Practical Living, Natural Health Blog

Hip, knee replacement surgery rates skyrocket over 7 years

April 29, 2008 on 1:12 am | In Uncategorized | Comments Off Implanting artificial joints, once the stuff of science fiction, has become so common -- and is expected to become even more so -- that it may overwhelm the health care system, according to a paper in the April 15 Arthritis Care & Research.

"The demand is exploding," said Sunny Kim, PhD, the paper's author and assistant professor of biostatistics at Florida International University in Miami. "Are we ready as a nation? I don't think so."

Analyzing data from the Nationwide Inpatient Sample, Dr. Kim found that primary hip replacements increased by 48%, from 153,080 procedures in 1997 to 225,900 in 2004. First-time knee replacements grew by 63% from 264,331 in 1997 to 431,485 in 2004. If these trends continue, an estimated 600,000 hip replacements and 1.4 million knee replacements will be carried out in 2015.

The fact that the number of these procedures is increasing and most likely will continue to grow is supported by other studies. For instance, one in the April 2007 Journal of Bone & Joint Surgery predicted that demand for primary hip replacement would grow 174% by 2030 and for an initial knee replacement by 673%.

Several theories are offered for this phenomenon. One is that the population is aging, although Dr. Kim's paper suggested that the rate of increase far outpaced the change in this demographic factor. Another, though, is that the population is heavier, and many experts consider this explanation to be the best reason why so many joints are wearing out.

"A lot of ideas get thrown around, but I would say that probably the No. 1 factor is obesity," said Trish Palmer, MD, a family physician and assistant professor of primary care sports medicine with Midwest Orthopedics at Rush in Chicago.

Hip replacements went up 48% from 1997 to 2004.

The rate of obesity and overweight has grown significantly and is recognized by many public health agencies and medical societies, including the American Medical Association, as a major public health problem.

But while obesity is considered to be a central problem, many experts point to other issues as also playing a role. Improvements in technology, both in joint construction as well as computer-assisted surgery to improve the precision of how it is aligned, lead physicians to be more at ease with making this recommendation.

On the patient side, controversies over the safety of pain relief medications such as the Cox-2 inhibitors are leading some to prefer non-pharmacologic options for long-term pain relief. "People don't want to take medications," said Paul Lachiewicz, MD, professor of orthopedics at the University of North Carolina at Chapel Hill. "They want it fixed."

Also, manufacturers of artificial joints have been promoting these devices in direct-to-consumer advertising, and patients are more aware of them than ever.

These dynamics may be driving down the age at which this operation is performed, as reflected in the increased number of people ages 45 to 64 who have knees or hips replaced. According to Dr. Kim's paper, in 1997 this age group comprised 27% of all first-time hip replacements and 26% of initial knee replacements. Both of these numbers increased to 36% in 2004.

"Orthopedic surgeons performing these procedures are much more likely to recommend the procedure be performed at an earlier stage, because we're more confident that the product will last longer and allow patients to enjoy a more active, pain-free, productive future," said Stephen Hurst, MD, an orthopedic surgeon in San Mateo, Calif.

Cost, access become issues

Still, even though experts say this technology has proven to be cost-effective for most patients, it is not without financial bite. That reality is the point from where most of the concern about the increase results. According to Dr. Kim's paper, joint replacements cost hospitals $9.1 billion in 2004, about half of that paid for by Medicare.

"People are not arguing that it's not a worthwhile intervention, but we are anxious about who's going to pay for it," said William Maloney, MD, chair of orthopedic surgery at Stanford University in California. "Hip and knee replacement could break the bank."

Knee replacements grew 63% from 1997 to 2004.

Other concerns stem from what could become an access issue -- will there be an adequate supply of surgeons to meet the demand?

"The number of orthopedic surgeons is not increasing at the rate that the need for joints is increasing," Dr. Hurst said. "It's going to be difficult to keep up. Most orthopedic surgeons are reasonably busy, and many are busier than they want to be."

