Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6057_Библиотеки_им_академика_М_И_Перельмана
.pdf
vertebroplasty In this minimally invasive pro-
cedure, the surgeon injects a type of bone cement
into
VERTEBRAE that have collapsed from VERTEBRAL
COMPRESSION FRACTURES caused by OSTEOPOROSIS or
other conditions of bone loss. In about 10 minutes,
the cement solidifies harder than bone, fusing frag-
ments and relieving
CHRONIC BACK PAIN.
Procedure
According to the North American Spine Society
(NASS), “after a diagnosis of the compression frac-
ture has been made through an MRI or CT scan, the
patient lies prone and is sedated with a mild anes-
thetic. Under the guidance of an imaging technique
called C-arm fluoroscopy, the physician injects a
cement-like mixture (polymethylmethacrylate)
into the vertebra. The entire process takes one to
two hours, although the actual injection usually
takes only about 10 minutes. The cement mixture
hardens in about half an hour and after a short
recovery period the patient is sent home.”
Risks and Complications
The NASS reported, “Percutaneous vertebroplasty
is relatively new and long-term results are not
known. Patients who have one vertebral fracture
are five times more likely to get another adjacent
to the damaged one; therefore steps should be
taken to limit the effects of osteoporosis. Although
complications appear to be less than 1%, percuta-
neous vertebroplasty can cause infection, bleed-
ing or embolism if the cement mixture gets into
the blood stream and passes through the heart and
lungs.”
An article in The Journal of Supportive Oncol-
ogy listed contraindications for vertebroplasty as
including
DISCITIS, OSTEOMYELITIS, and “inabil-
ity of the patient to lie prone for the duration
of the procedure.” Comparing vertebroplasty to
KYPHOPLASTY, the article reported, “Although an
increase in vertebral body height has been seen
with vertebroplasty alone, kyphoplasty results
in significantly greater height restoration (97%)
than vertebroplasty (30%.)” Furthermore, “both
treatments increase the strength of the vertebral
body, but only kyphoplasty restores stiffness,”
which may help patients to increase their
LOAD
TOLERANCE.
Outlook and Lifestyle Modifi cations
According to the Radiological Society of North
America, “vertebroplasty is often performed on
patients too elderly or frail to tolerate open spinal
surgery, or with bones too weak for surgical spi-
nal repair. Patients with vertebral damage due to a
malignant tumor may sometimes benefit from ver-
tebroplasty. In rare cases, it can be used in younger
patients whose osteoporosis is caused by long-term
steroid treatment or a metabolic disorder. Typically,
vertebroplasty is recommended after simpler treat-
ments—such as bedrest, a back brace or pain medi-
cation—have been ineffective, or once medications
have begun to cause other problems, such as stom-
ach ulcers. Vertebroplasty can be performed right
away in patients who have severe pain requiring
hospitalization or conditions limiting bedrest and
medications.” After the procedure, “about 75 per-
cent of patients regain lost mobility and become
more active, which helps combat osteoporosis. After
vertebroplasty, patients who had been immobile
can get out of bed, reducing their risk of pneumo-
nia. Increased activity builds more muscle strength,
further encouraging mobility.”
Halpin, Ryan J., Bernard R. Bendok, M.D., and John C.
Liu, M.D. “Minimally Invasive Treatments for Spinal
Metastases: Vertebroplasty, Kyphoplasty, and Radio-
frequency Ablation,” The Journal of Supportive Oncology
2, no. 4 (July/August 2004): 339–355.
North American Spine Society. “Percutaneous Vertebral
Augmentation,” NASS. Available online. URL: http://
www.spine.org/articles/NT_Percu_Vert_Aug.cfm.
Downloaded May 15, 2006.
RadiologyInfo ™. “Vertebroplasty,” Radiological Society
of North America. Available online. URL: http://www.
radiologyinfo.org/content/interventional/vertebro.
htm. Last reviewed September 1, 2005.
vitamin A This family of compounds strength-
ens bones and body cells but is commonly known
as a visual aid. For instance, beta-carotene readily
converts into vitamin A, aiding eyes and vision as
claimed by the parents intent on getting their
CHIL-
DREN to eat their carrots. While many dark orange
or green vegetables contain beta-carotene, another
precursor of vitamin A, retinol, can be found in cod
306 vertebroplasty
liver oil or meat. As the Linus Pauling Institute said,
“Different dietary sources of vitamin A have differ-
ent potencies. For example, beta-carotene is less eas-
ily absorbed than retinol and must be converted . . .
by the body.”
