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Don’t Dismiss Vitamin D

Vitamin DTwo recent studies suggest elderly adults shouldn’t skimp on their daily dose of Vitamin D if they wish to keep their mind and heart healthy.

The first study linked low levels of Vitamin D to an increased risk of dementia. According to researchers, older patients who have low levels of Vitamin D intake are about 122 percent more likely to develop mental health complications, like memory loss and dementia.

Dr. David Llewellyn said similar links have been shown in previous studies, but this research provides more accurate findings.

“We were able with much greater accuracy to sort of chart the level of Vitamin D that seems to be relevant to a dementia risk,” said Dr. Llewellyn. “It gives us valuable clues as to the kind of trials we should be doing next, and who we should be treating and with how much Vitamin D.”

For their study, researchers analyzed blood samples from 1,658 patients in 1992 and 1993, then again in 2008. The samples were tested for Vitamin D levels, specifically measuring for serum 25-hydroxyvitamin D concentrations. Patients were sorted into three groups based on their levels.

• Less than 25 nmol/L were severely deficient.

• Between 25 nmol/L and 50 nmol/L were deficient.

• Above 50 nmol/L were considered sufficient.

A follow-up analysis of medical records found that patients classified with severely deficient Vitamin D levels were 122 percent more likely to have developed dementia, while those who were classified as deficient were 51 percent more likely to have developed the disease than those with adequate Vitamin D levels.

Heart Health and Vitamin D

Another study found that Vitamin D can help keep a person’s ticker running smoothly.

This study comes from the United Kingdom, and it asked 5,292 subjects to ingest a daily supplement for three years. The participants either received a Vitamin D supplement, a calcium pill, a Vitamin D and calcium pill, or a placebo. Researchers then charted the health of each participant for three years.

After analyzing the data, researchers found that the group who took the Vitamin D supplement saw their risk of heart failure drop by 25 percent compared to groups that did not receive a Vitamin D pill.

The authors concluded, “Vitamin D supplementation might protect against cardiac failure in older people.”

Dr. Silverman comments

We’ve discussed Vitamin D so much on this blog I’m amazed people still fail to get their recommended amount. Whether you get it from food or in the form of a pill, make sure you are conscious about your Vitamin D intake, especially as you get older.

Related sources: Medscape,

Leg Tests Help Predict Hip Fractures in Women

One Leg StandTwo leg tests may be able to predict a postmenopausal woman’s likelihood of suffering a hip fracture, according to a 15-year study presented at the American Society for Bone and Mineral Research annual meeting.

The first test involves standing on one leg for 10 seconds, and the second test requires a person to squat down and pick an object up off the floor. If the tester cannot complete the activities, she is at an increased risk for a hip fracture.

“Squatting down to reach a floor and maintaining balance on 1 foot for a moment are essential functional abilities and very simple to measure,” said study author Toni Rikkonen, PhD. “Inability to accomplish either of them demonstrates functional decline with increased risk of mortality and fractures.”

Hip Study

For their study, researchers analyzed 2,791 with a mean average of 59.1 years. The women were asked to preform three baseline tests; the two mentioned above and a grip strength test. Just over half the women (1,587) showed no signs of physical deterioration in any of the three tests, but the others failed one or more of the tests.

Researchers followed up with the women on average 13.1 years after the baseline tests were preformed and examined any medical complications that occurred between the two dates. There were 578 fractures, including 35 hip fractures. When comparing the two groups, researchers noted that the women who failed one or more tests during baseline testing were significantly more likely to have suffered a hip fracture. Mortality risk and general fracture risk were also more common in the women who failed at least one baseline test.

Researchers noted that the one-leg stand test was the best predictor of hip fracture risk, followed by the squat test. The grip test was the weakest predictor of the three tests.

“The inability to stand on 1 foot is mostly dependent on balance and coordination. In addition, unilateral posture demands your hip and core muscles to compensate accordingly with the task and to provide additional support for the body,” Dr. Rikkonen explained. “Standing on 1 foot challenges both of these properties, muscle coordination and balance, which might explain having the most predictive value among tests.”

He concluded by saying that women can improve their functional limitations.

“Functional limitations are usually modifiable,” Dr. Rikkonen said. “These patients should be encouraged to use their legs and train their balance in a safe manner, regardless of their age.”

Dr. Silverman comments

I love the KISS principle. Keep it simple silly (and other versions).

These simple tests have the ability to help predict hip fracture risk. While there are confounding variables that might actually make a single leg balance in my office not so accurate (like foot or ankle pain), I am excited to add these tests to my routines in elderly patients. We know that core strength can be improved with training and physical therapy. I should be able to identify patients in need of physical therapy much more easily with these tests.

