Preventing Falls And Fractures

With the Snowpocalypse on its way this weekend I’ve been thinking about the rash of injuries that result from snow and ice every winter. Wrist fractures, back injuries, and the dreaded hip fracture happen when older adults slip and fall on snow and ice. What are some ways we have of preventing falls?

It’s obvious that preventing falls is much better than treating injuries when they happen. About 20% of hip fracture patients won’t leave the nursing home afterwards. Prevention strategies can be broadly divided into two categories: environmental measures and personal factors.

Environmental Measures

What can we do to make the environment safer and prevent falls? Snow removal and preventing the formation of ice (where possible) are obvious steps to take. Less obvious are installing railings on stairs, improving lighting, and placing awnings to prevent accumulation of snow and ice on landings and access points.

Personal Factors

Let’s face it, we live in northern Ohio. Snow and ice happen for about half the year. We can’t avoid it altogether and we can’t remove it all. So improving each person’s ability to avoid falls and avoid injury if they DO fall is critically important.

If you’re faced with ice and more snow than you’re comfortable with, stay home if possible. If you must go out, keeping one hand on something stable like a railing is smart when navigating stairs or other risky places. Using a cane if you have one can help.

Exercise, particularly Tai Chi, has been shown to reduce the risk of falls in senior adults. Better body awareness, better muscle strength and tone, and better balance are some of the benefits offered by regular exercise and Tai Chi in particular.

For the more adventurous, martial arts like jiu jitsu teach the student how to fall safely and reduce the risk of injuries in a fall. I myself have avoided serious injury in a fall not long ago, due to my training.

If you’re a woman over 60, make sure you’ve had a bone density (DEXA) test. This is a simple Xray that measures the strength of your bones. Using your bone density and other risk factors like age, gender and medical history, your doctor can estimate your fracture risk. If your fracture risk is high, you should discuss with your doctor what you can do to reduce your risk.

One important thing to do to keep your bones strong is to take vitamin D and a bone health supplement daily. Here in northern Ohio adults need 2000-3000 units of vitamin D every day, all year around. A lot of doctors tell patients to take calcium but bones need calcium, magnesium and vitamin D to be healthy. I recommend Shaklee’s OsteoMatrix which provides SMALL coated caplets proven to be well absorbed to support bone health.

Avoiding falls and avoiding injury from falls is very important. First, you have to stay on your feet. If a fall does happen, being able to fall safely and having strong bones to prevent fractures is critical.

QUESTION: Are you afraid of falls? What do you do to avoid them and stay safe?

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Dietary Fiber Decreases Health Risks

Do you eat plant-based? Vegetarian? Paleo? Keto? The Standard American Diet (appropriately abbreviated as SAD)? If you are interested in avoiding heart disease, stroke, cancer and diabetes, new research suggests you need to take a good look at your dietary fiber intake.

A huge meta-analysis of over 200 studies examining almost 135 million person-years of data was done. That’s an enormous amount of data! Both observational studies and clinical trials showed that eating higher amounts of dietary fiber resulted in lower body weight, blood pressure and cholesterol. Also, eating more fiber was associated with lower risk of heart attacks, stroke, diabetes and colon cancer.

How much lower was the risk? 15-30% decreased risk, which is huge! Statistical analysis suggests that the risk reduction really is from the fiber intake. First of all, there is a dose response curve, meaning that small increases in fiber result in smaller benefit, and larger intakes of fiber result in larger benefit.

How much fiber do you need to eat to get the benefits? This research suggests the most benefit is seen at intakes of 25-29 grams per day. The average American eats less than 15 grams of fiber per day. There is evidence that even more daily dietary fiber may give even more benefits!

What is the best way to figure out how much fiber you’re getting? I always recommend folks use MyFitnessPal, a free nutrition tracking program. Track for a week and see what your average fiber intake is. The best way to gradually add fiber is with FOOD, not supplements (although fiber supplements like Metamucil are better than nothing).

Fresh and dried fruits, veggies, beans, nuts, seeds and whole grains are your best sources of dietary fiber. WebMD has a nice article listing some high fiber foods to choose.

The higher fiber content of plant foods is likely the main reason plant-based diets are so healthy and result in such positive health benefits. Not able to give up meat, eggs and dairy altogether? Take positive steps for your health and start adding more plant foods (and therefore more fiber) to your diet today!

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Online Patient Portal Use

Does your doctor offer an online patient portal for you to communicate with her? Have you decided not to take advantage of this important opportunity? You might be making a mistake.

