Canyon View Medical Logo - Color

Photoshop can’t “fix” bones (bone health part II)

With the right software program, a couple of minutes, and a little skill, we can transform the girl in the picture on the left to the girl on the right.

That’s right! Photoshop can fix or manipulate many things within just a matter of minutes, making the enhanced version appear even better than the original!

Unfortunately, even with the right equipment and ample skill, a fractured hip can’t be repaired as quickly or as easily. Broken bones are painful at any age and weak bones can be deadly for the older population. Statistics clearly show that hip fractures are associated with loss of independence, decreased quality of life, financial burden and frequently death. In fact, it is estimated that 14 to 58% of people will die within a year following a hip fracture.

If the prime time for calcium deposition has passed (if you are older than age 30), you can still decrease the risk of a fragility fracture by…

#1. Being aware of your bone health
#2. Evaluating your risk for fracture
#3. Discussing treatment options
#4. Evaluating what is the best treatment for you

This article discusses bone health, risk factors associated with osteoporosis and subsequent fracture, and treatment options.

#1. HOW TO ASSESS BONE HEALTH
Bone Mineral Density (BMD) is a test that uses

X-ray technology to measure the number of minerals (specifically calcium) in the bone that reflects the strength of the bone.  A normal BMD is defined as a T-score greater than -1.0.  Osteopenia or mild bone loss is reflected via a T-score between -1.0 to -2.5 and individuals diagnosed with osteoporosis have a T-score of -2.5 or lower.  The majority of fragility fractures occur in patients with bone mineral density in the osteopenic range.

Bone Mineral DensityT-score
Normal-1.0 and above
Osteopenia (low bone density)-1.0 to -2.5
OsteoporosisLess than -2.5

Measuring the BMD is typically evaluated through a medical test called a dual-energy x-ray absorptiometry, otherwise known as a DEXA scan.  It is a simple, painless test that takes about 5 to 10 minutes to perform.  Typically, a DEXA scan should be done at age 65 for healthy women who are not at particular risk for osteoporosis. Depending on risk factors, it may need to be done earlier or be repeated every two to five years after the initial evaluation.

#2.  EVALUATING YOUR RISK FOR FRACTURE

There are several known risk factors that can increase the risk of fracture.  These are:

  • significant weight loss or lower body weight (women < 127 pounds)
  • smoking
  • family history of fractures
  • decreased physical activity
  • alcohol or caffeine use
  • low calcium and vitamin D intake (especially vegans, those with lactose intolerance, disease of the digestive system causing absorption issues or those who consume large amounts of protein or sodium causing excess secretion of calcium through the urine)
  • long-term corticosteroid use

The Fracture Risk Assessment Tool (FRAX) was developed in 2008 by lead researchers involved with bone health in a combined effort with the World Health Organization (WHO) to improve the predictability of assessing patients with low bone density and risk for fracture.  Although the FRAX calculator has not been proven in randomized controlled trials to be beneficial, it is a widely used tool in the treatment decision-making process throughout the world.

Advancing age is the most important risk factor in developing a low BMD. 

The FRAX is a helpful tool in assisting the decision making process regarding pharmaceutical treatment.

The American College of Obstetricians and Gynecologists (ACOG) and the American College of Physicians (ACP) recommend that women who have known osteoporosis should be treated with prescription medication.  If a woman falls into the low bone mass category (T-score between -1 and -2.5) the FRAX tool can assist the woman and provider in making a treatment decision.  Generally, if a woman is at increased risk of experiencing a hip fracture or other major fractures in the upcoming 10 years, treatment with medication is recommended.

Prescription medication is recommended when the FRAX calculator predicts a ten-year risk of:

a hip fracture of 3% or more
OR
a major fracture of 20% or greater

#3. DISCUSSING TREATMENT OPTIONS

All women should be getting adequate amounts of calcium, vitamin D and participating in a weight-bearing activity on a regular basis.  Ideally, this is done through a healthy diet.  However, over-the-counter supplements may be necessary for many individuals.

menopausal women – 1,200 mg/d ≈4 cups of milk or calcium equivalents

women with low bone density (osteopenia) – 1,500 mg/d

women at risk for fracture (osteoporosis) – 1,500 mg/d

All need vitamin D – 1,000 to 2,000 IU/d

All need regular weight-bearing and bone-strengthening exercise
(ie: walking, jumping rope, hiking, dancing, yard work, elliptical machine, elastic bands, free weights or weight machine)

All will benefit from exercises, such as Tai Chi or Yoga, that will improve coordination, flexibility and strengthen muscle, decreasing the chance of a fall.

