Saturday, June 30, 2007

Don't give up on the calcium and D!

A number of my patients quit taking calcium and D in 2006 after getting the wrong impression from news reports out of the WHI that these supplements did not help preserve bone density.

As an editorial(1) accompanying the article points out, calcium and D are necessary to prevent bone loss, but not necessarily sufficient to do the job alone in women at risk for osteoporosis. As Dr. Joel Finkelstein points out:

Calcium with vitamin D supplementation is akin to the ante for a poker game: it is where everyone starts. If the clinical data suggest that the risk of fracture is significant, however, a woman probably needs something more.

Furthermore, Dr. Finkelstein and others have noted that the vitamin D dose used in this sub-study of the WHI was only 400 units, and other studies have suggested that doses of 700 units or more are needed to positively affect bones.

Here's the other part of the report that never made it into the popular media. Only 59% of study subjects actually stuck with the program and took the calcium and D as directed. If the data was analyzed for hip fracture protection in the compliant group alone, there was a 29% risk reduction.(2)

1. NEJMVolume 354:750-752 February 16, 2006 Number 7
2, NEJMVolume 354:669-683 February 16, 2006 Number 7

Wednesday, June 27, 2007

Perturbation-based Balance Training

Here's a chance to push around an old person and get away with it.

Now it's not entirely clear how these Toronto doctors perturbed their elderly subjects, but Dr. Brian Maki and associates did make it clear that their subjects wore safety harnesses. They were suspended from the ceiling perhaps? The test group was then pushed and pulled about in a challenging and unpredictable manner during a training program. At the end of the study, the tottery oldsters had greatly improved their balance-recovery reactions.

Improved balance control decreases the risk of falling and improves the physical confidence of older individuals. Falls resulting in grave physical injuries such as a fractured hip and pelvis often initiate a downward and ultimately terminal chain of events in the elderly.

Tuesday, June 19, 2007

Sunday morning's splitting headache of a mini-stroke dealt the final blow to my mom's ability to form new memories. Dying, from what I've seen, is not so hard, but the road there is a helluva journey. I wish us all someone near and dear to go the distance with us on that final trip.

Saturday, June 16, 2007

Ritalin miracles

Coincidental or cause and effect? Yesterday I started my elderly mom on Ritalin, just a teensy dose, to see if its neurostimulating effects might put her aging brain cells back in touch with one another.

The phone rang early this a.m. Ordinarily, early a.m. phone calls are either disasters or my friend J calling because some new symptom makes her think she has cancer. Neither disaster nor phobias this a.m...the caller was my mother full of enthusiasm and tales of a night of interesting dreams. Her usual state of mind at 7 a.m. is befuddled if she's even awake at all. This caller, however, was my previous mom working with parts of her brain's frontal lobe that haven't fired in weeks.

Friday, June 15, 2007

Jacking up granny

My mother is increasingly dispirited and contentless as the result of numerous 'mini-strokes.' Doubtless over the last 5 years, and certainly in the last few months, she has lost small glumps of neurons to these little vascular blows, no one of which notable in its effects, but collectively devastating. As a result, certain critical connections have been lost, and now they've become numerous enough to leave her more than a bit unstuck in time and space.

As I sat and talked with her today--or rather she sat and I talked--I wondered if a little nudge to the noggin might not improve her situation. Ritalin certainly restores content to the distracted teenaged brain--so why not to the ischemic elderly one?

I used my handy daughter-as-doctor option to implement the plan on the spot. 5 mg. of Ritalin and one hour later, the change was astounding. She began adding her own observations to my conversational gambits, putting together concepts, pulling up related memories, and, best of all, when her sister called to chat, began laughing with pleasure over a story my aunt shared.

Her blood pressure rose from 80/60 (barely enough to pump blood up north to the head) to 134/80. While an increase in blood pressure and heart rate might not necessarily be the best long-term option for old hearts, the pleasure of laughter is worth it for us.

Monday, June 11, 2007

In praise of chiropractors

What does the aging parent of a soon-to-be college student do after a day at freshman orientation?

Speed down I-25 from Greeley to Denver, scarcely able to flex my right knee to hold the accelerator steady at 80 MPH. What was the big hurry? Had to get that aching knee and its cracked lateral meniscus to the local chiropractor before his office shut down for the day. And I made that university to office drive in one hour and 10 minutes door to door.

Now Dr. Visentin, the capable if somewhat unusual chiropractor who practices next door to The Mozart Lounge whose patrons smoke out front on the sidewalk for want of an outdoor patio, is not going to fix my aging meniscus. There's no give-backs on damaged cartilage. He can and did, however, line up my knee as best it could be lined after I stumbled and jerked it into misalignment this a.m. as I rushed to get the incipient student out of his bed.

If it takes a village to keep a half-century-plus doctor on her toes, count Dr. V in my census.

Saturday, June 09, 2007

Stay cool AND dry

Here's a news flash for hot, older women. Ditropan, tried and true for the agony of the overactive bladder, has a favorable effect on diminishing the agony of the menopausal hot flash.