FAQ Category: General

Vitamin D is important to our overall health. The most well-known effect of vitamin D deficiency is rickets, a disease that children can get if don’t get enough of the vitamin. It causes their bones to get soft and their long bones, like in the legs, can bend or break.

Recent studies suggest that people who take regular, approved doses of vitamin D may reduce their chances of developing certain types of illnesses and cancers. Researchers are also looking at how the vitamin may be associated with disorder such as multiple sclerosis, depression, chronic pain.

Dual energy X-ray absorptiometry (DXA, previously called DEXA) is a way to measure bone mineral density (BMD). DXA shows if you have osteopenia or osteoporosis. Low bone mass is called osteopenia. If osteopenia continues to progress or get worse, you can develop osteoporosis.

Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced enough that the bone microarchitecture is disrupted. The amount and variety of proteins in bone is changed.

Anyone with osteopenia or osteoporosis is at increased risk for bone fracture. The risk is greatest if you are over 85 years of age, a smoker, and have a previous history of bone fracture. Postmenopausal women are at increased risk at a younger age but this risk continues to increase with age.

Even if you do not want to take medications at this time, it is always a good idea to get a baseline measurement of bone density. Repeat tests can show you if your bone mass is getting worse. The test can also show how quickly your bone density is changing. As your risk of fracture goes up you may change your mind about the medication. Or you may change your plan if you suffer a fracture and want to prevent further fractures.

You may want to try and use exercise as a means of preventing further bone loss. You can use the DXA measurement to gauge your results. And if you change your mind later, you can always take medications and continue monitoring your bone density.

Bone mineral density (BMD) measurements have been the gold standard for diagnosing osteoporosis for the last 20 years. Doctors and patients have relied on dual-energy X-ray absorptiometry(DEXA or DXA). DXA is a type of X-ray imaging used to measure BMD and make the diagnosis.

However, studies show that using DXA as the only measure may not be enough. Current research suggests a change. Risk factors combined with DXA results are a better way to evaluate each person. And where DXA is not available in this country (or in other less developed countries), clinical risk factors may be enough to predict fractures.

Age and a past history of fracture(s) are the two most important predictive factors. The risk of low bone mass called osteopenia and the risk of osteoporosis go up with increased age. Other risk factors include current or past use of corticosteroids, current cigarette smoking, and family history of fracture.

Drinking more than two units of alcohol is another risk factor. One unit is equal to one 12 oz. beer, one five oz. glass of wine, or 1.5 oz. of hard liquor.

The older the individual and the more the risk factors, the greater the chances for bone fracture. Without the use of DXA, treatment is advised based on age, history, and physical examination. Even with DXA, there are many older adults with osteopenia who sustain a bone fracture. This fact suggests earlier treatment of low bone mass is needed in some people.

Lupus erythematosus is an autoimmune disease. It can present in one of two forms: the systemic form or the discoid (cutaneous) form. Systemic lupus affects the joints and organs, but can also affect the skin. The cutaneous form just affects the skin.

Skin changes vary from discrete, round, raised lesions that look like coins in a small area of the body to a rash-like skin lesion over a large area of the body. About 15 to 30 per cent of the patients with the systemic form, also develop the discoid form.

In a small number of cases, the person actually develops the discoid type first and later develops symptoms of the systemic type. Most of the time, the individual is diagnosed with systemic lupus erythematosus (SLE) and later develops discoid lupus.

A classic first sign of SLE is a butterfly-shaped lesion across the nose and cheeks. This rash may be flat but can also be raised and slightly bumpy. The discoid lesions are more often present on the ears, scalp, V-area of the neck, and back of the arms around the elbows. They tend to be round, disc-shaped lesions.

If you started out with the facial butterfly rash, you may not develop any further skin lesions. But you can expect to develop other areas of involvement such as the joints and organs.

That’s why it’s important to keep your follow-up appointments with the clinic staff. Recognizing early progression of your symptoms can help plan and direct treatment.

You may fall into the category labeled weekend warrior. These are folks who get in at least 150 minutes of moderate-to-vigorous exercise each week. But they do it all on one to two days.

The current U.S. guidelines for physical activity is at least 30 minutes each day. The intensity should be moderate. This means it raises your heart rate, you feel sligtly breathless, and you sweat a little. Only about half of the American adult population meet this goal.

And according to a new survey from the Centers for Disease Control and Prevention (CDC), only one to three per cent fall into the weekend warrior category. Most of these are men between the ages of 45 and 64.