More and more patients have the opportunity to access a growing portion of their electronic medical record directly through a patient portal. They can request medication refills and appointments, send emails to their care team, and even read the office visit notes generated by their doctors.

My employer does offer a patient portal but a number of my patients won’t take advantage of it. Sometimes they say that they don’t want to provide their email address. Elderly patients sometimes don’t have a computer at all. Sometimes they won’t say why they don’t want to enroll.

I do know that I like when that little box on my EMR dashboard is green, showing my patient uses the portal. I can email her directly about her test results and make sure all her questions are answered. She can see what medications and supplements WE think she’s taking and let us know if our records aren’t correct.

There was a report published recently that looked at online patient portal use. They found that over 60% of respondents said they did NOT use a patient portal. Most of those people also said they had never been offered one.

What I found interesting in this study was WHY people said they didn’t want to use an online patient portal. Patients wanted to talk to someone in person. Well, yeah! If I have something concerning or confusing going on I want to talk to a real person. But if all my labs are normal, shoot me an email. Oh, and also let me SEE my results (and download and print them too). That’s the bonus!

Clear and easy two-way communication between patients and their care team is very important. An online patient portal is one of many tools patients and physicians can use to facilitate communication. If you have the opportunity to sign up for an online patient portal please consider doing so!

QUESTION: Do you use an online patient portal? What has been your experience? If not, why not?

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Is It Pertussis, Or Just A Cough?

My husband and I got a notification from the county health department this week. A student at my son’s high school was diagnosed with pertussis.

My first thought was that s/he must have not been vaccinated. But then I looked into the data and found that isn’t necessarily so.

What is Pertussis?

Pertussis, or whooping cough, is a childhood illness that starts with typical cold symptoms and progresses to a horrible spastic cough. It is very dangerous for small children and can be fatal. 13 children in the US died from pertussis in 2017.

As a bacterial infection, pertussis does respond to antibiotics but only if they are started BEFORE the typical whooping cough begins. Unfortunately, before the typical cough starts it looks just like a cold. This is one of the reasons we vaccinate against it – there is no other way to prevent the awful, potentially fatal cough.

In case you are thinking “Oh, it’s just a cough,” here’s a video of a baby girl in the ICU with pertussis. And here’s a video of a 64-year-old man hospitalized with pertussis.

What about the vaccine?

I know you’re going to say “But Dr. Jen, if there’s a good vaccine available how does this happen?” The problem with the vaccine is that the immunity decreases over time. (The immunity you get from having whooping cough itself also appears to decrease over time, which is a scary thought.)

No vaccine is 100% effective, but the current vaccine is pretty good. Immunity is estimated at 80-90% over the first year and starting to wane about 4 years after vaccination. The pertussis vaccine was changed from whole-cell to acellular (no cells) in the 1990s because the whole cell vaccine had a lot of side effects. However, the new acellular vaccine is not as effective.

It is recommended that TDaP (tetanus, diphtheria and acellular pertussis) vaccine booster doses be given every 5-10 years. Unfortunately it is not indicated for adults over 65. Pregnant women and those who spend time with babies and small children should be particularly careful to get booster doses regularly.

Bottom Line

Even though the pertussis vaccine isn’t perfect it still does a nice job of reducing the risk of whooping cough in the US. According to the CDC, in 2015 there were about 20,000 cases of pertussis in the US and 6 deaths between 2014 and 2015. Worldwide it is estimated that there were 24 million cases of whooping cough and over 160,000 deaths in 2015. Most of these cases occurred in developing countries where vaccination coverage is low.

Community vaccination decreases the risk that someone will be exposed to pertussis. Personal vaccination decreases the risk that, if exposed, an individual will get sick. Because the most vulnerable individuals are babies under the age of 1 year (too young to be fully vaccinated) it is important that all of us get regular boosters.

We live in a country that vaccinates, and we all benefit from that. We all should roll up our sleeves and get vaccinated to protect our precious, vulnerable babies from pertussis.

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Merry Christmas!

My family and I are traveling this Christmas, but I wanted to take a moment to write to you. I’m hoping you have a wonderful, peaceful holiday with your loved ones!

