Bone Health

Bone health: Tips to keep your bones healthy (to be updated soon)

Protecting your bone health is easier than you think. Understand how diet, physical activity and other lifestyle factors can affect your bone mass.

 

Bones play many roles in the body — providing structure, protecting organs, anchoring muscles and storing calcium.

While it's particularly important to take steps to build strong and healthy bones during childhood and adolescence, you can take steps during adulthood to protect bone health, too.

Why is bone health important?

Your bones are continuously changing — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more bone mass than you gain.

How likely you are to develop osteoporosis — a condition that causes bones to become weak and brittle — depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it after that. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.

What affects bone health?

 

A number of factors can affect bone health. For example:

•   The amount of calcium in your diet. A diet low in calcium contributes to diminished bone density, early bone loss and an increased risk of fractures.

•   Physical activity. People who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts.

•   Tobacco and alcohol use. Research suggests that tobacco use contributes to weak bones. Similarly, regularly having more than two alcoholic drinks a day increases the risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.

•   Gender, size and age. You're at greater risk of osteoporosis if you're a woman, because women have less bone tissue than do men. You're also at risk if you're extremely thin (with a body mass index of 19 or less) or have a small body frame because you may have less bone mass to draw from as you age. Also your bones become thinner and weaker as you age.

•   Race and family history. You're at greatest risk of osteoporosis if you're white or of Asian descent. In addition, having a parent or sibling who has osteoporosis puts you at greater risk — especially if you also have a family history of fractures.

•   Hormone levels. Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels. Prolonged periods absence of menstruation (amenorrhea), before menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.

•   Eating disorders and other conditions. People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn's disease, celiac disease and Cushing's disease can affect your body's ability to absorb calcium.

•   Certain medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, are damaging to bone. Other drugs that may increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications and proton pump inhibitors.

What can I do to keep my bones healthy?

You can take a few simple steps to prevent or slow bone loss. For example:

•   Include plenty of calcium in your diet. For adults ages 19 to 50 and men ages 51 to 70, the recommended dietary allowance (RDA) is 1,000 milligrams (mg) of calcium a day. The recommendation increases to 1,200 mg a day for women after age 50 and for men after age 70. Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about supplements.

•   Pay attention to vitamin D. Your body needs vitamin D to absorb calcium. For adults ages 19 to 70, the RDA of vitamin D is 600 international units (IUs) a day. The recommendation increases to 800 IUs a day for adults age 71 and older. Good sources of vitamin D include oily fish, such as tuna and sardines, egg yolks and fortified milk. Sunlight also contributes to the body's production of vitamin D. If you're worried about getting enough vitamin D, ask your doctor about supplements.

•   Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, tennis and climbing stairs, can help you build strong bones and slow bone loss.

•   Avoid substance abuse. Don't smoke and avoid drinking more than two alcoholic drinks a day.

Enlist your doctor's help

Periodic BMD Test, if you are at risk as per

https://www.shef.ac.uk/FRAX/tool.jsp OR

https://riskcalculator.fore.org

If you're concerned about your bone health or your risk factors for osteoporosis, consult your doctor. He or she may recommend a bone density test. The results will help your doctor gauge your bone density and determine your rate of bone loss. By evaluating this information and your risk factors, your doctor can assess whether you might be a candidate for medication to help slow bone loss.

Uncontrollable Risk Factors: Being over age 50. Being female. Menopause. Family history of osteoporosis. Low body weight/being small and thin. Broken bones or height loss.

Controllable Risk Factors: Not getting enough calcium and vitamin D. Not eating enough fruits and vegetables. Getting too much protein, sodium and caffeine. Having an inactive lifestyle. Smoking.  Drinking too much alcohol. Losing weight.

Prevention: (consult your yoga therapist for guidance)

(This writeup is in the process of refinement. The images and text have been adapted from the resources on the internet)

Free Health Camps: Time for an audit

After witnessing many "health camps" in the past two decades, I have been advocating against such practice.

These are nothing but useless programs aimed at self promotion, business promotion, corporate advertising, catch volunteers for a clinical trial ; it suits the interests of self declared social activist organizations - to add to their scrap book. It also shows the failure of the health systems to reach the masses.

Remember that during these health camps, doctors have to discharge their duties under sub optimal conditions, patients are subjected to violation of their rights to privacy. Surgical health camps like dental/ cataract/ sterilisation are even more disastrous.

It is better to have screening camps instead, and get them to the hospital for proper care. CODS Manipal, OEU in KH, OBG in KH, SDM in Dharwad have successfully done it for years. Subsidized care through insurance based health cards is also a great way to spread health care.

However the publicity hungry, new age health administrators are more interested in the photograph with banners in the media, than actual health care to the needy.

Bilaspur sterilisation camp disaster should be ring the warning bell for the health administrators…avoid such camps in sub optimal conditions, avoid playing with the lives of people with contaminated generic medicines…

The Final Word to health administrators: If profit & publicity are your aim in life, join some tobacco/gutkha or liquor company…it gives you both.

