Generally, you can see bone density changes on x-ray even if it is not a conclusive study for osteopenia or osteoporosis. When I see evidence of bone density changes, I refer my patients back to their PCP (Primary Care Physician) for consideration of a bone density study.
Bone loss is a natural process that comes with aging. All of us lose bone at varying rates. Daily doses of calcium and Vitamin D are good in keeping bones strong. But new research suggests that another dietary move may be as important as the aforementioned.
You see, it is a matter of chemistry. When you digest carbohydrates, the process causes your digestive track to become acidic. Here lies the problem because high-level acid environment leaches calcium from bone. In contrast, fruits and vegetables create a skeletal friendly alkaline environment. The American diet tends to be acid-producing which is hard on older people whose kidneys can't clear acid compounds quickly. So by tweaking your diet, you may be able to prevent bone loss. Here are some suggestions:
1: Include two vegetable or fruit servings at every meal and eat no more than two daily servings or carbs like bread, cereal, and pasta. Also, here are some substitutions that will help as well.
Eat the first item instead of the second item:
Potatoes instead of pasta.
Fruit juice instead of soda.
Tofu instead of meat and poultry.
Wine instead of beer.
Raisins instead of Peanuts.
Happy eating everyone.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, February 18, 2009
Saturday, February 14, 2009
Glucosamine and Chondroitin update for Osteoarthritis
I see a lot of patients with Osteoarthritis (OA) of multiple joints in the foot and ankle. I have read data over the last 7 years of seeing patients to support both as dietary supplementation to help with the pain and stiffness associated with OA. Many of my patients reported some level of reduction of stiffness and/or pain in taking both.
A few years ago, a large arthritis study group known GAIT had delivered some disappointing news: Glucosamine and chondroitin sulfate didn't ease the pain in people with mild arthritis, though the combo did seem to help people with severe discomfort. New GAIT results further erode the hopes for the supplements, which don't appear to slow cartilage damage. Knees showed similar wear over two years, whether the patients took a placebo, a prescription painkiller, or supplements.
Still, these researchers are reserving final judgment, partly because volunteers' knees stayed healthier than expected. Looking at small differences (not big enough to be statistically reliable), the researchers say that patients on glucosamine alone fared the best. It seems that a combination of glucosamine and chondroitin, where study patients did worse, may interfer with the other's absorption.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
A few years ago, a large arthritis study group known GAIT had delivered some disappointing news: Glucosamine and chondroitin sulfate didn't ease the pain in people with mild arthritis, though the combo did seem to help people with severe discomfort. New GAIT results further erode the hopes for the supplements, which don't appear to slow cartilage damage. Knees showed similar wear over two years, whether the patients took a placebo, a prescription painkiller, or supplements.
Still, these researchers are reserving final judgment, partly because volunteers' knees stayed healthier than expected. Looking at small differences (not big enough to be statistically reliable), the researchers say that patients on glucosamine alone fared the best. It seems that a combination of glucosamine and chondroitin, where study patients did worse, may interfer with the other's absorption.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Springing forward may be bad for your heart.
According to 20 years of research by scientist in Sweden, turning the clock forward seems to be bad for your heart. Their research found that heart attacks rose by 6 to 10 percent for the three days after the clocks were set forward; declining by 5 percent for the three days after the clocks were set back. A lack of sleep may be to blame for the danger. This coincides with other studies that show a lack of sleep or chronic sleep deprivation is hard on the heart. It is recommended that you hit the sack early the first few days after setting to clocks forward. The researchers noted that if you are over 65 you are less apt to be harmed by the time change - perhaps because retired people are less tied to the clock.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Friday, February 6, 2009
Do's and Dont's in your Physician and Patient Relationship
As mentioned a couple of posts ago, I didn't realize that medicine was going to present itself with so many challenges. From decreased reimbursements, uncooperative patients, to people thinking that doctor's are loaded with money, a good relationship between a physician and patient can go along way for both parties being satisfied with the association. Here are a few suggestions with no particular order of importance except #1:
1: Expect office charges and have payments ready during your doctor visit: Nothing is more frustrating than to provide medical treatment to someone only to walk up at the end of the visit and hear them say, "I don't have the money, or, I can't pay you today." The physician is running a business and has people relying on him from staff to his own family. How would you feel if you completed your work and you heard from your employer, "I'm sorry. I don't have the money, or, I can't afford to pay you today." You don't put gas in your car without paying. You don't walk out with free groceries. You can't stay in your home or apartment if you don't pay. Why would you think a visit to the doctor is any different.
2: Missing appointments: Perhaps this is the second most frustrating part of practice. You schedule a time for a patient only for them not to show up and worse yet, not have the courtesy to call and cancel the appointment. This time allocated for you could have been used to see another person who had a medical need. In addition, physician's get paid when they see people. When you don't keep your appointment, you are taking money out of the doctor's pocket.