I’ve been reminded of a few things today:

  • Traveling makes you crabby sometimes
  • People do crazy things when driving in construction traffic
  • North Carolina has even more orange barrels than Ohio
  • When you’re 6’4″ you don’t fit on a pull-out couch anymore
  • Eating sushi while driving is not recommended

However, I also was reminded that traveling with my favorite people in the world to see my OTHER favorite people in the world is really a lot of fun 🙂

God bless you and bring you a bring you plenty of joy this holiday season <3

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Menopause Symptoms And Quality of Life

Women who have reached menopause often feel as though they’ve traded one problem for another.  Sure, you don’t have to deal with the hassle of menstrual periods and worry about pregnancy anymore.  The hot flushes, night sweats, sleep problems, mood swings and vaginal dryness are not much improvement though.

Ask women who have menopause symptoms what their least favorite part is.  They will say the hot flushes and sweats at random times of the day and night.  They will tell you about the poor sleep and emotional roller-coaster.  They often WON’T tell you they have vaginal dryness and intolerable itching and loss of urinary control.  They usually won’t tell you they can’t tolerate intercourse with their partner anymore.

A lot of times they don’t tell ME that either.  I ask every woman at her physical about these symptoms if she is heading into menopause.  Women are embarrassed to discuss those parts of their bodies, even with their doctor.

There was a research study published recently in Menopause that asked women with menopause symptoms specifically about vaginal, vulvar and urinary symptoms.  Women who had had no menstrual period for at least a year were asked to fill out a questionnaire, and then had a gynecological exam.

Over 90% of the women were found to have vulvovaginal atrophy.  After the ovaries stop making estrogen at menopause, the skin and other tissues around the vagina and urethra become thinner, dryer and more fragile.  This is called atrophy and is often responsible for the itching, irritation and pain with sex that many women experience.

Many women know about hormone replacement therapy for menopausal symptoms and often refuse to take it.  Not as many women know that there are safer alternatives for vulvovaginal atrophy.  I usually recommend women try over-the-counter DHEA cream which they can get at the health food store or online.  One of my patients told me she tried Julva cream which she bought online and it helped a lot.  (Not an affiliate and I have no personal experience with it, just passing along a report from a happy patient.)

Topical estrogen cream is also very effective and is safe to use even in women who have had estrogen-sensitive breast cancer.  This is a prescription and usually requires an exam to make sure the diagnosis is right.  Many things other than vulvovaginal atrophy cause itching in pain (including infections and some skin conditions).

If you or a woman you love is suffering with itching, pain and/or urinary symptoms after menopause please don’t suffer in silence.  See the doctor and discuss your symptoms so you can get treatment.  Treatment works!

QUESTION:  Have you had problems with menopausal vaginal symptoms?  How has it affected your life?

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DON’T Exercise For Weight Loss!

Everybody promotes the benefits of exercise for weight loss.  And yes, becoming more active is one of the best ways to increase your day’s calorie expenditure if your goal is weight loss.  However, is weight loss a good motivator for getting someone moving?

Turns out, it’s not.  In fact, it’s one of the WORST motivators.  People who said their reason for getting active was to lose weight were LEAST likely to exercise consistently.

What motivates someone to lose weight?  The most common reason is to obtain someone ELSE’s approval.  You might want to look better in a swimsuit or put a spark back in your marriage, or bring your cholesterol test results or blood sugars under better control.  The sad truth is that weight loss is usually motivated by outside factors rather than by a true and pure desire to slim down.

So if weight loss isn’t a good motivator for exercise, what is?  Here are some suggestions:

1.  Pure enjoyment.  I take care of quite a few runners.  I am a runner myself.  I don’t run to lose or maintain weight (although it is a nice side benefit) but just because I love running.  Runners will run until their toenails fall off altogether.  (Unfortunately I have a case of plantar fasciitis right now that is keeping me from running.)

Those who love tennis will play through excruciating elbow pain.  Those who love martial arts or boxing will suffer all kinds of trauma.  Family doctors are well accustomed to having to put the kibosh on our crazy sports-injured patients’ plans to do further harm to themselves in their love of their sport.  We just do it because we love it!

2.  “Me” time.  So maybe there isn’t an exercise that you love like the fitness fanatics in #1 above.  There are ways to make your exercise a getaway as well.  For instance, I have taken to watching movies and TV shows on Netflix while I’m on the treadmill.  With my busy life, this is the ONLY time I get to watch any TV or movies.  So on those crazy days when you’re just too tired to climb on the stationary bike or treadmill, you can bribe yourself also with a good movie or TV show.

