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Knee degeneration and osteoarthritis: what works and what’s a waste

June 28, 2011

Middle age and osteoarthritis of the knees: Walter, a 49-year-old heavy equipment operator, could barely climb out of his cab without his knee giving way, and he’s popping his wife’s Vicodin on bad days. Finally, he goes to the doctor and gets an x-ray. “You hardly have any cartilage left in your knees,” says the doctor. “There’s nothing that can be done. I’ll have you see the orthopedist in a few years and he might want to do a joint replacement.” Many doctors can get frustrated treating degenerated knees.

But, a lot can be done, before getting that final cure – a titanium and polyethylene knee implant. And, there are some things that shouldn’t be  done. Wanting a quicker fix, Walter sees the orthopedist who sends him for an MRI and recommends arthroscopy. “It’s 50-50 but it’s your best chance for improvement,” he says. Walter gets the procedure but he is on the wrong side of the coin toss. Six therapy sessions and six months later, he is having problems – limping, swelling, and sharp pains when he steps off a curb. “The doctor says I have to tough it out until I’m old  enough for a knee replacement. He prescribed some pills and told me to lose weight,” he says to his wife. But, treatment by conservative methods can improve symptoms and delay surgery for years, sometimes even indefinitely.

What should you do? What works?

  • Rehab, rehab,  rehab 3 days a week. More on rehabilitation  below. 
  • Losing weight. Even 20 pounds can make a difference.
  • Apply a cold ice pack after activities and before bed.
  • Use anti-inflammatories as needed, if they don’t make you sick.
  • Use a simple brace or sleeve if it helps you increase activity.
  • Cortisone shots 1-3 times a year during flares can help tolerate exercises.
  • Learn how to properly use a cane, especially if you’re limping.
  • Careful narcotic dosing, but only if it increases activity tolerance.
  • Walking on flat surfaces and cycling.

What doesn’t work:

  • Unless you have a big meniscus tear, arthroscopy won’t help much.
  • Recent NIH trials for glucosamine and chondroitin show they don’t work. Sorry!
  •  Expensive ant-inflammatories, unless you have a medical indication.
  •  Sleeping pills and muscle relaxants can slow you down, interfere with rehab.
  •  Experimental cartilage injections. If you really want it, go to a university.
  •  Synvisc or Hyalgan injections might help, but wear off quickly in many.
  •  Walking on uneven ground, including some hiking trails.
  •  Jogging or playing singles tennis, unless your totally rehabbed.
  •  Acupuncture. Always choose PT instead.

Physical Rehabilitation. It’s amazing what a dedicated rehab program can do for almost any degenerative joint, especially knees. There are some high-performance athletes with knee arthritis, and even a few marathon runners. They have symptoms, but their well-conditioned muscles minimize them. How rehab works:

You will see a physical therapist who doesn’t waste your time with heat, ice, or ultrasound. He will take you through a full set of exercises until you are trained to do them correctly on your own. The goals will be:

  • Increased muscle strength in the lower extremities
  • Increased cardiovascular and muscle endurance
  • Improved reflexes and balance, known as dynamic stabilization
  • Guidelines for proper use of a brace or possibly a cane
  • Guidelines for sports and other activities that may be hard on your knees
  • A customized program that works for you as an individual

Tips on physical therapy

Any doctor can prescribe it. Get 6-12 sessions, twice a week. Do the exercises at home as directed. Be religious about it. If you aren’t getting a serious, sports medicine approach by the second visit, get a referral to a therapist who treats sports injuries.

Special notes about knee rehab and pro football players

Physically rehabilitating an arthritic knee does not happen during six PT sessions, or after a few weeks. Muscles will be wasted, and fatigue easily. There will be loss of motion and inflammation. It takes at least 3-6 months of properly performed exercises 2-4 times a week. Improvement can continue for up to 12 or even 24 months. Also, be aware it took years for your knee arthritis to develop. Don’t compare yourself to pro football players who were already highly conditioned before they got sidelined from a knee injury or wear and tear. Pills and cortisone shots can reduce pain and help you tolerate the exercises. A brace can give some support while your muscles are being trained to stabilize the knee. Arthroscopy has been shown to be ineffective  in treating knee arthritis.

