Category Archives: Bones, Joints & Muscles

Hospital step up to help seniors avoid falls


By Susan Jaffe

Daphne Brown, 65, was putting away the dishes in her Washington kitchen when she fell to the floor. Jane Bulla, 82, fell at home in Laurel, Maryland, but managed to call for help with the cellphone in her pocket.

Susan Le, 63, who has trouble walking due to arthritis, hurt her leg when she tripped on a pile of leaves in Silver Spring. And late one night when no one was around, Jean Esquivel, 72, slipped on the ice in the parking lot outside her Silver Spring apartment.

Falls are the leading cause of injuries for adults 65 and older, and 2.5 million of them end up in hospital emergency departments for treatment every year, according to the Centers for Disease Control and Prevention.

The consequences can range from bruises, fractured hips and head injuries to irreversible calamities that can lead to death. And older adults who fall once are twice as likely as their peers to fall again.

Despite these scary statistics, a dangerous fall does not have to be an inevitable part of aging. Risk-reduction programs are offered around the country. Continue reading


Is a double knee replacement right for you?


Having both knees replaced at the same time has advantages

By Dr. David Kieras
Virginia Mason

samIf someone you know has severe arthritis in both knees that greatly reduces their quality of life, they may be a candidate for bilateral simultaneous knee replacement surgery, where both joints are simultaneously operated on in one surgical procedure.

Although not an option for everyone, this approach is enticing to many people who dread the idea of recovering from two separate surgeries, which delays recovery and a return to normal activities for several months, if not years.

Bilateral ‘staged’ knee replacement – one knee surgery followed by another – is not uncommon.  However, bilateral simultaneous knee replacement is more advanced and uncommon due to the special expertise and team coordination required.

It can be beneficial for people who have limited time off from work for rehabilitation and need to return to a more normal lifestyle as quickly as possible. Continue reading


States Seek to Protect Student Athletes from Concussions, Heat Stroke

SLN_Sept12_2_WGBT calculator

A Wet Bulb Globe Temperature calculator in use last week during a football practice of the Oconee County High School in Watkinsville, Georgia. The device, which measures temperature, humidity and radiant temperature is used to govern sports activities at all Georgia high schools. Photo © Stateline

By Michael Ollove

Athens, Georgia—When Georgia public high schools were asked several years ago to devise a policy to govern sports activities during periods of high heat and humidity, one school’s proposal stood out: It pledged to scale back workouts when the heat index reached 140.

Those who understood the heat index, the combined effects of air temperature and humidity, weren’t sure whether to be appalled or amused. “If you hit a heat index of 140,” said Bud Cooper, a sports medicine researcher at the University of Georgia who examined all the proposed policies, “you’d basically be sitting in the Sahara Desert.”

The policy reflected an old-school, “no pain, no gain” philosophy, a view that athletes need to be pushed to their physical limits—or beyond them—if they and their teams are to realize their full potential.

In some places, state, school and sports officials are recognizing that the zeal of coaches, players, and parents for athletic accomplishment must be subordinated to safety. Increasingly, they are adopting measures to protect student athletes from serious, even catastrophic injuries or illnesses that can be the consequence of a blinkered focus on competitiveness. Continue reading


Can’t find a doctor in your hometown? Sen. Murray wants to help – Puget Sound Business Journal


Washington MapSen. Patty Murray, D-Wash., is making the rounds in her home state, meeting with local healthcare leaders to promote legislation that would help train 1,500 primary care doctors to help treat people in underserved communities in the U.S.

via Can’t find a doctor in your hometown? Sen. Murray wants to help – Puget Sound Business Journal.


Premera to include Children’s in its networks – PSBJ


Seattle Children's Whale LogoSeattle Children’s Hospital will be included in the Premera Blue Cross health insurance networks through 2017 as a result of an agreement that ends a lengthy legal dispute.

via Legal wrangling pays off: Seattle Children’s, Premera make nice – Puget Sound Business Journal.


