Archive for Uncategorized

Jan
11

What You Should Know About Osteoporosis

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Osteoporosis and osteopenia are the consequences of aging, and all menopausal and post menopausal women are at risk. This is a problem as these conditions place you at risk for breaking a hip or fracturing your back with a significant enough fall. The inactivity these fractures cause, place you at risk for other serious medical conditions.

Bone thinning, which is what both of these conditions are, occur in response to a genetic predisposition, aging, poor nutrition, inactivity as well as other factors associated with some medications and medical conditions. The trigger is often the decrease of estrogen production that happens with the menopausal transition.

It may surprise you to find out bone is not a static calcium filled mold. It is a dynamic, living tissue that is constantly being repaired by being reabsorbed and renewed by the cells within it.

As we age, the bone building cells slow down while the bone resorbing cells continue to dissolve older bone. New bone is formed more slowly as a result. If your diet is low in calcium and Vitamin D, the bone you form may not be very strong. If there is enough bone loss to place you at risk for a fracture from a fall, due to decreased bone strength; you are diagnosed with osteoporosis.

Are you at risk for Osteoporosis? Perhaps if you are part of one of the following groups more at risk for this:

  • older women and men of northern European decent
  • Asians, especially women
  • 45% of postmenopausal women have low bone density.
  • Caucasian women have a 40% risk of a forearm or spinal or hip fracture (usually from a fall) in their lifetime.
  • Caucasian men have a 13% risk.

Interestingly, those of African decent have a decreased incidence of osteoporosis

The risks and causes of Osteoporosis include:

  • Age
  • Race
  • Smoking
  • Excess Alcohol intake
  • Certain Medications like corticosteroids, anti-seizure, anti-organ-transplant-rejection drugs and chemotherapy
  • Obesity
  • Underweight
  • Malabsorption
  • Kidney Disease
  • Liver Disease
  • Spinal Cord injury
  • Diseases of the Bone Marrow
  • Hereditary Bone Development Diseases
  • Endocrine and Metabolic diseases like Hyperthyroidism, Cushing syndrome, Hypogonadism

Although the main causes are 1) Estrogen deficiency and 2) changes of age,1/3 of all men and women with Osteoporosis have another coexisting cause of bone loss!How can you prevent and/or treat Osteoporosis?

Your bones are dynamic and constantly being remodeled.  Providing your body with the raw materials in the form of fresh, organic food is very important. The minerals you need are freshest in these foods.

A diet high in protein and minerals including calcium, phospherous, magnesium and zinc. Bone of comprised of these items, as well as blood, and if you have an insufficient amount of these minerals in your system, the body will remove them from bone to replace what is needed.  There is a balance between minerals so that if one is too low the other is excreted.

Low Vitamin D3 levels can also adversely affect bone density through poor utilization of the calcium you consume.

To prevent osteoporosis and help already weakened bones try these actions:

  • keep protein to a minimum – .8grams per pound of IDEAL body weight (excess protein causes mineral loss through the kidney). T00 much protein is actually detrimental to bone health!
  • eat lots of fresh fruits and vegetables to get important nutrients for bone support
  • do resistance exercises for 30 minutes 3 times a week – as good as estrogen in post-menopausal women. this helps activate bone building cells
  • practice balance exercises – falls are the main cause of fractures
  • learn to fall – take a basic judo course or Akido orientation
  • reduce stress – the stress hormone cortisol kills the bone forming cells called osteoblasts
  • discuss whether estrogen therapy is safe and indicated for you for a short while
  • bisphosphonate drugs can help for a few years but need to be stopped and they can be difficult to tolerate.

Osteoporosis is often over looked as a healthy concern, but can have a serious negative impact on your life by reducing mobility, strength and balance. Your bones are as important as the rest of you, they are part of the vehicle that allows you to do the things you like to do!

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Oct
21

Is It Safe to Mix Your Drugs?

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Having many medications available OTC (over the counter) is helpful for treating minor illness and maladies. We trust that what is available OTC is safe, and taken alone, they usually are. It is when we get into mixing things that trouble arises. And mixing certain medications both OTC and prescription, with alcohol can be very dangerous.

The FDA and medical community are working on raising awareness about combining seemingly innocent medications. Now that we can to the store to get our own remedies for pulled muscles, cold symptoms and allergies, even sleep; the possibility of an interaction is increasing. Most all of these medications are processed through the liver, and when this pathway gets clogged with too many drugs, the liver gets overloaded and inflamed. Blood levels of these drugs can become higher than intentioned, amplifying their affect.