My review of the information available on the internet revealed mostly garbage. Only specialized literature gives accurate facts, so get a good therapist, and a good doc when you can’t tolerate doing the exercises or daily activities.

References

I have no accurate references that can be understood unless you’re a health professional. This post is entirely from my professional training and experience. As always in medicine, there will be controversies. Feel free to write a comment if you run across any – you’ll get feedback.

What makes a man healthy, wealthy, and wise?

June 23, 2011

Whatever makes it happen, the news is that the three of them come together. Which of the following do you believe to be true?

Good health depends on personal choice and responsibility. People who aren’t healthy are to blame because they know better than to abuse alcohol, smoke, eat junk food, and not exercise.

People can be forced into an unhealthy lifestyle. Unsafe communities, stressful working conditions, and lack of access to good food and adequate healthcare are not their fault.

It turns out that both views have a foundation of truth.  But what makes motivates some people to go to the gym and eat their veggies while others park in front of the TV with a beer and a cigarette? A new study reports amazing findings on the role of social factors in health behaviors.

  • Health: Adults and children with higher incomes are more likely to eat good diets. Adults with lower income and lower education are more likely to smoke. College graduates were almost 3 times as likely to be in very good health as those who didn’t finish high school.
  • Wealth: Families with highest incomes were twice as physically active as those under poverty level. Teenagers in highest income families were 3 times more likely to be physically active.
  • Wisdom: Adults who are college graduates: 2.5 times more likely  to be active than those with less than a high school education.

Healthy, wealthy, and wise – they all go together. Why is that? There are some answers in  “What Shapes Health-Related Behaviors? The Role of Social Factors” the March 2011 Robert Wood Johnson Foundation study that inspired this post.

  • Income and wealth shape access to healthy conditions. Low income neighborhoods lack fresh food grocers and safe places for exercise.
  • Education means more health knowledge, better problem-solving skills, and fewer risky behaviors.
  • Children growing up in stressful conditions are more likely to adopt risky behaviors like smoking and alcohol abuse, which may serve as coping mechanisms.

The article goes on to say “many Americans live and work in circumstances that make healthy living nearly impossible, even when they are informed and motivated.”

Good health directly correlates with wealth and education. Is it fair? What should be done about it? Here’s a few ideas from report:

  • We must move beyond the insufficient step of providing information, and improve the conditions in people’s homes, schools, and workplaces.
  • Promoting programs such as Earned Income Tax Credit, minimum wage, and Early Head Start programs can give people the ability to make better choices.
  • Local programs can help to increase fresh food access and reduce desserts for children.
  • Consider universal free breakfast at schools.
  • Observe physical education requirements in schools.
  • Provide more accessible and safe walking and bicycling routes in communities.

10 recommendations to dramatically improve the health for all Americans:

For further study, there are over 70 references in this RWJF study. Here is the link again:

http://www.rwjf.org/files/research/sdohwhatwhapeshealthrelatedbehaviorsissuebrief20110324.pdf

The Robert Wood Johnson Foundation is a non-profit committed to building a healthier America.

Author opinion: While it’s our individual responsibility to take care of our health, not everyone has equal access to healthy behaviors. It becomes the responsibility of society to help people be healthy. The quality of life in America depends on it.

Healthy people are also at risk for heart disease

June 20, 2011

But the more unhealthy you are, the greater your risk. As an adult, it’s well worth the time to update your knowledge about coronary artery disease. Sure, you can learn how much blockage it takes in a coronary artery before you get a myocardial infarction. But unless you’re a cardiologist, you just need to know what to do about it.