Women’s health – Week 49: TMJ


tacuin womenFrom the Office of Researcher on Women’s Health

Temporomandibular joint (TMJ) and muscle disorders are a group of conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement.

Some estimates suggest that TMJ disorders affect over 10 million Americans and appear to be more common in women than men.

The exact cause of TMJ is not clear. Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders but, in most cases, symptoms seem to start without obvious reason.

A variety of symptoms may be linked to TMJ disorders. Pain in the chewing muscles and/or jaw joint is the most common symptom. Continue reading


How to pick running shoes


Running shoes full shotThe American College of Sports Medicine has written a short a guide for picking running shoes:

Running shoes should be selected after careful consideration. With so many brands and styles of shoes on the market today, it is important to find the best fit for your feet and your needs. There is no “right shoe” that fits all runners. However, research and injury patterns have shown that there are some general characteristics of a good, safe running shoe.

To read the guide go here: Selecting Running Shoes


Death with Dignity Act prescriptions rise 43 percent


Washington MapThe number of Washington state residents who obtained prescriptions for a lethal dose of drugs under the state’s Death with Dignity Act rose from 121 in 2012 to 175 in 2013, a 43% increase over the previous year.

Of the 159 who died

  • 77 percent had cancer
  • 15 percent had a neuro-degenerative disease, including amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
  • 8 percent had other conditions, including heart and respiratory disease,

Their ages ranged from 29 to 95 years. Ninety-seven percent were white, and 76% had some college education. Ninety-five percent lived west of the Cascades.

Of the 159 who died, 119 ingested the medication and 26 did not. In 14 cases, it is unknown whether they took the medicines.

Reasons that patients gave for obtaining the lethal prescriptions included

  • Concerns about loss of autonomy – 91 percent
  • Concerns about loss of dignity – 79 percent
  • Concerns about loss of the ability to participate in activities that make life enjoyable – 89 percent.

Under the state’s Death with Dignity Act, terminally ill adult patients have had the right to ask their physician to prescribe a lethal dose of medication to end their life. Since the law’s enactment, 550 people have acted on that right since the law went into effect.

The 2013 Death with Dignity Act Report and information about the Washington State Death with Dignity Act are on the agency website.


How much does a new hip cost? Even the surgeon doesn’t know


surgeons performing surgery in operating roomBy Jenny Gold

What will a gallon of milk set you back? How about a new car? You probably have a rough idea.

But what about a medical device — the kind that gets implanted during a knee or hip replacement? Chances are you have no clue. And you are not alone: The surgeons who implant those devices probably don’t know either, a just-published survey shows. Continue reading


Does knowing medical prices save money? California experiment says yes


Hip replacement  - thumbBy Ankita Rao

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations.

In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011.

The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000.

Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum.

Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report.

The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform.

Researchers found that patients who received “intensive communication” from CalPERS were supportive of the efforts and recognized lack of price transparency in the system. The report also said enrollees were satisfied with the level of care they received when choosing facilities that met their cost threshold.

But that information has yet to reach the larger population of health consumers, said Alwyn Casill, the director of public relations for the Center for Studying Health System Change.

“There is a tremendous need to increase public awareness of this problem,” she said. “It should matter to you as someone who is paying for health care, not just for you, but for everybody.”

While the report doesn’t completely detail CalPERS’ approach to reference pricing, Casill said there is optimism that it will be a model for other insurance plans and medical systems.

But that is further limited by the narrow focus of this initiative on just two kinds of procedures — others, like MRIs and CAT scans, are also vulnerable to wide pricing disparities.

Some experts say any real success on streamlining health care costs will include the ability for consumers to understand the issue and call for change.

“The numbers are dramatic,” said Julie Schoenman, director of research and quality at the National Institute For Health Care Management Foundation, a non-profit educational organization unaffiliated with the report. “I think you really do need to have good quality measures, good transparency. And a lot of patient education.”

