FAQ Category: General

One MET equals your RMR. Some experts rephrase this to say that one MET is equal to the rate at which the average person burns calories when at rest. This is also equal to the amount of oxygen you use while inactive. In the normal, healthy adult, this is about 3.5 ml of oxygen per kilogram of body weight per minute.

You use about one to two METs for activities such as combing your hair, washing dishes, or sweeping the floor. This value does vary depending on your age and your general health. Three to six METs are used to vacuum, walk one mile in 30 minutes, or garden. ctivities such as jogging, playing tennis, or biking more than 10 mph uses more than six METs.

METs can be used to put a value on the health benefits of various types and intensities of exercise. Moderate exercise (three to six MET range) has been shown to improve health and reduce the risk of heart disease or diabetes.

Anyone who has had a heart attack will be given a cardiac rehab program with exercise based on METs. At first they are restricted to activities in the one to two MET range. If their vital signs remain stable, they gradually increase the intensity of exercise in a prescribed manner.

A treadmill test is needed to measure your actual RMR. Most of the time individuals exercising just gauge their own MET based on the level of intensity for each activity.

It’s true that golfing can be hazardous to your health! Female golfers are more likely than male golfers to sustain golf injuries, especially involving the low back. Muscle strain is common and is often attributed to overuse.

Technical error is also a likely source of injury. It may be a good idea to spend a little of your time off work taking golf lessons. Using the proper form can go a long way in reducing muscle fatigue and protecting your joints.

Sudden or rapid change in club speed can put you at risk for injury. Set up your shot and follow through. Don’t let advice from fellow golfers change your style mid-stroke.

And always arrive at the golf course early enough to get in five or 10 minutes of a warm up and some practice shots at the driving range. With a proper warm up, you are less likely to injure yourself and it gives you time to get your mind and thoughts in the right perspective for the business at hand.

Whether you’re a beginner or even a semi-pro, golf lessons are always a good idea. Having someone else look at your form and technique goes a long way toward improving your stance and stroke. You may even be able to prevent some injuries from occurring.

More than 100,000 golf-related injuries are reported every year. The cost in medica bills, work-loss, pain, and legal expenses is in the billions of dollars. Don’t be a statistic.

The American Academy of Orthopaedic Surgeons offers the following handy tips:

New biologic agents are being developed for patients with rheumatoid arthritis (RA). The first batch of biologic agents called first generation therapy have worked very well. The new or second generation drugs include tocilizumab, abatacept, and rituximab.

Abatacept is a genetically engineered drug that was recently approved by the FDA. Abatacept interferes with the direct cellular interaction that occurs in RA. Signals needed to activate the immune system’s T-cells are interrupted.

It is recommended for patients who have tried disease modifying anti-rheumatic drugs (DMARDs) without success. Abatacept is not available in pill or tablet form. It is given in monthly 30-minute intravenous infusions.

Studies done so far with this drug have shown improved symptoms and quality of life for patients with RA. X-rays also showed improved joints with fewer erosions and greater joint space. Results weren’t so good when abatacept was used with other biologic agents. Patients had more serious side effects from the drugs when combined together.

If you are an RA sufferer, ask your doctor if you qualify for any of the new drug therapies. If you aren’t getting enough relief from your symptoms with the current drugs, you may be a good candidate to try something else like abatacept.

Have you tried any of the disease modifying anti-rheumatic drugs (DMARDs)? Early treatment of rheumatoid arthritis (RA) is often with nonsteroidal antiinflammatories (NSAIDs). If symptoms of joint pain and morning stiffness are not improved, then DMARDs may help slow or inhibit this disease.

DMARD therapy is used when patients have other signs of active disease or evidence of joint damage. Methotrexate (MTX) is one of the most commonly and successfully used DMARDs. Many RA patients take more than one medicine, including analgesics, NSAIDs, DMARDs, and/or low-dose steroids. NSAIDS and steroids may help with the symptoms but they don’t protect against joint damage like DMARDs do.

In addition, treatment with a single DMARD doesn’t always work. Patients may end up taking more than one DMARD. Treatment for RA should be followed by a medical doctor or rheumatology specialist. If you aren’t getting control of your symptoms, then further evaluation and treatment changes are needed.