3: Pay your co-pays: your contractual agreement requires you to pay a co-pay at your doctor visits. If you insurance company has a contract with a physician paying them $100 for the service and you have a $20 co-pay, the insurance company is only going to reimburse the physician $80. Again, the doctor is entitled to the full reimbursement with your responsibility of paying the co-pay.
4: When scheduling an appointment with a doctor, have your current insurance information to give to the person scheduling the appointment: Offices have to verify insurance coverages especially at specialist's offices. You may not have the coverage needed and have an out-of-pocket expense. You don't want to be surprised when you show up for the appointment.
5: Inform your physician when your insurance changes: If you have been with a physician for awhile, there is a likelihood that your will change insurance, especially if employer provided. When you call to schedule an appointment, provided the scheduler with your new insurance information.
6: Show up early to your appointment: My daddy always said, "Son, never be on time for an appointment, but never be late." I have always held this close to heart. Especially if you are a new patient, show up at least fifteen minutes early as every office has paper work to be filled out. If you are an established patient, also show up early. If the doctor has a cancellation, he can get you in early and will help with his day as well.
7: Provide a written list of illnesses, surgeries, and current medications: This just takes a couple of minutes to start and only a few seconds to update. This is invaluable to you the patient and the doctor. I always have patients who tell me at subsequent visits, "Oh! I forgot about that medication, that surgery, etc." If your like me, you need a list to help you remember.
8: Don't be the doctor: Being informed is one thing. Telling a doctor on how you want to be treated is another. The Internet is a wonderful tool, but it can be filled with misinformation and some terms can be difficult to understand. Allow your medically trained physician to treat you. It is important to ask questions so you can understand what is going on and why the doctor is making the choices they are. But please, don't direct your medical care.
9: Have realistic expectations: I treat abnormalities of the foot and ankle either medically, biomechanically, and even surgically. But, I am not God. I can not take a foot or ankle that is not functioning properly and get it back perfectly. Even with 'elective' surgeries, the outcomes are not going to be perfect. They will be much or significantly improved. It is important that you have realistic expectations of any medical or surgical outcome.
10: Things happen: All doctors and surgeons are required by law to have continued medical education to practice their craft. We go through residencies to learn from some of the best. But it is important to understand, that with all this training and education, things can just go wrong. Any physician is going to feel sorry for any medical or surgical outcome that is not what is expected. But going back to realistic expectations, you have to understand and be accepting of the fact that things can just plain go wrong.
I hope this helps with your physician relationships in the future.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: Expect office charges and have payments ready during your doctor visit: Nothing is more frustrating than to provide medical treatment to someone only to walk up at the end of the visit and hear them say, "I don't have the money, or, I can't pay you today." The physician is running a business and has people relying on him from staff to his own family. How would you feel if you completed your work and you heard from your employer, "I'm sorry. I don't have the money, or, I can't afford to pay you today." You don't put gas in your car without paying. You don't walk out with free groceries. You can't stay in your home or apartment if you don't pay. Why would you think a visit to the doctor is any different.
2: Missing appointments: Perhaps this is the second most frustrating part of practice. You schedule a time for a patient only for them not to show up and worse yet, not have the courtesy to call and cancel the appointment. This time allocated for you could have been used to see another person who had a medical need. In addition, physician's get paid when they see people. When you don't keep your appointment, you are taking money out of the doctor's pocket.
3: Pay your co-pays: your contractual agreement requires you to pay a co-pay at your doctor visits. If you insurance company has a contract with a physician paying them $100 for the service and you have a $20 co-pay, the insurance company is only going to reimburse the physician $80. Again, the doctor is entitled to the full reimbursement with your responsibility of paying the co-pay.
4: When scheduling an appointment with a doctor, have your current insurance information to give to the person scheduling the appointment: Offices have to verify insurance coverages especially at specialist's offices. You may not have the coverage needed and have an out-of-pocket expense. You don't want to be surprised when you show up for the appointment.
5: Inform your physician when your insurance changes: If you have been with a physician for awhile, there is a likelihood that your will change insurance, especially if employer provided. When you call to schedule an appointment, provided the scheduler with your new insurance information.
6: Show up early to your appointment: My daddy always said, "Son, never be on time for an appointment, but never be late." I have always held this close to heart. Especially if you are a new patient, show up at least fifteen minutes early as every office has paper work to be filled out. If you are an established patient, also show up early. If the doctor has a cancellation, he can get you in early and will help with his day as well.
7: Provide a written list of illnesses, surgeries, and current medications: This just takes a couple of minutes to start and only a few seconds to update. This is invaluable to you the patient and the doctor. I always have patients who tell me at subsequent visits, "Oh! I forgot about that medication, that surgery, etc." If your like me, you need a list to help you remember.
