Monday, September 16, 2019

Gout

Gout is a complex form of arthritis.  It typically causes sudden, severe attacks of pain, swelling, redness, and tenderness in the joints.  The most common joint affected is the base of the big toe.  Most patients will have episodic flares, with little or no symptoms between flares.  There are ways to manage this condition and decrease or even prevent symptoms.  Today we'll talk about the symptoms and causes of gout, and next week we will talk more about the diagnosis and treatment of gout.

GoutWhat are the symptoms of gout?
  • Intense joint pain - The onset of pain is sudden and severe, often waking you up from sleep.  The pain is most severe within the first 4-12 hours, and is often described as feeling like your big toe is on fire.  The most common joint affected is the base of the big toe, but other commonly affected joints include the ankles, knees, elbows, wrists, and fingers.  
  • Persistent discomfort - After the initial severe pain, some discomfort may last for days to weeks.  The longer a patient has gout, the longer the persistent discomfort may last, and the more joints may be involved.
  • Redness, swelling, tenderness - Affected joints may be so tender that even the weight of the bed sheet may seem intolerable.
  • Limited motion of joints - With repeated flares, affected joints may lose the ability to move as easily as they should.
What causes gout?

Gout happens because urate crystals accumulate in your joint which occurs when you have high levels of uric acid in your blood.  Urate crystals are sharp, and needle-like, and when they develop inside a joint, they cause the inflammation and swelling associated with gout.

Uric acid is produced by the body when it breaks down substances called purines.  Uric acid is normally dissolved in your blood and is eliminated by passing into the urine through the kidneys.
    
High levels of uric acid in the blood can be caused by the body either producing too much uric acid, or by the kidneys not getting rid of enough uric acid. 

What are the risk factors for gout?
  • Family history - If family members have had gout, you are more likely to develop it.
  • Age and sex - Men are more likely to develop gout because women tend to have lower uric acid levels.  However, after menopause, uric acid levels in women increase and approach those of men.  Men are more likely to develop gout when they are younger (between 30-50 years of age), but women are more likely to develop gout after menopause.
  • Diet - Eating a diet rich in foods containing high levels of purines will increase uric acid levels.  High purine foods include red meats, organ meats, seafood, and some others.  Other foods that increase levels of uric acid include high-fructose foods or drinks and alcohol, especially beer.
  • Obesity - When you are overweight, your body produces more uric acid, and your kidneys have more trouble eliminating it.
  • Medical conditions and certain medications - Conditions such as diabetes, untreated high blood pressure, heart disease, and kidney disease increase your risk of gout.  Some medications increase uric acid levels, such as certain diuretics, aspirin, and some others.
We'll talk more about gout next week.  If you have any questions about gout, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Friday, August 30, 2019

Osteoporosis Part II

Last week we talked about osteoporosis, including risk factors and complications.  This week, I wanted to talk about things that you can do to try to prevent osteoporosis.  We will also talk about ways that it can be treated, if it does develop, in order to decrease the risk of complications.

OsteoporosisAs I mentioned last week, bones are living tissue, and they are continually being remodeled with old bone being removed and new bone being created.  Bones continue to grow and reach a maximum size and strength (peak bone mass or bone bank deposit) on average sometime between ages 25 and 30.  There are two processes that increase your risk for osteoporosis.  The first is a decrease in bone bank deposits, and the second is an increase in bone bank withdrawals.
Preventing osteoporosis starts with optimal bone growth and development from a very young age.  It is never too early to start depositing into your bone bank!  It is estimated that a 10% increase in peak bone mass reduces the risk of an osteoporotic fracture during adult life by 50%.
People of all ages should eat a nutritious diet with adequate calcium intake.  We have learned that getting calcium through foods is much more beneficial and causes fewer long term complications than taking calcium supplements.  I would not recommend taking a calcium supplement without you discussing it with your doctor first.  The amount of recommended daily calcium varies depending on age and other factors. 

Here is the recommended dietary calcium intake for children and adults.
 
• Less than 4 years old consult your pediatrician
• 4-8 years old 1000 mg per day
• 9-18 years old 1300 mg per day
• 19-50 years old 1000 mg per day
• Men 51-70 years old 1000 mg per day
• Women 51-70 years old 1200 mg per day
• 71 years and older 1200 mg per day