Women who have a lower bone density should discuss the risks and benefits of starting a prescription medication, along with the above lifestyle modifications.  When medication is initiated, treatment often continues for three to five years and there is no benefit in continued DEXA testing during this period. Evidence shows that even if no increase in BMD occurs, women still have fewer fractures when treated with pharmacologic treatment.

The prescription medication works by slowing down the destructive process of the bone matrix, hence the cells that build bone are able to work more effectively.  It can be given via tablets that are taken weekly or monthly, through an injection every 3 months or an annual infusion directly into the bloodstream.

If oral tablets are used, it is important to take the medication on an empty stomach with a full glass of water and remain upright for 30 minutes afterward in order to allow for proper absorption and the least amount of side effects. Your dentist should be aware of the medication you are taking and regular dental check-ups are important to detect a rare side effect that decreases the blood flow to the jawbone.  Heartburn or difficulty swallowing should be reported to your provider and calcium and vitamin D need to be continued during the course of treatment.  Use caution with other medications (ie: ibuprofen or aspirin) that may cause more irritation to the stomach and esophagus.

#4. EVALUATING WHAT IS THE BEST TREATMENT FOR YOU

Personal risks and coexisting conditions should be discussed when deciding how aggressive treatment needs to be.  When symptoms of menopause need to be treated, hormone therapy will also help maintain bone mass.  Clinicians believed that when a woman stopped hormone therapy the rate of bone loss would increase at the same rate after stopping hormones as it would with natural menopause.  However, further analysis and reanalysis of the Women’s Health Initiative (WHI) trial data shows that even 5 years later, women who stopped hormone therapy had no increase in the hip or total fractures.  This suggests a residual benefit in reducing bone fractures for even several years after cessation of hormone therapy.

Risk and treatment need to be individualized for each woman.  Talk to your provider if you have questions regarding your bone health. 

To succeed in life,
you need three things:

a wishbone,
a backbone
and a funny bone.

-Reba McEntire

How to Beat Hay Fever, for Kids and Adults

Spring is here. For those with allergies, the warm weather and flowers are a sign of allergy symptoms to come.

Here are some tips that will help you lessen the symptoms of hay fever.

For the Itchy Eyes:

  1. Try anover-the-counter antihistamine eye drop like Zaditor or Alaway.
  2. See your doctor about prescription antihistamine eye drops like Pataday, Azelastine, or Patanol.
  3. See your doctor about a script for Singular, see #5 below.

For the Runny Nose, follow these steps:

  • Start with a Nose spray like Flonase, Nasacort or Rhinocort.
    • These actually do work better than over the counter allergy pills.
    • In ages 3-12 years old you can do one squirt in each nostril daily
    • In a person 12 and older do 2 squirts in each nostril daily
    • It will take 1-2 weeks before you start to see results, so hang in there.
  • Add on Allegra 180mg, or its generic Fexofenadine over the counter.
    • This is the best over the counter antihistamine allergy pill, non-drowsy.
    • If you take it long-term (more than a few months) it can lose its effectiveness, and if this happens try switching to another allergy pill instead (see #3)
    • They have an over the counter formulation for kids 2-11
  • Try Zyrtec (Cetirizine), Claritin (Loratadine), Xyzal, Benadryl, or their generics
    • Zyrtec and Claritin have formulations for children over the counter
    • Despite what the package says, you can take up to 4 tablets of Zyrtec and Claritin if one tab does not work, although you risk getting side effects of headache and drowsiness
    • If you take it long-term (more than a few months) it can lose its effectiveness, and if this happens try switching to another allergy pill instead.
    • Zyrtec and Benadryl may make you drowsy.
  • You can try buying Allegra, Zyrtec, Claritin combined with a decongestant in them. These are behind the counter at the pharmacy.  Don’t take these if you have high blood pressure.
  • See your doctor about a script for Singular, a prescription pill that blocks the allergy pathway through a different mechanism than the over the counter antihistamines. When this medicine is combined with the above meds, you can get even more relief from the allergies.
  • There is a cure for your allergies. Come see Dr. Beckstead for allergy skin tests to find out what you are allergic to. Once we find out what you are allergic to we can discuss either allergy shots or allergy drops under the tongue to cure you of your allergies for life.

Itching To Know More About Hives?

What are hives?

Red/salmon colored, itchy, raised bumps on the skin that come and go over a period of minutes to hours. They will often appear in one area and, over a period of hours, disappear and move to another area. They can occur in rare, single instances, in which case usually there is an obvious or self-limited trigger.  Or they can become chronic, reoccurring, in which case often there is no known trigger.

What hives are not: 

They are not red bumps that persist for days and do not change form.  They are not a flat, non-raised rash that does not itch.