Ibuprofen and Aleve both, in the NSAID category,and Tylenol; are some of the major causes of liver and kidney overload. There are many cold and sleep preparations containing both NSAIDS and Tylenol, and when taken during the same period of time, you can end up getting a large dose of pain relievers.

When you add alcohol to certain other medications such as antidepressants, anti-anxiety agents, sleep agents and ADD medication, prescription narcotic pain medications; this can be a toxic mix to the nervous system. I have had many people report to me unusual and mostly unremembered activity after having a few drinks and taking a sleep aid such as Ambien. It is frightening to think about getting on the internet and emailing people, or being on a hotel balcony and not remember any of it!

In most instances of receiving medications from a medical provider, they will be alerted to any potential interactions of prescription drugs. That is, if they know everything you are taking. It is not unusual for people to see more than one provider. It is important for you to inform all your providers about all the drugs you are taking. Do not assume they will know this from receiving notes from each other.

Ask your provider if any new medication can be safely taken with any OTC meds you routinely or even occasionally take. Ask them if you can take these medications with alcohol if you drink.

Being honest with your medical practitioner about what you do and take that is not prescribed, will keep you healthy and just may prevent a trip to the ER!

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Sep
26

Listen to These Physician Experts Talk About Food

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This video of 3 physician experts on diet is a powerful, and fun, discussion about our diets. Listen to what they believe constitutes a healthy diet and eating plan. It is easy to listen to, with some humor interjected.

The video is 30 min. long, but you can listen to it while doing something else!

A recent study has suggested it is ok for us to eat fat again. A small study comparing low fat with a low carb diet revealed a bigger weight loss in the low carb group vs the low fat group.  As one these experts Dr Mark Hyman states “It is all about the quality of your food”.

Some of the take points include:

1.The fats that are natural and plant based are most likely healthy, whereas man made fats are unhealthy and even harmful. Fats from grass fed beef may be considered a healthy fat by one of these experts!

2. If you eat crap, you will feel like crap! Eat lots of plants, cut out sugar, junk food, processed foods.

3.Find a way of eating with  a group foods that work for you. Some people with inflammation in their body, or with autoimmune diseases may not be able to tolerate certain foods such as gluten and diary.

4.There is no real science comparing the health of grain fed vs grass feed protein. Essentially it is important to limit the amount of animal based protein.

5. The Mediterranean diet vs Paleo diet vs 80/20 diet all basically have in common a healthy plant based  diet with healthy fats. The cardiologist in the group feels healthy fats are better than animal based fats for limiting heart disease.

6. Is butter healthy? Probably not, especially if you have heart disease. It is controversial with this group.

7. Wheat and gluten may be a problem for some people but can still be a part of diet in limited amounts. Howver, if you have insulin resistance, you need to limit grains and foods with a glycemic load.

Listening to this lecture may help you with decisions regarding your diet.

The final message: eat real food, food high in micro and macro nutrients, limit processed foods, and eat a way that makes you feel good in terms of energy.

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Sep
21

Are Your Supplements Safe, and Do You Need Them?

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Taking supplements seems to be a safe and healthy thing to do, right?  After all, if it is available without a prescription it must be safe!

You may be risking your health thinking this!

The supplement industry is a lucrative one as we are all searching for an answer to our aches and pains, fatigue, and changes in our bodies. What baby boomer do you know that is happy with becoming tired, fat, achy, bald and worse- less sexy? We must be careful what we reach for, in our attempts to push back the aging process.

A recent study out of Einstein Medical Center in Philadelphia published in Hepatology, a medical journal focusing on liver issues, illustrates the potential dangers with some supplements. The incidence of liver inflammation has risen by 13% over the past decade. States lead investigator Dr Victor Navarro in discussing the supplement industry, “With less stringent oversight for herbals and dietary supplements, there is greater potential for harmful consequences, including life-threatening conditions.”

The supplement industry is not required to prove the same level of safety that pharmaceutical drugs are required to show, nor do they have the prove the same level of efficacy! So you may be getting a supplement that could harm you without actually doing the job you originally bought them for.

