November 26, 2013

Prognosis Following a Fall

It is not new that falls among the elderly are dangerous and can lead to life changing disability. The statistics are frightening: 1 in 3 people over age 65 will fall each year. Fall prevention has been a huge initiative from the federal government since the 1990s. A quick rundown of their suggestions for prevention:
1) physical activity, especially exercise
2) with your doctor's assistance, reduced the number of medications your take
3) get regular vision checks and make sure stairs and hallways are well lit
4) prevent fall risks at home by removing throw rugs, installing grab bars/railings in bathrooms, hallways, and stairwells.

I participated in a fall prevention clinic when I did an internship at the VA in Birmingham, AL. It was one of the most exciting and rewarding activities during my training. Today, I work at an in-patient facility, evaluating patients every week. One of the questions we ask is, "have you fallen in the past 2 months?" and if so, "how many times." If the answer is "yes," we evaluate patients' fall risk using the Tinetti Balance Assessment tool.

Many falls among the elderly go unreported, especially if they do not result in injury. Many who fall end up in rehab with me because of a resulting hip fracture or head injury. So, what predicts a full recovery or lasting disability in the elderly following a fall incident? New York Times' Paula Span tackles this question in The New Old Age.

The answer to that question is multifactoral. From a physical therapy perspective, prior level of function plays a huge part in predicting recovery from a fall injury. The higher the function prior to an accident, the more likely we'll be able to return that patient to function. Another factor is a patient's medical conditions. If a patient is found to have a progressive or terminal illness, then their prognosis will likely decline over time. The nature of the injury plays an important role: hip fractures are more difficult to recover from than other injuries sustained from a fall.

The probability of recovering diminished with increasing disability before the fall. Among those with moderate disabilities, only a third recovered within a year. And “if you start off severely disabled, you’re not going to get that rapid or even gradual recovery.”

So, the results of this research begs a question: How will these findings impact health care policy in the context of health care reform? As health care budgets tighten, does it make sense to spend large quantities of money on the care of people whose positive outcome has diminishing returns? As health care dollars diminish, do we begin to pick and choose who is treated with aggressive rehabilitation? What would you choose if it was your mother?

Posted by linda | Permalink | Comments (View)




November 22, 2013

Discovery of New Knee Ligament

Anatomists in Belgium have reported the discovery of a new knee ligament. Actually, it's been there all along, even documented by a guy back in 1879 wrote about it, but it's so small that got buried under a pile of new anatomical discoveries until now.

It's called the anteriolateral ligament. It sits at the front of the knee toward the outside. It attaches to the femur superiorly at the lateral collateral ligament attachment and distally to the tibia lateral to Gerty's tubercle. It acts to stabilize the outer part of the knee, preventing it from collapsing inward.

And here's why it important. It reinforces the actions of the ACL - the anterior cruciate ligament. This ligament is probably most famous for the injurious tear that results from slowing down suddenly to change direction or pivot with the foot firmly planted, twisting or hyperextending the knee.

Positioned at the front of the knee, it (the ALL) would be vulnerable to tearing when an A.C.L. was injured; the same forces would move through both ligaments.

For those who have had an ACL repair and appear to be healthy but continue to experience knee instability or buckling, the ALL may be the culprit. Based upon the research of Drs. Claes and Bellemans, ALL repair may help ACL repairs restore full stability and function to the affected knee. Further research needs to be conducted to find out if this ligament can actually heal.

Posted by linda | Permalink | Comments (View)

November 18, 2013

How Posture Affects Your Brain

I don't know about you, but I grew up hearing things such as "stand up straight," meaning chest out, shoulders back. The resulting "military pose" was uncomfortable and hard to maintain. But it turns out that all those parents and teachers were on to something about the importance of posture.

I could speak volumes about the importance of balanced posture for functional mobility including the ability to lift our arms to improving standing balance, oxygenating the body and lubricating, or at least improving blood flow, to body organs. From an appearance standpoint, correcting a slouched posture can take years off of a person's appearance, magically transforming the decrepit looking elder into the vital individual they once must have been.

Now it turns out that science backs up the promotion of a balanced posture with surprising conclusions about it's impact on how we think and feel. LifeHacker discusses how posture affects opinion, mood, and even hormone production. They give tips for how to achieve better posture and emphasize that posture is a dynamic process, always changing because we are living, moving beings.