3. “Us” time.  If you have a workout buddy it’s hard to back out of a workout date.  Call a good friend and ask him or her if they would like to set up a regular time for a brisk walk or a fitness class.  Tell your buddy you could use a spotter for some extra-heavy sets.  Try a new form of exercise with your spouse.  My husband and I have practiced martial arts for years and now our boys do too.  Making it a family affair keeps us engaged and showing up even on days when ONE of us really doesn’t feel like going.

4. Health benefits.  Your body works better when you’re active.  Your digestion moves along better and you’ll have less problem with constipation.  Natural endorphins are released which relieve stress, anxiety and depression.  Sleep quality improves with exercise.  Lung function improves which means you’ll huff and puff less when chasing the kids and grandkids.

There are so many good reasons to get active and fit, you’re not limited to the promise of weight loss!  What will get you to the gym or motivate you to lace up your sneakers after a long day at work, when all you want to do is park yourself on the couch in front of the TV?  Be creative and find something you truly love!  If all else fails, create an irresistible incentive that will get you moving.

Guess what!  You’ll probably lose weight too 🙂

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What Is Acute Flaccid Myelitis?

It’s a parent’s nightmare.  Your perfectly healthy child comes down with a bad cold.  While they’re miserable for a few days they get better as expected.  Then shortly after the cough and snot are gone, your child gets sick again.  Suddenly your child loses the ability to walk because their legs become very weak.

Since 2014 there has been a new, rare and severe neurological condition reported mostly in children called acute flaccid myelitis (AFM).  This illness can result in permanent paralysis and the cause is not known.

Acute flaccid myelitis behaves almost exactly like polio but it is NOT caused by the poliovirus.  Doctors have checked and none of the patients have had poliovirus in their bodies.  However, almost all of the patients have had a fever or mild respiratory illness before the weakness started.  Most of the cases occur in the late summer and early fall, when the class of viruses that includes polio, enteroviruses, are most common.

AFM causes the sudden onset of weakness in one or more limbs.  Usually one side of the body is more seriously affected than the other.  There is usually no numbness or loss of sensation in the limb(s) although there may be associated pain.

Patients may also have trouble swallowing, weakness or drooping on one side of the face, double vision, problems speaking, and in severe cases trouble breathing.  If you or your child develops these sort of symptoms it is important to get care right away because treatment can be lifesaving.  Even though the cause isn’t known, prompt diagnosis and treatment are critical.

Other illnesses can behave like acute flaccid myelitis.  A stroke, West Nile Virus, Guillain-Barre syndrome and some other infections are on the list.

It’s estimated that one to two in a million children in the US will get AFM per year.  That’s REALLY rare, but very serious.  Parents need to know that if their child seems lethargic or has any weakness at all, they should seek care immediately.

QUESTION: Have you heard of acute flaccid myelitis?

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Eating Out With Food Allergies

As someone who has multiple food allergies/intolerances, I know from personal experience that restaurants can be tricky.  When you have to avoid a number of common ingredients, eating out makes one anxious

Parents of children with food allergies are understandably more comfortable eating their meals at home.  When they control the ingredients they can be sure their kids are safe.  However, there are a number of strategies that can make eating out safer for both children and adults with food allergies.

There was a poster presented at the American College of Allergy, Asthma and Immunology annual meeting this week in Washington State.  Researchers at University Hospitals Rainbow Babies’ and Children’s Hospital explored strategies used to avoid allergic reactions in restaurants.

They found that those who had never had a reaction used more safety strategies than those who had had reactions.  Once a person had an allergic reaction, they tended to increase their use of safety strategies.  This makes sense, right?  Anyone who has had an allergic reaction is pretty motivated to avoid another one!

The allergens people reported included the most common ones like peanuts, tree nuts, dairy, wheat, eggs and soy.  85% of the participants were children, they were split evenly male-female, and most were white.

Safety strategies varied widely.  The most common strategies included

  • Talking to wait staff, manager and chef about allergies
  • Checking menus and ingredients on the restaurant website, if possible
  • Choosing restaurants that are allergy-friendly or have a low chance of contamination
  • Ordering meals with simple ingredients
  • Double checking with wait staff after food arrives

The researchers found that the more different strategies were used, the less likely reactions were.  They also advised that whenever eating out, those who have food allergies should always bring an EpiPen or similar treatment with them in case of a reaction.

I know from my own experience that eating out with food allergies can be tough.  However, if you or your family member has food allergies, you don’t have to give up restaurant foods.  Simple strategies can make eating at restaurants safer and more enjoyable!

QUESTION:  Do you or a family member have a food allergy?  What strategies do you use to make eating out safer?