Is one method better than another? What kind of activities qualifies as healthy or beneficial? Is playing golf or gardening both days of the weekend enough to get the maximum health benefits?

These are questions we don’t have the answers to just yet. The CDC has several studies ongoing to try and find some better answers. The basic guideline of daily, physical activity and exercise has been shown to reduce the risk of death from heart disease, cancer, and diabetes.

We all face the same dilemma. The U.S. Public Health Department advises regular, daily physical activity. They report that study after study shows the powerful benefits of moderately intense exercise done on a regular basis. The rates of disease and death go down as the level of exercise goes up.

There are many different strategies to help people increase their activity and fitness level. Everyone has to find what works best for him or her. Some of the more commonly suggested ideas include:

In theory, gout can affect any joint in the body. It does seem to affect the great toe most often. In fact about half of all patients have symptoms here first. But other joints can be involved, including the knee. The hand, foot, and elbow are affected more often than the knee.

Less commonly, the shoulders, hips, spine, sacroiliac joints, and jaw are involved. Typical symptoms are a hot, tender, red, and inflamed joint. Urate crystals called tophi collect in the joint and nearby soft tissues. Tophi can be found in the ligaments, cartilage, tendons, and burse.

If enough deposits of urate crystals form, the skin bursts and a chalky material oozes out. Medical treatment early can help prevent this kind of progression of disease. Left untreated, eventually the big toe will become affected.

Early stages of gout can be completely without symptoms. It is a condition caused by too much uric acid in the blood. This is called hyperuricemia. Not everyone with elevated uric acid develops gout.

Age, genetics, chronic alcohol use, and obesity are factors that can change someone from being symptom-free to having acute gout. Other risk factors include the use of thiazide drugs and exposure to lead.

Your physician relies on your symptoms and the presence of any risk factors to guide the diagnosis. A blood test will show if your urate level is elevated. The longer you have hyperuricemia, the greater your chances of developing gout.

X-rays can also offer helpful clues but usually these are more definitive in later, chronic stages of gout. A quick response to treatment is often the best way to confirm the diagnosis. Diet and urate-lowering drugs are the first steps in therapy.

Your doctor will also continue monitoring your blood levels of urate. The goal is to get it down below nine mg/dL.

It does seem that we are often told that we can eat one food, only to be told later that maybe it’s not so good for us. To get such messages can be confusing and concerning.

For the most part though, it’s a common sense approach to diet that is best. While it doesn’t hurt to consume products we’re told will have added benefit, a healthy well-rounded diet is the best way to go.

To follow a good diet, it would help to get a copy of the American Dietary Guidelines. You could ask your doctor or you can access it on the web by going to the US Department of Health and Human Services (HHS) website at www.health.gov. These guidelines will tell you what types of food and how much you should consume, according to your body’s needs. For example, a pregnant woman would need more nutrients than a man the same age. In general, you need a good mix of dairy products; fruit and vegetables; meat, fish, poultry and legumes; and bread products or grains. It’s important not to over or under eat and to limit consumption of processed, high sugar and high sodium foods.

Natural doesn’t mean safe. There are many things that grow in nature that are dangerous or poisonous to humans. While a natural product may be good for one person, it may not be for another. Or, you can have something like the case with grapefruit juice. The properties of the juice cause certain medications t be too potent and can cause harm.

If you want to take natural products, be sure to discuss this with your pharmacist or doctor to be sure that there are no interactions with the medications that you take.

Osteoarthritis (OA) is a degenerative process that affects the major joints. Most patients report hip, knee, or spine involvement. First, the cartilage that lines the joints starts to break down.

Then the layer of bone underneath the cartilage develops cracks and uneven wear. The body tries to repair the breakdown but a lack of blood supply to the area delays or prevents regeneration.

As the old saying goes, Motion is lotion. Movement helps the joint stay moist and smooth moving. But the pain and swelling of OA keeps the person from wanting to move. That’s when early over-the-counter analgesics and antiinflammatories can be helpful.

Tylenol is the first choice of many patients. It is safe, helps reduce pain, and it’s low in cost. About half of all OA sufferers find that a nonsteroidal antiinflammatory drug (NSAID) such as ibuprofen works well to control inflammation as well. By keeping the inflammation out of the joint, further damage can be prevented.

Your best course of action is to keep moving. Low-impact exercise such as swimming, water aerobics, or bicycling can help. Sometimes a shoe insert, taping the kneecap, or an off-loading knee brace can help align the joint and reduce uneven forces. A physical therapist can help you find the right type and amount of exercise. The therapist can also advise you about bracing or shoe supports.