Since vitamin A is fat-soluble, this nutrient can
be stored in body fat cells for future needs. That
same trait, however, makes it easy to accumulate
too much vitamin A, which, in excess, can lower
bone mineral density. Either too much or too little
vitamin A can also result in
BIRTH DEFECTS. Although
a well-balanced diet rarely needs supplements, a
doctor may recommend a specific dosage to treat a
specific concern. Otherwise, a multi-vitamin usu-
ally works well, but good
NUTRITION works better.
Statistics and Studies
According to the Office of Dietary Supplements,
“researchers are now examining a potential new
risk factor for osteoporosis: an excess intake of vita-
min A. Animal, human, and laboratory research
suggests an association between greater vitamin
A intake and weaker bones. Worldwide, the high-
est incidence of osteoporosis occurs in northern
Europe, a population with a high intake of vitamin
A. However, decreased biosynthesis of vitamin D
associated with lower levels of sun exposure in this
population may also contribute to this finding.”
Higdon, Jane. “Vitamin A,” Linus Pauling Institute, Ore-
gon State University. Available online. URL: http://
lpi.oregonstate.edu/infocenter/vitamins/vitaminA/
index.html. Downloaded May 15, 2006.
Office of Dietary Supplements. “Dietary Supplement Fact
Sheet: Vitamin A and Carotenoids,” National Insti-
tutes of Health. Available online. URL: http://ods.
od.nih.gov/factsheets/vitamina.asp. Downloaded May
15, 2006.
vitamin B-complex This family of eight vitamins
includes thiamine (B1), riboflavin (B2), niacin
(B3), pyridoxine (B6),
FOLIC ACID (B9), cyanoco-
balamin (B12), pantothenic acid, and biotin. While
each B has a unique chemistry and unique influ-
ence on the body, each is water soluble. This means
the body washes away the excess, yet too much at
once can irritate nerves, especially if Bs have been
taken separately. Conversely, inadequate intake
can result in
BIRTH DEFECTS OF THE SPINE, fatigue, or
spinal nerve irritation. Since B vitamins may help
to ease
TENSION, these nutrients can have therapeu-
tic value in such conditions as
REFLEX SYMPATHETIC
DYSTROPHY and FIBROMYALGIA.
If B supplements are needed to treat a bone,
SPINE, or nerve condition, they should not be taken
individually unless a doctor prescribes otherwise.
Debates about B continue, for instance on their value
in treating neurological conditions. As the Agency
for Healthcare Research and Quality reported, “B
vitamin supplementation may be of value for neu-
rocognitive function, but the evidence is inconclu-
sive.” For general use, a multi-vitamin supplement
containing 100 percent of the daily requirement
for each B vitamin would be preferable to products
favoring one B over another. Even more favorable
would be well-balanced
NUTRITION with such natu-
ral food sources as shellfish, eggs, dairy products,
and fortified grain products of cereal or bread.
Agency for Healthcare Research and Quality. “B Vitamins
and Berries and Age-Related Neurodegenerative Dis-
orders,” AHRQ. Available online. URL: http://www.
ahrq.gov/clinic/tp/berrytp.htm#Report. Downloaded
May 15, 2006.
vitamin C Also known as ascorbic acid, this water-
soluble vitamin occurs naturally in citrus fruits, but
strawberries and uncooked red or green peppers
pack more C punch. Not only does this nutrient
protect the immune system, but vitamin C may
help a body to lose
WEIGHT.
Dosage and Potential Side Effects
Information from the Linus Pauling Institute Web
site advised, “In the U.S., the recommended dietary
allowance (RDA) for vitamin C was recently revised
upward from 60 mg daily for men and women.
The RDA continues to be based primarily on the
prevention of deficiency disease, rather than the
prevention of chronic disease and the promotion
of optimum health. The recommended intake for
smokers is 35 mg/day higher than for nonsmokers,
because smokers are under increased . . . stress from
the toxins in cigarette smoke and generally have
vitamin C 307
lower blood levels of vitamin C.” Although ade-
quate intake has not been established for
INFANTS,
the dosage for
CHILDREN gradually increases from an
RDA of 15 mg at age one to 75 mg during
ADOLES-
CENT years.
Statistics and Studies
A 2006 issue of The Annals of Nutrition and Metabolism
published these recent findings from Switzerland:
“A large number of randomized controlled inter-
vention trials with intakes of up to 1 g of vitamin C
and up to 30 mg of zinc are available. These trials
document that adequate intakes of vitamin C and
zinc . . . shorten the duration of respiratory tract
infections including the common cold.” In addi-
tion, “vitamin C contributes to maintaining the . . .
integrity of cells and thereby protects them . . . in
the inflammatory response.” With more
RESEARCH
needed, vitamin C may prove similarly useful in
easing inflammation that occurs in such conditions
as
ARTHRITIS. Also, “vitamin C concentrations . . .
rapidly decline during infections and stress,” thus
indicating the need for more C in times of
TENSION.