Related source: Medscape

Jamaal Charles Dealing With High Ankle Sprain 

Jamaal CharlesJamaal Charles, the top pick in many fantasy football drafts just a few weeks ago, suffered a high ankle sprain during Sunday’s loss to the Denver Broncos.

Head coach Andy Reid announced the injury Monday, but he stopped short of projecting how many games Charles might miss.

“It doesn’t look to be a real severe one, but it does have the components of a high ankle sprain,” said Reid. “What does that mean? We’ll see what happens.”

 Components of a High Ankle Sprain

Reid said Charles’ injury exhibits the “components of a high ankle sprain,” but what does that really mean? Since he also added that it doesn’t appear to be a serious high ankle sprain, we can reasonably assuming Charles isn’t dealing with a Grade III high ankle sprain, so let’s examine the components of the other two grades.

Some conditions present in a Grade I or Grade II high ankle sprain include:

  • Mild partial disruptions of one of the ligaments connected to the tibia or a greater tissue disruption between at least two of the three connecting ligaments.
  • Usually the tibiofibular ligament is slightly or mildly damaged.
  • Stress tests determine the stability of the ankle. Grade I sprains appear stable, while Grade II sprains are too painful to test under normal conditions and usually require anesthesia or an MRI to test for stabilization.
  • Grade I injuries usually heal within a few weeks, while Grade II injuries usually take about 8-10 weeks to return to full strength.
  • Surgery is not required for Grade I high ankle sprains, and Grade II sprains can be operative or non-operative, depending on the ligament damage.

Based solely on the fact that we haven’t heard any significant news within 48 hours of the injury, I would venture to guess that Charles is dealing with a Grade I sprain. If we assume it at least knocks him out for a few weeks, a date that jumps out for a potential return is October 19, a Week 7 matchup against the Chargers. The Chiefs have a bye in Week 6, so even if Charles was ready to return in two weeks, the Chiefs may opt to hold him out of their Week 5 matchup to give their star running back an additional 14 days to recover.

Again, we’ll likely have a clearer idea in the coming days if team doctors or Charles himself details more about the injury, but for now we only have Reid’s suggestion that Charles is dealing with a not-so-severe high ankle sprain. If it turns out he needs surgery, Charles could be out for two months. Considering the Chiefs are already 0-2, they could be eliminated from playoff contention by the time Charles is ready to return. In that event, the team may opt to hold him out until 2015.

We’ll keep tabs on his forecast in the coming days.

Related source: USA Today

Refuting a Study Condemning Surgery for Heel Fractures 

Heel Fracture SurgeryLast month, Reuters published an article comparing the outcome of surgery versus non-operative care when it comes to heel bone fractures. In their article, researchers claim “surgery by open reduction and internal fixation in patients with typical fractures of the heel bone didn’t improve outcome compared with non-operative care.”

They went on to chastise operative care for heel fractures, saying:

  • “[There was] no symptomatic or functional advantage after two years.”
  • “The risk of complications was higher after surgery.”
  • “We had anticipated benefit in at least some of these measures, but there were no differences in patient reported general health, quality of life, or ability to return to work. Ranges of movement of the injured hind foot were no different between treatment groups, and even heel width (a commonly suggested reason for surgery, to facilitate shoe fitting) was the same. Walking speed and five different metrics of gait also showed no difference at two years after injury.”

Worst of all, they concluded by saying, “There is no justification to continue with this surgery for closed displaced intra-articular calcaneal fractures without severe displacement. Patients and their surgeons can choose safer but equally effective non-operative care. “

Why They’re Wrong

This study and the research on it is poorly presented, but this is typical of a group trying to please a universal health plan, not trying to fret out the truth in care. In essence. they basically compared an out of date surgical technique to non-surgical technique.

Since 2005, I have not performed an open reduction and internal fixation using the technique described in the article. That surgery has a high rate of wound complications and infection, which they make a particular point in noting. This technique often requires prolonged immobilization in a cast and forces the patient to be non-weight bearing for 10 weeks (just as in non surgical treatment).

Instead, I have been using minimally invasive procedures using one or two small incisions. I achieve the same strength of fixation alignment without any wound problems. Instead of waiting up to three weeks for the skin and the tissues to be ready to handle the insult from the large classical L-shaped incision, surgery can proceed safely within the first week of the injury. Instead of patients placed on their side, the surgery can be done with patients lying supine on their backs, a safer position for anesthesia. Patients are removed from the cast after two weeks and begin weight bearing at six weeks. Their recovery from injury is more than twice as fast, the incision becomes invisible and the pain and swelling are greatly reduced.

