But it’s very difficult to sustain long-term. And you’re talking about, we’re talking about middle-aged women specifically, like that’s your target audience. And so think about it, you’ve got your kids, you’re taking care of your parents, and you’ve got meals to put out, and now all of a sudden you’re being extremely restrictive there and thinking about different people’s dietary needs. So we have to be a little bit practical and try to do these things in conjunction with Western medicine. But I definitely, I do encourage patients who are motivated to do that.

Ruthie Miller (19:49.434)

I definitely did that. I was very motivated. I couldn’t get out of bed. And it’s like, either you try changing your diet or you stay in bed for the rest of your life. And so now I call myself vegan plus salmon. And my whole life, I would say I could never be vegan because I can’t give up eggs. Well, when you’re in debilitating pain, it’s like, fine, I’ll give up eggs, I’ll give up cheese, I’ll give up whatever you want me to. And it’s definitely helped a lot. I think dairy is a big trigger for me. Gluten is tough, but I try.

Naureen Alim (20:12.884)

Yeah. See, and so you’ve kind of figured exactly. And you may have found that maybe gluten wasn’t. So it’s different for different people as well. So I think that’s a great point is trying to figure out what it is for you. And some people have this really dramatic response like you did, Ruthie, and some people just don’t. Or they think they don’t, they stop, they reintroduce the food, and that’s when they realize, oh, wait a minute, I was actually feeling much, much better when I wasn’t. So there is a little trial and error there as well, definitely.

Ruthie Miller (20:43.79)

Yeah, I was very strict about it for about six weeks and it was tough, but honestly, I’ve never felt better. So that, I mean, that’s a good motivator. It’s when you actually feel good and you feel healthy. It’s like, okay, there’s something to this.

Naureen Alim (20:57.033)

It’s worth it.

Leyla Seka (20:57.174)

You’re feeling more normal, right? I mean, you’re like almost normal, right?

Ruthie Miller (20:59.962)

I do, I do. I mean, I am also taking medication and I think the two things together have really helped.

Leyla Seka (21:07.512)

Yeah, absolutely. And I had a hip replacement and now I’m happy. Because I wasn’t. I will honestly say, even my friends were like, Leyla, your mood is changing. Because I was in pain all the time. Even things I love, like my kids or having things that I enjoy doing, just I didn’t really enjoy them as much because it hurt all the time. 

Naureen Alim (21:33.874)

And that goes back to like, that’s a reason to go see your doctor, right? If it’s affecting your mood and your mental health, that goes on the list of reasons to go talk to somebody.

Leyla Seka (21:37.173)

Right. Yeah, absolutely, absolutely. I was talking to him, it’s just nothing was happening. 

Ruthie Miller (21:52.0)

It’s hard because you’re kind of going through this by yourself even if you’re talking to the doctor because even when you say I’m in a lot of pain I mean I couldn’t explain it to people how much pain I was actually in and you don’t want to be that Debbie Downer who’s like, “Look Ruthie’s always in pain,” you know, so it’s very it’s very isolating and it’s very hard.

Leyla Seka (22:11.79)

Well, and we grew up with it. And we grew up in the Suck It Up Generation. Suck it up, suck it It hurts, suck it up. You don’t like your job? Suck it up. Just, suck it up.

Naureen Alim (22:17.193)

Yes. And that’s true of women too, right? Like you’re busy, you’ve got a lot of things. And actually that’s another point that you just made me realize is that it’s not just suck it up. It’s sometimes you just don’t have the time because you’re caught up with so many things that you put yourself last. And that often then actually escalates the issue. So I think that, you know, we have to be cognizant of all of these things that you just mentioned.

Ruthie Miller (22:47.502)

Yeah, 100%.

Leyla Seka (22:49.518)

So as we’re, mean, midlife, arthritis is coming for people. I mean, I’m already there, right? But arthritis is knocking on the door for most of my friends and all of us, like, and that’s your specialty. That’s like what you do, right? So like, with that kind of where we are, like, what would you give a healthy person who doesn’t really think they have arthritis, but is moving into that age bracket where it’s coming? Like, what are like your three pieces of advice, right? Like, here are the three things. If you want to try to keep your joints healthy and try to minimize the arthritis impact of what is coming with inevitable aging of the body. Like, what are your three magic tips? Like, here are the three things you gotta do.

