FAQ Category: General

Good question. Research often begins with animals in a controlled setting under strict guidelines. A review committee or ethics board must approve the study first. Guidelines for the care and treatment of lab animals are followed.

The metabolic rate and life cycle of each animal is compared to humans. For example, when it comes to tissue healing, a week in the life of a rat is equal to about a month in a human. This gives scientists an idea how long healing might take place in a human after each intervention based on the results in rats.

Study results on animals help scientists decide if similar studies should be done on humans. Sometimes the outcome of animal studies clearly shows that human studies aren’t needed. In other cases, a small number of humans may be tested. If more study is needed, then clinical trials are started in humans. This step is needed before allowing a drug or other treatment to be used on the general human population.

It sounds like you have a doctor who is up to date on some of the latest findings. Celebrex is a newer antiinflammatory called COX-2 inhibitors. These drugs reduce
inflammation without causing bleeding ulcers.

A recent study from Sweden did report delayed tendon healing when a similar drug was used after surgery. The study was done on rats and the drug was Dynastat, the first injectable
COX-2 inhibitor. Dynastat is in the same family as Vioxx, but not exactly the same. As a result of their findings, the researchers advised avoiding COX-2 inhibitors in the early days after tendon injury.

You may be without your Celebrex for a week to 10 days. After that time, COX-2 inhibitors are known to improve healing time. Their ability to reduce inflammation helps increase
the tissue remodeling process that occurs later in the healing phase.

Each third party payer makes its own rules and guidelines about payment for services. The same is true for what is considered medically needed or unnecessary. In the case of ultrasound treatment for bone fractures, the following is a list of when some companies will cover this treatment method:

The exact way ultrasound helps speed up bone healing isn’t clear yet. It could be improved blood flow or the way bone responds to mechanical stimulation. Maybe ultrasound changes the genes and the body responds with faster healing, or maybe the tissue starts remodeling faster. No one knows for sure.

Studies have been done on patients with fresh bone injuries using pulsed, low-intensity, ultrasound. A tiny, battery-operated ultrasonic healing device can be placed on the skin
over a fracture. Low-intensity ultrasound is pulsed directly to the fracture site. Daily twenty-minute home therapy continues until the fracture is healed.

Many fractures occur in older adults who could benefit from this treatment. However, Medicare and private insurance companies won’t approve the use of this treatment. More studies are needed to prove it works and show how it works.

The two main core muscles are the transversus abdominis musdcle and the multifidus muscle (a deep back muscle). It’s thought that these muscles work together to help stabilize the
spine. Improving core muscle strength is designed to improve athletic performance and prevent injury.

There are many ideas about how to strengthen the core muscles. One type of exercise called Pilates (named after Joseph Pilates in the early 1920s) is very popular. Pilates exercise can be done as a floor exercise without any equipment, but more often uses a device called a transformer to help condition muscles and improve core
strength.

The medicine ball toss (a weighted ball) is also used by many people. You can toss and catch the ball alone or toss it back and forth with a partner while sitting or standing side by side. There are many ways to use the ball whether working alone or together.

Even though core training or strengthening is widely used, there isn’t a lot of data to show how or when it works best. Research is needed to help identify the best exercise
strategy. Scientists are working on finding out what’s “normal” core strength in everyday people of all ages compared to athletes. Studies comparing uninjured versus injured
players is another area of interest.

Osteoarthritis (OA) occurs with increasing frequency as people age. About 10 percent of all adults have some knee OA by age 55. Most people have some arthritis by the time they turn 65. Studies show X-ray changes associated with OA occur in 80 percent of all people by age 75.

OA is the most common disease affecting joints in the world. About 21 million Americans have been diagnosed with OA. This number is expected to increase even more over the next 10 to 15 years.

Your chances of having symptoms from OA will increase as you age. However, there are a small number of people who never suffer from this disease. You may be one of them!

You may not need to. A two-handed backhand increases the strength of rotation in your trunk. This gives you greater strength for the stroke while protecting your back during the swing.

A recent study of 109 elite tennis players included 55 females. In that group, less than 3 percent used a one-handed backhand. Trunk strength measured from side to side and between men and women showed women have greater trunk strength and muscle endurance using this method.

Experts say there are some advantages to the two-handed backhand. It gives the player a shorter backswing. This gives a quick and powerful return of the serve. It’s also a good shot when the ball comes close into your body.

Many of today’s players actually prefer a two-handed stroke. It’s to your advantage if you can control the power with accuracy.

What makes up “normal” aging still remains, in large part, a mystery. Research is ongoing to find out what’s normal and expected and what is the result of our sedentary lifestyle. Getting older is strongly linked with loss of mobility and decline in function.

Studies show people between the ages of 65 and 75 start to need more help with daily activities. Almost half of all adults age 85 and older need help with household chores and self-care.

