UCSF orthopedic surgeon Dr. Paul Toogood discusses the types and origins or Arthritis.
Tag Archives: Women’s Health
WOMEN’S HEALTH: RISK FACTORS AND PREVENTION OF OSTEOPOROSIS
I have heard the same story over and over. You get older, you trip over your dog or on the edge of a rug, you fall and break your hip, and in treatment or convalescence, you get a pneumonia and die, or at least you get weaker, setting you up for the next fall. Your course is downhill.
The culprit is often OSTEOPOROSIS. Osteoporosis is a disease characterized by loss of bone mass, as opposed to Osteomalacia, discussed in a recent podcast on this site, which is softening of bone The word itself is a MEMONIC for the RISK FACTORS; Then comes WHAT TO DO.
The RISK FACTORS and Prevention Strategies can be remembered in the following mnemonic:
Osteoporosis prevention begins when you are a child, with healthy diet rich in Calcium, and lots of exercise. Your bone mass peaks in the early 20s. While you are young, in your reproductive years, your reproductive hormones, Estrogen and Testosterone protect you.
Women should develop a Preventative strategy during menopause. Being THIN, like i am, is generally a marker of good health, much better than being Fat.
But especially as you get older and Lose muscle mass, Osteoporosis can become a problem, maybe because your bones don’t get the stress required to keep them strong.
BONE DENSITY DECLINES WITH AGE. I get a DEXASCAN as often as my insurance allows, about every 2 years, and am due this summer.
More and more treatments for Osteoporosis are emerging, if your bone loss becomes severe enough.
KEEP IN CONTACT WITH YOUR DOCTOR.
–Dr. C
HEALTH: HOW SLEEP HAS CHANGED DURING COVID-19
From the Wall Street Journal (June 1, 2020):
“The biggest problem has been staying asleep,” says Philip Muskin, a professor of psychiatry at Columbia University Medical Center in New York. “People aren’t exercising, their days have no structure at all.”
Preliminary results from a survey taken by around 1,600 people from 60 countries show that 46% reported poor sleep during the pandemic, while only 25% said they had slept poorly before it, according to Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, who studies how stressful events affect people’s sleep. Forty percent also reported increased alcohol consumption.
The key is to prevent the sleep problem from becoming chronic, she says. It is important to avoid associating your bed or bedroom with a place where you are awake. Experts recommend that if you can’t fall asleep, or wake up in the middle of the night and are unable to go back to sleep after 20 minutes, get out of bed and do something relaxing.
HEALTH: ARE FACE SHIELDS THE BETTER PROTECTOR?
From a New York Times article (May 24, 2020):
Dr. Perencevich believes that face shields should be the preferred personal protective equipment of everyone for the same reason health care workers use them. They protect the entire face, including the eyes, and prevent people from touching their faces or inadvertently exposing themselves to the coronavirus.
The debate over whether Americans should wear face masks to control coronavirus transmission has been settled. Governments and businesses now require or at least recommend them in many public settings. But as parts of the country reopen, some doctors want you to consider another layer of personal protective equipment in your daily life: clear plastic face shields.
COMMENTARY
When I take my walk, which currently is my only outing, I wear a face SHIELD for my personal protection against contracting Covid 19 from others.
I gave up on the face MASK because it is uncomfortable, especially when I am breathing heavily while walking rapidly up hills.
There isn’t much research supporting the self-protective use of face shields, but the video accompanying this article was enough for me; notice the aerosol-free area behind the face shield.
While walking, I breathe In deeply through my nose, and exhale through my mouth, using “pursed lips”, which aids in oxygen extraction by holding the alveolae open.
Exhaling through the mouth also clears the air behind the mask for subsequent nasal inhalation.
With nasal inspiration, any SARS CoV-2 aerosol particles would be deposited in the nasal passages, Which are that much farther away from your vulnerable lung.
It isn’t perfect. For one thing, it wouldn’t protect you much if someone coughed at you from the side or behind. I often hold my breath reflexes when I hear someone cough, or when I pass closely (even 6ft.) to someone.
The face shield holds promise for protecting you from viral infection, including the “flu”.
—Dr. C.
TELEMEDICINE: A REVIEW OF 9 CONDITIONS THAT CAN BE TREATED ONLINE (VIDEO)
TELEMEDICINE is here to stay! With all its’ advantages Patients will demand It!
This video is one of the few to highlight WOMENS’ HEALTH as an appropriate field for Telehealth. A remote visit first may at least let the Doctor order some tests that will accelerate your care.
Urinary problems can also be appropriate for telemedicine; the MEDICAL HISTORY is such a VALUABLE DIAGNOSTIC TOOL!
Psychological and Psychiatric care could be completely remote, by telemedicine. The Doctor could save on expenses, and deliver care less expensively.
Distance disappears as a barrier to Consultations and second opinions. A University medical center or prestigious multi specialty Clinic are on your doorstep.
