I knew when I was 5 years old that I would be a doctor, though I couldn’t say how that idea got in my head in the first place. As I grew older, my own pediatrician was my inspiration—and the only doctor I knew. He encouraged my interest from an early age, allowing me to come on hospital rounds with him before I had even finished high school. He taught me the most important lesson I ever learned about medicine. As we walked into a patient’s room, he paused and told me to pay attention to what I smelled, and listed for me what it might indicate. Just which disease he was teaching me about that day is long gone from my memory, but I’ve always remembered that moment because suddenly I understood that part of becoming a doctor was learning to use all your senses—and developing a sixth sense, a kind of medical intuition. Medicine was more than science.That was still very much on my mind when it came time to apply to medical school. Though I applied and was accepted to both traditional and osteopathic programs, where almost all of the coursework and clinical training are identical, in the end I chose osteopathy, which does require extensive additional work focusing on the musculoskeletal system, including bone health. To me the big difference was that osteopathy stressed taking care of the whole person, rather than a specific set of symptoms or a certain group of organs or a particular disease. When I read the passionate works of Andrew Taylor Still, the founder of osteopathic medicine, particularly about the connections among the body, mind, and spirit (a more revolutionary stance at that time), I knew there was no other choice for me. I knew that to really take care of my future patients, I’d need the latest medical research, and cutting-edge technology, and an understanding of the biochemistry that makes the human body work. But I also knew it would be equally important to integrate all aspects of a person’s life and health into the hard, cold science. What I saw in holistic medicine that was missing from strictly traditional training was the core belief that a patient is much more than a collection of symptoms.Even so, my medical training did not feature a course on “Patients Are People, Too,” or “Alternative Medicine, Open-mindedness and You,” or “Why a Thorough Physical Takes More than 15 Minutes.” Many of the specific details of providing a broad range of quality care I’ve picked up over the years from colleagues I admire, my own reading, and very often my patients themselves.But from the start I was steeped in an atmosphere that focused on preventing illness, which was the only sensible way I could see to approach anything called “health care.” I usually spend about half an hour with each patient, talking about diet, stress, exercise, his or her childhood, what the individual did this weekend and what I did this weekend—and then maybe what brought that person in that particular day. I ask patients coming into my practice for the first time to allow an hour and a half for our first consultation. It takes time for me to get to know the people I care for, and for them to get to know and trust me.As a physician, I see my job as providing patients with all the information they need to make their own decisions. Patients have a duty, then, to learn as much as they can about keeping themselves healthy, and to work with their doctors to find strategies and solutions that are right for them. This book will work the same way. I’ll give you all the knowledge you need to build and protect the strength of your bones. Your job is to take that ball and run with it. I’ve laid out a very specific plan of diet, exercise, and nutritional supplements—and conventional and complementary treatments, if that becomes necessary—that will keep you standing tall and strong for the rest of your life. Only you can say which approaches will work for you, which options you want to pursue, and how to incorporate my program into the rest of your life.*6\228\2*
-
Healthy bones Osteoporosis Rheumatic Comments Off
-
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
If you are in a great deal of pain and discomfort, your physician may recommend use of NSAIDs. I personally believe that medication is a short-term solution, and other steps must be taken to correct this problem.Exercise
When a joint is injured, the knee begins to swell, which can hamper the movement of the knee and can cause the muscles to atrophy or weaken, placing more force on the joint at a time when it is least able to sustain it. Therefore, it is very important to get the joint moving as soon as possible and to keep the muscles strong. For articular cartilage problems such as arthritis or chondromalacia, I recommend a low-impact exercise program that strengthens the muscles without stressing the joint. Activities such as swimming, riding a stationary bicycle, or even using a cross-country ski machine could be beneficial. (If you use a stationary bicycle, set the seat in such a way so that you do not bend you knee more than 90 degrees, because it often causes discomfort.) If you are disciplined about exercising, you may work out on your own. However, if you exercise haphazardly, you may need to work out with a trainer or at an exercise rehabilitation center. In this world of medical cost containment, there will unquestionably be a cutback in rehabilitative services, so that patients will be required to exercise on their own.“Washing Out” the Joint