Having a heart attack is not a one-time deal. Even if you survive this number one cause of death in men and women, you’re stuck with a chronic disease that puts you into a high-risk group for life. You’ll never be the same. Here’s some new facts:

  • Aspirin doesn’t lower your risk of having a first heart attack.
  • Slim people on good diets and regular exercise have less but still some risk.
  • Quitting smoking drops the risk within weeks. Less than a half-pack also lowers it.
  • 2 drinks a day only helps if you’re already a drinker. It’s not better to drink red wine.
  • Recent studies show extreme exercise – eg marathons – may hurt heart health.
  • Sedentary lifestyle is a number one risk factor for heart disease.
  • Genetics is big – siblings and parents with early heart attacks are a warning sign.
  • Just 20 pounds of extra weight increases the risk.

Warning signs! Knowing the warning signs saves lives, maybe yours. If someone has signs of a heart attack, call 911. Don’t drive yourself to the hospital. Paramedics can start emergency care as soon as they arrive.

What else is important?

  • Check your blood pressure whenever you get the chance. A surprising number of middle age men are going  around with high blood pressure and don’t know it. Not getting treatment or skipping medications increases the chance of a heart attack.
  • Get your glucose level checked even if you’re not overweight. Mild diabetes easily goes undiagnosed. Controlling blood sugar lowers risk of heart disease.
  • Caffeine and stress don’t increase the risk for high blood pressure or heart disease.
  • Heart health is always about lifestyle –  diet, exercise, moderation, etc. Other posts on this site here cover those and offer many links.
  • It’s good to get an unbiased cardiologist’s second opinion before a doctor does a procedure on your heart. Not everything has been shown to make a significant difference. Insist on being fully informed, and make sure your investment of time, pain, and money is worth it. Even if it’s a 911 call, you can get a second opinion later.
  • Click here to test your knowledge!

 

More links:

Meditation and prayer are good for your health

June 17, 2011
What? An American-trained medical doctor suggesting that spiritual work can heal you? It’s not just an opinion. Rigid scientific studies published in western medical journals have shown that prayer and meditation can improve outcomes in very sick patients. Nobody was able to explain it satisfactorily. They just showed that it works.
 For thousands of years Shamans, Witch doctors, and faith healers of various sorts have practiced “magic” to heal people, way before medical schools were invented. We can’t be sure if it really worked, but – people claimed to get cured. Maybe there was something to it. Here’s a couple studies:
If we view patients as whole beings, people must be approached as more than a physical body or a complex set of organ systems. In most faiths and spiritual beliefs, people are understood to be mind/body/spirit. It is well known that for thousands of years faith and healing have been intertwined, but is there scientific evidence that this can work? There is western evidence-based medicine to support the use of spiritual care. There are published studies that conclude the use ofwhile Other articles are supportive, while some are controversial (search prayer +clinical +outcome +medical).

Middle Age Men and Depression: A Matter of Fact

June 14, 2011

You’re cranky all the time, and one Saturday you don’t get out of bed until noon. “Honey, what’s wrong, are you down about something?” your wife asks.

“How the hell should I know? What difference does it make anyway?” you say, pulling the sheets up to your chin and turning to face the wall. “I want out,” you start to say, but sitting in front of some shrink who’s going to tell you to cheer up and put you on another pill, hell…better left unsaid. Anyway, once you get up, pound down a few cold ones, and mow the lawn before the game comes on at 3, you’ll be fine because nothing beats watching the 49ers smash the Cowboys. And they better smash them good, because you have 200 bucks riding on it with the spread.

Middle age men are often stoic, “tough as nails,” and refuse to admit they are depressed. They may consider it a character defect or a sign of weakness. Recognizing the symptoms of depression is the biggest hurdle to diagnosis and treatment. Approximately half of those experiencing symptoms never get proper diagnosis or treatment. If left untreated, more than one out of every 10 people battling depression commit suicide.

What are the symptoms of depression?