When you compare a minimally invasive operation to fully open surgery, the differences are so large you can see why I so vehemently disapprove of this study!

The variety of options for minimally invasive technology have been developed over the last 4-6 years. Studies like this do a discredit to surgery and to surgeons, confuse the public, make insurance communications a hassle at best, and can block the top care for patients at the worst.

I am sure this paper will be discussed at next weeks combined IFFAS/AOFAS: International Federation of Foot and Ankle Societies and American Orthopedic Foot and Ankle Society meeting in Chicago. It’s an honor for the US to host the event. I am excited to go and learn from surgeons around the world. I can’t wait to let my patients benefit from all the shared information.

Related source: Reuters

Diabetic Foot Infections Decrease…Or Do They?

Diabetic FootMedical researchers claim the incidence of diabetic foot infections have fallen by 50 percent over the last 15 years, but are Americans really becoming healthier, or are the statistics simply being manipulated?

Back in 2006, diabetic foot infections occurred in an average of 2.3 out of 100 individuals discharged with diabetes-related conditions. In 2010, that number sits at 1.1 percent, according to Bryson Duhon, a clinical assistant professor of pharmacy at the University of Texas at Austin. He added that the number of limb amputations from diabetic limb infections dropped from 35 percent to 21.6 percent over the 15-year span.

But Duhon isn’t quick to take the data at face level. In fact, he claims that the drop is simply due to a manipulation of the statistics. First, Duhon claims that a new characterization of the disease has impacted the numbers. In 1997, the diabetic criteria for fasting blood glucose dropped from 140mg/dL to 126 mg/dL, which meant millions more Americans were now categorized as diabetic. Also, these diabetics were some of the healthiest and least likely to succumb to a diabetic foot infection, which is often a late-stage complication of the disease.

“Although encouraging, the primary decrease in incidence was likely a result in newly diagnosed diabetes,” Duhon explained. “With less stringent criteria for the diagnosis of diabetes over the years, more patients are diagnosed with new and less severe diabetes as in the past. Thus these patients are less likely to experience the severe complications of diabetes such as diabetic foot infections.”

Duhon said the true diabetes statistics have remained rather static over the last 15 years.

“You are getting the same number of foot infections — but you are getting more diabetes diagnoses,” Duhon said. “So, to be honest, there really isn’t a reduction in these infections. We aren’t doing a better drop of preventing these infections or treating them.”

The New England Journal of Medicine reported similar findings, claiming the widened diagnostic criteria primarily caused the reduction in infection rates.

Dr. Silverman comments

Don’t like the percent of people having the disease? Don’t get better at treating it, just raise the denominator and lower the incidence in the population of people with the disease!

These findings only perpetuate the notion that statistics don’t lie, statisticians do.

Walking Can Reverse Damage Done By Sitting

Walking benefitsBy now you’ve likely heard the reports that sitting for more than eight hours a day can lead to negative health effects like heart disease, poor blood circulation and stroke. While that information may be scary, researchers say you can prevent the damage by breaking up your seated sessions with short walks.

The study conducted by researchers at Indiana University found that impaired blood flow in the leg arteries can be reversed by breaking up your sitting regimen with five-minute walking breaks.

Medical evidence suggests that blood can pool in the legs and cause poor blood flow to the heart. In fact, research suggests that normal blood flow can be impaired by as much as 50 percent by just one hour of sitting. Scientists say just 300 seconds of walking every hour can combat the issue.

“American adults sit for approximately eight hours a day,” said Saurabh Thosar, the study’s lead author. “The impairment in endothelial function is significant after just one hour of sitting. It is interesting to see that light physical activity can help in preventing this impairment.”

Thosar noted that individuals who walked for five minutes after an hour of sitting did not experience poor blood circulation.

The Study

For their study, researchers examined a group of healthy males between the ages of 20 and 35, although they did not regularly exercise. Participants were told to break up their sitting patterns with five minutes of walking, and researchers determined it led to better blood circulation. In fact, researchers said breaking up long chunks of sitting is better than going for a longer workout after a particularly lengthy sitting session. They cited a study that found that six hours of sitting counteracted the positive health benefits of one hour of exercise. Researchers say sitters should opt for regular exercise, and hourly movement.

“Walking definitely increases blood flow in the legs,” added Thosar.

While standing workstations are becoming more people, Thosar concluded that standing is better than sitting, but not as beneficial as walking.

“If it’s static and people are not moving, perhaps people are still not using their muscles as much as during walking,” he concluded.

Dr. Silverman comments

This study echoes the usual sentiments I perpetuate on this blog. Treat your body right, as you only get one. Get regular exercise, avoid sitting for too long and eat right.