Also, the growing number of people getting this procedure done at younger ages increases the likelihood that they may outlive their artificial joint and will need to have it replaced with another one. Those surgeries are costlier and riskier, and the rate of these types of procedures has started to inch upward as well.

"There's no doubt that for all the same reasons, revisions are going to increase, and revision is a much more expensive and much more difficult [procedure] for the patient and for the doctor," said Anthony DiGioia, MD, director of the bone and joint health program at Magee-Womens Hospital at the University of Pittsburgh Medical Center. "It raises the stakes."

To cut the risk of revision and other complications, the American Academy of Orthopaedic Surgeons is working to establish a registry to identify implants that last longer and strategies that can lengthen their life even further. A request for information from vendors who may become a part of the project was issued in March. Numerous other countries, including Canada, Sweden and Great Britain, already have such registries.

Starving for perfection: The changing face of anorexia

April 29, 2008 on 1:12 am | In Uncategorized | Comments Off It was a daily menu of gum and tea sprinkled with 20 or so over-the-counter diet and water pills, 10 laxatives and six hours running on the treadmill. A few times a week, she would cut on her body with knives she kept taped under chairs; a release of pain, anger and starved emotions. At night she would lie awake, agonizing about how she could stay committed to this regimen.

"I'd eat one meal a week if I had to," says Sherri Crowl, now 40, of Edinboro, Pa. "My eating disorder started when I was 8." After 30 years, Crowl was diagnosed with anorexia nervosa. "I kept thinking, if I could be thinner, people would be in awe of me and want to be that size, too."

With eating disorders often passed off as a phase, intervention can be delayed or nonexistent. "Primary care and family physicians are so underutilized in getting people into treatment," says Kimberly Dennis, MD, a psychiatrist and medical director at Timberline Knolls, a residential treatment center near Chicago that helps women with eating disorders, addictions or other destructive behaviors. "Denial is huge, and a high-functioning intelligent woman who is not maintaining a healthy weight is easier to let go. Many physicians don't know what to do."

Take Crowl. When her heart had nearly stopped beating, she assured friends, family and medical professionals she was healthy. When she finally sought help, the doctor who did the admitting tests said her heart was beating so slowly that without treatment, she would die in a month. "I was shocked," she says, explaining that she still kept thinking that she exercised six hours a day -- of course she was healthy.

Her story is not so rare. Bodies of all ages fade into wisps of what once was, and anorexics are dying at a rate of 10% to 20% from complications of starvation or from suicide. Still, skeletal frames continue to sashay down runways; extreme- makeover programs highlight body perfection; and reality shows reward weight loss and excessive exercise. In the war on obesity, thinness has become the hallmark of success. "There's this continued glorifying of unhealthy and unnatural images," says Harry A. Brandt, MD, a psychiatrist and medical director of the Center for Eating Disorders at the Sheppard Pratt Health System in Baltimore.

To further complicate diagnosis, anorexia is no longer only a disorder of white teenage girls. It affects all ages, races and cultures. It even can cross gender boundaries. About 15% of anorexics are men. "Men are underdiagnosed and undertreated," Dr. Brandt says. "If a man loses weight, the physician does a mega medical work-up. It couldn't possibly be an eating disorder."

The disorder's new faces

The face of anorexia is changing, says Brenda Woods, MD, a family physician and director of primary care medicine at Remuda Ranch in Wickenburg, Ariz., an inpatient and residential treatment facility for women and girls, with facilities in Virginia and Arizona. "We are seeing age spectrums different from what is expected. We've had a 400% increase in calls by women older than 40 and a 700% increase in the child population, age 7 and 8. That's why we started a child program."

Many anorexic children can't verbalize why they don't eat or why they will eat only certain foods at certain times. "Maybe they had a previous episode of choking and that scared them, or somewhere they developed a fear of becoming fat," Dr. Woods says. "It's very common. If Mom is always on a diet and not eating what the family eats, the child will mimic that behavior."

10% to 20% of anorexics die from complications of starvation or suicide.