Naureen Alim (23:32.352)

So it’s not supplements. No, think like this is so, because I take care of autoimmune diseases as well, I don’t just take care of patients who are older and sort of dealing with just osteoarthritis. I have a lot of young patients who have autoimmune disease in their 30s. And the things I say to them, I think is applicable not just to the sort of autoimmune inflammatory arthritis, but to osteoarthritis as well, which is, hey, basically it all summarizes into being healthy overall. 

So in terms of foods, you don’t have to be too restrictive, try to be whole, natural and organic if you can, as much as possible, try to use the 80-20 rule there. And then two and three are kind of similar. I really encourage patients to walk because that’s a form of, and essentially for exercise. So I encourage exercise, I always at least say walking because that applies to any age group, it’s sustainable, it’s not super injury prone. You can do it anywhere in the world. You don’t have to have access to a gym, right? So that’s one thing. 

And then for my young females, especially, I do definitely say start the weight training now. Start picking up those weights. That is super, super important. Those days of just sort of being cardio-cardio all the time are gone.

You know, there is a shift for all of us women to really incorporate muscle and strength training. Because again, so many benefits as I’m sure you guys have heard from other people along the way, but from my perspective, it’s joint protection, it’s stability, it’s improving your movement, keeping you active for you to be able to do things and increase your longevity.

Ruthie Miller (25:13.658)

That’s great. I’ve lost so much of my muscle mass. I mean, I need to start working on that again ASAP. I couldn’t even lift my bag into the overhead bin last time I flew on an airplane. And that’s an issue.

Naureen Alim (25:23.294)

Yes, exactly.

Leyla Seka (25:24.942)

Okay, got something. I got something I’d started, and this is a little off topic, but I’m just gonna bring it up. I found this gym and it’s called High Intensity Training, and you only go for half an hour a week. I mean, I just want everyone to realize, they don’t let you come more than half an hour a week, and you work out with the trainer and you do like five reps as slow as possible. And I gotta tell you, I’m in the best shape of my life. And half an hour a week, like I hate the gym. I hate it. I hate being around other people working out. I don’t like working out. I sweat all the time. I got no interest in it. But half an hour a week and I’ve seen a difference. So this new high intensity weight training thing, I’m very excited about this. This is my new thing I’m into.

Naureen Alim (26:12.0)

Yes, it has to be something you enjoy as well and something you’ll keep up with. So that’s a plus.

Leyla Seka (26:17.132)

Right. And half an hour a week?

Ruthie Miller (26:20.154)

Sort of a more basic question, which I should have asked earlier, but can you just at a basic level, what’s the difference between osteoarthritis and rheumatoid arthritis? I mean, I know they’re very different, but like what’s the root difference there?

Naureen Alim (26:35.92)

You know, Ruthie, I just made a Reel on this actually. Yeah, it’s just ironic that you asked me this question. It’s all fresh in my head. So osteoarthritis is what we just kind of have been talking about in general, right? With aging and wear and tear of the joint. And we don’t fully understand the mechanisms. Rheumatoid arthritis is going to be sort of more your autoimmune inflammatory. You know, this isn’t the best way to explain it, but I think the simplest way is that there’s something in your immune system that’s dysregulated and that’s quote unquote attacking your joints and causing that inflammation and joint damage and joint pain and so on. So the features are different as well.

So when someone comes into my office and I’m interviewing them for the first time, I’m also trying to figure out, you know, what is it that they have? Do they have normal 50 year old hip arthritis or is this something like autoimmune systemic inflammatory? So kind of just, again, using the two of you as examples, but you know, osteoarthritis, it’s gonna be pain that gets worse with activity. Pain that’s kind of more towards the end of the day after you’ve been up and about using that joint, for example. If you do have stiffness, stiffness is normal, sort of that gelling phenomenon where you sort of get up and you’re creaky and you got to move around a few steps before you get better. That’s what we call stiffness. And that may last up to 30 minutes is usually normal. Generally it’s going to be around 15 minutes. And you can have joint swelling.