When choosing a brand of supplement, the choice is often between buying something at a supermarket or drug store vs ordering online. There can be a big difference in price, as well as quality.
What do you look for?
A reputable manufacturer formulates their supplements based on scientific research. They buy quality raw materials and they pay independent labs to perform quality assurance ie. no contaminants and the supplement meets the manufacturer’s claims.
You want to read the ingredient label and look for red flags; such as added sugar, artificial coloring and flavor, or added chemicals.
You also want your supplement to have a seal of approval from US Pharmacopeia (USP), or Natural Products Assoc. (NPA), or Consumerlab.com.
If buying from a local store, it is best to buy from retailers that do a brisk business. Increased turnover means fresher supplements as they degrade over time.
There are many websites that review many of the more popular brands and manufacturer, Consumerlab is an independent lab that is mentioned often as a reputable evaluator. The following website, SupplementReviewPal, also has information on many supplements both off the shelf and ordered.
What supplements do you need to take and are safe?
If you are eating a healthy diet of fresh foods, you may not need much in the way of supplements. It is always good to check with your medical provider before starting anything, and do nothing involving megadoses until you have your levels checked through blood work; as this can be dangerous. Too much iron supplementation can overload the liver, Vitamin A can be dangerous to the liver also.
Here is my general opinion about what supplements are useful
  • Most women can use some supplemental calcium, but be careful not to get calcium carbonate as this is hard for the body to absorb.
  • Most of us also need some extra Vitamin D, make sure you get D3; and unless advised by your medical provider, stick to 1000-2000 IUs and have your levels checked every 6 months or so.
  • Omega 3 Fish oil is helpful if you do not eat fish 3 x a week; otherwise you probably don’t need extra .
  • You most likely do not need B vitamins if you eat meat, but if you are vegetarian a supplement may be helpful
  • Most likely do not need Vitamin C except around cold and flu season, and not in mega doses
  • Vitamin E can be dangerous in some people with heart disease, I recommend a 200-400 supplement for few days for women having breast pain but this rarely applies to post menopausal women.
  • Extra magnesium can help with headaches and constipation, 400 mg a day.

When choosing a supplement, make sure you actually need it and get a recommended dosage from your medical provider so as not to overload your liver. Stay away from too much, you really shouldn’t need many supplements if you are eating and absorbing a balanced diet of fresh foods. Make sure your brand has the seals of approval from USP, NPA or ConsumerLabs.

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Sep
12

MENOPAUSE, MONEY AND YOUR JOB

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I was recently contacted by the NIH regarding my thoughts on the use of HRT for treatment of menopausal symptoms. I was asked to review a brochure from NIH (National Institute of Health), to see if viewers may find some benefit from their information.

Hot flashes can can certainly be a very difficult symptom of the menopausal transition. They can interfere with sleep, affect our confidence at work as well as concentration. They are embarrassing, make us feel old; and can make coping with social situations difficult. Some of us have it bad, others not so much.

Now, according to a recent study, they are costing the companies we work for; in the form of lost time at work.

Really?

A recent analysis of data looking at the insurance claims of 500,000 menopausal women, all of whom were insured by Fortune 500 companies. Half suffered from hot flashes, and half did not. This analysis took place over the space of a year.

This analysis revealed a surprising 1.5 million more health care visits in the group with hot flashes compared to the control group. The cost of lost work by this group was estimated to be over 27 million dollars and the cost of this additional health care almost 340 million!

I am not sure that 250,000 hot flashing women could actually rack up this amount of cost to their employers and health insurers; but the point is noted. Hot flashes affect women and affect productivity.

This change has apparently been amplified since the Women’s Health Initiative findings of an increased incidence of stroke and heart attacks to users of HRT; resulting in more women opting not to use hormone replacement.

While hormone replacement therapy may carry an increased risk of breast cancer and cardiovascular events if you are in a high risk category for either of these, it can also be very safe to use for several years. This can be a life saver if you are someone suffering from hot flashes.

For my readers following me for the past few years, you are probably aware that I am a proponent of HRT if you are low risk. I feel they are safe to use for a limited time and can help ease the transition.

The following link to an NIH brochure containing information regarding Hormones and Menopause will allow you to review the position of National Institute of Health regarding the safety of hormone use for many women at low risk for cancer and heart disease. It contains some good information that I basically feel is sound. The brochure can be read online or ordered for free.