Many patients find it helps to take a supplement containing glucosamine and chondroitin. Studies have not been able to prove or disprove the use of these supplements for OA. Results seem to vary depending on the product and dose used. It may be that only certain people are helped by these supplements. For the moment, until more is known, it seems that they can’t hurt and they may help.

Ticks are a problem during the early spring and summer months in Montana. But you are not likely to encounter deer ticks that transmit Lyme disease. Rocky Mountain spotted fever is a greater concern in the northwest region.

Whenever you are outdoors in areas where there are ticks, it’s a good idea to routinely practice tick prevention.The Infectious Diseases Society of America (IDSA) and the American Lyme Disease Foundtion (ALDF) advise using an insect repellent that contains diethyl-toluamide (DEET) on skin or clothing.

For those who prefer to remain chemical-free, there are other preventive steps that can be taken. Wear tightly woven, light-colored clothing. You’ll be more likely to see them if they get on you. Pull your socks up over your pant legs. Wear a hat to keep them out of your hair.

Ticks can drop down from trees so avoid sitting or standing under trees. It’s best to avoid sitting on the ground where there are leaves or other forest debris.

Check yourself and others often. Perform a full-body tick-check each night before going to bed. Ticks seek warm, moist areas so be sure to inspect hair, scalp, the groin area, and under the arms. If you have pets with you, inspect them as well. Be sure and check inside their ears.

Contact the Chamber of Commerce for the area you intend to visit. Ask whether ticks are active in their area and any precautions they may recommend.

It depends on the type of tick that bit you. Not all ticks pass diseases to humans. The deer tick (I scapularis) is the one that transmits Lyme disease. The specific bacteria they carry is called Borrelia burgdorferi.

Not all deer ticks carry the bacteria. It is estimated that about 20 per cent of the tick population are infectious. And not all people who are bitten get Lyme disease. Scientists aren’t sure why this happens to some, but not all, people.

Older adults or anyone with a weakened immune system may be at increased risk. Studies also show that the tick can’t pass the bacteria to you (the host) until it has been attached to your skin for 36 to 48 hours. If the tick is just crawling on the skin or clothing, you are still safe from the disease.

Likewise, if the tick was attached but not engorged, your risk of disease is less. You should remain alert to any symptoms of later-stage Lyme disease. This can include severe headaches, painful joint swelling, or numbness and tingling of the fingers and toes.

Symptoms can appear for the first time years after a tick bite. It’s a good idea to see your physician at least once a year for a check-up. Late-stage Lyme disease can also present with unknown cardiac (heart) problems.

Studies on the effects of Tai Chi just on men have not been done yet. It would be a good idea since low bone mineral density (BMD) doesn’t jut effect women. Men can have reduced BMD and osteoporosis, too. In fact, so much attention has been paid to women in this area, that men are often underdiagnosed and undertreated for this condition.

Tai Chi has many health benefits for men and women. Millions of Chinese men have used this form of exercise to maintain health and well-being. The smooth, flowing movements improve joint motion and muscle strength. Shifting from side to side helps improve balance and coordination.

The Surgeon General’s 2004 report specifically recommended the use of Tai Chi as a tool for falls prevention. It is a safe exercise with no adverse effects reported in any study. No equipment is needed. Although it is usually done standing, Tai Chi can be adapted for those older adults who need to remain seated while exercising.

There is no reason to think that all the benefits associated with Tai Chi aren’t also effective in men. It is a novel form of exercise that appeals to men and women alike with benefits for all who practice it consistently.

Tai Chi is an ancient Chinese martial arts form. It has been practiced by millions of Chinese for centuries to improve and maintain health. Tai Chi is based on the idea that there is a life force in and around us called Qi. Others might call this karma or the Holy Spirit. The exercises are designed to strength the body, calm the mind, and balance the flow of Qi.

There is no worship of a god involved. No preaching of any kind occurs during the sessions. Tai Chi uses breathing and smooth, slow motions to create a practice of meditative movement. Anyone can do it and adapt it to their own belief system.

Many studies show that Tai Chi improves balance, strength, and coordination. The flowing, circular motions help maintain joint motion, walking speed, and posture. A small number of studies have looked at the impact of Tai Chi on bone density. This is important for older adults, especially postmenopausal women.

As a whole, the studies have not been able to show that Tai Chi slows down the rate of bone loss. But it is clear that people with osteoporosis fall less often and are therefore at a reduced risk for fracture by doing Tai Chi.

