Tag Archives: Prevention

Hip Fractures in the Elderly Can Be Prevented

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By: Pamela Egan, NP

A broken hip or a hip fracture is a very common injury, especially in older adults and in the elderly. Broken hips are the most common bone fracture that requires hospitalization. Hospitalizations for broken hips are rising each year to the tune of about 300,000.

Falls are the most common cause of hip fractures in the elderly. High-force injuries such as motor vehicle accidents are the most common cause of hip fractures in younger patients who typically have stronger bones. Pathologic fractures such as weakened bones from infection or cancer can also be a cause of hip fractures.

Usually, osteoporosis is the cause of hip fractures in the elderly. Osteoporosis is a condition that causes loss of bone mass. The bones are thinner and weaker than normal. Adults with osteoporosis are at much higher risk of developing a hip fracture than someone without osteoporosis. The risk of osteoporosis is on the rise possibly due to an overall decrease in hormone replacement therapy and low vitamin D levels. Other risk factors associated with hip fracture are females, Caucasians, and sedentary lifestyle.

There are two types of hip fractures. A femoral neck fracture occurs when the ball of the ball-and-socket hip joint is fractured off the femur. Treatment of a femoral neck fracture depends on the age of the patient and the amount of displacement of the fracture.

Interotrochanteric hip fracture occurs just below the femoral neck. These fractures are easier to repair more often than femoral neck fractures. The usual surgical treatment involves placement of a plate and screws to stabilize the fracture.

Treatment of a hip fracture almost always requires surgery. Some surgeons are using a newer implant that uses a rod inserted down the center of the bone rather than a plate along the outside of the bone. Both types of fracture fixation (the plate and the rod) have shown good healing and have had excellent results.

Physical therapy is usually started immediately and patients can usually walk with their full weight on the implant. Patients are usually encouraged to begin walking immediately following surgery. Most commonly, patients will get up with the physical therapist the next day following surgery. It usually takes a year for full recovery.

Complications often occur in patients who suffer broken hips. By getting patient up and out of bed as soon as possible, the risk of complications is reduced. Mortality rates in the first year following a broken hip are around 25%, and the rates are highest in older populations. The cause of death following a hip fracture is often due to blood clots, pneumonia, or infection. Furthermore, only about 25% of patients who sustain a broken hip return to their pre-injury level of activity. About one year after a patient sustains a broken hip, mortality rates return to normal, but a patient who previously sustained a hip fracture is at higher risk of breaking their hip again.

Treatments for osteoporosis are available, and will help elderly individuals avoid serious complications of this disease such as a broken hip.

An assortment of products are available through medical equipment stores that can help to reduce the risk of the slips and falls that lead to hip fractures. Mobility devices such as medical walkers, rollators, canes and power scooters can help to provide ambulatory assistance to elderly individuals, as well as to those with limited strength or mobility.

Bathroom safety devices can also help to reduce the risk of injury in one of the most dangerous areas of the home for susceptible individuals. Among the most effective of these items are grab bars. Grab bars (also known as safety rails) can be mounted against a wall, inside the shower and on the wall of the bathtub. They provide a gripping surface to help individuals maintain balance and avoid falling down (and ostensibly breaking a hip). Shower chairs provide a seating surface for inside the tub, thereby eliminating the need to stand. This in turn dramatically reduces the risk of slipping while in the shower. Raised toilet seats reduce the amount of bending over necessary for one to assume a seat on the toilet. Finally, non-slip bath mats add traction to the floor of the tub or shower, making it less slippery and subsequently less dangerous.

Lastly, nutrition plays an important role in preventing both osteoporosis and hip fractures. By making a point of getting good nutrition, the risk of osteoporosis and weak bones in general is reduced significantly. The elderly should almost without exception see to it that they are ingesting sufficient amounts of calcium, magnesium and vitamin D3, either through diet or supplements. Since estimating the amount of these nutrients in one’s diet can be so difficult, I receommed going the supplement route just to be sure.

It is important when buying supplements to insist on vitamin D3 (cholecalciferol) as opposed to supplements containing ergocalciferol (vitamin D2). D3 is more readily absorbed by the body, and is a far more effective form of the nutrient in terms of boosting the immune system, preventing disease and improving bone density.

The Role of Prevention in Medicine

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Guest Post by Peter F. Egan Jr. (Pam’s Eldest Son)

Pam has been unusually busy lately, so I’ve taken the liberty of filling in for her while she’s away from her blog. You may periodically see posts from me when my mother is particularly busy. I regret the inconvenience, but vow to do my best to keep the content at the same, exceptionally-high level of quality when I do fill in. I hope you enjoy what hopefully will not become a regular appearance.