So check it out! Don’t be afraid to discuss possible use of hormones to ease your menopausal symptoms if they are interfering with work and social activities. As they did for me, they may help ease the worst of it for a few years, and help you establish some changes in your routine to accommodate the changes that menopause can bring!

ps. There is no financial incentive for me promoting this brochure, I receive nothing from NIH or any other organization; and the brochure is free.

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Most menopausal women crave sleep if they have been sleep deprived for any length of time. If like me, you have had periods of sleepless nights; you know how negatively this can impact your day.

It comes as no surprise to anyone that adequate sleep and healthy habits, along with some exercise, is the balance we all need in order to maintain health.

You know, that whole life balance thing. It works though, doesn’t it?

There are times of course, when we are super motivated and energized by a task or challenge. We may choose to shorten our sleep hours and forgo our usual run or walk; and we still feel fine. In time however, when this energizing task is done, we can feel the need to regroup. The intensity in our lives is gone and we feel the need to get back to that balance, to recharge.

A new study out of San Fransisco has shown that lack of sleep and life balance actually contributes to aging by taking its toll on our genes. The lead researcher at UC San Francisco, Dr Eli Puterman,  excitedly points out that the study participants who exercised, slept and ate well had less aging impact on their bodies. This was in comparison to a control group of participants that did not participate in these healthy habits. Interestingly, they both had the same degree of stress according to the self report questionnaires.

I have spoken of telemere length in a different post, but basically, telemeres are the ends of our genes. When our cells divide, which happens daily and throughout the day, these telemeres can shorten. When they shorten, our genes do not work as well. This is felt to be a major cause of aging, illness and even cancer.

We now have some proof that healthy life style may very well protect us at our most basic level, our genes!

Knowing what you need to do is the easy part, but maybe doing it is the hard part for you. Getting started isn’t as hard as you think though.

Chose one part of your life that you know you need to change, and feel that you can change. It doesn’t need to be big, small steps all mount up.

As a young girl, during times of frustration, my father had a favorite saying. “Rome was not built in a day. ”

We all want quick changes though, with a quick pay off. So pick something you feel you can change and practice it everyday.

  • Go to bed at a reasonable hour no matter what, read something unimportant to your life for 30 minutes; and turn off the light.
  • Set out water bottles for work and drink this instead of soda, coffee drinks, or sweat tea.
  • Mark on your calender the day you will do something involving movement, then place your exercise clothes somewhere prominent the night before do that you cannot miss them.
  • Pick 3-4 nights out of the week that you will prepare yourself a healthy dinner without bread, potatoes, pasta, or rice.

These are but a few examples, small ones that anyone can do if they put their mind to it. And that is what it is all about. Deciding you want to look and feel better, have a healthier future; and perhaps set an example and inspiration for a loved one.

Take one action after you have finished this post. Write down what you want to change, and what you feel you can change. Share it with our readers if it will help you commit, so we can all get inspired by your ideas. Ask me questions if you are stumped on how to start, or continue. If you want or need more in depth help, go to our coaching page and contact me.

Making changes can be hard, or sometimes scary. If often feels easier to keep doing the same thing, even when it does not get you the result that you want. So you really must decide that change is what you want, and commit yourself to it by practicing it every day.

 

 

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Jun
17

The Energy Thief

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Its all about energy. The energy to live our lives, work our jobs, nurture our relationships.

Where does all this energy go at the end of long day, bad week/month or even year?

Fear.

I am not talking about bite your fingernails or there’s a serial killer lose in my house fear. No, I am talking about the subtle undercurrent of fear we all have.

Fear we cannot have the lives we want, or that something will interfere with the balance that we have created for ourselves. Fear that we will fail, fear that we will lose.

We keep our fears deeply hidden most of the time. Many people are masters at concealing their fears, some of us are working on our fears, so we may be more comfortable with the idea of living with fear. But we all have some degree of fear, very few of us are without it.

When a trigger hits us; we respond with anger, anxiety, tension. We can feel it when it happens within us, although we often want to blame the trigger and not ourselves and how we respond.

These fears we have drain us daily when we respond negatively to things, when something or someone triggers us. When we get drawn into the negative spiral our fears send us on.

That is where all the energy goes. That is why there is sometimes no energy left for what make us feel good and what is good for us. Then we make decisions that undermine us. No energy for exercise, reach for the bad food that comforts us, reach for a cigarette or a drink. We may even start a fight with someone we cherish, just to relieve the anxiety.

