RAGBRAI ends today. It is one of the largest organized week-long recreational activites anywhere. Officially the (Des Moines) Register Annual Great Bicycle Ride Across Iowa, the 2015 event included 17,000 registered participants for the entire 7 days. Thousands more tag along for a day or two near their homes.
With neighbors, we hosted an extended family group of ten, including children down to age 5. The family had gathered from Charleston, SC, Pittsburgh, PA, Ames and Iowa City, IA to spend a week together. We supplied showers, beds, laundry facilities, supper and breakfast. Many other Waterloo-Cedar Falls residents supplemented the official campground at UNI.
The sheer numbers of bicyclists created local traffic havoc for hours as they snaked their way from Souix City to Davanport covering 467 miles (the shortest route ever). The towns affected got to meet interesting folks from nearly every state and several foreign countries.
We thoroughly enjoyed getting to know our guests. The families we hosted have enjoyed a full week together seeing and meeting Iowa and its people.
Read “The Blue Zones” and “Thrive” by Dan Buettner. Plan to have a Blue Zones experience of your own.
Jay Ginther, MD
Determining the correct 25-hydroxy Vitamin D level is still a work in progress. In the 8 years I have been attending meetings, we have made considerable progress. NOF 2007 was the first time any society proposed an intake above 400 IU daily and a 25-hydroxy Vit D level of more than 20 ng/ml.
At the 2015 U. Wisconsin “Bare Bones Symposium” the latest recommendations were discussed. I have summarized them here.
Take Vitamin D3. D3 is Cholecalciferol (what we make in sunshine). Vitamin D2 is Ergocalciferol (what plants make and use). D3 works much better in people than D2 becuse it is the right stuff. It lasts 5 times longer and the assay is more accurate.
Test for 25-hydroxy Vitamin D level and aim for between 40 and 80 ng/ml. At 40 ng/ml over 98% of people can absorb and utilize Calcium fully. You want to have some margin of safety since lab test results vary by at least 20%. If you are seriously deficient, we give 50,000 IU of D3 every M, W, F based on your level and size, to correct the level quickly.
If you do not want to test your level, and you are the “average person” of 154# or 70 kg, you should take 3800 IU daily. This should achieve the 40 ng/ml level – eventually. If you are very deficient, this could take a year or more. If you are larger than the old average, or you have digestive issues, you will need more.
Finally, some cancer researchers believe that 70 ng/ml is better for preventing and treating cancers. If they are right, you should go for the higher level. If they are wrong, you have done no harm by going for the higher level.
Take Control of your Bone Health. Take enough D3.
Jay Ginther, MD
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
My mother died 2 weeks after my first child was born. I never met my wife’s mother. The only Grandma my children ever knew was Grandma Mary. And the only Grandpa her grandchildren knew was my father. Every summer the merged families visited her cabin on the shore of Lake Ontario for a week or more.
Grandma Mary was nearly 100 when she died last winter. We waited for summer to gather. My generation, her grandchildren and her great-grandchildren. The memorial service was a sharing of memories of Gma Mary and our times at “the Lake”. We began and ended with a piper honoring her Scottish heritage and a parade of the great-grandchildren around and around. A huge picnic. Catching up on each others lives.
Watching the sunset over the far away Toronto skyline is a tradition. Then fireworks from surrounding locations celebrating the 4th. We added Chinese lanterns drifting north over Lake Ontario. My children and their children will never forget.
Families are Blue Zones.
Jay Ginther, MD