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

tacuin women

Women’s Health – Week 6: Bone Health and Osteoporosis


From the Office of Research on Women’s Health

Bones are living tissue. A healthy body with strong bones is essential to overall health and quality of life. Strong bones support us and protect the heart, lungs, brain, and other organs from injury. Weak bones break easily. They cause pain and interrupt everyday activities.

Osteoporosis, or porous bone, is a disease characterized by low bone mass. It makes bones weak and more likely to break – especially the bones of the hip, spine, and wrist.

The disease is a major public health threat for an estimated 44 million Americans, 68 percent of whom are women. Every year, 1.5 million Americans suffer a fracture because of weak bones, mostly in the wrists, spine, and hips.

Osteoporosis is called a silent disease because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist, or fall results in a fracture (broken bone). Many people are unaware of the link between a broken bone and osteoporosis.

While white women over the age of 50 are at highest risk for osteoporosis, women and men of every age and ethnicity should be concerned about bone health.

If you are older than 65, have broken a bone after age 50, have relatives with a broken bone, have certain medical conditions (for example, hyperthyroidism or arthritis), or take certain prescription medications (such as thyroid medicine or glucocorticoids), you may be at higher risk for osteoporosis. Talk to your health care provider and find out if you need a bone density test.


Diagram showing a healthy spine versus a spine showing signs of osteoporosis. Click on the image to view larger.

Some steps you can take to help prevent osteoporosis and fractures:

  • Be physically active every day to keep your bones strong. Weight-bearing physical activity causes new bone tissue to form, which makes bones stronger.
  • Eat a healthy diet, including calcium and vitamin D, which are critical for good bone health.
  • Know that smoking and heavy alcohol use reduce your bone mass and increase your risk for broken bones.
  • Reduce your risk of falling with physical activity to make you stronger and to improve your balance and coordination (making you less likely to fall).
  • Make your home safe by removing things you can trip over (like small rugs and stepstools), using non-slip mats in the bathtub and shower, and installing bright light bulbs to make it easier to see.
  • Ask a health care provider to review your prescription and over-the-counter medicine because some medicines, or combinations of medicines, can make you less alert, slower to react, and can lead to a fall.
for more information:
NIH and You
Milk matters is a public health education campaign that promotes calcium consumption among tweens and teens, especially between the ages of 11 to 15, a time of critical bone growth. Bones grow fastest during the tween and teen years, and adequate calcium intake during these years helps prevent osteoporosis later in life. But, studies show that most tweens and teens are not getting enough of it in their diets. Fewer than one in ten girls and only one in four boys ages 9 to 13 are at or above their adequate intake of calcium. Although the consequences of low calcium consumption may not be visible in childhood, the Eunice Kennedy Shriver National Institute of Child Health and Human Development recognizes lack of calcium during the critical years of bone development can have a serious effect on the health of young people later in life.

for more information:


tacuin women

Women’s health week 5 – Autoimmune disorders


From the Office of Research on Women’s Health

The immune system is a network of your body’s cells, tissues, and organs that works to defend the body against attacks by dangerous microscopic organisms,  such as bacteria,  parasites, fungi, and viruses that can cause infections.

For example,  when you cut yourself,  bacteria enter into your body through the cut. Your immune system immediately goes into action,  using a variety of cells to find and destroy the danger.

Similarly, when you are first exposed to a virus, your immune system mounts an attack and in the process develops a memory of the virus so that if you are exposed for a second time, your immune system is able to begin the fight against the virus faster. Your immune system works to keep you healthy.

The key to a healthy immune system is its remarkable ability to distinguish between your own body,  which it tolerates and keeps safe, and infectious organisms, which are dangerous and it attacks.

But sometimes, for reasons we do not yet fully understand, the immune system breaks down and mistakenly attacks the body’s own organs, tissues, and cells. When your immune system attacks your healthy body,  you develop an autoimmune disease. Genes,  or heredity, seem to play an important role. Today, we know of more than 80 human autoimmune diseases, many of them rare.