8: Don't be the doctor: Being informed is one thing. Telling a doctor on how you want to be treated is another. The Internet is a wonderful tool, but it can be filled with misinformation and some terms can be difficult to understand. Allow your medically trained physician to treat you. It is important to ask questions so you can understand what is going on and why the doctor is making the choices they are. But please, don't direct your medical care.
9: Have realistic expectations: I treat abnormalities of the foot and ankle either medically, biomechanically, and even surgically. But, I am not God. I can not take a foot or ankle that is not functioning properly and get it back perfectly. Even with 'elective' surgeries, the outcomes are not going to be perfect. They will be much or significantly improved. It is important that you have realistic expectations of any medical or surgical outcome.
10: Things happen: All doctors and surgeons are required by law to have continued medical education to practice their craft. We go through residencies to learn from some of the best. But it is important to understand, that with all this training and education, things can just go wrong. Any physician is going to feel sorry for any medical or surgical outcome that is not what is expected. But going back to realistic expectations, you have to understand and be accepting of the fact that things can just plain go wrong.
I hope this helps with your physician relationships in the future.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Facts and Fiction regarding Fibromyalgia Syndrome
I have patients who come into my office complaining of generalized foot pain. It is frustrating to me as the practitioner and the patient when the patient can only say, "my feet hurt!", with no definitive reason. During the history phase of the visit, I find out that the patient has been diagnosed with fibromyalgia. There are still some social stigmas regarding this syndrome and here are a few facts regarding this debilitating disease.
1: FMS is caused only by stressors, such as infections or injuries. False: There may be multiple causes, though recently it was proven that FMS is primarily a disorder of pain signaling in the central nervous system. This is probably a genetic component. This precise nature of the cause is still unclear.
2: The presence of tender points provides a definitive diagnosis of FMS. False: The American College of Rheumatology (ACR) classification criteria involve indentification of 11 tender points, but pain and tenderness are often more widespread without the presence of true tender points. There is no simple approach to diagnosis, and that can be a barrier to effective treatment.
3: The prognosis for patients with FMS is hopeless. False: There is no cure, but early appropriate treatment can prevent deconditioning and dysfunction. A variety of pharmaceutical and nonpharmaceutical therapies are available, and a multidisciplinary approach that combines therapies is recommended. Drug use focuses mainly on pain reduction, and physical therapy is geared to disease consequences, such as pain, fatigue, and sleep disturbances. Several alternative therapies have been shown to be effective.
4: FMS is a "phantom" illness that's "all in the patients head." False: Many in the medical profession have held the view that FMS does not exist or is a manifestation of depression or anxiety disorders. FMS often is associated with depression - depression can cause FMS, and the symptoms of FMS may lead to depression - but FMS is a real illness in its own right. Again, better understanding can lead to earlier and more effective management.
5: Because FMS is such a complex disorder, treatment provided by a rheumatologist or other specialist is required. False: No specialized care is necessary, and the condition usually is managed by generalist physicians. Some rheumatologic practices are no longer accepting FMS patients - they find FMS patients difficult and they also know they might not provide any better treatment than the generalists.
FMS is a complicated disease that is still misunderstood and very little understood regarding the cause. With knowledge on your part and finding an understanding generalist, your disease can become manageable.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: FMS is caused only by stressors, such as infections or injuries. False: There may be multiple causes, though recently it was proven that FMS is primarily a disorder of pain signaling in the central nervous system. This is probably a genetic component. This precise nature of the cause is still unclear.
2: The presence of tender points provides a definitive diagnosis of FMS. False: The American College of Rheumatology (ACR) classification criteria involve indentification of 11 tender points, but pain and tenderness are often more widespread without the presence of true tender points. There is no simple approach to diagnosis, and that can be a barrier to effective treatment.
3: The prognosis for patients with FMS is hopeless. False: There is no cure, but early appropriate treatment can prevent deconditioning and dysfunction. A variety of pharmaceutical and nonpharmaceutical therapies are available, and a multidisciplinary approach that combines therapies is recommended. Drug use focuses mainly on pain reduction, and physical therapy is geared to disease consequences, such as pain, fatigue, and sleep disturbances. Several alternative therapies have been shown to be effective.
4: FMS is a "phantom" illness that's "all in the patients head." False: Many in the medical profession have held the view that FMS does not exist or is a manifestation of depression or anxiety disorders. FMS often is associated with depression - depression can cause FMS, and the symptoms of FMS may lead to depression - but FMS is a real illness in its own right. Again, better understanding can lead to earlier and more effective management.
5: Because FMS is such a complex disorder, treatment provided by a rheumatologist or other specialist is required. False: No specialized care is necessary, and the condition usually is managed by generalist physicians. Some rheumatologic practices are no longer accepting FMS patients - they find FMS patients difficult and they also know they might not provide any better treatment than the generalists.
FMS is a complicated disease that is still misunderstood and very little understood regarding the cause. With knowledge on your part and finding an understanding generalist, your disease can become manageable.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
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