Researchers are looking for new, more effective drug treatments with minimal side effects. This alternative treatment is called biologic therapy. These are immune system modifiers to help prevent the destructive inflammatory cycle of RA. They work by stopping the start-up of immune cells involved in the RA cycle.

Some of these have been approved by the FDA for limited use with RA patients who have not been helped by any of the DMARDs. Again, talk with your doctor about your current situation and what options are open to you.

You are seeing first hand the breakdown of an idea called knowledge transfer. Knowledge transfer is the process of getting information about advancements in treatment to the physician. This type of information transfer isn’t always easy. Experts say it takes 12 to 16 years for a proven effective treatment to be put into clinical practice.

Many physicians still practice based on a fixed belief system rather than based on evidence from research. A recent study in Canada on the treatment of low back pain (LBP) showed that even when given proven Clinical Practice Guidelines (CPGs) for acute LBP, most doctors ignored the information and conducted “practice as usual”.

In Canada where they have nationalized medicine, doctors may not get paid if they don’t follow accepted CPGs. In the United States, this type of “policing” health care is less likely to happen. Like you, consumers have become their own patient advocate by trying to find out what treatment might work and asking about it.

Before asking your doctor about something knew you’ve heard about, try to find out as much as you can. Bring that information with you to your appointment. Even if your doctor hasn’t heard about it, reviewing the material together can help the physician see if there’s any merit to the idea for you.

Osteoporosis or thinning of the bones during pregnancy isn’t unheard of but it is unusual. Only a handful of cases have been reported. The only real risk factor that we can see is the pregnancy itself.

Even though her mother and maternal aunt don’t have this problem, it’s possible there is a genetic link. This hasn’t been studied or proven yet. It seems most likely that chemical and hormonal changes in some women during pregnancy may be the source of the problem.

Yet there’s another group of people affected most often by transient osteoporosis and that’s middle-aged men. Obviously these men are not pregnant so the hormonal and chemical changes in their body must be different from women during pregnancy. Transient osteoporosis describes a condition that goes away on its own.

Bone pain and fractures are possible with this condition. The most effective treatment remains unknown. More study is needed to help find the cause and prevent transient osteoporosis.

Osteoporosis or brittle bones is caused by decreased bone mineral density (BMD). But what causes a decline in BMD? Most commonly, decreased estrogen in middle-aged or older women after menopause. So you’re right that it affects women more often than men.

Most men who do have osteoporosis are 65 years old or older. You may have a form called regional migratory osteoporosis. ‘Regional’ tells us that it affects only certain areas of the body. In postmenopausal women, the osteoporosis is more diffuse, meaning it affects bones throughout the body.

Migratory describes a changing location of bone changes and symptoms. Ankle, foot, or knee pain occurs first followed by hip and other joint pain. The symptoms and effects of osteoporosis tend to go away in a year’s time. This type of osteoporosis is referred to as a self-limiting condition. The cause and risk factors in middle-aged men remain unknown.

Fosamax is one of several drugs in a general group of medications known as bisphosphonates. Bisphosponates are manmade or synthetic chemicals. They keep the bone destroying cells called osteoclasts from absorbing bone.

The exact steps in the bone forming pathway by which fosamax or other bisphosphonates work is unclear. In part, they inhibit a key enzyme in the osteoclasts and cause death of the osteoclast cells. Once the osteoclasts are stopped or inactivated, then less bone is destroyed leaving a positive bone balance.

Patients with total joint replacements can suffer failure of the implant when bone destruction causes loosening. Studies show that bisphosponates are absorbed by the bone mineral in areas where the bone has been drilled and reamed for a joint implant. Even though it’s a systemic drug, it appears to have local effects.

With osteoarthritis, most patients feel the best when they get up in the morning or after prolonged rest. Once they’ve been up on the joints for hours, then pain and stiffness gradually increase.

Yet studies have confirmed that moderate exercise and physical activity actually help stimulate cartilage growth and repair. It’s likely the answer is multifactorial. In part, staying hydrated with fluids on a consistent basis will help keep the joints lubricated.