Symptoms of autoimmune disorders vary widely and depend on the disease. Symptoms often include dizziness, fatigue, a general ill feeling, and a low-grade fever. Your health care provider can diagnose autoimmune disorders through a physical exam. He or she also will ask you about your symptoms and family history, and will likely conduct laboratory tests.

These are some of the more common autoimmune disorders:

Lupus,  also known as Systemic Lupus Erythematosus,  occurs when your immune system attacks healthy cells and tissues by mistake. This can damage your joints,  skin,  blood vessels,  and organs. Lupus affects more women than men, and is more common in African American, Hispanic, Asian, and Native American women. Symptoms include joint pain or swelling, muscle pain,  fever with no known cause,  and red rashes,  often on the face (also called the butterfly rash).

Rheumatoid Arthritis is not like osteoarthritis,  which only affects your joints and bones. Rheumatoid arthritis affects joints and bones (often of the hands and feet),  and may also affect your skin and other organs. Rheumatoid arthritis generally occurs in a symmetrical pattern,  meaning that if one knee or hand is involved,  the other one is also involved. People with rheumatoid arthritis may have flare-ups,  which means that the pain and inflammation from the arthritis may appear to come and go suddenly. If you have rheumatoid arthritis,  you may also feel sick or tired,  and have a fever. Rheumatoid arthritis occurs more often in women than men.

thyroid graves disease exophthalmos

A diagram showing the tyroid gland and exophthalmos (bulging eyes) as a result of Grave’s disease.

Grave’s Disease is a disease of the thyroid gland (located in the front part of the neck below the larynx,  or voice box). Your thyroid controls how quickly your body uses energy. If you have Grave’s disease,  you have an overactive thyroid. Symptoms of an overactive thyroid include insomnia,  irritability,  weight loss,  sensitivity to heat,  fine brittle hair,  bulging eyes,  and shaky hands. Grave’s disease is treated with radioactive iodine,  medication,  and sometimes surgery. Grave’s disease is more common in women and those under the age of 40.

Sjögren’s Syndrome is a disease that causes dryness in the eyes and mouth. It can also lead to dryness in other normally moist areas such as the nose,  throat,  and skin. Sjögren’s syndrome is more common in women and those over the age of 40.

Most autoimmune disorders are chronic (long-term) diseases that can be controlled by treating the symptoms. For some,  symptoms come and go,  and flare ups can occur. Autoimmune disorders are serious conditions and should not be taken lightly. If you are having symptoms,  talk with your health care provider.

If you are diagnosed with an autoimmune disorder,  your health care provider will work with you to decrease your symptoms and control the autoimmune process while maintaining your body’s ability to fight disease. Treatments vary according to the disease and symptoms and there is still no known way to prevent most autoimmune disorders.

For more information:,,  and
tacuin women

Women’s health: Week 4 – Arthritis


From the NIH Office of Research on Women’s Health

tacuin womenArthritis is a chronic (long-term) disease. The word arthritis means joint inflammation. Inflammation is a response of body tissues to injury or irritation.

Arthritis can affect joints in any part of your body and may cause pain, stiffness, and swelling in the joints and in areas close to the joints.

The most common form of arthritis is osteoarthritis. Health care providers sometimes call osteoarthritis a degenerative joint disease. It is related to age and most often affects the fingers,  knees,  and hips.

Osteoarthritis occurs when your cartilage,  the tissue that cushions the ends of the bones within the joints,  breaks down and wears away. In some cases, all of the cartilage may wear away, leaving bones that rub up against each other.

Osteoarthritis can follow an injury to a joint, even many years later. For example, a young person might badly hurt her knee playing soccer. Years after her knee has apparently healed,  she can develop arthritis in her knee.

Osteoarthritis is more common for:

  • Women after age 45.
  • People who are overweight.
  • People with jobs that put stress on particular joints.