Aging can’t be changed but the level of activity can be reversed in most people. Regular exercise and physical activity increases muscle strength, balance, and endurance.

A recent study from the Netherlands showed the positive effects of a task-oriented exercise program. Instead of using weights (dumbbells) for resistance training while standing in place, the women in the study carried heavy baskets and objects up and down stairs and through an obstacle course. Improved daily function was one positive outcome from the exercise program.

Have your mother examined by her primary care doctor. If she checks out okay, suggest she get back to a program of regular exercise. Most adults stick with an exercise program if they join a group, either at a health club or senior center.

This would be a good question to pose to her doctor. He or she can look at her lab values and tell you what level of activity and exercise she should be able to do safely. If everything is normal, then activity is probably a good thing. Studies clearly show the benefits of exercise and movement at all ages.

At age 77, a hospitalization or disabling condition can really set a person back. A loss of function can mean less independence. Most people see this as a decrease in the quality of their lives.

A recent study of healthy older women showed there is promise that a functional exercise program like your mother is doing can help prevent loss of strength in the legs. If your mother’s daily activities involve going up and down stairs, then keeping up her leg strength by doing those activities is important.

She should be told to let her doctor know if she’s having any shortness of breath, chest pain, or dizziness during activity or at rest. Unusual fatigue is also a warning symptom to report. If the doctor says she is safe to engage in activity at her level of tolerance then she can increase her activity as she is able.

At one time the word race was used to put people in a biologic category. When the DNA code was finally deciphered, scientists realized humans are all the same bilogically. Cracking the DNA code and seeing that all humans are 99.99 percent the same is called the genome project.

As a result of the genome project, the term “race” to describe differences in people could no longer be used. Race is used today to put people in social and political groups. It’s actually used in medical and scientific research to profile groups of people. This helps us find out who is at risk for what diseases and why.

Ethnicity looks at where we live and where we grew up, in other words, our geographical origins. Ethnicity also views how we eat, our customs, our traditions, and our habits.

Good question. Statistics are gathered from 23 different countries that make up the group we call Hispanic. This means there is a lot of diversity among Hispanic Americans.

The United States Government uses Hispanic to describe anyone who speaks Spanish as his or her first language or native tongue. This includes Americans from Latin America. It also includes Spanish-speaking people from other parts of the world. Latino is the
name preferred by people of Latin American descent living in the United States.

People of Latin or Spanish origins don’t all agree on the use of these terms. Some people want to keep their heritage by identifying themselves separately. Others feel the term Hispanic includes everyone no matter what their religion, color, or national origin.

In general, the combined groups living in the US are the fastest growing ethnic group in the United States. The 2000 Census predicts by the year 2050 Hispanics will make up 25 percent of our population. They currently are at 12.5 percent.

The term ‘cyst’ refers to any sac that contains fluid or a semisolid material of some kind. Cysts usually occur in soft tissues like the ovaries, bladder, skin, or digestive tract. There can be cysts in the knee and shoulder, too.

Cysts can occur in bone just under the layer of cartilage that attaches to the bone. These are called subchondral bone cysts. A subchondral bone cyst in the hip socket is an acetabular cyst. Acetabulum is another word for the socket or cup-shaped part of the hip joint.

Doctors aren’t exactly sure what causes acetabular cysts. One idea is that thinning of the layer of cartilage occurs with aging. Then tiny cracks form in the cartilage leading to the development of cysts. This theory suggests the cysts are brought on by mechanical stress.

Another idea is that a labral tear occurs forcing fluid into the acetabulum through the tear. The labrum is a rim of cartelage around the acetabulum that helps hold the head of the femur (thighbone) in the socket. Once synovial fluid enter the acetabulum, a bone cysts forms.

There’s no known link between ovarian cysts and acetabular cysts. It’s may be just a coincidence that you have two different kinds of cysts in your body.

Synovial chondromatosis is a rare condition, especially in someone so young. Most patients affected are in their 40s and older. It is also known as articular chondrosis and synovial chondrosis.

The main area affected is the synovium, a lining around the joint that holds the joint fluid inside the joint. The knee is affected most often, but the hip, shoulder, and elbow can also be involved.

On X-ray or CT scan there are grape-like clusters of cartilage that are loose and free to move about inside the joint. There may be just a few fragments, but sometimes there can be 100s.

Treatment is usually needed to remove the tissue, but the problem can come back. If they aren’t taken out, these loose bodies can cause damage to the joint.

Anti-coagulants such as aspirin or warfarin (Coumadin) thin the blood by keeping the platelets from clumping together to form a clot. These drugs usually have a short-acting effect.

For example, in the case of heparin used during surgery, this drug has a very short life. It is eliminated from the body in 30 or 40 minutes. The risk of bleeding is very minimal. The effects of other anti-inflammatory drugs last less than 24 hours.

