Category: Wellness

I see patients frequently in my office who work high stress jobs all day, on the computer, on deadlines, demanding bosses, carting the kids all over after school, after work; who come in with pain in the back of their shoulders, or neck.  I have also seen patients come in with pain in their knee after standing a long day at a conference they really did not want to be at.  What these both have in common is that the pain is real.  The tenderness in the muscles, soft tissues, and joint are definitely there, but after a thorough examination there is not really a specific anatomic structure that we can define as the source of the pain. 

We live in a very high stress environment these last few years and I think it is important to remember that our bodies have an amazing ability to tell us that the stress level is getting too high in ways other than what would one normally see such as chest pain, heart attack, and ulcers.  In orthopedics, the body does talk to us when stress levels get too high.  It is always a good idea to have an orthopedic condition checked out by a capable practitioner, but I think it is also important to check in on your own “life pulse”; to check in with yourself about what is going on in your personal life, your work life, your relationship, when the pain started, when it gets better (vacation is always a good barometer). Many reduce stress through exercise, basic walking is probably the best and safest, meditation and yoga (but be careful of the child’s pose and downward dog). But if you hurt, these activities may not be comfortable or possible. So, consider reading or just spending some quiet time with the cellphone, texting, and TV all turned off.  Just enjoy this beautiful area we live in on the bay area. Look at the scenery around you, breathe, and relax.

It is easy for me just to go out in my garden and look at the beautiful flowers and landscape.  I have worked hard to create, although like most people, it only usually last 5 or 10 minutes until I start looking at the tree that needs to be pruned or weeds that need to be pulled. But I try to make the time.

Have you ever heard the term “I feel like I have the weight to the world on my shoulders”, or “so and so is the pain in the neck”, or “I do not feel like I can take another step”.  These phrases would definitely show up in our body when stress gets too high.  The purpose of my blog today is really to remind us all of the value of taking 15 minutes daily to just stop with the texting, turn off the phone, turn off the TV and just find a comfortable place to sit, lie, run, or move to  wherever you body finds a restful place.

-Lesley J. Anderson, MD

As you know, the first of the Boomers turn 65 this year. It is clear that Boomers are entering the Medicare years kicking and screaming. There is a new catch phrase in my office which is: “that is unacceptable.”  I am not going to state that we have to stop doing most things because we are older.  However, there needs to some common sense.

I had a lovely 65-year-old woman come in this week who was petite, approximately 5 feet 2 inches and weighed about 115 pounds, in great shape.  She did not look her age and her complaint was that she could not be as “vigorous” as she wanted to be. 

I asked her what vigorous meant.  She stated “I cannot do deep knee bends with the rest of the class nor I can do lunges like I used to because my knee hurts after I am done.”  Well this was “not acceptable.”  She had no pain during walking; bicycling, climbing stairs or hiking.  It turns out she had a little bit of mild arthritis in her knee and a degenerative meniscus tear.  She has seen another orthopedist who told her she should have surgery.  Mind you, the only pain she had was after she did her vigorous activity.  After spending some time explaining to her that it is normal for our knees to age.  The type of tear she had was not the cause of her pain, but it was due to the overload she was placing on her knee by doing lunges and deep squats.  Surgery definitely would not fix this. 

No one denies that it is extremely important that we keep moving as we age.  Walking, bicycling, and swimming are excellent activities to keep our cardiovascular health, muscular strength, and endurance.  Light weight lifting is also well known to be able to enhance muscular tone and improve the way our bodies look.  When I asked the patient why she was so focused on these “vigorous exercises.”  She states that she wanted to stay in shape.  Granted, these are exercises to stay in shape if you are 20 or 30 years old, but in an aging body these two exercises can cause significant compression through the knee joint, stress fractures, meniscus tears that require surgery.

When I asked her if she knew what the biggest cause of orthopedic disability was in older patients, she was not sure. I indicated that the answer were balance problems – and the falls it causes. You can fracture your hips and break your wrist.  It is known that a hip fracture over the age of 70 has a very high incidence of death within six months. That IS unacceptable. The reason why we fall is that we loose our balance- you trip over the phone cord, the sleeping dog, a bump in the sidewalk. Boomers can reduce the chance of this happening,  

When I told her this she stated “oh my balance is awful.” So, activities like tai chi, standing on one leg and throwing a ball against a wall, and Pilates, are all excellent activities for enhancing our balance.  Boomers, we all need to stay strong, walk, and keep our heart healthy.  Please use common sense when choosing exercises and remember that you have to balance your goals of exercise which includes feeling and looking healthy, with the goals of keeping your overall health which includes being mindful about the activities you choose to do, listening to your body, and using common sense.

– Lesley J. Anderson, MD

As you know, the last few blogs have been evolved; the value and importance of having your vitamin D3 checked.  There have been a number of articles in the media noting that vitamin D does everything from treat cancer to reduce heart disease to even grow hair! (Just kidding)  Obviously these claims are not my area of expertise and I would certainly take a lot of pause until one looks at the evidence-based studies on these areas and check with your internist

What we do know is that vitamin D is absolutely essential for good bone health.  We are just scratching the tip of the iceberg in terms of its effects.  I cannot tell you how many patients coming in to my office with knee pain that are middle-aged men that I get vitamin D levels on, are dramatically low. The Bay Area has one of the lowest Vitamin D levels in general in the country.  Women on the other hand, are generally within normal limits and that may be because they are a lot more conscious about taking vitamins and calcium supplements.  For men, I urge you to take at least 1-2000 mg a day especially if you have darker skin since you do not tend to absorb this well. Get a level checked to see where you are and how much you need to take.