It’s interesting that 30 minutes of walking spaced out at the end of each hour is more beneficial than sitting for six hours and then working out for an hour, but it makes sense. It’s like doing dishes. It’s easier to do a few after each meal than do a weeks worth that you’ve continually been putting off. Just like your health, taking regular preventative measures is better than trying to eat healthy on Monday after a caloric and lethargic weekend.

Related source: Washington Post

Reigning Triple Crown Winner Cabrera Dealing With Bone Spur

Miguel CabreraDetroit Tigers superstar and 2013 Triple Crown winner Miguel Cabrera is dealing with a bone spur in his right ankle, which could cause him to miss time during a crucial set of September games.

The Tigers currently sit 0.5 games back of the second Wild Card spot and 2 games back of the AL Central leading Royals, but they may have to make a playoff push without regular help from last year’s MVP. Team trainers aren’t suggesting that Cabrera needs surgery to address the issue, but it’s clear any operation wouldn’t occur until the season ended.

“We don’t know if he requires surgery,” said manager Brad Ausmus. “We don’t know if it’s going to be [healed by] rest, or if surgery would help, and that’ll be determined when the season’s over.”

Ausmus added that a problematic bone spur is what’s causing the pain.

“That is what’s causing the irritation – not spurs, I would say it’s one,” said Ausmus. “That’s what the general consensus is, but whether it’s rest that will help the inflammation or irritation go down in the area, or whether it’s something that has to be done surgically, we don’t know that.”

Cabrera is still putting up great numbers this season, hitting .310/.370/.519 with 22 home runs and 100 RBI, but he’s having a down season compared to years past. He leads the American League in doubles, but if he was working with a healthy base, it’s all but certain a few of those shots off the wall would have cleared the fence.

Dr. Silverman comments

While I don’t think Ausmus is trying to craft an excuse as to why the Tigers might miss the playoffs, it’s clear that Cabrera needs to go under the knife this offseason, and the manager doesn’t want to come out and openly say ‘yes he needs surgery but he’s going to play through it because we need him.’

If Cabrera wanted to ride off into the sunset this offseason and hang up his cleats, he could probably get away with just resting his foot. If he wants to return to Triple Crown from, he’s going to need to have the spur and any underlying conditions addressed.

I’ve seen this exact injury many times, and I’d venture to guess that ankle instability and arthritic spurs are the root of the problem. Oftentimes this combination can cause recurrent problems, and although Cabrera has been rather durable this season, this isn’t the first time we’ve heard grumblings that’s he’s dealing with right foot discomfort. He’s one of if not the best hitter in the game right now, and he can certainly play well through the pain, but he needs to have the foot surgically fixed if he wants to play pain free next season. Rest could help in the short term, but the problem will surface again during another long season if the root cause goes untreated.

Related source: CBS Sports

Stress Fractures and Sports

Stress Fractures in SportsFall marks the peak sports season in both professional and high school sports. The NFL just got underway, MLB is headed towards the playoffs, and the NHL and NBA begin in a month. On the high school level, football, cross country, tennis, boys soccer and girls tennis gets going when the leaves begin to change color. When you’ve got a record amount of high school athletes and the majority of professional athletes competing at the same time, it’s no wonder so many injuries occur in the fall.

One of the more common injuries that can sideline a player for the remainder of their season is a stress fracture in their leg. These tend to be more common in high school athletes who don’t train correctly or who overtrain at the beginning of a season.

“Any sport with repetitive motions, such as extended running, puts you at risk of developing a stress fracture — whether it’s cross-country, basketball, swimming, gymnastics, or tennis,” said orthopedic surgeon Dr. Alexis Colvin. “Athletes are particularly at risk when they start increasing the amount of time they’re doing the activity — say, when a runners are training for a long distance race, and increase their mileage too quickly.”

Preventing Stress Fractures

The biggest issue facing athletes with stress fractures is that they try to push through the pain. Oftentimes they believe the pain is just soreness, and since they don’t want to miss any games, they play through the discomfort. This only makes the problem worse.

“It’s not like an acute sports injury due to a trauma, like taking a hit and tearing a ligament — the important thing is not to keep training through the pain, because, it’s just going to get worse,” said Colvin “There are gradations in terms of the injury to bone from overuse, and if you keep training, the bone can be broken all the way through.”

Treating stress fractures usually involves rest and gradual return to full sporting activities, but Colvin notes there are three things amateur athletes can do to help prevent stress fractures from developing.

Train Right – As we mentioned above, overuse and overstressing your body before it’s ready can lead to stress fractures. You wouldn’t try to run a marathon without working your mileage up, so don’t go into the first day of football or soccer practice without some offseason conditioning.

