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Bones, Joints, and Muscles

July 25th, 2010

Leukemia Can’t Tame the Spirit of 11-Year-Old “Lion King” Star Shannon Tavarez

Nearly 140,000 people are diagnosed with leukemia each year in the U.S. Leukemia is the most common type of cancer found in children, including Shannon Tavarez, the 11-year-old who plays Nala in Broadway’s “The Lion King”.

Photo by: Mushroom and Rooster, Flikr, Creative CommonsShannon suffers from a rare type of leukemia known as acute myelogenous leukemia (AML). Early symptoms of the disease—fever, fatigue, paleness, bone and joint pain, and infections—are easy to confuse with more run-of-the-mill illnesses like a cold or the flu. That’s what Shannon’s mother thought.

“I started noticing she was very tired and fatigued, and it wasn’t normal,” Shannon’s mother, Odiney Brown, told ABC News. “The day we found out, we immediately admitted our lives had just changed completely.”

AML can quickly go from bad to worse. In order to recover, Shannon will need a bone marrow transplant, and like so many others with the condition, she now struggles to find a donor. Finding an exact match won’t be easy, either, because Shannon is African American and Hispanic—two highly underrepresented donor groups.

Even in the event that a donor is found, it is likely that Shannon will need additional treatment. “It is generally an aggressive disease that requires chemotherapy,” Shannon’s doctor, Dr. Barbara Asselin of Golisano Children’s Hospital at the University of Rochester Medical Center, told ABC News. “The first hurdle is to see if we can achieve a remission in the bone marrow and don’t see any more leukemia cells.”

Asselin says the chances of recovery are less than other forms of childhood leukemia, but that she remains optimistic about a cure. For now, Shannon is trying to enjoy life as a normal 11-year-old girl, watching movies at home and chatting online with friends between treatments.

Read more from ABC, or find out how to become a donor through the National Marrow Donor Program.

April 5th, 2010

Protein Has Positive Effect On Bone Health

Consuming lots of protein was previously thought to take a toll on bone health, but new information from Seattle’s Group Health Research Institute has medical professionals re-thinking the diet advice they give women. As it turns out, eating lots of protein may not be so bad.

Photo by: Dyanna, Flikr, Creative CommonsThe research team, led by Jeannette Beasley, monitored the protein intake of 560 pre-menopausal women. Protein could be animal or vegetable-based.

According to the Mayo Clinic, the average percentage of protein from calories that should be consumed daily is 10-35 percent. The women, aged 14 to 40, consumed between 6 and 28 percent, placing them in the “high protein” category.

“The range of protein intakes for optimizing bone health among pre-menopausal women is unclear,” authors noted in the study. “Protein is a major constituent of bone, but acidic amino acids may promote bone resorption.”

Participants were checked annually for changes in bone mineral density (BMD). According to the report, the average BMD was similar for all participants regardless of protein consumption. Women with low vegetable protein intake, however, tended to have a slightly lower BMD.

“For every percentage increase of energy from protein, no significant longitudinal changes in BMD were observed at any anatomic site over the follow-up period,” study authors concluded. “Data from this study suggest that a higher protein intake does not have an adverse effect on bone in pre-menopausal women.”

Beasley says that protein provides a small benefit to bone health, but that these benefits may not reduce fractions in the long run. “Findings in young women could be different from those in older women because bone mass is still building up before age 30,” Beasley told Reuters.

The important thing is to keep an eye on bone health, get checked regularly, and to keep your meals balanced. Beef, chicken, fish, pork, and tofu? Yes, yes and yes! As long as it’s complemented by plenty of vegetable protein.
April 4th, 2010

New Test Can Help Reduce Risk of Falling

Photo by: Jeffrey Beall, Flikr, Creative CommonsYou can test your blood sugar, you can test your blood pressure, but did you know you can test your risk of falling? You can now thanks to a screening tool developed by the University of Missouri School of Health Professions.

University of Missouri associate professor Carmen Abbott created the test to help predict an individual’s risk of falling, which they hope will help reduce the risk of injuries.