An interesting article in the British Bone and Joint Surgery looked at outcomes of total hip replacement and its relationship to vitamin D levels.  What was surprising is that patients with low vitamin D levels preoperatively did not have as good outcomes as those with normal vitamin D levels.  So this is an exciting area of study and we look forward to more articles looking at how we can improve your bone health, improve your outcomes with surgery, and in any way stay out of our office is in the first place!.  That would be a good thing.

-Lesley Anderson, MD

More on Vitamin D.  A study put out by the Hospital for Special Surgery in New York reinforces the alarmingly high rate of low vitamin D in patients scheduled for orthopedic surgery.  In a chart review of 723 patients, they found that 43% of all patients had low vitamin D levels, and of those, 40% had severely low levels.  The highest rates of low vitamin D levels were seen in patients in Sports Medicine Services as well as who had trauma or fractures.  Over one half of patients (52%) had low vitamin D levels in patients undergoing sports related surgery!  The highest rate was in patients between age of 18 and 50 years and it was significantly higher in men (5X higher). In patients sustaining fractures, 66% had low vitamin D levels.  In individuals with darker skin tones (Blacks and Hispanics) were over 5 times more likely to have low vitamin D levels when compared with those with lighter skin tones (White and Asians).

Bottom line:  Get your vitamin D level checked.  If you are a runner and have had arthroscopic surgery, I am routinely recommending, particularly in men, to have your vitamin D levels checked and corrected because we are seeing an increasingly high number of stress fractures and bone bruises that occur when patients go back to high-level sports that involved running, jumping, or pounding.  We do not know for sure whether the low vitamin D levels correlate with the reason why one develops this.  On the other hand, it seems like it could be very likely.  You should be taking at least 1000 mg of vitamin D3 tablets a day and I recommend you take it as a supplement unless you drink four cups of milk a day.

Lesley J. Anderson, MD

Losing weight during the holidays or any time can be a struggle for many people.  In the Jan/Feb 2011 article in the AARP magazine, Brian Wansink listed some easy ways to cut calories, identify your weakness and tricks to help loose at least 20 pounds in six months. 

Most of our patients have an ongoing battle with their weight. In our practice it is especially important because for every pound you gain puts 4-6 pounds of stress on your knees! Similarly, losing just 5 pounds will take 20 pounds off your knees. Arthritis will progress much faster in an overweight patient in the knee and is a leading cause of need for total knee replacements in patients over 50. As we get older, it comes more difficult to loose the weight.  A few extra calories a day can add up to being 50 pounds heavier in a matter of months.

 Wansink identified a few ways to cut calories.  You eat 22% less by using smaller plates and pour 29% less by using tall, thin glasses instead of short, wide ones.  If you store all your snacks in small-single serving food-storage bags, you’ll eat up to 20% less. 

It’s also important to identify the environment.  By identifying your weakness, you can change the eating environment.  Common weakness including meal stuffing, party binging (I know the holidays are coming up), desktop/dashboard dining, restaurant indulging and snack grazing.  Once you identify the danger zone, you can focus on changing the habit.

Wansink identified 10 easy tricks that helped people loose at least 20 pounds in 6 months. It really is one of the better and more practical guides I have seen.  To see the article for yourself, click below.

http://pubs.aarp.org/aarptm/20110102_PR?folio=42#pg44

Sometimes is nice to have moral support.  Many of my patients found support and great success with FA and Weight Watchers. You also know I will be one of your greatest cheerleaders for your success. It makes for fewer total knee replacements for me and that makes me happy.  

http://www.foodaddicts.org/

http://www.weightwatchers.com/

The main thing about weight lost is to have reasonable goals and to modify the goals as time goes no.  Tracking your progress and reaching your goals not only feels good, but makes you healthier.

Lesley J. Anderson MD

Vitamin D is a hormone that helps maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium from the stomach, helping to form and maintain strong bones. Recently, research also suggests vitamin D may provide protection from osteoporosis, hypertension (high blood pressure), cancer, and several autoimmune diseases.

With the advent of sunscreen use, and reduced intake of dietary sources of Vitamin D, Americans are been found to be very deficient in Vitamin D.

Low Vitamin D is an epidemic in African Americans with 30 % having a critically low level (<10ng/ml).

As part of a routine physical exam it is important that your physician does a screening blood test for Vitamin D. (25-OH-Vitamin D).

At the same time, it is recommended that unless you get 15 minutes of non-sunscreened exposure to sun a day to the arms and face, then supplements of Vitamin D is recommended.

A routine daily intake of 800-1000u of Vitamin D3 daily (over the counter) is recommended. More is not necessarily better. There is no indication to ever take more than 3000u a day.

If your Vitamin D level is >40ng/ml, then you will have a 50% lower risk of breast cancer. In addition, the risk of colorectal cancer, breast and prostate cancer is reduced 30-50% by taking 1000u /day.

Should you take Vitamin D? For almost everyone, the answer is Yes! It is recommended you discuss this with you primary care doctor or ask me about it on your next exam.

– Lesley J. Anderson, MD