For me, I work on posture with myself and my patients every day. Too many directives for correcting posture is like exercise: too many and none of them will be followed. So I tell folks (myself included) simply lift your sternum (breast bone) toward the ceiling. This can be done when sitting or standing. It serves to activate the paraspinal muscles of the lower thoracic spine (the muscles on either side of the back bone on your lower rib cage). This serves to draw the shoulders back and aligns the head over the spine, requiring much less effort than the military pose we were taught as kids.

Give it a try. You'll see how much easier it is to breathe and you may even feel improved blood flow into your head.

Posted by linda | Permalink | Comments (View)

October 7, 2013

Chronic Kidney Disease (CKD)

As I settled into the seat next to my husband, he said, "the vet called back with the test results." Neko Case was playing that night at Radio City Music Hall and we named our first cat after her. We now have an answer as to why our cat lost 3 and 1/2 pounds in a couple of months. He has chronic kidney disease Stage 4.

Kidney disease in felines shares much in common with chronic kidney disease in human beings. Upon his diagnosis, I gave myself a crash course in kidney anatomy and physiology, lab values, and disease staging. We have more tests to conduct to try to figure out why he developed this terminal disease.

What we do know is that he tested negative for feline HIV/AIDs and feline Leukemia, both to which can result in kidney failure. He has also been cleared of a bacterial infection. Usually, cats with this condition have anemia, but he does not test positive for that yet, which may mean something else, such as kidney cancer. His next appointment with the vet will be for ultrasound. Hopefully, at that appointment, they will be able to check his blood pressure (which I am doubtful will be accurate unless they can calm him down). Hypertension in cats is another common side effect of CKD.

What we have done so far, is change our cats' diet to a renal veterinarian formula that is low in protein and phosphorus. He likes it so far, but he wants to eat the gravy and leave the meat. Also, Pepcid for nausea and prevention of mouth sores - we have seen no vomiting since we changed his food. And, subcutaneous fluids, which the vet has taught me to administer, with a needle. We've both managed that pretty well - thankfully, that is every other day for now. Also, I have found Helen Fitzsimons' website called Tanya's Comprehensive Guide to Feline Chronic Kidney Disease immeasurably helpful with the day in and day out support and details regarding the care and treatment of this condition in my cat.

It is possible that Neko's lab values will improve with treatment. BUN stands for blood urea nitrogen which measures nitrogen in the blood that is a natural by-product of protein breakdown. Creatinine is a by-product of muscle breakdown and these numbers usually appear elevated together in CKD cats (and people). What this means is that filtering capacity of the kidneys is diminished and unable to remove toxins from the blood so the animal is making diluted urine. Common symptoms include increased thirst with urine output, which, oddly, results in dehydration. Subcutaneous fluids absorb more efficiently through the tissue than drinking water, and result in improved hydration and detoxification of the body.

So far, treatments are going well and I can tell he is feeling better. I have a feeling it may be a matter of time before bribing him with food will no longer be adequate distraction from administration of subcutaneous fluids. Luckily, the whole thing takes only 5 minutes. My fear is that he will tire of the new food and we'll have to stand on our heads to get him to eat. For now, we won't invent any problems and will take one day at a time.

Posted by linda | Permalink | Comments (View)

September 12, 2013

Be Safe With Your Neti Pot

After a particularly bad allergy season this year, I bought myself a Neti Pot. A neti pot is used to irrigate the sinuses in order to clear dust a mucus out of the upper respiratory system. Proponents of this therapy swear by its effectiveness from improving breathing to preventing sinus infections.

I can't remember if I've had one before - my husband seems to think that I did and we threw it out many years ago. My early attempts at using a neti pot proved a failure. I remember two things. One, it was painful. And, two, like a turkey in the rain, I thought I was drowning. Clearly I wasn't doing something right, but onto the shelf it went where it collected dust and generally went to waste.

This year, however, after 2 weeks of sore throat and not being able to smell or taste anything, I decided to revisit the neti pot. I read the directions carefully, I was able to successfully irrigate my sinuses. And my sense of smell came back for about 15 minutes followed by a 25% improvement in overall ability to smell for the rest of the day. Same thing the next day with a continued increase in the ability to taste my food by 10%.

Then I woke up with a sore and swollen throat and inflamed lymph nodes. I went to the walk-in clinic and told them my history and the use of the neti pot. And here's where the safety warning comes from. It's not a lecture about keeping your neti pot clean - the internet is rife with recommendations that are adequate, from running it through your dishwasher to dipping it in boiling water to sanitize it. That's a no-brainer.