All the while, the pressure to be thin reaches younger ages. According to the National Center for Health Statistics, 51% of 9- to 10-year-old girls feel better about themselves if they are on a diet. Forty-two percent of first- to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat.

"Extreme dieting sets up a competition among kids," Dr. Brandt says. "There's the cohort effect. One or two start dieting, and there is a competition to be thinner."

That's how it was for Ileah Foster. "I am African-American, and [dieting] is not relevant in our culture. I wasn't overweight, but I was bigger than my friends. I wanted to be skinny like them," says the now 27-year-old Houston resident who struggled with anorexia. "After I began to lose weight, I loved the way I felt, the feeling of being hungry. It was like a drug that I needed."

Foster recalls a time the family was having pizza and her father forced her to eat two pieces. "I waited until everyone was in bed and went into the garage and ran in place for an hour-and-a-half to burn it off," she says.

Images in society, however, whether on TV or in print, can make coming back from this disorder difficult. There are even more than 500 pro-anorexia Web sites. "They are promoting an illness," Dr. Brandt says. " We've tried to put pressure on providers to close these sites down."

These sites -- also known as pro-ana for those related to anorexia and pro-mia for those geared to bulimia -- deny charges that their messages perpetuate disordered eating behaviors. Still, they offer tips and tricks on dieting, self control, secrecy or ways to hide behaviors. Stanford University researchers say about 39% of America's young people visit such sites, and 96% report learning new dieting and purging techniques.

15% of anorexics are men.

Crowl admits she was embarrassed to seek treatment because she was older. "I thought 38-year-old women don't have eating disorders."

It's estimated that the number of people older than 40 with anorexia has quadrupled in the last five years. The Renfrew Center near Philadelphia, where Crowl was treated, developed a program, Thirty-Something and Beyond, to meet the needs of this population. The symptoms are similar to those of younger patients, but the stressors and triggers are different -- spouse, children, older parents. "There are huge issues of loss," says Holly Grishkat, PhD, a clinical psychologist at the center. "Often their lives are out of control. What's difficult, especially if they've been this way for 30 or more years, the anorexia has become part of their personality."

Dr. Woods blames part of the problem on what she calls "Desperate Housewives Syndrome" after the TV show. "The boomers are getting older, and they are often the dieters of 20 years ago, still unhappy with their bodies," she says. "There is a lot of pressure to take back the body of their 20s or teens. They think, if I lose weight and get fit, I'll stay young."

People in this age stratum with anorexia can be classified into three general groups: Those who have had an eating disorder since they were 16; those who had anorexia as a teen but mid-life changes are triggering a return; and those with later-life onset. Each category has specific challenges, potential complications and comorbidities. For example, a major complication of lifelong eating disorders is osteoporosis. "They might be 35 and already had a hip fracture," Dr. Woods says. "Some younger women have the bones of a 70-year-old. They can develop pneumonia or have renal insufficiency as a result of chronic dehydration."

Intervention and treatment

Anorexia is often about control and emotion, and at its core are issues greater than food. "The general profile of the anorexic is a perfectionistic tendency," Dr. Woods says. "They are focused, organized and driven, and that goes into their attitudes about food. Anorexics are rigid, and they are preoccupied with weight, shape and size."

Some are dealing with old scars, fear of abandonment, distorted body image, feelings of inadequacy and not fitting in. For many, it is emotion management. "Their problems are often with living life, being in relationships," says Dr. Dennis of Timberline Knolls. Many anorexics also face comments from well-meaning friends, family and physicians -- "Why don't you just eat," or "Oh, it's not that bad, you look fine" -- that push them further into the disorder.

5% of anorexics fully recover with treatment; 40% relapse in the first year.

Anorexics come in many sizes. Some are able to not appear too thin. Others may be 5'4" and weigh 70 pounds. It is not only difficult to diagnose and treat, it has the highest suicide rate of mental disorders. About 5% of diagnosed patients fully recover, and 40% relapse in the first year. For 75%, it is a lifelong condition.

