Know Your Bones

Donate a mammogram!

It only takes a minute....
* Y * 6 * Y
Please tell ten friends to tell ten today! The Breast Cancer site is having trouble getting enough people to click on their site daily to meet their quota of donating at least one free mammogram a day to an underprivileged woman. It takes less than a minute to go to their site and click on "donating a mammogram" for free (pink window in the middle).

This doesn't cost you a thing. Their corporate sponsors/advertisers use the number of daily visits to donate mammograms in exchange for advertising.

Here's the web site! Pass it along to people you know.

http://www.thebreastcancersite.com

Exploring Fibromyalgia's Mysteries

  My friend, Marianne, sent me an LA Times article that seems to be the cutting edge of treatment, and opinions, on fibromyalgia.  I think the near future holds a lot of useful information—understanding of brain physiology is a lot better than even 15 years ago, when I was in med school.  Time will tell if any of the drugs they mentioned will pan out—limited by cost, accessibility, drug interaction and side-effects? 

Mare and I have a mutual friend, Jean, dealing with fibro—have you tried any of these meds?  What works best for you?

New discoveries to explain this stuff from a biochemical/physiological standpoint will go a long way toward convincing my colleagues that it’s real.

I’m becoming a fan of meticulous nutrition, sleep and activity modification for patients with any kind of health issue:  joint pain, high blood pressure, diabetes… The body wants to be balanced/well; if it’s got plenty of reserves, it can withstand poor habits, and you’re “lucky” and “healthy”.  But when its reserves are overwhelmed (and I’m guessing that some people have fewer reserves than others), then you get symptoms and disease.  Meticulous attention to good habits boosts the body’s reserves, minimize symptoms, and get closer to balance/wellness, reducing the need for drugs. 

I think I might order that infomercial-guy’s book on Natural Cures from late night TV!  He makes a lot of logical points! 

Stand Tall Against Osteoporosis!

The National Osteoporosis Foundation encourages you to realize the importance of exercise in building healthy bones! NOF is the nation's leading voluntary health organization solely dedicated to osteoporosis and bone health; there are various ways for you to make a difference!

October 20th is "Virtual Fitness Day" to encourage all individuals to take personal responsibility and individual action to "Stand Tall Against Osteoporosis" and to build strong bones for life!

Participation is easy: simply perform your normal daily fitness routine on October 20th. If you don't have a normal fitness routine it's time to get started and prevent osteoporosis as well as improve your overall health! Take the steps, park your car in the back corner of the lot or "walk the block" with friends! To participate in this exciting and worthwhile event, visit NOF's website at http://www.nof.org/ and make an online pledge today.

Encourage your patients, co-workers, friends and family members to participate as well! Working together, we can improve the quality of life for people living with or at risk for osteoporosis. We are grateful for your commitment!

Ask your pharmacist--if you can find one!

USA Today's 8/17/05 article about a shortage of pharmacists should be a wake-up call for an aging society, or for puzzled patients scratching their head with an arthritic finger after the Vioxx verdict! 

Choose your pharmacist as carefully as you choose a physician.  Thanks to his/her extensive training and expertise, your pharmacist is a valuable consultant who can advise you about:

     --how to get the best results from your medications, whether by prescription or over-the-counter.

     --potential drug interactions between the medications you take.

     --which drugs to avoid because of allergies or other problems.

     --possible side effects.

     --what foods, drinks, or activities to avoid while taking a certain medication.

     --what to do if you miss a dose.

     --your drugs’ cost, insurance coverage, and possible lower-cost options.

Remember, you can ask your pharmacist about non-prescription treatments.  Ask them to help you decipher the Active Ingredients label on the package of any over-the-counter medications you buy.  They can cross-reference these ingredients with your other medications and advise you about possible drug interactions.

Use only one pharmacy so all of your medication records are at one location.  Most pharmacies use a computerized database to keep track of the prescriptions they fill for you. This database will cross reference your medicines to check for potential problems… if it knows about everything you take!