“It’s very important for adults to understand their won fall-risk factors,” Abbott said in a press release. “This test can become a primary prevention strategy that can be used in regular screenings.”

The test is made up of 16 parts, including a questionnaire and physical tests. It includes questions about fall history, what types of medication an individual takes, and whether he or she experiences dizziness. The physical tests include strengthen balance and range of motion exercises.

Testing each person allowed researchers to develop a customized risk prevention plan. “Personalizing the risk exercise prescription palatable to an individual that has not taken physical activity or the idea of decreased physical function seriously,” authors wrote.

In the University of Missouri press release, Abbott offers tips for people who wish to improve their coordination and reduce their risk of falls.

“It’s very important for adults to understand their own fall-risk factors,” she says. “What’s more important is for adults to know their risk and stay as active as possible.”

March 28th, 2010

Milk, Calcium and Finding What’s Best for You

Osteoporosis affects more than 10 million people in the U.S., 80 percent of whom are women. According to the National Osteoporosis Foundation (NOF), another 34 million with low bone mass are at risk.

Photo by: Tambako the Jaguar, Flikr, Creative CommonsInadequate amounts of calcium and vitamin D in the diet are contributing factors, and what better way to get these minerals than drinking a glass of milk? You might be surprised to learn that cow’s milk isn’t the only “milk” around that’s chockfull of these nutrients.

An article by MSNBC nutritionist Joy Bauer gives a whirlwind of options for getting the recommended amount of calcium. The milk-a-palooza has plenty of options for everyone, including vegans and people who are lactose-intolerant.

We broke down these options to give you the benefits associated with each:

Reduced Fat and Enhanced Skim Milk

Good, old-fashioned cow’s milk contains about 30 percent of the recommended daily intake of calcium and more than 6 percent protein. Organic and vitamin D enhanced options are also available.

Lactose-Free Milk

Lactose-free milk is made from actual cow’s milk. The enzymes needed to digest lactose are added to make it safe for people with lactose intolerance to consume. It’s full of protein and calcium, and has less fat and sugar than regular milk. Some brands actually taste like cow’s milk.

Soymilk

Protein-packed soymilk is made from soybeans. It is low in cholesterol and saturated fat and is a source of good carbs, Omega-3 fatty acids, and vitamins A, B1 and B2.

Rice Milk

Rice milk is made from water and ground rice. It has more carbs and less protein than regular milk, but many varieties are fortified with calcium and vitamin D. As an added bonus, rice milk (like soymilk) often comes in several flavors.

Almond Milk

Almond milk has no lactose or cholesterol, which makes this a very healthy option for those of you who are lactose-intolerant or vegans. It’s full of protein, vitamin E, manganese and unsaturated fat. Its subtly sweet flavor makes it a hit with children.

There are plenty of other great sources of calcium if milk’s not your thing. The NOF site recommends eating right, maintaining a healthy lifestyle and getting tested early for bone density to reduce your risk of developing osteoporosis and its complications.

Visit MSNBC.com to read Bauer’s full story on getting the most from milk.

December 31st, 2009

Certain Contraceptives Could Cause Bone Loss in Women

Use of certain contraceptives may cause significant bone loss in women, according to a study in Obstetrics & Gynecology. Some women who used the birth control shot and certain oral contraceptives with low hormone doses lost up to seven percent of bone mineral density (BMD).

Photo by: A.Drian, Flikr, Creative CommonsThe study followed 703 Caucasian, African American and Hispanic women using oral contraceptive pills (OCPs), the birth control shot Depo-Provera (depot medroxyprogesterone acetate, or DMPA) or nonhormonal contraceptives. They were divided into age groups—one between 16 and 24, and another between the ages of 25 and 33.

Although women who used nonhormonal contraceptives showed little if any loss, women who took OCPs and DMPA lost 0.4–6.8 percent of bone mineral density. BMD loss appeared to differ most by age.

“DMPA users 16–24 years old lost significantly more bone at the spine (4.2% compared with 3.2%) and femoral neck (6.0% compared with 4.2%) than those 25–33 years old,” authors of the study wrote. “However, OCP users 16–24 years old lost significantly less bone density at the spine (0.4% compared with 0.8%) than women 25–33 years of age.”