What else can you do to decrease your risk of osteoporosis? 
  • Avoid under-nutrition or malnutrition, especially during childhood and adolescence.  Be aware of possible eating disorders and the effects they have on nutritional status.
  • Maintain an adequate supply of vitamin D, which is often found alongside calcium in fortified foods.  Vitamin D is made in your body when your skin is exposed to sunlight.
  • Participate in regular physical activity, particularly weight bearing exercises, or activities that provide resistance, such as walking, jogging, running, weight training, dancing, aerobics, hiking, stair climbing, and push-ups.  Daily activities like gardening, vacuuming, mowing the lawn, or shoveling snow are also beneficial.  Remember that weight bearing exercises are the only exercises that enhance bone growth or stop bone loss.
  • Avoid smoking and second-hand smoke exposure.  We learned decades ago that there is a direct relationship between tobacco use and lower bone density.  
  • Avoid excessive alcohol intake.  Too much alcohol intake interferes with the body's calcium balance.  It can also cause hormone abnormalities that can affect our bone bank balance, as well as vitamin deficiencies that can affect our bones.
  • If you have thyroid problems, be sure to have this monitored regularly by your doctor.  Excessive thyroid hormone, either from an overactive thyroid, or thyroid replacement at a dose that is too high, can lower your bone mass.
  • Talk with your doctor about a bone density test.  This is a painless test which can detect osteoporosis before a fracture occurs.  The age at which you should have this test depends on your risk factors, so discuss it with your family doctor at your next annual exam.
How is osteoporosis treated?
There is no cure for osteoporosis, but there are a number of treatment options.  The treatment option recommended as the first line treatment for most women is use of a medication in the bisphosphonate class.  This class includes several different medications which may be taken by mouth daily, weekly, or monthly, as well as given by injection on a less frequent basis. There are also several other classes of medications that can be used to treat osteoporosis.  Which medication is best for you depends on many things including other medical problems or your risk for other medical problems, other medications that you take, and other factors as well.  If you have osteoporosis, you should talk with your doctor about which of treatment option is best for you.

If you have any questions about your risk for osteoporosis or prevention, send a question to one of our doctors.  For a list of calcium-rich foods from the National Osteoporosis Foundation, follow this link:
https://www.nof.org/patients/treatment/calciumvitamin-d/a-guide-to-calcium-rich-foods/

If you have any questions about osteoporosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Monday, August 26, 2019

Osteoporosis

Osteoporosis is a medical condition in which the bones become brittle and fragile as a result of loss of tissue.  This is typically a result of hormonal changes, or deficiency of calcium or vitamin D.  The complications of osteoporosis, including hip fractures and spinal fractures, can cause significant disability.  We'll talk today about this condition, and whether you might be at risk.  Next week we'll talk about how you can help prevent it from happening to you.
What causes osteoporosis?
OsteoporosisYour bones are living tissues that are constantly being broken down and rebuilt by specialized cells.  Osteoporosis is the result of the rebuilding process not being able to keep up with the breakdown of bone.  The rebuilding process relies heavily on calcium and vitamin D.  When you are very young, your body makes new bone faster than it breaks it down.  As you get older, this gradually shifts to a steady state, then shifts to the breakdown outpacing the rebuilding. 
  
Most people reach their peak bone mass by age 30.  Think of this as a "bone bank account."  You can only deposit into it until you are about 30 years old, but you have to rely on that bank account for the rest of your life.  It is important to try to get to the highest peak bone bank balance that you can, so you can withdraw from your bone bank account as you age, without that balance dropping too low.   
What are the risk factors for osteoporosis?
Risk factors include things that decrease your bone bank deposits, or increase your bone bank withdrawals.  Some risk factors are out of your control, but some you can control.  Risk factors include: 
  • Age - Risk increases as you get older.
  • Sex - Women are at much higher risk for osteoporosis than men.
  • Race - The risk is highest in people who are white or of Asian descent.
  • Bone frame size - Smaller body frame size increases your risk.
  • Family history - Having a close relative with osteoporosis increases your risk.
  • Hormone levels, including
    1. Reduced estrogen levels at menopause is one of the greatest risk factors for developing osteoporosis.  
    2. Reduced testosterone levels as men age also increases the risk.   
    3. Too much thyroid hormone can cause bone loss, either due to your thyroid being overactive, or taking too much thyroid hormone to treat an underactive thyroid.
    4. Abnormal function of the parathyroid or adrenal glands.
  • Dietary factors
    1. Low calcium intake - If you don't get enough calcium when you're young, you end up with a lower peak bone bank account.  As you age, lower calcium intake doesn't allow you to keep up your balance.
    2. Eating disorders - Severely restricting your intake of food, or being significantly underweight contributes to lower bone mass.
    3. Soft drinks - We are not sure why, but people who drink a lot of carbonated soft drinks do have a higher risk of osteoporosis, especially if this intake starts at a young age.
  • Lifestyle factors
    1. Sedentary lifestyle - Weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, including walking, running, dancing, weightlifting, and many others.
    2. Smoking - Tobacco use has been shown to contribute to weak bones.
    3. Alcohol - Regular consumption of more than 2 alcoholic drinks a day increases your risk.
What are the complications of osteoporosis?
  • Hip fractures - These are often caused by a fall.  Hip fractures can result in significant disability and even increase the risk of death within the first year after injury.
  • Spinal fractures – These fractures can occur from an injury, such as a fall. Sometimes the bones in your spine become weak enough that they just crumple without any injury (like crushing an aluminum can).  This can cause significant pain, and can cause you to lose height or become unable to stand fully upright. 
  • Other fractures - Any bone in your body will be more likely to break from an injury.
Osteoporosis is a serious health concern in the United States.  Over 1.5 million fractures per year are attributed to osteoporosis.  Estimates indicate that U.S. medical costs for osteoporosis range from $10 to $22 billion yearly, which does not include the indirect costs of reductions in survival, quality of life, and productivity.
   
Next week we will talk about how you can help to prevent osteoporosis as well as available treatments.
If you have any questions about Osteoporosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor