Archive for the ‘Fracture’ Category
Spring is here. The birds are singing. Soon flowers will be blooming. All the world is coming to life. And more hips will be breaking.
32% of all hip fractures (nearly 1/3) occur in Spring! Nearly 1/3 of hip fractures over 70 are in men. And nearly 1/3 of those men die within months from medical complications initiated by their hip fractures. Dangerous!
What can we do to avoid those fractures? Decrease Fracture Risk! How? Do the following:
It is March; this is Iowa; almost 90% of persons not on major doses of Vitamin D3 are low. (By late September that falls to less than 60% that are low.) Remember that if you have a low Vitamin D level, you cannot absorb enough of the Calcium you consume in food and/or supplements. Take extra Vitamin D3.
Remember that while Calcium Citrate is always absorbable, Calcium Carbonate often is not. Remember that you need enough Magnesium to absorb Calcium. A Senior Multiple Vitamins & Minerals has enough Magnesium for those of us over age 50, and lots of other good stuff too.
Protein is a big deal, especially over age 60, when our protein needs actually increase. 80% of bone and 90% of muscle are protein. Regular exercises, including Balance Exercises, are necessary to Prevent Falls.
Take Control Naturally with proper nutrition and exercises.
Jay Ginther, MD
Falls are the immediate cause of most “wrist”, shoulder and ankle fractures, and of many Hip fractures. Two or more falls in a year indicate a need for more than basic balance and strength training. You need to analyze why you fell. Then work to avoid repetition. Formal Physical Therapy, teaching exercises to do at home, is best.
Major Fall Risk Factors: loose rugs and minor step-ups into a room; the scuffing gait needed for slippers, sandals or clogs; poor vision and bifocals; bending to pick something off the floor without hanging on to support; not using chair arms; slow gait; and not using a cane or walker on uneven surfaces (out-of-doors). If you have any of these, work to eliminate them.
Walking for exercise does NOT reduce falls. Even walking over a mile daily. Balance and strength training DO reduce falls. The simplest to do at home is to stand on one leg. The goal is 30 seconds. Many of us need to hang on to something solid at first and gradually work up to “no hands”. PT will teach additional exercises as you improve.
Lifestyle Integrative Functional Exercises! Look at all daily activites, then modify your lifestyle to avoid Fall Opportunities. Avoiding Falls is just as important as taking osteoporosis medications for Avoiding Fractures.
Take Control Naturally. Avoid Falls. Avoid Fractures.
Jay Ginther, MD
Fractures get no respect. 20% of women and over 30% of men over 65 die within 6 months of a Hip Fracture. But nobody is worried about hip fractures!
Hip Fracture is never mentioned on the death certificate. The complications of the hip fracture get all the credit. Pneumonia, pulmonary embolis (blood clots), worsening heart failure, kidney failure or even septicemia (infection in the blood stream) from bed sores might make the list, but not the initial event, the hip fracture.
Nearly 80% of Vertebral Fractures are mistaken for pulled muscles or arthritis in the back. Yet vertebral collapse fractures are a strong indicator of death within the year in men and women. Again, pneumonia, heart failure, respiratory failure (shortness of breath), malnutrition from inability to eat enough get the blame. The vertebral fractures and resulting kyphosis (humpback) never get credit for the misery and death they cause.
More women die each year from complications of fractures than from breast cancer or stroke or heart attack. Nobody seems to care, because the fracture itself is never blamed for the complications it causes.
If we identified the original fracture starting the rapid decline, we would be more concerned with bone health and fracture risk. As it is we ignore fracture risk at our peril, especially as we get older like me (60’s).
Respect Fracture Risk. Take Control of your future.
Jay Ginther, MD
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