Then we are spreading our badness to someone else, the ultimate of negative spiraling.

Like many people, I often find I am out of the energy I need to do the things I want to do. I blame it on aging, doing too much, this or that stress depending on the week. Then I will come upon someone, often a patient, who is in their late 60′s to early 80′s. They have a sparkle in their eyes and a smile on their face, they are busy and active; sometimes still working full time! I think, THAT is how I want to be!

When I came upon a book about this very topic, The Untethered Soul; the title intrigued me, the cover drew me in. Who doesn’t need more energy, who doesn’t want to remain active and vital; engaged in life and seeking new ideas to try, not afraid?

Saving ourselves from ourselves takes being aware of our actions, even when in the midst. It takes deciding to tackle what we have been fearful of for years or even decades. Some of us can do this on our own, and some of us need help and guidance. Aging often causes us to confront our fears and worries, probably because we know we do not have an endless supply of time.

When we free ourselves from these boundaries we have placed; then we have the energy to truly grow. To work at becoming the person we wish we were! Think about it, read the book, talk to someone who can help. Work on what is holding you back from exploring, now may be just the right time for you.

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May
05

Detox the Easy Way and Beat the Menopause Blues

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There is no doubt that the menopausal transition can cause you to feel tired, bloated, heavy and quite honestly ugly.

There is a lot that is changing but truthfully how we look changes slowly; but it can feel as if we are aging over night. We wake up one morning and feel there are tons more grey hairs and wrinkles. Even more distressing is the feeling that we have gained 5 or 10 pounds overnight, while we slept!

While most of these feeling are from the intricate interplay of hormones, it may be time to revamp your diet. Food metabolism can change during menopause; and this often leads to the bloating, fluid retention and weight gain the we menopausal women experience.

Detoxing, or cleansing can help feel as if you have reset the thermostat a bit. But how to detox? I am not talking about detoxing from alcohol or recreational drugs, I am talking about detoxing from what you eat and what you drink.

There are many programs, products and diets that you can find in stores and on the internet that can help with detoxing. The truth is though, you do not need something fancy to detox or cleanse your system.

Detoxing basically involves a program to eliminate waste and toxins from your body. Your body naturally does this daily, and a cleansing program is merely increasing these processes.

First there is increasing urination and bowel movements. This moves toxins the kidney has filtered through urination, and that the bowel and liver have eliminated through stool. Increasing water consumed to up to 2 qts daily, and fiber intake with vegetables, fruits and whole grains; will do both of these, naturally.

The next part of your body that helps with detox is your skin. Increased sweating will help move toxins through your skin and lymph system. Saunas can help you sweat, so can exercise.

Your lungs are also a part that helps with cleansing. Breathing deeply and more quickly as what is needed with exercise, will help cleanse your lungs from the toxins you breath. This also help with improved blood circulation.

Many programs or diets include spices and foods that help with increase of metabolism, such as cayenne pepper. Exercise is another way to increase your metabolism.

You may like detoxing or cleansing through a program because it gives you specific steps to follow. The issue I have with many detox program as it is very restrictive caloric-ally. This severe calorie restriction can cause you to feel tired, and irritable. While you may lose weight, you can quickly gain it back. Any cleanse or detoxing that involves taking laxatives seems suspect to me, as elimination should happen naturally and through the diet.

The Master Cleanse is a popular one I see patients using a lot. It involves drinking a lot of water flavored with cayenne and lemon, eating fruits and vegetables, juicing for a day or so. You do not have to take fancy supplement, just a multivitamin. You are told to do this for 5 days only as it is very restrictive in food choices. It also involves a sea salt flush, which I am not sure how healthy this is.

Looking at these diets, it comes to mind that they are the basic backbone of how we should be eating any way. You can end up cleansing in a more limited way daily, through drinking lots of water, eating foods high in natural fiber, exercising vigorously to cause you to breath heavier and sweat.

You don’t need a special program, or super restrictive diet that leaves you feeling grumpy and tired.

Cleansing you body daily with non processed foods that are low in sugar and high in fiber, drinking plenty of water, and exercising; is not only a healthy lifestyle change, but a  helpful way to beat the menopause blahs!

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May
01

END OF AN ERA?

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A recent announcement from the FDA came as no surprise to those of us following the changing guidelines for PAP smears. The FDA has approved the use of HPV high risk DNA detection as a sole screening tool for women!