The MD was adamant about the irrigation solution. Use commercially sold saline solution designed for use in the neti pot. Or, if you're economical like I am and want to make your own solution (1/4 tsp of both sea salt and baking soda), use distilled water only. DO NOT USE TAP WATER. Even if you boil tap water or filtered tap water, there may still be organisms in the water that you don't want in your sinuses.

Take home message: Don't mess around - the sinuses are too close to the brain to take a risk of introducing a pathogen to delicate sinus tissue.

Posted by linda | Permalink | Comments (View)

July 14, 2013

Shortening Your Exercise Program?

I have been reading multiple articles in the past few months that have been analyzing data about just how much exercise we really need in order to stay fit. The consensus is that exercise should occur approximately 3 times a week - more does not incur greatly increased benefits and too much may actually become detrimental.

On a daily level, the American College of Sports medicine recommends, at a minimum, 20 to 30 minutes of moderate intensity exercise - and you can break that into three 10 minute increments throughout the day. That means 60-80% of maximal heart rates based upon your age (220 - your age x .70) or exercising just on the edge of being able to carry on a conversation (or if you're alone, sing along to your workout music).

But, people are busy and life's priorities crowd out the best intentions (at least, that's the most common reason people give for not exercising regularly). So the new trend is to crystallize the day's workout into shorter workouts. The most popular so far is scientifically formulated 7 minute routine of high intensity exercise training which requires no specialized equipment and exercises all areas of the body.

Here's the problem that I have with many of these ideas. Not everybody can do these exercise programs. Depending upon health status, prior injuries, age, lifestyle, and goals, an exercise routine really needs to be customized to the individual. This is why visiting your doctor first is so important: they can gauge your readiness for exercise. Athletic trainers are also a good resource for establishing an exercise program or tweaking an existing program that has gone stale.

Be aware that moderate intensity is different for everyone. A middle-aged, overweight, sedentary person may be exercising at moderate intensity climbing a flight of stairs while another may be fit enough to jog 2 miles. Exercising with a buddy is a great motivator if you both are well matched fitness-wise. In other words, don't let anyone else push you so hard that you feel injured or don't enjoy yourself, or else you'll never stick with the program.

The most important take-away message is to MOVE.

Posted by linda | Permalink | Comments (View)

June 27, 2013

Combatting "Over-Fatness" - Confounding Factors

In a prior post, I reveal that I have managed to eke my way into the "over-fatness" category of body composition. I have decided it is time to become serious about reforming some of my less healthy consumption and activity habits. By being more conscious about my food choices and breaking out those free weights, I'm hoping to increase my lean muscle mass.

However, there have been some things that have impeded my progress. But first, let's talk about my successes. First, I've shaved off 7 pounds. Second, my body fat percentage has dipped just enough to get me back into the "average" range at 30.2%. My pants are beginning to close easier.

But, you may think, if I've become serious about shifting my body mass content, why is it taking so long?

First, weight management is greatly helped if the entire household is on the same program. We have been eating more salads, but temptations such as doughnuts and ice cream still enter the house. I'm human, I deserve a treat every once in a while.

Second, I had a slight accident. I strained my shoulder at work when I was transferring a frightened patient to a wheelchair. She was not in a state of mind to follow my verbal cues for hand placement and, instead, grabbed my shoulder. The muscles of my entire right upper quadrant were strained and I needed to rest it before continuing my weight training program. Strengthening from an injury requires that I start back at square one, going through the motions of exercise before adding resistance.

Third, I visited my Mom. Something about taking a mini-vacation, back in the care of my mother, where food is readily available and encouraged at all times, made me want to eat. And my activity level plummeted in the car-centric lifestyle of the suburbs that is so different from my daily walks in the city. A week after I got home, where the trend apparently continued, I found I had gained all but one pound back. With those pounds came the increase in body fat percentage.

Now I'm back at the beginning.
And so, the work begins again

Posted by linda | Permalink | Comments (View)

May 27, 2013

Combatting "Over-Fatness" with Activity

In a prior post, I reveal that I have managed to eke my way into the "over-fatness" category of body composition. I have decided it is time to become serious about reforming some of my less healthy consumption and activity habits. By being more conscious about my food choices and breaking out those free weights, I'm hoping to increase my lean muscle mass.

All of this started back at Christmas when my husband gave me a FitBit activity tracker. He later acquired one for himself, along with the companion Aria scale. We've begun a friendly competition, comparing walking distance and stair climbing every evening. I average approximately 5 miles of walking a day, but unfortunately, this is not enough to actually burn the excess adipose tissue which the Aria reveals has taken over my body.