To Prevent, Or Not To Prevent? That Is The Role Of Medicine

There are a lot of people out there who seek general, all-around care by a physician who will consider all aspects of their lifestyle – factoring in such things as nutrition and diet – when assessing a patient. A good number of Americans (I don’t have a scientific percentage handy) expect their doctor to help them prevent the onset of illness rather than treat it after the fact, and unfortunately too many primary care doctors (though not all) leave much to be desired in this regard.

That said, there are undoubtedly many, many good one out there. It is a reality though that too many doctors place too little emphasis on prevention, preferring instead to deal almost exclusively with post-symtomatic diagnosis, and post-diagnostic treatment. As a patient, you owe it to yourself to do your research and look around until you find someone you’re comfortable with – both in terms of the person as well as his or her outlook on caring for the patient.

For those who hold a more broad view of the role of medicine (and see a role in prevention as well as post-diagnostic treatment), my advice to them would be to consider seeing a nurse practitioner. Nurse Practitioners traditionally have been more inclined than physicians to embrace the concepts of wellness and preventive medicine, focusing on the overall health of the patient and on prevention until symptoms arise. Obviously, at this point the focus would shift to diagnosis and treatment. However, the goal of preventive medicine practitioner (and many nurse practitioners) is to prevent and/or delay things reaching the diagnostic stage (with symptoms present) for as long as possible.

The risk of illness is reduced when the body and immune system is healthy, and the risk of injury is reduced when the bones and joints are healthy. Point being, when the body is healthy, injury and illness tend to occur less frequently on a general scale and are generally less severe when they do occur. Preventive medicine practitioners (again, often nurse practitioners) have a reputation for being cognizant of this, and for determine plans of care accordingly.

FTR: Yes, that is supposed to be a cheesy Shakespeare reference in the title.

Does Vitamin D Help Prevent MS?

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With the release this month of a new study out of Australia (first appearing in Neurology), the evidence continues to mount in support of a potential (and at this point probable) link between high levels of vitamin D3 (cholecalciferol – the “sunshine vitamin”) in the blood and a reduced risk of developing multiple sclerosis (MS).

While the scientists responsible for the study were careful to point out that the research involving 611 people who had not been diagnosed with MS at the time of the study established a link only between increased sun exposure and a corresponding decrease in the probability of developing MS. The study did not definitively establish that increased levels of vitamin D in the blood were the cause of the reduction in MS risk, or for that matter whether that was merely a byproduct of sun exposure with no direct bearing on the prevention of multiple sclerosis.

In recent years it has been learned by way of scientific research that more than 20 different diseases, illnesses and adverse conditions are brought about (at least in part) by vitamin D deficiency. Granted, even if a conclusive link is determined to exist, more research would be needed to determine if high levels of the nutrient were the preventative mechanism or if the disease was brought on by vitamin D deficiency and/or the compromised immune system resulting from the nutritional shortcoming.

That said, back in 2006 a study by the Harvard School of Public Health was published in the Journal of the American Medical Association linking Vitamin D to a lowered risk of MS.

In 2009, it was established by a team of Canadian and British researchers that vitamin D deficiency by a mother during pregnancy and an increased risk of developing multiple sclerosis in people with a genetic predisposition for the disease.

A study published in January of 2010 by researchers at the University of California found that insufficient vitamin D levels may be associated with a higher risk of relapse attacks in patients who developed multiple sclerosis during childhood.

Now in 2011 we have a study by Australian scientists confirming a link between sun exposure and a lower risk of developing MS. That means that almost every year for the past five years, studies either confirming or implying a link between the nutrient and the disease have been published for all to see.

In light of the many different studies by scientists from all around the world all arriving at the same or similar conclusions, it begs the quesiton of why are scientists from this most recent study so cautious about declaring vitamin D as a mechanism that can aide in the prevention of multiple sclerosis? Is the issue that these scientists fear ridicule from their peers if they were to tout a vitamin as a means of preventing an illness? Is the problem that the scientific community is not much of a community at all, with little-to-no communication between rival groups of researchers leading to a mass-ignorance within the community regarding research already completed by other scientists?

For those of you who don’t know, vitamin D3 (cholecalciferol) is the form of vitamin D made within the body and is the product of direct exposure to sunlight. In the Australian study, the researchers determined that those who spent the most time in the sun had the lowest risk of developing MS or MS-related symptoms. They also found that those subjects displaying no signs of MS had substantially higher vitamin D levels than their less fortunate counterparts.

