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DRUG THERAPIES FOR HEALTHY BONES: FRANCES
I took estrogen for twenty years, but had to stop after I developed a serious blood clot. After that, the trouble started. I broke bones a few times from doing nothing in particular. I kept cracking vertebrae, and was in excruciating pain. I was crippled from it. I could hardly walk. I know I would have been in a wheelchair by now if I hadn’t found a way to make improvement.
A bone scan confirmed I had severe osteoporosis, and my doctor recommended Fosamax. A year later, a scan showed I had 5 percent improvement. The doctor was pleased, but I thought the process was very slow. So the doctor started me on Miacalcin nasal spray, too, and in another year I gained another 6 percent. The improvements were in my hack and hip.
I take 1,000-1,200 mg of calcium a day, and I try to get as much calcium in my diet as I can. I haven’t had any more breaks since I started on the prescriptions, and though I still need my pain medication when I go out, I don’t use it as constantly as I used to.
I am so much better than I was three years ago. I feel better. Going up and down stairs is still hard because I have arthritis in my hip—j am over 80, you know—but I get around and do things around the house just fine. I’m going out and having a bit of fun, rather than just sitting in my house.
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KNEE PROBLEMS: CHONDROMALACIA
Chondromalacia, one of the most common causes of knee pain in younger people, can be caused by a traumatic injury to the patella, such as a severe blow, but can sometimes occur for no apparent reason. Chondromalacia also appears to be part of the normal aging process. In fact, in older people, the wearing away of articular cartilage is called osteoarthritis. However—and this is what’s confusing for so many patients— there is no evidence that chondromalacia in younger people will lead to arthritis down the road. We used to assume that chondromalacia in the young would automatically develop into arthritis. However, careful studies have shown that there is no clear-cut progression. In fact, we now believe that although the end result is the same, chondromalacia and arthritis may be very different problems caused by different circumstances. In addition, there is no direct correlation between patellar pain and destruction caused by chondromalacia. Sometimes a person with mild symptoms can actually have more destruction than someone who is in constant pain.
Chondromalacia is rated according to the severity of the condition on a scale of 0 to grade 4, with 0 considered healthy, smooth cartilage. In grade 1 chondromalacia, there is some blistering or disturbance on the surface of the articular cartilage; grade 2 chondromalacia, the surface is scratched or fissured; grade 3 chondromalacia, the Assuring is deeper or down to the bone; grade 4 chondromalacia, the surface is worn away down to the bone and the bone is also worn out.
The pain caused by chondromalacia is somewhat mysterious, because there are no nerve endings in the articular cartilage. However, it is believed that when the articular cartilage is damaged to the point that it is no longer an efficient shock absorber, the force exerted through the bones, which are rich in nerve endings, is all the greater. We perceive the extra force as pain.
Chondromalacia is usually diagnosed by symptoms. An X ray will not show chondromalacia. An arthroscope will conclusively show the presence of chondromalacia and the stage of the disease. However, if your doctor suspects that chondromalacia is the problem, he will probably prescribe a good strengthening program since there is little that can be done surgically to improve the situation. In some cases, the surgeon may wash out the area, that is, smooth the surface of the articular cartilage (on the back of the patella) and remove any debris that may be causing the joint to “catch.” Patients are also usually advised to refrain from activities that may aggravate the pain.
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COMMON COMPLICATIONS OF SPINAL CORD INJURY: LOW BLOOD PRESSURE AND DECUBITUS ULCERS
Low blood pressure
Normal methods of maintaining blood pressure are sometimes damaged by spinal cord injury. Blood pressure may drop suddenly when moving from a lying to a sitting position, especially during the first few weeks after the injury. This phenomenon, called orthostatic hypotension, is what Franklin experienced when he got dizzy the first few times he tried to sit up.
To prevent a substantial drop in blood pressure when sitting up, you may need to wrap your legs or use an elastic belt around your abdomen in order to eliminate pooling of blood. Rising slowly also helps. At first you may feel faint and may even pass out, but this will improve with practice. Often, as in Franklin’s case, the problem is eliminated spontaneously with regular sitting and activity. For those with severe problems sitting up, a tilt table is sometimes useful. Faintness and dizziness on sitting up can recur whenever you’ve had prolonged bed rest.
Decubitus Ulcers
Pressure sores, or decubitus ulcers (also known as bed sores), develop on the skin in areas subjected to prolonged pressure that temporarily decreases the blood flow to that area. The skin can easily recover if the pressure is relieved, but when pressure persists, pain and eventually irreversible damage can result.
Decubitus ulcers are a potential problem in the absence of normal sensation in the skin, because the individual does not feel discomfort after putting pressure on one area for too long. The first approach to preventing decubitus ulcers when you are confined to bed is to change position every two hours, turning onto the side or onto your back. Once you begin sitting up in a chair, regular pressure releases will get pressure off the sensitive areas. These will become part of your daily routine for the rest of your life. The several kinds of pressure releases relieve the pressure of body weight from particular areas of skin.
A common type of pressure release for those who can use their arms is a wheelchair pushup, using both arms to lift your body above the seat for about a minute to relieve pressure on the buttocks. If you cannot use your arms, pressure can be relieved by using an electric wheelchair that automatically tilts back your upper body and thus shifts your weight. To prevent decubitus ulcers from forming while you sleep, you may need to change position every few hours. This may require assistance from another person.
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COMMON COMPLICATIONS OF SPINAL CORD INJURY: LOW BLOOD PRESSURE AND DECUBITUS ULCERS
Low blood pressureNormal methods of maintaining blood pressure are sometimes damaged by spinal cord injury. Blood pressure may drop suddenly when moving from a lying to a sitting position, especially during the first few weeks after the injury. This phenomenon, called orthostatic hypotension, is what Franklin experienced when he got dizzy the first few times he tried to sit up.To prevent a substantial drop in blood pressure when sitting up, you may need to wrap your legs or use an elastic belt around your abdomen in order to eliminate pooling of blood. Rising slowly also helps. At first you may feel faint and may even pass out, but this will improve with practice. Often, as in Franklin’s case, the problem is eliminated spontaneously with regular sitting and activity. For those with severe problems sitting up, a tilt table is sometimes useful. Faintness and dizziness on sitting up can recur whenever you’ve had prolonged bed rest.
Decubitus UlcersPressure sores, or decubitus ulcers (also known as bed sores), develop on the skin in areas subjected to prolonged pressure that temporarily decreases the blood flow to that area. The skin can easily recover if the pressure is relieved, but when pressure persists, pain and eventually irreversible damage can result.Decubitus ulcers are a potential problem in the absence of normal sensation in the skin, because the individual does not feel discomfort after putting pressure on one area for too long. The first approach to preventing decubitus ulcers when you are confined to bed is to change position every two hours, turning onto the side or onto your back. Once you begin sitting up in a chair, regular pressure releases will get pressure off the sensitive areas. These will become part of your daily routine for the rest of your life. The several kinds of pressure releases relieve the pressure of body weight from particular areas of skin.A common type of pressure release for those who can use their arms is a wheelchair pushup, using both arms to lift your body above the seat for about a minute to relieve pressure on the buttocks. If you cannot use your arms, pressure can be relieved by using an electric wheelchair that automatically tilts back your upper body and thus shifts your weight. To prevent decubitus ulcers from forming while you sleep, you may need to change position every few hours. This may require assistance from another person.
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