Why am I getting hives?

Common triggers:

-Virus infection (acutely)

-Allergic reactions to a food or medication (acutely)

-Cold or heat induced

-Sunlight exposure

-Friction induced/tight clothing

-Ibuprofen/Aleve

-Stress/lack of sleep

-Alcohol

How can I treat my hives?

-Avoid the common triggers

-Take a daily antihistamine like Benadryl, Allegra, Zyrtec, or Claritin

-Also take a daily antacid with antihistamine properties like Pepcid or Zantac

-Get a script from your doctor for Singular, a prescription medication that blocks the allergy pathway through a different mechanism than the over-the-counter antihistamines.

If I have chronic hives, should I be tested for allergies?

You should have blood work, checking your blood counts, inflammation markers and thyroid function tests, since rarely immune system dysfunction in these areas of the body can cause chronic hives.  Research has shown, though, that it is very rare for chronic hives to be caused by an allergy.  It is not often that skin tests reveal helpful information for people with chronic hives.  However, if you are wondering if an allergy is triggering your hives you can come in to be tested (1).

Resources:

  1. Saini, S. Chronic urticaria: Clinical manifestations, diagnosis, pathogenesis, and natural history. UpToDate. uptodate.com. Accessed 3/26/18.

Caring For Your Child’s Cold

As we head into the winter season, you may notice that your children are becoming sick more frequently. The most common illnesses encountered by our pediatric group during this time of year are upper respiratory infections, croup, sore throats, and ear infections. There are many common concerns that parents have such as Why is this cough lasting so long? Does my child need antibiotics? How high of a fever is too high? Does my 18-month old has Strep throat? Why is my child always sick?

One of the most common reasons for a parent to bring their child to the Doctor’s office this time of year is a viral upper respiratory infection, otherwise known as “the common cold.”

The common cold may be caused by any one of hundreds of different viruses and do not require antibiotics. Antibiotics are medications that have been developed to treat infections caused by bacteria and have no effect on viruses. That being said, when your child develops a cold due to a virus, they can become susceptible to bacterial infections such as ear infection, sinus infection, or pneumonia.

Cold symptoms can include a combination of sore throat, cough, stuffy and/or runny nose, fevers in the first 1-2 days, and headache. While worrisome, if the symptoms have been present for a week to 10 days and seem to be improving, little more than rest and symptomatic management are required. Most colds will worsen over the first 3 to 5 days, start to improve around day 7, and mostly resolve around day 10. The cough, however, can sometimes last up to 20 days.

The mainstay of cold treatment continues to be treating your child’s symptoms and making sure they get plenty of rest.

Acetaminophen and ibuprofen are best for controlling fevers and discomfort. Be sure to check with your doctor about appropriate dosing. Cough is difficult to treat and often times over the counter medications provide little to no relief. In children older than 12 months, one tablespoon of honey can help decrease cough and is very safe to give during the day and before bedtime. It can be given in some warm water, mixed in with a tea, or just right from the spoon. Cough drops may be used in older children as well. Nasal saline irrigation is very helpful for clearing the nose of mucus, which often makes it difficult for your child to breathe while eating and sleeping. Using just a few drops in each nostril, then using a bulb suction to remove some of the mucous (or having your older child blow their nose) can really help make them feel more comfortable. Humidifiers, if available, can also provide some comfort.

While the typical cold may last up to 10 days without causing concern if you are noticing improvement, there are some signs to watch for that may mean your child has developed a bacterial infection. The first clue is if a fever over 100.5 degrees develops after other cold symptoms improve. Increased fevers after 5 days of symptoms should always be evaluated by your physician.

Important points to remember:

  • Fevers in a normal viral cold occur in the first 1-3 days
  • Cough can normally last up to 20 days, as long as it’s not worsening
  • New or ongoing daily fevers over 100.5 degrees after 5 days of cold symptoms should always be evaluated by a physician
  • Nasal congestion or runny nose that is worsening or not improving after 10 days may be a sinus infection
  • If you are ever in doubt or have concerns, schedule an appointment with your child’s physician

Be sure to return as I will be discussing these in the next few blog posts.

If you would like your child to be seen by a Canyon View Pediatrics provider please call 801-894-1333 to schedule an appointment.

Canyon-View_Provider-Haley-PLEDGER
providers
Haley Pledger, PA
801-465-2559
Women’s Care
page
Matthew Walton, DO
Canyon-View_Provider-Austin_BILLS
providers
Austin Bills, DO
801-798-7301
Family Medicine
Canyon-View_Provider-Aaron-FAUSETT
providers
Aaron Fausett, PA
801-465-9820
Family Medicine
Load more results