Archive for December, 2014
Usually we operate on a Hip Fracture. We do that in order to: preserve Independent Living; or preserve independent ambulation in Assisted Living; or preserve assisted ambulation in a Care Facility; and always to preserve quality of life. But what if none of those goals are possible?
At the St Paul Geriatric Fracture Conference this month, it was proposed that alternative care to surgery is sometimes more humane and less costly to society – both laudable goals. The ideal care for a patient with a fractured hip is to thoroughly discuss all alternatives before proceeding to surgery.
Family and other caregivers should all join the patient for a relaxed discussion of the future, weighing quality of life issues radically changed by the usual loss of function / independence imposed by the fracture. Only after concensus is reached, should surgery proceed – if that is the chosen path.
Unfortunately, the clock is ticking. The likelihood of death, medical complications of the fracture, medical complications of surgery, and permanent disabilities begin to increase only 12 hours after fracture. Gathering all interested parties and making informed life-changing decisions within that time limit is very challenging.
Ideally the patient, family, care-givers and primary physician have discussed the possibility of fracture and come to tentative decisions about what sorts of care are desired. This is especially true for patients who already cannot ambulate, are becoming demented, or have a limited quality of life.
Involve the patient in the decision while he/she can still express his/her desires. Written Advanced Directives are ideally on file with physician and hospital. Allow the patient to Take Control of his/her Future.
My wife and I have discussed our desires with our children. We have advanced directives on file. You should too.
Jay Ginther, MD
Christmas with your grandkids is a blue zone. So are all family gatherings regardless of season. We spent the Christmas holiday with extended family.
Read “The Blue Zones” by Dan Buettner.
Savor the good times.
Jay Ginther, MD
Today we are just over 100 days away from the next Natural Vitamin D3 from the sun in Iowa.
Today, Sunday the 21st of December is the Winter Solstace of 2014 in North America. The sun is the lowest on the horizon. That means sunlight today has to travel through the greatest amount of earth’s atmosphere to get to us.
Today, the earth’s atmosphere completely protects us from Sunburn and Skin Cancer by blocking the sun’s UV rays. This is good.
Today, the earth’s atmosphere completely protects us from Vitamin D3 by blocking the sun’s UV rays. This is not so good.
Our next Natural Vitamin D opportunity will come at mid-day (a little after 1 PM in Waterloo, Iowa) in early April. Until then you need to get your Vitamin D from foods or supplements. Vitamin D3 tablets, capsules, gel caps or drops all can work. So can tablespoons of Cod Liver Oil or several pounds of Mushrooms daily.
Test for your 25-hydroxy Vitamin D level to determine if you are getting enough. Almost everyone is too low at 20 ng/ml and almost everyone has enough above 40 ng/ml. I aim for between 40 and 80 for optimal bone health for myself and for my patients.
It is Winter. Do you know where your Vitamin D is coming from?
Take Control of your health by finding out.
Jay Ginther, MD
“Why did I Fracture?” and “Why do I have Osteoporosis?” are common questions I hear from older women and men. They are taking Calcium and Vitamin D3, eating a diet with Protein, Fruits and Vegetables, and Exercising regularly. They are “doing everything right”, and still they have deteriorating bones. What is wrong?
The simple answer is “Birthday Disease” – too many birthdays. Increased Fracture Risk (Clinical Osteoporosis) is totally natural as we age. Women after Menopause, and men after age 70, lose 1-2% of their Bone Mineral Density (BMD), and more of their Bone Strength, every year.
When I was in Medical School, 40 years ago, that was the end of the story. Many older women (and some older men) became kyphotic (stooped over), fractured and fell, and either died or went to a nursing home for the rest of their lives. Then, there was nothing we could do to stop it. Today we can often prevent osteoporosis, fractures and misery.