Of course, barriers remain in the form of regulations, litigation, bureaucracy, and Insurance, but these can be overcome, if the Will is there.
—Dr. C
INFOGRAPHICS: “HOW SLEEP AFFECTS YOUR HEALTH”
OPINION: FACE MASKS AND SHIELDS TO PREVENT COVID
My main exercise for the day is a 45 minute fast walk around my community.
Hat – check. Sunglasses – check, FACE SHIELD – check.
Yes, face shield. The shield has the advantage of allowing me to talk, plus being more comfortable to wear. I clean it with a woolen cloth on one side and cotton on the other, hoping for a condenser electrostatic effect (I’m open to suggestion from engineers).
If I cough, any large particles of mucus would impact the shield, leaving only tiny aerosol particles to escape around the edges into the environment to endanger others.
It is Saturday today, and I pass a man and a woman pushing a baby buggy, and give them wide berth. I don’t consider 6-feet far enough distancing. 12-18 feet would be better, since, at 88-years of age, I am at least 2-3 times more susceptible.
A 12-year old zooms by me on a scooter. His age predicts less viral effluent, and the exposure time is less. I then go by a large collection of 20-year olds, Wide berth again, and, holding my breath, continuing to walk fast.
As I walk, I breathe air in through my nose, and out through my mouth. I feel the warmth (and purity) of the exhaled air, which may push aside and dilute any contaminants coming from the outside.
Another group of young adults! Well, maybe the risk is not as bad as the numbers would indicate. Odds are there would be only one spreader in the group, and the healthy ones would act as particle filters for me.
So far, not a single young person had a mask on. They are probably just thoughtless young people, and not necessarily “objectors” believing that mask-wearing is a sign of submission. As Peggy Noonan said in her column in today’s WSJ:
“…IT’S A SIGN OF RESPECT, RESPONSIBILTY AND ECONOMIC ENCOURAGEMENT”.
Going forward, we must all do our part to reduce the likelihood of another Covid surge. WEARING A MASK PROTECTS OTHERS.
I finally spied 2 masks! They were fitted on 2 ceramic lions flanking a front door. It is true that felines can catch Covid. But ceramic ones?
I thought I was walking fast, but was overtaken from the rear by a long-legged young lady. She passed within 4 feet of me, and of course had no mask on. I only hope she didn’t have Covid, and that my shield worked.
On the subject of the effectiveness of wearing a shield, while walking I tune into the odors along the way. I use the odors as surrogate aerosols, especially a recently fertilized curbside flower bed, I compare walking by the flowers, with and without my face shield, and find that the shield reduces but does not eliminate the odor. For more distant odors, like a barbecue, it does not make a difference.
Perhaps the shield, like the prow of a ship, pushes aside STREAMS of particle-laden air. Like coughing or talking nearby. But if the particles (yes, odors are nanometer particles) are well mixed with the air, there is no effect. Air must be breathed, after all.
There are a couple of other things I practice on my walk. I exercise my EYES by looking into the DISTANCE as much as possible. I try to walk as erect as I can. Gravity, my friend in grounding many big Covid-containing mucus particles, tries to bend me over.
The BOTTOM LINE, until more information is available), is: SPREADERS WEAR MASKS, SUSCEPTIBLES WEAR SHIELDS. Of course, hand-washing, social-distancing, coughing into your elbow, and staying at home, especially if sick, are all still important admonitions.,
-Dr. C.
THE HEALING POWERS OF YOUR POSITIVE ATTITUDE
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
From “Do Not Go Gentle Into That Good Night” by Dylan Thomas
My brother recently sent me a video featuring a confident man with a famous last name and a winning message: You beat Covid by fighting it. I would like to comment on several recommendations in his inspiring speech.
It is usually best to approach a problem with a POSITIVE ATTITUDE and a PLAN (1). This is particularly true with the ravages of old age (my area of expertise). Memory loss? Try to memorize poems. Balance loss? Practice standing on one leg. However………….
One person’s good experience is not a medical study. Medicine calls it a testimonial. This applies to my individual experiences as well. Going forward, I will be recounting many personal experiences with common diseases and conditions. Be careful about applying my solutions to your condition.. EXERCISE CRITICAL THINKING.
Be especially careful not to equate fame with medical expertise.
Mr. Cuomo’s result, if indeed the outcome was changed by his efforts, was most likely influenced by a powerful PLACEBO effect (2) which can be associated with striking outcomes, as we know from countless inspiring testimonials of “hopeless” cancer and other terminal conditions.
Even if we KNOW a treatment is likely due to the placebo effect, it remains effective. I don’t believe I’m doing harm with my speculations.
A couple of generations ago, confidence in doctors was much greater than it is now. We had fewer effective treatments, but surprisingly good results. As medical information of various quality proliferates and medicine loses prestige, it it is losing a valuable tool. Still, we have the placebo effect.