You might have some form of arthritis if you have some of these symptoms:

  • Lasting joint pain.
  • Joint swelling.
  • Joint stiffness.
  • Tenderness or pain when touching a joint.
  • Problems using or moving a joint.
  • Warmth and redness in a joint.

If you experience these symptoms,  talk to your health care provider about a management plan for your specific needs. Health care providers can use several methods to diagnose and rule out other problems. If you have the condition,  treatment options include:

Osteoarthritis arthritis

A diagram showing the eroded cartilage in an osteoarthritic knee.

  • Exercise:  Daily exercise,  such as walking or swimming, helps keep joints moving, lessens pain, and makes muscles around the joints stronger. Three types of exercise are best if you have arthritis:
    1. Range-of-motion exercises,  like dancing,  relieve stiffness,  keep you flexible,  and help you move your joints.
    2. Strengthening exercises,  such as weight training, will help improve muscle strength. Strong muscles support and protect your joints.
    3. Aerobic or endurance exercises,  like bicycle riding,  make your heart and arteries healthier,  help prevent weight gain,  and improve the overall working of your body. Aerobic exercise may also lessen swelling in some joints.
  • Weight control:  Weight loss can lessen stress on your weight-bearing joints,  limit future injury,  increase your ability to move around,  and lessen the need for medications.
  • Rest and relief from stress on joints:  It is important that you learn to recognize your body’s signals,  and know when to stop or slow down. This will help to prevent pain caused by being too active.
  • Non-drug pain relief:  If you have osteoarthritis,  you may find medication-free ways to relieve pain including:
    • Applying heat or cold (or a combination of the two) can be useful for joint pain.
    • Getting a massage where a massage therapist lightly strokes and/or kneads the painful muscles. This increases blood flow and brings warmth to a stressed,  inflamed area.
  • Medications to control pain:  Health care providers prescribe medicines to get rid of or lessen the pain and to improve your ability to function.
  • Surgery:  For many people,  surgery helps relieve the pain and disability of osteoarthritis.

Another form of arthritis is called rheumatoid arthritis, which is an autoimmune disorder.

For more information,  please see Week 5.

for more information:
Complementary and alternative therapies
People with arthritis often try various complementary and alternative therapies. Some people have found pain relief using acupuncture. Others have also tried folk remedies such as wearing copper bracelets,  drinking herbal teas,  and taking mud baths. Nutritional supplements such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis,  as have certain vitamins. While these practices may or may not be harmful,  no scientific research to date shows that they are helpful in treating osteoarthritis.

for more information:



FDA Updates Safety Recommendations for Metal-on-Metal Hip Implants


An FDA Consumer Update

The US Food and Drug Administration has updated its safety information and recommendations to patients and health care professionals based on the agency’s current assessment of metal-on-metal hip implants, including:

  • the benefits and risks
  • the evaluation of published literature
  • the results of an FDA advisory panel meeting held in June 2012


Implant components slide against each other during walking or running, which releases tiny metal particles. These particles may damage bone or soft tissue surrounding the implant and joint. Soft tissue damage could lead to pain, implant loosening, device failure and the need for revision surgery.

Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause discomfort or illnesses.

Recommendations for People Considering a Metal-on-Metal Hip Implant

  • Be aware that every hip implant has benefits and risks.
  • Discuss your options for hip surgery with your orthopedic surgeon.

Recommendations for People With Metal-on-Metal Hip Implants

  • If you are not having any symptoms and your orthopedic surgeon believes your implant is functioning properly, continue to follow-up routinely with the surgeon every one to two years.
  • If you develop new or worsening problems, such as pain, swelling, numbness, noise (popping, grinding, clicking or squeaking of your hip) or a change in your ability to walk, contact your orthopedic surgeon right away.
  • If you experience changes in your general health, including new or worsening symptoms outside your hip, let your doctor or other health care professional know you have a metal-on-metal hip implant.

For More Information

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