What the Fitbit has encouraged is for me to take more stairs while I'm at work. At home, I'll bring the garbage and recycling down from our 3rd floor walk-up apartment to curb separately. David will take the dog on longer walks, partly to up his mileage count, but also to help rehabilitate her from a recent knee surgery.

I also began performing squats and lunges at home, and some yoga. Unfortunately, using the carpet sweeper on the living room rug to clear away the animal hair does not burn as many calories as I would hope. The free weights remain in the box under the bedroom chair and soup cans suffice for now for upper body exercise. While my 2lb weight loss remains steady, my body fat percentage has not budged one tenth of a percent; not one. This is going to be harder than I expected.

I'm uniquely positioned at work to exercise. I'm a physical therapist. I've recently been transferred to work in our rehab gym. Unfortunately most of our exercise equipment is designed for very low functioning patients. There is not treadmill or exercise bicycle; our gym weights go up to only 10 pounds and we use them as counter weights to prevent equipment from shifting during use.

Then I was assigned a patient who had sustained a stroke. He was fairly young, fit, and "high-functioning." His problems dealt primarily with balance and his ability to talk and problem-solve rather than strength. I worked with him for full week, racking my brain to increase the physical challenge for him. Every day we walked and increased the number of stairs we climbed by a flight a day until we hit the ground floor of the hospital: 8 flights, 18 steps per flight (typical is 13 steps).

Finally, I saw the body fat percentage on the Aria shift three tenths of point.

Posted by linda | Permalink | Comments (View)

April 30, 2013

Combatting "Over-Fatness" with Food Choices

In my prior post, I reveal that I have managed to eke my way into the "over-fatness" category of body composition, despite having an average BMI. I have decided it is time to become serious about reforming some of my less healthy consumption and activity habits. By being more conscious about my food choices and breaking out those free weights, I'm hoping to increase my lean muscle mass.

I've been calorie counting and trimming back on the number of indulgences for about two weeks, and I've lost 2 pounds - my body fat composition has not budged a bit. Here's what I have learned (and already known for years):

1) alcohol: nothing but empty calories: 130-180 calories per 12 oz bottle - no need to eliminate a treat from my diet, just cut back to one or two a week. Craft beers, which are my preference, dark beers, and high alcohol beers pack more calories.

2) sweets: choose wisely - go for quality not quantity. Be critical about what choose to indulge in. You want this treat to really count, so be picky about what you choose. For me, two dark chocolate Dove Bites really do the trick: 42 calories each.

3) starches: convert white processed breads and rice to brown. I like the nutty taste of brown basmati rice which is actually found to have better nutritional content than white basmati rice.

4) portion control: this is a basic tenet of Weight Watchers. Surprise, surprise - if left to my own devices, I tend to put a cup of that basmati rice on my plate. This is technically not an incorrect amount of rice in a meal, but if your tracking your food by serving, that's 2 servings of grain which should increase the percentage of "forgiveness" foods (vegetables) you should be putting on your plate.

5) breakfast: I need protein for breakfast or I won't last the morning without a metabolic meltdown by 10:00 am. The worst thing I could consume in the morning would be a plate full of pancakes or waffles - I'd be better off without breakfast at all. A peanut butter sandwich only lasts until 11:00 am. So, I switched to an egg sandwich, about 340 calories, when made with olive oil. Cutting back to one egg instead of two, saves an additional 70 calories, and I can still last until lunchtime.

6) water: if possible, swap out as many portions of fluid out for water. Hate water? Squeeze some lemon juice or a jigger of fruit juice to make it more palatable. Need to get off of soda? Try seltzer water with a jigger of juice. Better yet, let a regular soda go flat, then try to drink it - that stuff is disgusting. Also, a new study shows that consumption of just one soda per day ups your risk for acquiring type 2 diabetes by 20%. Often, our body will send a signal of hunger when, in fact, we're thirsty. Try drinking fluid first, especially if you feel tired or have a mid-afternoon craving, to see if the signal is truly hunger or really thirst.

7) dairy: for me, there is something unique about dairy products that helps me feel healthier. Go low fat (1% milk); vitamin D, essential for bone metabolism, is a fat soluble vitamin that requires some of the fat present in dairy products for absorption into the gut. Lactose intolerant? Go for fermented dairy: yogurt or kefir - I'm on a Kefir kick right now because of the probiotics it provides for healthy gut flora.

Ultimately, when talking about weight loss, the rule still remains: less calories in, more calories out.