Over the past decade or more, much research into the role of HPV has been performed. This has yielded the information that the majority of cervical cancers arise from the activity of the Human Papilloma Virus on the cervix. Prolonged inflammation from an active HPV infection causes changes on the cervix which can lead to cancer.

Most likely your recent PAP smears have included a test for high risk HPV DNA activity. This is a virus that is acquired through sexual activity, and most of us have been exposed to this virus at some time of our lives. The vast majority of us suppress the virus and it lies dormant, never causing a problem. A smaller percentage of us however, do not suppress the virus efficiently enough, and it becomes active from time to time.

Enough activity over enough time from the high risk strains of HPV can place us at risk for cervical cancer.

A PAP smear takes a superficial scraping of cells from the cervix and looks for abnormal looking cells. An HPV test indicates whether the virus is active at the time of the PAP smear.

A positive HPV test and a normal PAP smear would indicate active virus but no inflammation of the cervix. This sort of result indicates the necessity for regular yearly screening, looking for inflammation from prolonged HPV activity.

A negative HPV test and normal PAP smear indicates no activity and no abnormal cell. This normal result often means a PAP and HPV can be done every 3, or even 5 years. The process from HPV activation to a cancer is felt to be slow, often years. Therefor, most gynecologic professional societies feel this is a safe interval.

A positive HPV and an abnormal PAP smear indicates the virus is active and causing damage to the cervix. In most women, this abnormality will correct itself as the immune system activates to suppress the virus. In some cases however, the immune system cannot suppress the virus and it goes on to cause pre-cancer and the cancer cells of the cervix.

Detection of high risk DNA activity is the factor that often drives decision making on the screening interval for PAP smears. So it makes sense that a test using only this modality will become available and recommended.

This gives women and their providers an option for screening. It is important to realize however, that a recommendation from the professional gynecologic societies has not been evident yet.

The PAP smear still has a place in women’s screening. It can detect uterine problems that a HPV DNA test would not pick up. Whichever screening test you set your heart on for this year, remember that a pelvic exam is still recommended yearly. Not undergoing a PAP smear does not mean you do not need a yearly exam!

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Apr
22

CHOICES FOR AGING KNEES

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Knee pain is perhaps the most commonly expressed joint pain in the over 40 population that patients discuss with me in the clinic. What to do about the problem can be challenging for people.

Osteoarthritis is a wearing down of the cartilage in the knee joint, usually from overactivity over a life time. It is often aggravated by prior sports injuries when young, as well as being overweight. It is said that more than 27 million people in the US have osteoarthritis, with the knee being the most prominent joint affected.

Many people have enough destruction of the knee joint that a knee replacement is the only choice left due to extreme pain and immobility.

Most people however, are best treated with less major therapies, including physical therapy and arthroscopic surgery. Arthroscopic surgery is performed by an orthopedic specialist and involves inserting a tiny tube into the knee joint. Through this fiberoptic tube, the different components of the knee can be seen and sometimes repaired.

While many people have arthroscopic surgery for their knee problems, there have been several trials suggesting this does not really give a person much benefit for treatment of OA of the knees. Physical therapy has been shown to relieve the pain of OA, but an optimal treatment regimen has yet to be standardized.

Researchers recently collated data from 48 different studies in which PT was compared to other non-exercise interventions for OA of the knees. It was found that the most beneficial treatment included a physical therapy program consisting of aerobic and resistance exercise with specific target at quadriceps (thigh) strengthening, supervised 3 times weekly for at least 4 weeks.

What does this mean for you if you have OA of the knee?

The idea of exercise to improve your already aching and painful knee, may seem like something you do not want to do. Perhaps you think surgery is the easier route, but now there is data to indicate that this is not going to be beneficial for you.

While going to physical therapy 3 times weekly may present some obstacles for you, such as time and money; there are often ways to deal with these issues.

The flip side to not doing PT is the cost of not exercising because of pain, with the resulting impact on your health. Additionally, most of us can skip a few extra things we do in the course of a week, and save that money for the PT session. Most PT offices open early and stay open late to accomodate people with rigid work schedules.

Ask your provider about physical therapy if you have OA of the knee, before going the route of surgery. Most reputable orthopedic surgeons will suggest this first, before doing arthroscopic surgery. Working hard to improve your knees will pay off well in the long run!

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