According to the National Institute of Mental Health:

  • difficulty concentrating, remembering details, and making decisions
  • fatigue and decreased energy
  • feelings of guilt, worthlessness, and helplessness
  • feelings of hopelessness and pessimism
  • insomnia, early morning wakefulness, or excessive sleeping
  • irritability, restlessness
  • loss of interest in activities or hobbies once pleasurable, including sex
  • overeating or appetite loss
  • persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • persistent sad, anxious, or “empty” feelings
  • thoughts of suicide, suicide attempts

You need support from the people around you — your family and friends — when you are recovering from depression. Seek out a few whom you can rely on. Don’t choose only one person, since that can be overwhelming for the person. Talk to all of them about your depression. Many symptoms of depression are also those of low testosterone. A testosterone blood test should be part of a depression work-up for every middle age man.

Suicide is number eight in the top ten killers for middle age men. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) — or the deaf hotline at 1-800-799-4TTY (1-800-799-4889).

Warning signs of suicide with depression include:

  • a sudden switch from being very sad to being very calm or appearing to  be happy
  • always talking or thinking about death
  • clinical depression (deep sadness, loss of interest, trouble sleeping) that gets worse
  • having a “death wish,” taking risks that could lead to death, like driving through red lights
  • losing interest in things one used to care about
  • making comments about being hopeless, helpless, or worthless
  • putting affairs in order, tying up loose ends, changing a will
  • saying things like “It would be better if I wasn’t here” or  “I want out”
  • talking about suicide (killing one’s self)

If you or someone you know is genuinely threatening suicide, it may be necessary for urgent intervention. 911 will dispatch police and ambulance service. This may result in a 5150 (forced observation for up to 72 hours), but may save a life.

References:

Positive Thinking is like Pulling a Rabbit out of a Hat

June 9, 2011

Think positively! You’ve heard that a thousand times, and like me maybe you’ve wondered how they do it – those people who go around bursting with vitality, living everyone’s dream, seemingly bullet-proof to failure. Like the rabbit from a hat, positive thinking must come from somewhere, but where? It turns out that it’s a lot easier to figure out how the clown tricked you with the rabbit than to know where positive thinking comes from. But, it’s an important story, because for middle age men how we think can make the difference between life and death.

Talk about diet and exercise, learning about Lady Gaga’s abs routine, seeing a picture of a pile of raw vegetables can push one to make choices. You can choose this, and be healthy, or you can choose that and die young from a heart attack. We know that. It’s a no-brainer. So how can we “think positively” and make better choices?

From piles of data and mountains of research, come two sources of information that can jump-start your brain into positivity.

By the way, if you want to know where positive thoughts come from, they come from the same place as negative thoughts. The Unconscious. Wait, that gets us into years of Jungian analysis and tear-jerking psychotherapy. Not anymore – welcome to cognitive behavioral therapy.

You can understand cognitive behavioral therapy (CBT) in one paragraph, from a medical doctor who’s not a psychotherapist, because you don’t need to be a shrink to understand and apply CBT. You can do it yourself! Here it is:

  • Behind every feeling is a thought. You can’t control the feeling. We are animals, with a primitive part of the brain that senses fear, desire, and all the rest. Anger comes from fear. Love comes from desire. We know what feels good and bad. However, when it feels bad, you can learn to be consciously aware of the thought that caused that bad feeling. When you practice this, you become an expert on your own mind, and you can begin to pull rabbits out of the hat – you can choose to reframe your thought. That’s it! That’s cognitive behavioral therapy! Why spend $6,000 on anger management or self-empowerment sessions when you can read the first 30 pages of a book and do it yourself?