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Just What Are Supplements FOR?

My new student and I were talking in the office the other day.  She was surprised (and all my students are, actually) at how often I talk to patients about nutrition.  Usually without my patients really WANTING to hear my opinions about nutrition, LOL!

So we got to talking about the question, “What are supplements for?”  This is something I don’t think I’ve ever put in so many words before.

We know our diets stink.  People eat too much meat, too much junk food, too much sugar.  We don’t get enough whole fresh foods.  Even if we did get all our servings of fruits and veggies (and I try really hard) our foods aren’t as nutritious as they were in the past.

This decrease in the nutrition content of food is generally because of changes in farming practices and because we tend to get our food from far away.  We get peaches from Chile instead of from Georgia.  We get apples from Washington State instead of from local orchards.  And we want to eat apples in June when they haven’t been harvested in over 6 months.

So one of the main reasons I advocate supplementation is to make up for gaps in our diet.  A good quality, comprehensive multivitamin (and yes, Shaklee’s Vita Lea is the best on the market, the one I use and recommend) goes a long way to filling in for days when our diets aren’t the best, or when the food we eat has lost nutrition due to storage and processing.

Other than a multivitamin, what other supplements do we take to make up gaps in our diet?  People under stress tend to use up the B vitamins more quickly.  People who suffer with migraines tend to have gene mutations which make them need more B vitamins.  More than half of us don’t get enough magnesium in the diet.  We eat way too much omega 6 oil, so omega 3 fats from fish oil supplements can help correct that.  And of course nearly everyone needs a vitamin D supplement especially in winter.

These supplements as mentioned above are used from a Functional Medicine approach.  This means we give the body what it needs to function properly, and avoid poisoning it!  Supplements used in this way are generally very safe, and very few side effects.

Giving the body what it needs doesn’t just refer to food.  This includes fresh clean water, plenty of rest and quality sleep.  Practicing our faith and getting fresh air and sunshine, exercise, and time with those we love are “nutrients” as well.  The word “nutrient” comes from the same root as “nurture.”  When we nourish ourselves properly we will be healthier!

And poisons or toxins include pesticides, alcohol and excess sugar but can also include excess stress.  Negative self-talk is toxic.  Smoking, recreational drugs and artificial food ingredients are other examples of things we should avoid in order for our bodies, minds and spirits to be as healthy as possible.

How else can supplements be used?  Supplements can also be used as drugs.  Some examples are St. John’s wort for depression, milk thistle for liver disorders, and red yeast rice for high cholesterol.  These supplements are considered botanical drugs.  They have risks just like pharmaceutical drugs do.  The risks tend to be lower, but the effectiveness is lower as well.  Some supplements can be used either way.  For instance, magnesium in high doses is a very effective laxative and is used for bowel prep before colonoscopy.

How can you tell the difference between a supplement used for a functional medicine purpose and one used as a drug?  It’s pretty simple actually.  Is the nutrient or supplement found in food, and can one be deficient in it?  One can be deficient in magnesium, but there’s no such thing as a milk thistle or St. John’s wort deficiency.

I’d like to use a very current controversy to illustrate the difference.  Right now there are a lot of supplement companies starting to market krill oil as a “better fish oil.”  Early research suggests that the main omega 3 fatty acids in both krill oil and fish oil are better absorbed from krill oil and may influence cholesterol and glucose metabolism in favorable ways when compared to fish oil.

The problem is that krill isn’t food for humans.  We have little or no idea what a safe dose of krill oil would be, or what the long-term effect may be.  There are no studies showing how krill oil supplements affect heart risk or any other health risk in humans.  Fish oil supplements are generally made from edible fish like sardines, tuna or salmon.

So fish oil is a functional medicine supplement, made from a human food that most of us don’t get enough of to balance out the oodles of omega-6 fatty acids in our diets.  Krill oil is not a human food, containing a form of omega-3 fatty acids not clearly understood.  I would therefore classify krill oil as a drug, one that’s not well understood.  Certainly not well enough to recommend regular use.

Before someone recommends a supplement to you, think to yourself whether that supplement is meant to fill a gap in your diet and provide nutrients your body needs to function well.  If not, it is a drug.  Make sure you understand the risks and benefits, because there are always risks with drugs, whether they come from nature or from a factory.  Often the ones that come from the factory are safer because they’re better understood and better studied.

QUESTION: Have you ever thought before about the question “What are supplements for?”  What do you think now?

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