Less common now on the rheumatoid arthritis side. It’s gonna be predominantly small joints multiple joints lots of stiffness, especially in the morning. So like maybe 30 minutes to an hour to get going. You’ll have sort of that red hot swollen kind of joint feeling and then there may be other features like that’s what I had mentioned in the beginning, like you may have low grade fever rashes or other things that suggest it’s more than just your hip or your knee. It’s something more systemic.

Ruthie Miller (28:23.502)

It’s a little bit of a bummer that it’s the same name because they’re very different.

Naureen Alim (28:27.666)

Yes, the arthritis component. Yes, exactly. And everybody would just, and most people say, use the word arthritis. And then we’re left to sort of figure out, what is it? Is it rheumatoid arthritis or osteoarthritis? And there’s a whole host of autoimmune diseases that I treat. You know, gout. Gout is another form of arthritis. And then some people have heard of Lupus, right? And that’s an autoimmune disease and that has arthritis as a component. So you’re absolutely right. The terminology is sometimes difficult for someone who’s not in the medical field.

Leyla Seka (28:59.438)

Yeah, it’s hard. This is hard. Like, I don’t like this part so much. Like, all these parts of aging, but the like creaky joints and the weird, like inexplicable, unbelievable pain that doesn’t end, although mine ended and I’m very grateful for that. That was painful, but.

Naureen Alim (29:16.926)

Yeah, that’s that’s a different kind of thing.

Ruthie Miller (29:18.99)

Are there any golden tickets for managing acute pain? I mean, other than medication, there, you know, is there anything that we wouldn’t have gotten online? Like as a medical professional, you know, heating pads, long baths, I don’t know, whatever. Are there like…

Naureen Alim (29:33.895)

Yeah, that’s exactly, yeah, I was just thinking that exactly. So the debate of hot and cold is still there. So I just tell patients to go with what feels better most of the time, but I find in general patients like heat. So I’ll say heat and rest. The common acronym for when people have tendonitis, you have heard of tennis elbow and things like that. So it’s RICE – rest, ice, compression, elevation. So you can try all of those things. We talked about some over the counter, like, you know, the stuff like Ben Gay, but there’s also over the counter topical anti-inflammatory. So you’re not taking the medication by mouth. Now those are available. And so there’s all kinds of patches and things like that, that you can try.

And this is not really acute pain per se, but you know, water-based therapies and aquatic therapy is also a great way to sort of treat and maybe prevent joint pain. So those are some things that you can try as well.

Leyla Seka (30:31.416)

Amazing. Do you have arthritis, Naureen?

Naureen Alim (30:36.096)

So I think I do have the creaky knees, okay? And sometimes a bum shoulder, so I always tell my patients, do as I say, don’t do as I do, because sometimes I’ll push through that in the gym and you really, you you should listen to your body. So it’s, you know, I’m in the same age group, you guys. So I mean, you know, we’re all there.

Leyla Seka (30:51.995)

Right, right. Classic.

Naureen Alim (30:58.336)

I’m also like, you know, now starting to take a little creatine before I go work out and I might try experimenting with some of these supplements that we mentioned, but you know, I just hate taking stuff. I’m just like, what else can I do? 

Ruthie Miller (31:09.626)

You can be a science experiment too. And well, I think that’s a good place for us to stop and wrap it up today. Big thanks to Dr. Nareen Alim for joining us today. You can find a recap of everything we talked about on our website at sideprojecthq.com. And you can also learn more about Dr. Aleem on her Instagram, which is @FitnessRheum. We’ll link to it on our channels as well. So Naureen, thank you so much for joining us. This was awesome and totally inspiring conversation. And I’m going to go start lifting some more weights.

Naureen Alim (31:55.678)

That’s right. That’s it. That’s all we got to do. Thank you.