Many of the study’s participants chose to discontinue DMPA use. Some switched to nonhormonal contraceptives, and were actually able to regain some bone mineral density—up to 4.9 percent at the spine and 3.2 percent at the neck for nonhormonal contraceptive users. Those who switched to OCPs also regained BMD, but their rates were much lower.

Authors wrote, “Use of very-low-dose OCPs after DMPA discontinuation may slow bone recovery.” Women who switched to OCPs were only able to regain up to 2.3 percent at the spine and 0.7 percent at the neck. According to the study, African American participants recovered bone mineral density in the neck better than Hispanic or white women regardless of which method they chose.

Authors wrote, “Recent prospective studies have demonstrated that once DMPA is discontinued, BMD increases more among prior DMPA users than nonusers, suggesting that DMPA-related bone loss is reversible.”

Although this is very encouraging, authors say more information is needed to fully understand bone mineral density recovery.

October 30th, 2009

Five Ways to Fight Cavities from Halloween Candy

There are likely to be plenty of ghosts and ghouls about this Halloween, but one thing that may have parents spooked this time of year is candy and dental health. Roughly 30 percent of 5-year-olds in Plymouth, England, were found to have some form of tooth decay, according to a newly released review.

Photo by: LifeinFlux, Flikr, Creative CommonsThe review examined the 2007-2008 dental records of U.K. children, 211 of whom were Plymouth five-year-olds. This number was just under the national average of 30.9 percent, but other regions were significantly worse.

The United States had similar rates. Almost half of children ages 12 to 15 and about one in four American children aged 2 to 5 is affected by tooth decay. Overall, it affects 4 million children in the U.S. alone. Americans consumed an average of 23.8 pounds of candy each in 2008, and with the holiday season approaching, parents should be on the watch for cavities.

As Halloween approaches, candy consumption is likely to skyrocket, but there are plenty of ways to protect trick-or-treaters from tooth decay. Try these five tips to help reduce the amount of sugar:

1. Choose reduced-sugar or sugar-free candies. Most stores carry equally tasty sugar-free or reduced-sugar versions of Halloween favorites, including chocolate, peanut butter cups and various filled or hard candies. These options won’t completely eliminate the risk of tooth decay, but they can significantly cut sugar intake.

2. Give out unconventional goodies. When it comes to candy, sugar-free gum is your safest bet. Candies that can melt and/or stick to teeth are the worst. Other ideas might include stickers, press-on tattoos, plastic rings, or other small toys.

3. Go to a Halloween program or event. Choosing alternatives to trick-or-treating significantly cuts the candy haul. These events are a great place for adults and children to socialize while enjoying snacks and fun activities.

4. Set a limit. Put a limit on the amount of candy a child is allowed daily. This helps prevent candy binges while reducing sugar consumption. Candy can also be used as a reward for good behavior.

5. Donate excess candy. Many communities have programs that will send it to troops or donate $1 for every pound of candy donated. Candy can also be donated to fire stations, schools (for rewards), or other offices in the community.

Regularly brushing teeth and reducing sugar intake can help prevent cavities. Consuming fewer sweets can also help decrease children’s risk for obesity and diabetes. Dentists and parents alike recommend that candy be consumed in moderation.

September 16th, 2009

Daytime Surgery May Be More Successful

It may be in your best interest to postpone surgery until regular OR hours. According to a study appearing in The Journal of Bone and Joint Surgery, patients with after-hours operations have 24 percent more unplanned follow-up operations than those who went under the knife during regular office hours.

Photo by: Zoutedrop, Flickr, Creative Commons
“Although everyone wants to be treated immediately… it is not always best to rush a patient to the OR in the middle of the night,” explains Dr. William M. Ricci MD, Associate Professor of Orthopaedic Surgery at the Washington University School of Medicine.

The study followed 203 patients who underwent orthopaedic surgery—surgery on bones and joints. While there was no significant difference between radiation exposure, healing time or actual treatment, there was a noticeable disparity between operations that occurred between the daytime and nighttime shifts.