Children tend to get sick quickly and deteriorate medically, Dr. Woods says. "Their prognosis is good with early intervention. Still, some are missed. They are starving, but because they are growing taller, their weight doesn't change."

Dr. Woods says it's important to talk to children about what they are feeling, to find out what's behind their behavior. Are they worried about something? Are their friends dieting? Are they trying to lose weight? "Eating disorders are about feelings," she says. "It's also important in children to make sure there is not a medical cause for the weight loss."

Primary care physicians have the opportunity to make important interventions for patients young and old. They need to ask the specific questions about what patients are eating and doing in terms of diet and exercise habits. And they need to be caring and honest, Dr. Dennis says. "Don't worry if the patient responds with anger -- that's meaningful. And it might be a time to engage the family."

Once in recovery, some anorexics cannot get on a scale or know what they weigh. Yet office staff insist, Crowl says. Once she is on the scale, they often make comments about what they see. "When that happens, my mind spirals," she adds. "If I hear my weight, I will start to restrict. I'm so fixed on numbers."

It's a hard cycle to break. Dr. Brandt says new data on eating disorder prevention underscore the importance of people being comfortable in their own bodies and realizing what is overweight for one person might not be for another. "Maybe you are at your body's normal body weight. Maybe you have the genetics to be large. Discrimination against the obese drives people to change, and we encourage people to engage in unhealthy behaviors. Genetics loads the gun, and society pulls the trigger."

Food safety falls short of national goals

April 29, 2008 on 1:12 am | In Uncategorized | Comments Off After declining precipitously from 1996 to 2004, the rate of most diseases caused by foodborne pathogens was unchanged in 2007. Also, some numbers have started to go up, according to a report in the April 11 Morbidity and Mortality Weekly Report.

"[This] serves to remind us that food safety is a continuing problem that starts at the farm and continues through the food chain all the way to the kitchen, be that the kitchen of a restaurant or someone's kitchen at home," said Robert Tauxe, MD, MPH, deputy director of the Centers for Disease Control and Prevention's division of foodborne, bacterial and mycotic diseases.

Researchers gathered data from 10 state laboratories and found rates for Campylobacter stuck at 12.79 illnesses per 100,000. Listeria remained at 0.27 per 100,000. Salmonella hung at 14.92, although the typhimurium and heidelberg varieties became less common. The incidence of Salmonellanewport increased. About 6.26 per 100,000 people were sickened by Shigella, and Shiga toxin-producing Escherichia coli struck 1.20 per 100,000. Cryptosporidium increased by 44%, although this may be due to improved testing and treatment options, and 2.67 per 100,000 were made ill by this parasite. All case rates were higher than Healthy People 2010 goals.

Concern about food-related illness continues after a spate of recent outbreaks and related product recalls. For example, Malt-O-Meal Co. last month recalled various cereals because of Salmonella contamination. The CDC recorded 21 related illnesses in 13 states. In March, another Salmonella outbreak that sickened 50 people in 16 states was associated with imported cantaloupes.

In order to reduce such outbreaks in the future, the Food and Drug Administration issued a food protection plan in November 2007. The American Medical Association published in 2001 and updated in 2004 a resource, "Diagnosis and management of foodborne illnesses: A primer for physicians and other health care professionals," in conjunction with the CDC, FDA, the American Nurses Assn. and the U.S. Dept. of Agriculture. An online version is expected within the next few months.

Quest for new antibiotics leads to novel sources

April 29, 2008 on 1:12 am | In Uncategorized | Comments Off Washington -- As bacteria become resistant to increasing numbers of antibiotics the search is on for new and effective antimicrobials. Researchers are hunting near and far -- on the ground and even in the swamps.

For instance, the minerals from certain clays, which have been used medicinally for thousands of years, could form the basis of a new generation of inexpensive antibiotics, researchers from Arizona State University reported at the national meeting of the American Chemical Society in New Orleans, April 6-10.

And proteins found in alligator blood are being eyed as powerful new medications that could help fight infections associated with diabetic ulcers, severe burns and the "superbugs" that are raising fears in the medical community. The alligator study was also presented at the chemical society's meeting.