Mr. Cuomo was fortunate to have a good, positive doctor, and to believe in him. Positive affect is powerful.
FEVER is not the virus incarnate, but the bodies RESPONSE to the virus. Fever survived the culling of evolution because it confers a survival advantage, and is helpful.(3) Viruses replicate less rapidly at higher body temperatures.
I always told my patients: “ if you are stuck with the infection, enjoy the fever”. Of course high fevers, above 104 degrees F should be reduced.
I’m not sure that Covid patients should hold their breaths to “fight the virus”, although the length of time you can hold your breath is a good measure of breathing difficulty. Blood CO2, the main driver of dyspnea (shortness of breath), must not be allowed to accumulate. The accompanying hypoxemia (low blood oxygen ) is not desirable either.
I agree with most of the advice quoted by Mr. Cuomo. Lying on the back has proven dangerous in severe Covid. Taking deep breaths (even if painful) will help keep the alveoli (air sacs) expanded. Change of position is important for the same reason, and adequate fluids, including water, is always beneficial.
So educate yourself as much as you can about your condition. Pick out the best doctor you can find (the subject of a future opinion piece) and place yourself in her care. Enjoy a sense of relief and confidence. Even physicians need the objectivity and support of their own doctor.
Finally, armed with a positive attitude, make the most of whatever placebo effect you are accorded.
—Dr. C.
OPINION: THE ” FOUR PILLARS OF HEALTH AND THRIVING”
Homo sapiens have been around for upwards of 200,000 years and our bodies have evolved to deal with conditions far different than we experience in today’s life.
For about 95% of our species’ existence we have had:
- Far more SLEEP. We were diurnal, going to bed at sundown, awakening at sunrise.
- A more natural and varied DIET. We had to gather or kill what we ate.
- Far more EXERCISE as we walked many miles on most days.
- INTELLECTUAL STIMULATION. Well, here at least we moderns have an advantage, and our brains are better for it, If we get enough Sleep, Diet and Exercise.
Intellectual stimulation is really just a form of exercise. Exercise of the brain; as the brain is in a way like a muscle. If you don’t exercise your muscles, they waste away. If you don’t exercise your brain, your synapses waste away. To overwork a cliche : use it or lose it. Your muscles and brain are very energy-intensive and therefore expensive in evolutionary terms. Metabolic mechanisms have evolved to weed out that which is not needed and not used.
We could then say that there are the “Three Pillars of Health: Sleep, Diet, and Exercise, with the understanding that exercise refers to both muscles and brain. But they are exercised in such radically different ways, and each is prominent at different times in life. Children are reluctant to exercise their brains and are in constant motion. The elderly have much less muscle to exercise, but the aged brain still works quite well if you nurture and use it. So Intellectual Stimulation is best considered a separate category.
SLEEP, DIET, EXERCISE and INTELLECTUAL STIMULATION are then the “Four Pillars of HEALTH and THRIVING”.
These Four Pillars come as a package, reinforce each other, and are intricately interconnected. You can’t afford to neglect one without diminishing the others. But we will be discussing them separately, since they are separately researched and enacted.
Keep tuned.
—Dr. C.
TELEMEDICINE: Obstetrics & Gynecology Services
The following list contains preventive services that may be done via telehealth (from ACOG.org):
General Health
- Alcohol screening and counseling regarding alcohol use
- Anxiety Screening and referral*
- Counseling regarding aspirin to prevent CVD and CRC
- Blood pressure screening (if patient has appropriate resources available such as a blood pressure cuff)
- Contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants*
- Depression screening and referral
- Fall Prevention counseling
- Counseling regarding folic acid supplementation
- Healthy diet and activity counseling
- Interpersonal and domestic violence screening and discussion of available resources*
- Obesity screening (if patient has appropriate resources available such as a scale)
- Substance use assessment (drug use)
- Tobacco screening and cessation counseling
- Urinary incontinence screening*
Infectious disease
- HIV risk assessment*
- Sexually Transmitted Infection prevention counseling*
Cancer
- Counseling and possible prescribing of medications to reduce breast cancer risk
- Risk assessment for BRCA testing
- Skin cancer counseling
Pregnancy and postpartum
- Breastfeeding services and supplies*
- Postpartum contraceptive counseling, discussion of methods, and prescribing contraceptives that do not require an in-person visit such as intrauterine devices or implants
- Depression screening and referral
- Counseling regarding folic acid supplementation
- Interpersonal and domestic violence screening and discussion of available resources*
- Preeclampsia prevention with low-dose aspirin
- Preeclampsia screening (if patient has appropriate resources available)
- Tobacco screening and cessation counseling
*WPSI recommendation. For more information about each recommendation, please see our WPSI Recommendation page.
Download Well-Woman Care Chart
Read this May 4, 2020 “Women’sHealth” article for information about what a Telemedicine Visit is like
Doctors Without Waiting Rooms 