While perhaps more research is needed to formally establish what most of us already strongly suspect is true, based on the available information it definitely appears likely that within the next couple of years science will conclude that the nutrient/hormone vitamin D3 helps prevent multiple sclerosis.

While science may be paranoid about implying a relationship between vitamin D and the prevention of multiple sclerosis, this author sees the writing on the wall and will be upping the dose on his vitamin D3 supplements.

Vitamin D3 and Probiotics Can Help Fight Acne

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Vitamin D3, Probiotics are Powerful, Natural Acne Remedies

Acne can result from such factors as hormonal disharmony, bacterial overgrowth, improper eating habits, chronic constipation, heredity and excess oil in the body. Although often overlooked, a direct link exists between Vitamin D and the skin.

Who would have ever thought that Acne was related to an imbalance of flora in the gut or a low Vitamin D level?

If you don’t know me by now, I try to find the cause of symptoms and disease rather than prescribing synthetic medications to cover up symptoms, especially complex acne medications like antibiotics, steroids, and accutane.

Accutane has been linked to Chron’s Disease. Not only does this drug dry up the face, it dries up the whole body. Many times once antibiotics are stopped, acne comes back raging. Sometimes, we just need to take a step back and look at natural remedies that worked in the past.

Vitamin D3 Helps Prevent Acne

Let’s review some simple facts regarding Acne:

Why are more and more adolescents suffering from severe acne? Is it something we’re eating, something we’re taking?

Over the years, our children have received more and more antibiotics for minor ailments. I myself am guilty of demanding antibiotics for my four children when they were younger. My youngest son lived on antibiotics prior to receiving ear tubes. Interestingly, he is the one who has suffered the most with acne.

Many adolescents are treated with antibiotics such as Doxycycline or Minocycline for their acne. The trouble with antibiotics is that while they will indeed kill off the bacteria that may be causing infection, they are non-discriminatory and so will attack the friendly flora in the digestive tract that actually work to keep us healthy. My patients act surprised when I tell them that many elements of the immune system are based the gut.

In a healthy gut, the good bifidobacteria that make up about a third of the gut flora naturally produce antimicrobial agents, which kill off or inhibit the more harmful micro-organisms. When this balance is disrupted and the harmful bacteria are allowed to thrive, they can bind to the gut wall where the damage they cause includes intestinal permeability problems. We fail to absorb the good nutrients, vitamins & minerals and allow the wrong toxins through our intestines. This can lead to nutritional deficiencies, allergies, acne, and auto-immune disease.

The over-prescribing of antibiotics is one of the most common causes of this imbalance. However, supplementing the diet with a good quality probiotic will help re-balance the intestinal system and put those good bacteria back in control. Whenever you are prescribed antibiotics you need to take a probiotic with at least nine strains to counter the negative effects on your digestive system. It is important to note that not all probiotics are created equal. I often prescribe a pharmaceutical strength probiotic with Vitamin D3 for my acne patients.Probiotics Supplements

Even if you suffer from a serious skin condition such as acne, you will likely notice a dramatic improvement to your skin if you take a probiotic supplement. This is because acne has been linked in some studies to intestinal health with researchers reporting increased blood levels of toxins absorbed from the gut in acne sufferers. These toxins come from those pathogens or bad bacteria that take over our intestinal tract. It has been shown that in about 50% of cases of acne, the natural balance of the gut bacteria has been disrupted and the bad bacteria are multiplying faster than the good bacteria. This is referred to as dysbiosis- the disturbance of the natural balance, which is an underlying cause of acne. Probiotics really can make a dramatic and positive difference on your skin.

Although a Vitamin D deficiency does not directly result in acne, obtaining sufficient Vitamin D can help resolve acne by making the skin and body healthier as a whole. Because the sun provides the most potent source of the nutrient, make sure you get enough exposure to the sun to improve your chances of having well-nourished skin. Of course, too much exposure to sun can also cause its own problems, so use your discretion. If your Vitamin D3 levels are low, synthetic forms of the nutrient used in supplements can help with the treatment of several common skin conditions, including acne.

Many clinics are now offering LED Light Therapy which also diminishes inflammation within the sebaceous gland to prevent propions-bacterium (P-acne) from reproducing.

Pamela Egan, NP, ABAAHP Diplomat, CDE is a board certified Adult & Family Nurse Practitioner, American Board of Anti-Aging Health Practitioner, Certified Diabetes Educator, Clinical Specialist in Mental Health can be reached at 985-892-3031.