Wise Up – Learn more about signs and symptoms of stress fractures so you don’t let a small problem snowball out of control. Check out some of our past blogs on stress fractures and learn form other websites like

Proper Nutrition – If you’re not eating right, your body isn’t getting the vitamins and nutrients it needs. This can weaken your bones and make you more susceptible to injury. Make sure you’re getting plenty of Vitamin D, calcium and protein.

Related source: NY Daily News

In Heart Health Race, Low Carb Diet Beats Low Fat 

Low Carb DietsA new study conducted by researchers at Tulane University found that in the battle of weight loss and heart health, a low-carbohydrate diet beats a low-fat diet.

Research has long since confirmed that low-carb diets tend to outperform low-fat diets when it comes to weight loss, but there was debate over their implications for heart disease, as many low-carb diets are high in fat. New research suggests low-carb is the way to go for both weight loss and heart health.

“This study shows if you are overweight and have cardiovascular disease risk factors and haven’t had success on other diets, certainly a low-carbohydrate diet is worth a try,” said lead researcher Lydia Bazzano.

Low-Carb Heart Health Study

For their study, Buzzano and colleagues recruited 148 obese individuals between the ages of 22 and 75, who, while overweight, did not have diabetes or heart disease. The group was split in two, with half following a low-carb diet for one year (<40 grams/day) and the other dining on a low-fat diet (<30% of daily calories from fat and <55% of daily energy from carbs). Both groups were advised not to change their level of physical activity, and they each received regular guidance about portion control, healthy eating and nutrition. About 80 percent of individuals stuck with their diet for the full year.

After analyzing the data, researchers found that individuals on the low-carb diet lost more weight than those on the low-fat diet – roughly eight pounds per person. But what they found most interesting was that neither group showed an increase in total cholesterol, and those in the low-carb diet exhibited lower levels of fat circulating in their blood, a general predictor of heart attack and heart disease.

“I thought that was a very striking finding,” said Buzzano, adding that those on the low-carb diets scored lower on baseline test for heart disease risk. She concluded by saying individuals should reach for healthy forms of protein like chicken, fish, nuts and beans over carbohydrate-dense or processed options.

Dr. Silverman comments

While this new study focuses on heart health, it’s of little surprise that cutting excess carbs from your diet is beneficial for your health. I mean, we’ve already found evidence that cutting carbs can lower your Alzheimer’s risk, it can lower your risk of developing diabetes, and can help you avoid becoming addicted to unhealthy foods.

Studies have already found that cutting carbs is great for your heart, but now we’re seeing it in relation to low-fat diets. It’s nice to see a comparison of the two. I hope to see similar studies in the future, and I hope readers keep their carb intakes in mind!

Related source: Reuters

Medical Alert App Helps Save Baby’s Life 

Pulse PointA Washington infant is alive today thanks to the heroics of one man and his smartphone.

The whole ordeal began one afternoon while Jeff Olson was working his job as an auto mechanic. Olson had his phone nearby when he heard what he described as an Amber Alert-like alarm. Olson grabbed his phone to see what was going on and was alerted to a medical situation by an app he had previously installed called Pulse Point.

Pulse Point alerts nearby app users of emergency situations. In this case, Olson was alerted about a person in need of CPR two blocks from his location.

“I looked at it and it said CPR needed and it gave the address,” Olson told local ABC affiliate KXLY-TV.

Olson, who happens to be a volunteer EMT, sprung into action. He ran down the street until he arrived at the address.

“I asked the lady standing outside, ‘Do you have a medical emergency here?’ And she said it’s an infant and he’s blue,” Olson said.

Bystanders watched as Olson worked against time.

“This guy just came out of nowhere and just scooped the baby up and really knew what he was doing which was such a blessing to all of us,” store clerk Lesley Reckford told KXLY.

Olson was able to preform CPR and resuscitate the infant.

“I don’t think I’ve ever done CPR on an infant before or even rescue breathing and when I got done I shook for about ten minutes,” Olson said after the ordeal.

Dr. Silverman comments

Kudos to Mr. Olson and the Pulse Point app. It’s certainly an app that doctors, nurses, medics and EMTs should have on their phone.

After doing a little research, the app works by connecting to local fire departments and emergency service centers. When a connected fire department gets a call about an unresponsive child or a traffic collision, it sends out a notification to any app users whose location puts them in the immediate vicinity. Sometimes this can help a person avoid a traffic snarl. Other times, like in the case above, it can save a life.

I want to check out this app for myself. Who knows how many people injure their ankles just a block from me!