Others views on Health Camps: click here

Rat Poison in Brand Generic Antibiotic supplied at Sterilization camp, led to deaths

Now it is the turn of Doctors to taste the bitter pill!

How hospitals discourage doctors: A step by step guide

RICHARD GUNDERMAN, MD, PHD | PHYSICIAN | SEPTEMBER 26, 2014

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.

Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.

That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a health care consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said:

***

The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.

Though physician compensation accounts for only about 8% of health care spending, decisions that physicians strongly influence or make directly — such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital — have been estimated to account for as much as 80% of the nation’s health care budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.

Transforming previously independent physicians into employees has increased hospital influence over their decision making, an effect that has been successfully augmented in many centers by tying physician compensation directly to the execution of hospital strategic initiatives. But physicians have invested many years in learning their craft, they hold their professional autonomy in high esteem, and they take seriously the considerable respect and trust with which many patients still regard them.

As a result, the challenge of managing a hospital medical staff continues to resemble herding cats.

Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the health care solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus.

How can this goal be achieved? A complete list of proven tactics and strategies is available to our clients, but some of the more notable include the following:

Make health care incomprehensible to physicians. It is no easy task to baffle the most intelligent people in the organization, but it can be done. For example, make physicians increasingly dependent on complex systems outside their domain of expertise, such as information technology and coding and billing software. Ensure that such systems are very costly, so that solo practitioners and small groups, who naturally cannot afford them, must turn to the hospital. And augment their sense of incompetence by making such systems user-unfriendly and unreliable. Where possible, change vendors frequently.

Promote a sense of insecurity among the medical staff. A comfortable physician is a confident physician, and a confident physician usually proves difficult to control. To undermine confidence, let it be known that physicians’ jobs are in jeopardy and their compensation is likely to decline. Fire one or more physicians, ensuring that the entire medical staff knows about it. Hire replacements with a minimum of fanfare. Place a significant percentage of compensation at risk, so that physicians begin to feel beholden to hospital administration for what they manage to eke out.

Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass.

Refer to such decisions as anecdotal, idiosyncratic, or simply insufficiently evidence based. Make them feel that their mission is not to balance benefits and risks against their knowledge of particular patients, but instead to apply broad practice guidelines to the care of all patients. Hiring, firing, promotion, and all rewards should be based on conformity to hospital-mandated policies and procedures.

Subject physicians to escalating productivity expectations. Borrow terminology and methods from the manufacturing industry to make them think of themselves as production-line workers, then convince them that they are not working sufficiently hard and fast. Show them industry standards and benchmarks in comparison to which their output is subpar. On the off chance that their productivity compares favorably, cite numerous reasons that such benchmarks are biased and move the bar progressively higher.

Increase physicians’ responsibility while decreasing their authority. For example, hold physicians responsible for patient satisfaction scores, but ensure that such scores are influenced by a variety of factors over which physicians have little or no control, such as information technology, hospitality of staff members, and parking. The goal of such measures is to induce a state that psychologists refer to as learned helplessness, a growing sense among physicians that whatever they do, they cannot meaningfully influence health care, which is to say the operations of the hospital.

Above all, introduce barriers between physicians and their patients. The more directly physicians and patients feel connected to one another, the greater the threat to the hospital’s control.

When physicians think about the work they do, the first image that comes to mind should be the hospital, and when patients realize they need care, they should turn first to the hospital, not a particular physician. One effective technique is to ensure that patient-physician relationships are frequently disrupted, so that the hospital remains the one constant. Another is …

***

The sound of a door roused me again. The man in the three-piece suit emerged from the office, he and the hospital executive to whom he had been speaking shaking hands and smiling. As he turned, I looked about. Where was “How to Discourage a Doctor?” It was not on the table, nor was it on the chair where I had first found it. “Will he think I took it?” I wondered. But instead of stopping to look for it, he simply walked out of the office. As I watched him go, one thing became clear: Having read that document, I suddenly felt a lot less discouraged.

Richard Gunderman is a professor of radiology, Indiana University School of Medicine, Indianapolis, IN.  This article originally appeared in The Health Care Blog and was reprinted with the author’s permission in http://www.kevinmd.com/blog/2014/09/hospitals-discourage-doctors-step-step-guide.html

Cartoon courtesy: https://foreverfomo.files.wordpress.com/2014/06/carrot-stick.jpg

Excerpts from my LifeBook

Do Not Substitute: a clear message

A prescription by a doctor is his "signature", as far as patients treatment is concerned. Of late the it has become a trend substitute medications in Private pharmacies, corporate hospital pharmacies. Medicines manufactured by spurious companies, substandard generics may not yield the intended results, thus rendering the treatment ineffective. Who suffers? The TRUST, between the patient and the doctor!

The rules are very clear: No pharmacist can substitute a Brand Generic medicine, without doctors prescription/ permission. (Reference: Rule 65 of the Drugs and Cosmetics Act, 1940 and Rules 1945, amended till 1995)

In a healthy development, a court has punished a pharmacist for substitution the medicines prescribed by a doctor...