Okay, an example can help. Here’s one from my individual experience: a son-of-a-bitch cut me off in traffic. HOONNKK HOONNK! I’m hitting my horn and raising the middle finger to him. I catch myself. I think about this book I’m reading about CBT. I find the thought that made me angry. He thinks he’s better than me. I’ll show him. Then, I dig for a different thought – he’s freaking out because he’s late to work, or he just had a fight with his girlfriend. My anger dissolves, I make a silent apology, and I feel better. From then on, I’m able to let people cut me off without ruining my morning. This is a simple example, but it doesn’t matter. You can succeed in rooting out your worst thoughts and exchange them for better ones, making you feel better, almost all of the time. You can pull the rabbit out of the hat. You can become a positive thinker, and that will allow you to choose the vegetables over the cheesecake, the gym over a TV and pizza, or a visit to a doctor over daily bottles of wine to deal with a bad mood.

The book is “Thoughts & Feelings,” a classic do-it-yourself guide to cognitive behavior. Open this link and click on preview, and you’ll get enough of the book to change your thought patterns without having to buy it.  http://books.google.com/books?id=ygRexKbYwe0C&printsec=frontcover#v=onepage&q&f=false

I promised a second source of information to catalyze your brain to think positively:

The Political Mind (2008) http://georgelakoff.com/writings/books/

This will help you create a new “cultural narrative,”otherwise known as your “mindset” or “point of view.” That’s a good thing because it turns out we aren’t even consciously aware of how we see ourselves in the world around us. He shows us how to become conscious, and that gives us the power to choose. George is a professor at UC Berkeley, and a cognitive scientist. I emailed him a request that he guest author this blog, but he’s too busy writing more books. Well he’s not going to get rich soon – You can get this one at Amazon.com for $5! Here’s what the publisher had to say:

In his new book, Lakoff spells out what cognitive science has discovered about reason, and reveals that human reason is far more interesting than we thought it was. Reason is physical, mostly unconscious, metaphorical, emotion-laden, and tied to empathy-and there are biological explanations behind our moral and political thought processes. His call for a New Enlightenment is a bold and striking challenge to the cherished beliefs not only of philosophers, but of pundits, pollsters, and political leaders. The Political Mind is a passionate, erudite, and groundbreaking book that will appeal to anyone interested in how the mind works and how we function socially and politically.

All the best to the empowerment of your mind.

Shocking Health Facts and Myth-Busters

June 5, 2011

You might believe that things are the way they should be because it’s common sense…but not always! Try these:

Bottled water is good for your health:  ever since I saw trucks parked by Lake Arrowhead, suctioning off the surface water through giant hoses, I wondered about this. It turns out that bottled water is just as polluted as tap water and the plastic bottles made in the U.S. last year were enough to circle the Earth 190 times.

Caffeine is bad for your heart: a Swedish study a few decades ago linked daily coffee drinkers with a higher rate of coronary artery disease. It was later discovered the Swedes were eating pastries with their coffee – the pastries were causing heart disease. Studies since then prove that caffeine does not increase the risk of heart disease, and may even have  a protective effect against certain cancers.

Groceries are always safe to eat: there are controversies about pesticides in produce. Organic foods are supposed to fix that – but not always. And here’s one that is even scarier. After you see this, you’ll want to make sure your meat is still attached to the bone.

Fluoride is good for kid’s teeth: it may damage the enamel, something called “dental fluorosis.” Check with your dentist. If he’s not up on this, give him this article.

Guys on magazine covers get those bodies from hard work and dedication: They shoot anabolic steroids. Then they starve themselves, wrap their bodies in plastic wrap, and undergo water deprivation. That gets rid of the normal fat and water under the skin. Oh, and they are also dedicated hard workers.

Crunches are the best way to get a flat tummy: not even close! This video is worth the 8 minutes, unless you’re already happy with your midsection.

You must hire a personal trainer to learn how to work out: Maybe, but if you want one for free, here he is, and it’s worth watching the 9 minute show over again:

You’ll catch a cold if you go outside: colds and flu are passed from infected people and can even be transmitted before that person has symptoms. Smokers need days longer to get better. People spend more time indoors in the winter. That’s where contamination takes place. Learn more and how to prevent them.

Here’s two sites that bust a lot of myths.  Got any more? Send them in and share!

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