All operations used intramedullary nail fixation to mend tibial or femoral fractures. This is a procedure in which a rod, or “nail”, is used to set the bone. The day was divided into two shifts—the morning shift between 6:00 a.m. and 4:00 p.m., and the night shift thereafter.

Second shift patients had shorter operations, but they also had more follow-up operations and more nail removal surgeries—27percent versus 3 percent for patients whose surgeries occurred during regular office hours. Dr. Ricci believes that much of this can be attributed to the long hours many surgeons put in.

“The reality is that the on-call night surgical team may not be well rested as it is likely they had just finished a normal day shift,” Ricci says. Ricci, who is also chief of the Orthopaedic Trauma Service in the Department of Orthopaedic Surgery at W.U., also explains why non-emergency operations should wait.

“We in the healthcare industry don’t have unlimited resources,” Ricci says. “Many hospitals in the U.S. do have a dedicated night team of orthopaedic surgeons who otherwise are without daytime responsibilities. There are surgical teams on-call for those instances when treatment must be immediate.”

Ricci believes giving orthopaedic surgeons more time to operate on trauma patients can help reduce the risk of minor complications from nail fixation surgeries. He encourages patients to wait for surgery if possible, but insists that actions be taken immediately in urgent situations: “Naturally, when the medical condition is emergent and time is a critical factor, immediate surgery should proceed regardless of time of day.”

August 6th, 2009

U.S. Children Not Getting Enough Vitamin D

Seven in ten children in the United States are not getting enough vitamin D, according to the National Health and Nutrition Examination Survey (NHANES, 2001-2004).
Photo by: Tsuacctnt, Flickr, Creative Commons
Vitamin D, 25-Hydroxyvitamin D, is a fat-soluble vitamin that promotes calcium absorption, fortifying bones and teeth, and maintaining the level of calcium and phosphorus in the blood.

Vitamin D deficiency can result in conditions such as rickets in children (usually <11 ng/mL), and osteomalacia and osteoporosis in adults (typically levels <25 ng/mL). Low levels of vitamin D also increase the risk of bone and heart disease, and are also associated with higher blood pressure and lower calcium and HDL cholesterol levels in later life.

Based on the information obtained from the survey, researchers found that, of more than 6,000 of children followed, nine percent (equal about 7.6 million) were vitamin D deficient, and a greater number were found to be getting an insufficient amount—61%, representing 50.8 million U.S. children. Only 4% received the recommended daily amount of vitamin D.

Children classified as “insufficient” had 15-29 ng/mL, while those who were classified as “deficient” had levels of 15 ng/mLor less. Normal range, according to the National Institute of Health, is 30-74 ng/mL.

The study is the largest of its kind to date, gaining nationwide rather than just regional data. "We expected the prevalence of vitamin D deficiency would be high,” says lead author Juhi Kumar, M.D., M.P.H., of the Children's Hospital at Montefiore Medical Center, “but the magnitude of the problem nationwide was shocking."

Vitamin D deficiency is more common for female children, those that are older, obese, drink less than one glass of milk week, and those who spend four hours or greater on the computer or watching television per day. African-American and Mexican-American children also had a greater risk.“It’s very hard to get enough vitamin D from dietary sources alone,” says Dr. Michal Melamed of the Albert Einstein College of Medicine in Bronx, New York.

Melamed, co-leader of the study, attributes part of this problem to lifestyle, recommending parents send their children outdoors. One source of vitamin D is UV-B sunlight, which converts cholesterol in the skin into vitamin D. She also recommends ditching the sunscreen for a while: “Just 15 to 20 minutes a day should be enough…don't put sunscreen on them until they've been out in the sun for 10 minutes, so they get the good stuff but not sun damage.” Individuals with darker skin and those who live in northern regions with less sun exposure should spend more time outdoors.

The American Academy of Pediatrics recommends that children and teens get at least 400 IU per day, double the previous recommendation of 200IU per day. Good sources of vitamin D include fish, milk, eggs, cod liver oil, and fortified foods. Vitamin D levels can also be increased with the use of supplements.

The study's abstract is available online, and will be published in September's issue of Pediatrics.

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