End of monopoly & restrictive trade practices at Private Hospitals

1. Generic medicines/ Branded Generics are not necessarily cheaper than Branded medicines!

Generics/ Brand Generics pass on close to 800% margin to the retailer, while the price may be just cheaper by 40% (click here for info) or check table:

In some corporate hospitals price of the Brand Generic can be higher than Branded medicines as brand generic suppliers can stamp the MRP dictated by the administrators! 

Example: Injection Meropenem: Meromac -branded MRP is Rs 871, Merofit- Brand Generic: Rs 2494. The hospital supply rate for both are around Rs 750. 

2. No pharmacist can substitute a Brand Generic medicine, without doctors prescription/ permission. (Reference: Rule 65 of the Drugs and Cosmetics Act, 1940 and Rules 1945, amended till 1995)

3. Debate required on : whether a hospital can insist on medicines to bought in its own pharmacy, where choices are limited, and drugs from non FDA listed drug companies.

4. Remember: you have placed your trust with your DOCTOR. He knows what is the best for you. It is well within your right, to expect "no substitution" and choice of medicines at a pharmacy. Restrictive trade practices have been banned in India! (through MRTP Act, 1969)

While even your cooking salt is branded, why settle for an unbranded life saving medicine?

The Second Opinion & Facebook

Every patient has a right for second or third opinion. Likewise, when approached by a patient, doctor too has the privilege of giving his opinion. Patient has the liberty to choose the treatment from the doctor he/ she trusts.However, patient or his relatives have NO RIGHT to malign the first opinion/ defame the doctor on the social networking sites. It is also a punishable offence under section 66 (A) of the Information Technology Act for causing damage to public image.

Background:

A patient is brought to a hospital with an ankle injury. Orthopaedic Surgeon examines the patient, after X Ray, patient is advised to undergo internal fixation by surgery. However, patients husband decides to seek second and third opinions, where non operative management was advised. Upon hearing the second and third opinions, patients husband posts the x ray with his version of the story, ridiculing the first opinion, thereby indirectly suspecting the motives, ethics of treatment of the hospital/ surgeon who gave the first opinion.

The post goes viral on the Facebook (in fact patients husband runs an application based on facebook- besides the point!), within 2 days with 22000 shares.

Question here:

is not about the validity of first/ second or third opinions on the patient/ x ray in question. It is about the gross misuse of a social networking site, for maligning an institution- hospital, defaming an orthopaedic surgeon of repute. Sadly, Dr Attique Vasdev (Manipal University Alumnus) who was at the receiving end of the facebook post, is not on facebook. He came to know about the post through his friends & Orthopaedics- Manipal University Alumni group on facebook. All efforts to post Dr Attique`s version of the incident, were promptly removed by the patients husband.

Dr Attique Vasdev`s version:

“The patient was referred to me by an old patient and came into the ER on the eve of 18th of November. I recommended an X-ray which indicated a Lateral Malleolus Fracture with Syndismotic Disruption. In view of the fact that this kind of fracture can lead to degenerative changes or painful joints, as per the AO [Arbeitsgemeinschaft für OsteoDePuy Synthesefragen or translated to Association for the Study of Internal Fixation ] guidelines of fracture management for ankle injuries the recommended strategy is surgery as the best course of action. My opinion was in the best interest of the patient, and the patient alone. I did not at any point state whether this was a ‘grade 3 fracture’. That is not terminology we use and was not used in your case.”

Dr Ashok Rajgopal, Chairman, Bone and Joint Institute, Medanta :The Medicity has reviewed the case and his view is as follows, "I am honestly shocked at the contents of the post going viral. The x-rays show a very clear indication for intervention. Anyone with experience in fracture treatment and who has attended any AO [Arbeitsgemeinschaft für OsteoDePuy Synthesefragen or translated to Association for the Study of Internal Fixation] course, which is the bible of fracture treatment, would endorse, whole heartedly, the opinion given by Dr Attique."

Medanta Medicity (post on FaceBook):(however removed by the patients husband): 

“It is extremely unfortunate that irresponsible statements of this nature have been disseminated. We uphold the highest standards of professionalism and ethics. Your post attempts to malign the reputation of the doctor concerned and the institution, on the basis of allegations that are patently false.”

Note from this Blog Editor:

Of late it has become a fashion to criticize the treatment protocols, treatment options suggested by the doctors. Remember that medical profession is guided by many regulatory bodies apart from highest level of practice of ethics by the professionals. There are periodic checks to ensure adherence to current treatment protocols. It takes many years for a surgeon, before he can build his practise & repute. It is also true that difference of opinion is common in the medical science, hence the patients have been provided with the privilege of second opinion, under patients charter of rights. Now, professional bodies (IMA, MCI, State Medical Councils) should pass resolution, that if a doctor is defamed on the social networks before complaining to the statutory bodies, the complaint should not be registered.

Defamatory posts on social networking sites, can do little damage to the reputation of the surgeons/ hospitals, however it can definitely cause a major damage to the most essential link in the treatment chain – TRUST.