Very often, a patient with an injured joint may have difficulty extending her leg and keeps the knee in a flexed position. This is often due to a protective spasm of the hamstrings, and gentle exercise may help return the leg to normal motion. However, a “locked” leg may also result from a torn or jagged piece of cartilage that is caught in the joint (either between the tibia and the femur or the patella and the femur) and is preventing full extension. If your doctor suspects that this is the case, he may arthroscope the knee to “wash out” the debris and smooth out the surface. Although this isn’t a permanent solution, many patients feel better.Reattaching the Cartilage
If a big piece of articular cartilage with its underlying bone is ripped off in an injury, it may be possible to reattach it back into position using wires or absorbable pins. If indeed, there is a significant bone attached, the injury is an osteochondral fracture, and if there is a short interval (roughly 4 to 8 weeks) between injury and surgery, there is an excellent chance that the fracture will heal if pinned back into position. If the injury does not include a bone surface, the articular cartilage by itself cannot be reattached with any certainty of success. Instead, attention is directed to the bone to produce fibrocartilage, which, although biomechanically inferior to articular cartilage, will fill the defect.
It would be wonderful if there was a synthetic material that could be used to “paint” back missing areas of articular cartilage. Unfortunately, there is nothing comparable that is available now. Although investigation and experimentation is being done, today there are only three methods of replacing absent cartilage:
Procedures designed to stimulate or regenerate the growth of cartilage cells.
Bulk allografts (bone transplants).
Cartilage cell growth and subsequent transplantation.Regeneration of Cartilage. Since the 1800s, scientists have dreamed of developing a way to get the body to regenerate articular cartilage, and although there have been some promising developments in this field, it is still highly experimental. In the body, cartilage is produced by special cells that, depending on their location, have the ability to produce either bone, fibrous tissue, or cartilage. We don’t know the precise triggers that “turn on” these cells and instruct them to produce cartilage. We do know, however, that injuring the bone can in many cases trigger the growth of cartilage. There are several ways that we do this, but basically they all involve making the bone bleed. In some cases, the surgeon will drill holes in the bone to stimulate these special cells to grow cartilage. Another procedure called abrasion arthroplasty involves a more aggressive procedure that causes more bleeding and hopefully produces more fibrocartilage. All of these procedures to stimulate fibrocartilage production can be done arthroscopically, but because the bone is actually involved, the procedures are associated with more discomfort than routine arthroscopy.
Bulk Allografts. Bulk allografts are pieces of bone and/or cartilage that are taken from a cadaver and put in the patient. For years, this procedure has been done in tumor patients. Unfortunately, many of these cancer patients also underwent chemotherapy and radiation treatments and thus were immunosuppressed, which made them prone to infection. As a result, there was a rather significant complication rate—as high as 50 percent—including severe infection, possibly requiring amputation.
The use of bulk allografts for cartilage transplantation in nonimmunosuppressed patients should result in a lower complication rate. As of this writing, however, there are too few cases to collect any significant data.
Cell Transplantation. Cell transplantation is another experimental method of replacing lost articular cartilage that has received a great deal of publicity lately. In this procedure, cartilage cells are taken from the patient and then cultured in the laboratory. The cells multiply, producing an abundance of cartilage, and then are reintroduced surgically into the patient. Theoretically, cell transplantation will heal, thus restoring the surface with normal articular cartilage. This experimental procedure was recently reported in the Scandanavian medical literature. The results were promising; however, the patient population was small and primarily had minor defects on either the patellar-femoral or tibia surface. The femoral surface defects appeared to do better than the tibial defects. As exciting as this new procedure may be, it leads many unanswered questions including: How big a defect can be filled? Will it be applicable to all three compartments—the patellar-femoral, the medial femoral-tibial, and the lateral femoral-tibial? Will the patient be able to return to sports? Only time and experience will answer these questions.
*27\185\2*
Recent Comments