Posted by linda | Permalink | Comments (View)

April 25, 2013

Over-Fatness

It's been creeping up for years - middle-age spread has finally struck. The scale may not have moved, but clothes my clothes do not fit right. My clothing binds, once fitting pants have gotten too short, size "long" fits better than size "regular". An occasional indulgence became a daily habit, and the slippery slide into middle age spread has caught me in free fall.

Since the beginning of the year, I've been tracking my activity, mostly walking, since I got the Fitbit for Christmas. I average about 5 miles of walking every days. My husband saw how much I was enjoying my Fitbit, so he decided to get one for himself, and got the Aria scale that you can order along with it. The Aria uses bioelectrical impedance to calculate body fat percentage when combine with weight, height, and age data.

Since its arrival, I've been plunged into a world of body composition calculations, base metabolic rate analysis, calorie counting, and classic transference. A "quick and dirty" measure of body fat percentage can be calculated with BMI and waist circumference to determine the following categories: underweight, ideal, average, and obese. BMI calculators, the traditional method for calculating ideal weight, only factors in height and weight to give a gross estimate of where we are compared to a large population of people. Where this scale breaks down is at the level of the individual. It does not factor in bone density, lean body mass, percentage of body fat, nor fitness.

For example, a shorter than average man or one who body builds may show up as "over weight," even obese, according to the BMI scale. I, having occupied the underweight region most of my adult life, now fall within the average section of the BMI scale. I hate that "blankety-blank" scale. My husband finds the transference hilarious. What the Aria has revealed is what I have known for some time.

I have "over-fatness," a term I learned in PT school, to describe body composition that is beyond the norm in adipose tissue. Our food odyssey through NYC in search of the best doughnut/gelato/bakery along with my advancing age, has changed my body composition. Unfortunately, the 5 miles of walking I accomplish every day is not the sustained activity I need to burn fat. It's time to get serious about diet and exercise before I reach an age where accomplishing fitness becomes difficult. In subsequent posts I will share what I have learned, what is working, what is not.

Posted by linda | Permalink | Comments (View)

April 20, 2013

Mindfulness is a Route Toward Happiness

I discovered a website designed to help people change their thought processes. It's called Purpose Fairy.

Mindfulness is a means toward living in the moment. Staying in the moment helps prevent regretful thoughts about our past and worrying about the future. These may sound like inspirational jargon, but reading this blog, I could actually feel my mind relaxing.

Posted by linda | Permalink | Comments (View)

April 4, 2013

Getting Older People to Adopt Exercise

It was the picture with this article that caught my attention and cracked me up. Not only is it the angle, where these people are all legs, but it's the fact that they look exhausted - I feel this way at the end of my work day.

I spend the majority of my work day coaxing older people to exercise. It's not easy. Often, we are working with people who are ill, in pain, unmotivated, or pushing against cultural biases about physical activity. Many people believe that if they feel weak and tired that if you exercise before you walk, you will not have the energy or stamina for walking - this is actually not true. Many people believe that exercise means exercising to exhaustion.

With those beliefs, no wonder so many avoid it. They associate it with pain, exhaustion, inconvenience, sweat, and a host of other things to be avoided. In reality, exercise is anything you do to keep your body moving, and this is the point I try to get across to my patients.

Once we have blasted through the belief system that exercise is difficult to accomplish, it is necessary to establish activity as a habit. That requires a cue, followed by an action, which should result in some sort of reward. When I say reward, I do not mean a pint of Ben and Jerry's ice cream, I mean a sense of accomplishment, and X on a calendar, or the body's natural endorphins. The cue can be a pair of tennis shoes by the door, or exercise pants on the dresser, or that calendar with Xs marking the days you worked out. The action, of course, is the exercise.

Next is working that new habit into a lifestyle change that is sustainable. When I talk to my mother about exercise, she considers a walk around the supermarket with a grocery cart a work out. *sigh* Okay, she is right, that is activity; it's not sustained activity that builds endurance, but it is something. She been talking about moving her computer downstairs into a spare bedroom - but I've continued to discourage that, because the stairs are a great form of exercise, so long as she is safe on them. Housework - that counts. And when you begin to add up all the little things that can be done in a day, it get easier to add in more to increase activity levels.

The good news is that the body is amazing resilient and malleable even into old age. For the elderly, especially, stillness=weakness, decreased quality of life, and ultimately decreased longevity. A body well used will pay back its occupant by remaining strong enough to be active. Staying active reduces social isolation and depression thereby sustains quality of life for the aged.

Posted by linda | Permalink | Comments (View)

Google
  Web massage.largeheartedboy.com


1 |  older