Perhaps it will help if you explain the health benefits of Tai Chi. Offer to go with your mother to a class or two. If the instructor approves, she could watch at first. If there’s nothing objectionable, then she may want to try it for herself. As the saying goes, seeing is believing. In this case, maybe seeing will lead to better understanding.

Hereditary exostosis is also known as osteochondroma. In this condition, the growth plate at the end of the child’s bone starts to develop tumor-like growths. These cartilage-bone growths replace the bone with fibrous tissue. The affected areas of the bone get weak.

Visible deformities can be seen in some children. Often that’s when the diagnosis is made. In many cases, the condition is present but remains hidden. Any of the bones can be affected but deformities of the upper arm, forearm, knee, tibia (lower leg), and ankle are the most obvious.

There is a wide range of severity for this disease. Gender doesn’t seem to be linked with how mild or severe the condition is. Even within one family, there can be an inconsistent pattern. Hereditary exostosis is autosomal dominant. This means each of your husband’s children will have a 50 per cent chance of inheriting the disorder.

Because males and females are equally affected, all of his children who have this disorder will be likely to have affected children. Sometimes an autosomal dominant disorder skips generations but hereditary exostosis has a 96 per cent penetrance, meaning it affects nearly all generations.

Generally, when a person with this condition reaches maturity, and their bones stop growing, the exostoses also stop growing. In a small number of patients, the tumors can become cancerous. Regular screening is advised for anyone with this condition.

If someone enters a career that’s known for its short work-life spans, such as professional sports, it’s important that they are properly prepared for the life that will come after their career ends. While most young people aren’t ready to think about retirement, it is a reality.

Organizations can work with their players to teach them how to get ready for the upcoming life changes, whether they are sudden or planned. Having experts speak with them about financial issues could help prevent the money problems that might happen once the big pay checks are no longer in the picture. Speaking with counselors about the transition from playing to retiring might help give the players a new perspective on how things could be following retirement.

If retirement is due to a career-ending injury, providing the player with good pain management skills can help prevent, or lessen, the cycle of chronic pain. Ensuring that the retired players have access to mental health care professionals and providing good follow-up may also help catch those who might otherwise fall through the cracks.

There are two terms we must understand when discussing how bone grafts work. The first is osteogenic. Osteogenic cells are bone-forming cells. The second term is osteoinductive.

Osteoinductive cells help start or keep the process going that leads to forming new bone cells. Anything that can cause osteogenic cells to form is osteoinductive.

When taken from a bone bank, the bone cells are osteoinductive. The process of sterilizing and freezing bone cells for storage destroys the osteogeneic properties but does not harm their osteoinductive abilities.

Likewise, bone tissue taken from your own body to use as a graft will die at the graft site but not before it sets up a series of steps to form new bone growth. Scientists are also working to develop bone substitutes to speed up the healing process.

For example, special proteins called bone morphogenetic proteins (BMPs) are a new source of osteoinductive molecules. When combined with certain growth factors, BMP reduces infection, improves wound healing, and accelerates bone healing.

The body breaks down the bone graft and replaces it with new bone cells. This process is called creeping substitution. This takes place until all the graft has been resorbed by the body and new bone has replaced it.

Sarcoidosis is an immune system disorder that can affect any organ. The lungs are involved most often with inflammation as the main problem. Prednisone is an antiinflammatory steroid used to control the side effects of the inflammation.

The problem is that although prednisone works well for inflammation, it has its own side effects. Bone weakening and bone death called osteonecrosis is one of those side effects. Bone fracture, especially of the hip, is not uncommon after years of steroid use.

There is a risk of further bone damage from the use of these medications. Usually the physician can prescribe other drugs to counter the negative effects prednisone has on the bone.

New drug products called bisphosponates are available to help build up bone density loss caused by aging, osteoporosis, or osteonecrosis. If your mother is not taking a medication of this type, encourage her to ask her doctor about it.

The way your husband was walking is a gait pattern called ataxia. The person has enough strength to walk normally but is unsteady because he is unaware of limb position. It appears to be related to loss of position sensation from the feet.

In older adults this type of ataxia is linked with vitamin B12 deficiency needed for normal neurologic function. Degeneration of the spinal cord can occur with subsequent ataxia and other symptoms.

A loss of gastric acid or other gastrointestinal problems that impair the release of B12 from food can result in vitamin B12 deficiency. B12 comes from animal sources so strict vegetarians are also at greater risk for deficiency.

Symptoms can be irreversible unless treated early. Treatment is with Vitamin B12 supplementation. Monthly injections of B12 are the standard form of administration. Vitamin B12 is also available orally in pill form or by nasal spray. Periodic follow-up with your physician is important.