Our Fractured Health System By the Seat of Your Pants

Thanks to Elisa at Healthy Concerns for bringing a recent NYT article to our attention--I would have missed it otherwise, and it strikes right at the heart of all that is wrong with our fractured health system!  Worth printing out to read:  Awash in information, patients face a lonely, uncertain road.  I'm also looking forward to reading the related pieces. 

Unfortunately, what this story describes is true:  bewildered patients, whose heads are spinning with technical jargon and what-ifs; their doctors pressed for time, because the payors don't value the time spent sorting out the variables intelligently with them; unending escalation of health costs if the rationale behind the treatment is "What do you want?"

Evidence-based medicine will guide decisions in the future, but for now it's just you and the seat of your pants. 

Just imagine if you had the luxury of unlimited face-to-face consultation with your doctor to guide your decision.  What's it worth to you?  What kind of assistance would it take to help you understand your diagnosis, the treatment options, how to weigh the options in your circumstances, and follow you through a successful treatment?  How would you organize your thoughts?  Have you been handed any brochures or literature that's actually been helpful?  How do you receive this level of service from other trusted advisors (whether your lawyer or hairdresser?)  How much do you pay them?  What's the solution? 

Tylenol leads to hypertension?

  I was surprised to hear today's news linking acetaminophen (Tylenol) with high blood pressure.   According to Reuter's take on a Harvard study, "Women who take higher doses of common, over-the-counter painkillers such as ibuprofen and even Tylenol have higher blood pressure than women who do not."

"In our study, women who took 500 milligrams (mg) or more of acetaminophen per day, on average, were about twice as likely to develop high blood pressure as women who did not use acetaminophen," said Dr. John Phillip Forman of Harvard Medical School and Brigham and Women's Hospital in Boston, who led the study.

Now, the 500 mg he's talking about equals ONE extra-strength Tylenol pill.  I'll track down the  journal Hypertension to read the actual text and the author's comments in the referenced study.  I'm eager to learn what mechanism the authors propose is the problem. 

Throughout "Know Your Bones: Making Sense of Arthritis Medicine", I emphasize the safety of acetaminophen over NSAIDs for most patients with other health issues:  high-blood pressure, ulcers, heart disease...will I have to rewrite the book?!

Dear readers:  don't look for a simple answer to a complicated issue here; ie, don't start gobbling aspirin just because it didn't cause hypertension in this study (like ibuprofen and apparently Tylenol did.)  Aspirin may be tried and true, but it is NOT for everyone.  Keep away from aspirin if you've got sotmach ulcers, asthma and nasal polyps, take Coumadin--or understand why your doctor says it's OK. 

If any public-educational good comes from this headline, let's hope it's to hammer home the idea that just because a drug is available OTC, doesn't mean it's "harmless." 

Surgeons can't offer what they don't yet have

My heart goes out to Bryan, who posted comments on an earlier post.  He's frustrated that there's no cure for OA.  He's right that currently available treatment options are incomplete and only palliative, not a true solution to the problem.

Please understand that scientific principles exist, even if we don't like them.  Cartilage tissue is very complicated.  Research hasn't yet revealed why the deterioration is OA is so unpredictable (one hip is shot, the other is fine; knees are worn out, but ankles are OK), so we don't yet know how to halt or reverse that deterioration.  That's the role of ongoing research.

Joint replacement and fusion are reliable solutions when arthritis is painful and limiting despite extensive non-surgical treatment.  Surgery like this is not done to restore normal, brand-new joints; it is designed to improve a patient's current function.  Sure, all surgery has drawbacks, but no one should have surgery unless what is to be gained far outweighs the drawbacks. 

When arthritic joints are overloaded with heavy physical work or vigorous sports, they're gonna hurt.  Respect the biomechanics at stake, and you'll stay functional and comfortable.  Listen to your joints, and do what they will allow.  If you ignore them and expect more than they're capable of doing, they'll complain.

There's a broad range of treatments to relieve the symptoms of OA; your doctor should help you tailor a combination of those treatments over time as your symptoms wax and wane:  activity modification (not overloading the joints), medication, exercise (to improve the tissues capable of improvement: muscle strength, ligament flexibility, balance, bone density), surgery (to improve a single joint's pain/instability--not restore the one God gave you.)