The list of diseases that are becoming more difficult to fight with first-line antibiotics is growing longer. Included are tuberculosis, staph and strep infections, malaria, head lice and, recently, meningococcal disease. Methicillin-resistant Staphylococcus aureus, or MRSA, is particularly notorious for making the jump from a hospital problem to one that causes illness and deaths in communities.

This dangerous trend has prompted efforts by public health and medical societies, including the AMA, to educate physicians about the importance of appropriately prescribing antibiotics and the need to inform patients about the dangers of antimicrobial resistance.

Thinking outside the box

The importance of the quest for new medications has sparked interest in the healing powers of clay. "The catch word is MRSA," said Shelley Haydel, PhD, assistant professor in the School of Life Sciences and the Biodesign Institute at Arizona State University in Tempe. "We've shown in the laboratory that [some clay] does have some effectiveness at killing MRSA."

Clay's power was a surprise to Dr. Haydel. "When I first got involved, I looked at it with a skeptical eye," she said. But when a paste of clay killed bacteria in 12 hours, she was hooked. Dr. Haydel and her colleagues have screened about 30 different clays -- samples from all over the world -- and found three with antimicrobial properties.

Some clay has antimicrobial properties.

Dr. Haydel isn't sure what the medical community's response will be to this unorthodox approach. "We have to show that it is safe -- and we believe that it is safe because it's been used for so long -- and effective at getting rid of infections in test subjects.

"If we don't have to know exactly how it is working and just show that it is working and not causing additional harm, we may be a couple of years away from clinical use."

Meanwhile, Mark Merchant, PhD, assistant professor of biochemistry at McNeese State University in Lake Charles, La., is wrestling alligators in the pursuit for a new antibiotic. After subduing a gator he extracts blood.

Previous studies by Dr. Merchant showed that alligators have unusually strong immune systems that can fight fungi, viruses and bacteria without having prior exposure to them. Scientists believe this is an evolutionary adaptation to promote quick wound healing, as alligators are often injured during territorial battles in the unhygienic world they inhabit.

Dr. Merchant and colleagues have already isolated white blood cells and extracted the active proteins.

"We're very excited about the potential of these alligator blood proteins as both antibacterial and antifungal agents," he said. "There is a real possibility that you could be treated with an alligator blood product one day." However, that day is not likely to arrive for seven to 10 years.

In another development, the Food and Drug Administration approved a test April 3 that allows rapid screening for MRSA. The nasal test, which will provide results within 24 hours according to the manufacturer, improves on the two-day wait that had been necessary previously.

Best tips for maximum weight loss

April 27, 2008 on 1:42 pm | In Uncategorized | Comments Off

There are many ways to lose weight like fat burners, diet pills, diet foods and special fitness programs. But most of us want to lose weight at a fast pace that was gained in many years of time period. But most of these programs are gimmicks. They will not teach you how to solve the problem that made you gain so much of weight and how to adopt a healthy lifestyle.

Follow the following weight loss tips that will help you lose maximum weight:

1. Weight training – With weight training, one will keep on burning high amount of calories compared to the fat for the whole day. Initially, you should go for weight training 2-3 days a week. One should do weight lifting on alternate days to give proper rest to their muscles initially. You can practice it at home or at a gym with free weights.


2. Eating 5-6 meals a day – Instead of 3 heavy meals, take 5-6 small meals during the whole day. Men should go for 6 meals and women should go for 5 meals throughout the whole day. With small & frequent meals, you will feel the highest level of fitness. When you take frequent and small meals during the day, you will be speeding up your metabolism and thus will be able to burn more calories. And one more thing never skips your breakfast.


3. Drinking high amount of water – You must have heard too much about it in the past drinking high amount of water is the key to lose maximum weight loss. According to the experts, one should drink 8-10 glasses of water everyday. And in case you try to fulfill your thrust with other resources like soda, coffee or tea, you will be missing the opportunity to drink one more glass of water.