In part, motion is lotion. Movement helps distribute the synovial fluid evenly throughout the joint. Good nutrition and adequate calcium and vitamin D are also needed to help strengthen the bone that is just underneath the joint.

And finally, moderate activity and exercise is usually defined as 20 to 30 minutes four to five times a week. Walking or biking (including treadmill or stationary bike) are acceptable ways to improve exercise without overdoing it. Good shoes and a good walking surface can also help.

It’s not clear yet how the body responds to addictive substances. Whether there is a biologic or inherited factor remains uncertain. Some scientists think genetics combined with environmental interaction can actually trigger a substance abuse disorder at conception.

Studies in mice suggest there may be a genetic link. Certain strains of mice seem to have a greater risk for addiction when given the same drug type and dosage. Other studies have looked at the possibility that pain (for which the drug is taken) changes the way the drug works.

There’s further evidence to suggest that pain and genetics interact to change the effects of substances like morphine. Perhaps some individuals have a greater sensitivity to opioids, and others are resistant to their effects. Much more study is needed to sort this all out and find ways to separate the mind altering from pain-relieving qualities of opioids.

The routine use of antibiotics to prevent infection after arthroscopic surgery remains a highly debated topic. The American Academy of Orthopaedic Surgeons (AAOS) has not put out an advisory statement yet. They say there’s not enough evidence for or against an antibiotic policy.

Health experts are concerned about the cost of routine or prophylactic use of antibiotics to prevent infection. They say it’s expensive and the risk of infection with arthroscopic surgery is low anyway. There’s also plenty of data to show that overuse of antibiotics has led to bacteria that are resistant to these drugs. That means when someone does get an infection, the antibiotic may not help.

There are other drugs that can be used besides penicillin. Talk to your doctor and your pharmacist. Find out what might work best for you. It is certainly possible to request ‘no prophylactic antibiotics.’ It’s likely you’ll have to sign a form to show this was your choice against your doctor’s best advice.

If you have diabetes, immune system problems, or any skin disorders, then you may want to rethink your decision. Your doctor will check you for any other risk factors that could increase your risk of infection. You wouldn’t want to go to the time, trouble, and expense of a joint replacement only to lose the implant to infection later.

Preop showering is to help prevent infection. Most surgeons, clinics, and hospitals have a detailed regimen to help patients avoid infections. One way to do this is to wash away as many of the bacteria on the skin as possible.

Avoiding local (skin or wound) infections can prevent deeper (joint) infections. Deep infection requires the use of IV antibiotics and can lead to more surgery. The patient could even lose the implant if the infection causes it to loosen up.

Hair removal by shaving can leave tiny nicks in the skin where bacteria can enter. The surgeon does remove the hair from around the surgical site. But they use clippers instead of razors to protect you.

There are many other steps taken by all involved to prevent infection. Hand washing, step-by-step sterile procedures, and the routine use of antibiotics are just a few. Patients can do their part by following a few simple instructions such as you’ve received.

As Ben Franklin once said, “An ounce of prevention is worth a pound of cure.” Hand washing, showering, and careful skin prep are small ounces of infection prevention.

Cyst refers to a pouch or sac usually under the skin. Most cysts are filled with some type of fluid either clear (serous) or blood. A synovial cyst for example is filled with synovial fluid from a nearby joint.

The cyst is lined with synovial tissue. A link or channel between the joint and the cyst allows fluid to move freely between the two structures.

A ganglion cyst may be empty but often is a knot of tissue, sometimes formed of nerve cells. There is no synovial lining and no synovial fluid inside.

Both these conditions are considered forms of arthritis because they affect the bones and involve inflammation. Both affect the spine although ankylosing spondylitis (AS) damages the entire spine from top to bottom. Rheumatoid arthritis (RA) is more likely to affect the neck (cervical spine) and smaller joints of the hands and feet.

The inflammatory process in the body is very similar. But that’s where the similarities end. The effects of the inflammation are very different from AS to RA.

In rheumatoid arthritis the lining of the joints is affected first. Then the cartilage protecting the bone starts to wear away. Next comes the top layer of bone (subchondral bone) just under the cartilage. The result is a weakened, unstable and usually painful joint.