A single dose of aspirin can suppress normal platelet clumping for 48 hours up to one week. It’s not until new platelets form and are released that full clotting can occur again. That’s why doctors tell patients to stop taking aspirin before any surgery. You wouldn’t bleed to death but you might bruise easily. The wound might ooze and fail to heal properly.

It’s true there are extra costs with the new minimally invasive surgery (MIS). But MIS doesn’t just reduce the size of the skin incision. It also decreases the physical trauma to the patient.

Studies to date show MIS has a better outcome. There’s less bleeding and less damage to the soft tissues. In the case of using MIS for spinal surgeries, muscles don’t have to be cut and stripped out of the way. Some studies show they use fewer pain relievers.

All these factors means a faster recovery time. Money is saved for many patients if they
can return to normal function sooner. They miss fewer days at work or school.

With shorter operating times, hospitals are able to use the equipment and operating room for more patients. This spreads the cost of the equipment out and should ultimately reduce the cost for everyone.

Patient satisfaction is often difficult to measure. Your dilemma is one example why. These types of surveys are quick and easy. But they don’t give the therapist information about why a person is (or isn’t) happy with the care or service.

Finding the right survey to use can be a challenge. For example the results of some questions may point to a lack of parking and poor location as sources of patient dissatisfaction. This could result in a clinic relocating when the real problem was not enough time with the therapist.

Studies show there are many aspects of patient satisfaction. The two most common factors
are the patient-therapist relationship and the environment. The first includes things like therapist competence, personality, and communication style.

Location and accessibility of services and continuity of care are environmental factors. Cost and payment issues and the clinic itself (cleanliness, noise, equipment) add to or detract from patient satisfaction.

our best bet is to fill out the survey as best as you can. Then write a note with some specifics you think might help the clinic improve. Be sure and tell them what you do like as well as what can be improved.

You raise a good question. We all need to be more careful evaluating reports of this type. Patient satisfaction is usually measured by asking the patient various questions. It could be as simple as the question, “Overall, how satisfied are you with your care?” Or it can be a long survey with many questions about a lot of factors.

Most people won’t take the time to fill out a long survey. The best way to really find out what patients think is a simple, easy series of questions. It should measure both internal and external factors. Internal measures ask about the patient’s experience with the clinician. Did the doctor, nurse, or therapist answer your questions? Did the clinician treat you with respect? Was the treatment explained thoroughly?

External factors look at the clinic itself (location, noise, cleanliness). The cost of care is another external measure. Even a patient’s interaction with the receptionist or billing agent can influence how satisfied he or she may have been. These kinds of things don’t have any direct bearing on how well the treatment worked for the patient.

There are two answers to this question. The first has to do with results from studies in
the area of social sciences. Researchers have found that patient satisfaction and
perceived quality of life are valid measures of treatment outcome.

For example, a chronic back pain patient may not have less pain after treatment. But treatment can be deemed “successful” if he or she can cope or function better. The patient who is happier or more contented despite the pain and disability has fewer health
problems. This can mean lower health care costs too.

Along a different line of thinking, healthcare is becoming more competitive. Most places have more than the “town doctor.” Patients have many choices as to who is the provider of their healthcare services. A satisfied customer will come back for care in the future. Patient satisfaction translates into dollars. It’s a matter of economics in today’s medical settings.

Falls are, in fact, a cause of death in 10,000 people 65 years and older in the United States every year. Falls also account for 87 percent of all fractures in this same age group.

There is much that can be done to change this. The first step is to identify risk factors. Reducing those risk factors comes next. Poor vision, poor lighting, household clutter, painful joints, and muscle weakness are just a few risk factors. Poor health, fatigue, and some medications are additional risk factors.

Some things can be done right away to help. Others take more time. For example, remove any barriers to freedom of movement. This might include piles of magazines and newspapers. Throw rugs in doorways can easily trip the person who can’t lift a painful, arthritic limb. Make sure there are nightlights for dark hallways and the bathroom.

n exercise program to stay fit is essential. Strength and balance are keys to avoiding falls. The right exercise program can help a person recover quickly when caught off balance.

inally, make sure there isn’t a medical problem causing these falls. Dizziness leading to falls can occur from sudden changes in blood pressure or dehydration. Falling can be the first sign of neurologic problems.

It’s not clear what circumstances surround your husband’s use of the LBPP chamber. Is he part of a study held by doctors? Will he be evaluated before, during, and after using this device?

The LBPP chamber was designed for use with astronauts in weightless conditions. It takes
the workload off the lower half of the body. Under this kind of exercise, the heart rate
goes down. The result is less demand or workload on the heart.

The pressure around the legs inside the chamber helps the blood flow back to the heart.
This also reduces stress on the heart. This type of exercise unit could actually be a
very good device for older adults who are severely deconditioned or who have heart
disease.