Magic wands do exist in medicine: antibiotics cure infection, insulin restores blood sugar to normal, pins and screws hold broken bones in place so they can heal properly.  It's very likely the future holds a solution for cartilage deterioration--we just don't have it yet.

The Arthritis Foundation is an excellent resource for the latest research, news about treatment options, patient advocacy and support.  Please visit and support them with your membership and donations.   Check out the US Bone and Joint Decade, for reassurance that lots of smart people are working hard on behalf of people dealing with musculoskeletal problems!

Raise Awareness of Real Beauty and Support the Girl Scouts!

The folks at Dove soap have partnered with the Girl Scouts of the USA to promote a concept of Real Beauty!  I LOVED scouts as a kid (and earned every merit badge, thank you very much :)!) and my girls are enjoying Brownies. 

Now is the time to stand firm and celebrate your curves!  By signing the Dove Real Beauty Pledge Book , you can help support programs which help foster improved self-esteem among young girls. 

For every signature in the Pledge Book, Dove will donate $1 to Uniquely Me, a Girl Scouts of the USA program which supports improved self-esteem among young girls.  The goal is to raise an additional $50,000 for Uniquely Me by August 31st--with your help of course! 

I encourage my friends and readers, and Blogosphere colleagues, like  Embracing Women's Health,   Sugar Shock,  Interpret-her,  Healthy Concerns and Lipsticking to add your signature to the Pledge Book and Dove will donate $1 in your behalf to Uniquely Me!

Look for my Pledge at about #2337:  "Direct your energy toward building your strength, resilience, independence, INTERdependence = Real Beauty.  Know your bones!"

Humana report

So Humana has a color, full-page ad in the WSJ singing about how much money it saved--here's the link: 

If the findings of Humana's SmartSuite actuarial study are to be believed (and the glass-half-full optimist in me wants to agree), health costs become more manageable when patients are allowed to manage their care.   Eureka!  Doctors and patients determining their preferred course of treatment, without a meddlesome, non-clinical middleman?

Their study found that despite fears to the contrary, patients will pay to fill their prescriptions and see their primary care physicians.  Or at least these white-collar, midwestern office workers did for 2 years.

It would have been nice if the payors admitted, in so many words, that their attempt at "Managed Care" was a dismal failure.  20 years of HMOs got us ridiculous costs, 1:7 without coverage, frustrated physicians...basically nothing good.  We'll let them think it was their idea to devise "consumer driven" policies, where patients pay more out of pocket to receive medical services (rather than the "it's only $5" co-pay charade).

The next challenge is for clinicians to rise to the occaision, and provide the level of service our patients will expect.   We're now accustomed to delivering care on the cheap, cramming lots of patients onto the schedule to overcome stingy reimbursements and rising practice overhead.  I welcome the change--and hope my patients are willing to ask for their money's worth.

You are what you eat: don't be junk!

Thanks to a team of researchers in Japan who have demonstrated a connection between "bad cholesterol" and degeneration of the discs of the spine.  At the 2005 meeting of the International Society for the Study of the Lumbar Spine, Mika Hangai, the principal investigator stated, "Aging, obesity, high LDLc, high HbA1c and arteriosclerosis were significantly associated with disc degeneration."

Let's connect the dots:  your living tissues are constantly growing, turning over and breaking down.  Every part of your body relies on healthy blood flow and the right nutrients to repair itself and stay strong and resilient (read: young!)  If you're using crappy building supplies (junky, processed, fake food), your body's foundation is overloaded (by obesity) and the blood flow trying to deliver healing elements and flush away cellular wastes are clogged (by arteriosclerosis), guess what?  You're gonna hurt!  Worse than that, you hurt because you're falling apart! 

Connie Bennett's blog Sugar Shock is an eye-opening expose of the politics and pathology surrounding Big Sugar.   She keeps a close eye on the shenanigans, and has first-hand experience on how transforming your eating plan (for the better) will improve health (for the better!)

Good health and a state of "wellness" means you respect the way all of your body's systems are interrelated.  Do everything you can to sustain your vigor and balance in ofer to ward off anything that threatens it with disease and deterioration!  Know your bones!