AS causes inflammation where the muscles and tendons attach to the bone. The body tries to repair itself in these areas causing stiffness of the soft tissues and fusion of the bones. The spine becomes rigid but brittle. Patients with AS are at risk for fractures and damage to the spinal cord.

The good news for both you and your grandson is that there are new and better medical therapies for both conditions. Medication can help prevent the progression of both RA and AS.

You are noticing the difference between speed versus endurance. Muscle power generated for each type of activity differs based on muscle fiber type. There are some muscle fibers that fire just to give you the speed you need. Other muscle fibers come into play when staying power is what you want. These two muscle types are called slow and fast twitch fibers. Another name for these are Type I and Type II fibers.

Some people tend to have more of one type compared to the other. Athletes with the greatest power and speed tend to have more type II muscle fibers. These are the fast twitch fibers. There are even several types of fast twitch fibers. Some are designed to kick into high gear.

You probably have more type I fibers. They are considered “fatigue resistant”. Type I fibers are made for activities with lower intensity and longer duration. Endurance athletes seem to have more type I fibers — this is not due to training but rather from genetic factors.

A loss of function after a fall, accident, injury, or illness is very common in the older adult. They do lose their confidence. They are afraid to do their regular activities because they might fall again or something else worse might happen.

Sometimes it’s just a matter of motivating the person to try again. In other cases they really need some individual help to get back on track. It might be a good time to speak with her doctor about a plan to help her regain her strength, balance, and confidence.

Sometimes a home health nurse or physical therapist can help. These individuals have been trained to assess for problems that can be leading to her loss of balance for example. A specific program of exercise can be supervised until she gets back to her former level of activity and ability.

Education is important too. Older adults need to know that activity and exercise can prevent further loss in function. A program tailored to the specific needs of each person is best after a major change in physical level of activity.

Many independent living (IL) groups report that motivating older adults is a real challenge. Like your father, many folks have moved to IL due to a decrease in their physical function. They will often tell you they’ve “run out of gas” or are too tired to exercise. Anyone with even mild dementia is even less likely to remain active.

At the same time we know from many studies that exercise and activity help boost energy levels. Further decline can be stopped or slowed down by remaining active. There are many other benefits of activity and exercise as well.

Families can help by reminding their loved ones about these facts. They can make plans to take the IL resident on outings and include them in family activities. A recent study was done in which IL residents were given a test of function. Based on the results of the survey, a risk level was given for disability (mild, moderate, severe). Education of this type really motivated the folks to join an activity group.

Talk to the activities director at the IL. Find out what they do to help inform residents about the benefits of activity. This may be more helpful than any nagging the family can do.

There are many studies that have been done to answer this question. Age and height have to be matched as well as activity levels, weight, and size. Recently researchers used mathematical models to scale the information from such studies. This means that instead of comparing apples to oranges, they are matching apples to apples.

For example, strength studies of the arms and legs have been done in a lab in Australia. Body mass is added into the calculations. Strength is measured and compared based on body mass. They found that on average men have stronger arms than women. Leg strength appears to be about equal.

The reasons for these differences remain unknown. Future studies will focus on how muscle power is produced and why it’s different from arms to legs in males and females.

Fibromyalgia is recognized by the American College of Rheumatology as a syndrome with widespread pain and tender points. Most patients also have many other subjective symptoms. Headaches, cold hands and feet, sleep problems, and depression are just a few of the problems reported.

The cause of fibromyalgia is unknown. Researchers agree there is probably more than one system involved. The nervous system, endocrine system, and immune system all seem to be part of the process.

Biofeedback studies have shown a definite prolonged muscle contraction after the activity has been stopped. Massage may help by physical and psychologic means. A good massage tends to result in mental and physical relaxation. Increased blood flow to the area helps rid muscles of by-products of metabolism and overuse.

Massage also helps the lymphatic system. Lymph fluid is part of the immune system. It moves through the body as a result of the muscles contracting and relaxing in a pumping motion. Muscles that are constantly tight and in spasm slow down the lymph fluid. Massage can improve lymph flow and improve immune function.

Most patients with fibromyalgia must find ways to help them manage their symptoms. Massage, electrical stimulation, gentle stretching, and activity are just a few that can be used.