Higdon, Jane. “Vitamin C,” Linus Pauling Institute, Ore-
gon State University. Available online. URL: http://lpi.
oregonstate.edu/infocenter/vitamins/vitaminC/index.
html. Downloaded May 15, 2006.
Wintergerst, Eva S., Silvia Maggini, and Dietrich H.
Hornig. “Immune-Enhancing Role of Vitamin C and
Zinc and Effect on Clinical Conditions,” Annals of
Nutrition and Metabolism, European Journal of Nutrition,
Metabolic Diseases, and Dietetics 50, no. 2 (2006): 85–94.
vitamin D With a well-deserved reputation for
aiding
CALCIUM uptake, this fat-soluble vitamin
aids
BONE BUILDING and prevents RICKETS. Recent
RESEARCH indicates vitamin D regulates cellular
activity and may boost the immune system too.
Dosage and Potential Side Effects
Fortified dairy products provide an excellent food
source but may cause an allergic response, particu-
larly in
INFANTS with lactose intolerance. For older
CHILDREN, ADOLESCENTS, and adults, yogurt provides
a good source without aggravating allergies. Better
yet would be brief daily
ACTIVITY in the sun.
A fact sheet from the Office of Dietary Supple-
ments explained, “UV rays from the sun trigger
vitamin D synthesis in skin.” However, “season,
geographic latitude, time of day, cloud cover, smog,
and sunscreen affect UV ray exposure and vitamin
D synthesis. For example, sunlight exposure from
November through February in Boston is insuffi-
cient to produce significant vitamin D synthesis in
the skin. Complete cloud cover halves the energy
of UV rays, and shade reduces it by 60%.” Also,
“sunscreens with a sun protection factor (SPF) of
8 or greater will block UV rays that produce vita-
min D.” Therefore, “an initial exposure to sunlight
(10–15 minutes) allows adequate time for Vitamin
D synthesis and should be followed by application
of a sunscreen with an SPF of at least 15 to protect
the skin. Ten to fifteen minutes of sun exposure at
least two times per week to the face, arms, hands,
or back without sunscreen is usually sufficient to
provide adequate vitamin D,” but “it is very impor-
tant for individuals with limited sun exposure to
include good sources of vitamin D in their diet.”
Besides dairy products, natural sources include
eggs and cold water fish. For babies, “the American
Academy of Pediatrics . . . recommends a daily sup-
plement of 200 IU vitamin D for breastfed infants
beginning within the first 2 months of life unless
they are weaned to receive at least 500 ml (about 2
cups) per day of vitamin D-fortified formula. Chil-
dren and adolescents who are not routinely exposed
to sunlight and do not consume at least 2 8-fluid
ounce servings of vitamin D-fortified milk per day
are also at higher risk of vitamin D deficiency and
may need a dietary supplement containing 200 IU
vitamin D.” Because vitamin D is fat-soluble, how-
ever, excess amounts can quickly accumulate in the
body, causing the person to experience a toxic reac-
tion. Then, “vitamin D toxicity can cause nausea,
vomiting, poor appetite, constipation, weakness,
and weight loss. It can also raise blood levels of cal-
cium, causing mental status changes such as confu-
sion. High blood levels of calcium also can cause
heart rhythm abnormalities.”
To keep D in perspective, an article in The Jour-
nal of Steroid Biochemistry and Molecular Biology said,
“Actual toxicity is not seen below serum 25OHD
values of 250nmol/L,” which means “a value that
would be produced only at continuing oral intakes
308 vitamin D
in excess of 10,000IU (250microg)/day.” The arti-
cle also summarized the importance of vitamin D
in “optimizing intestinal calcium absorption” and
minimizing risks of
FRACTURE in ELDERLY patients
with
OSTEOPOROSIS.
Heaney, R. P. “The Vitamin D Requirement in Health and
Disease,” The Journal of Steroid Biochemistry and Molecu-
lar Biology 97, no. 1–2 (October 2005): 13–22.
Office of Dietary Supplements. “Dietary Supplement Fact
Sheet: Vitamin D,” National Institutes of Health. Avail-
able online. URL: http://ods.od.nih.gov/factsheets/
vitamind.asp. Downloaded May 15, 2006.
vitamin E According to a fact sheet from the
Office of Dietary Supplements, “vitamin E is a fat-
soluble vitamin that exists in eight different forms.
Each form has its own biological activity, which is
the measure of potency or functional use in the
body.” However, “alpha-tocopherol (α-tocopherol)
is the name of the most active form of vitamin E in
humans. It is also a powerful biological antioxidant.
Vitamin E in supplements is usually sold as alpha-
tocopheryl acetate, a form that protects its ability
to function as an antioxidant. The synthetic form
is labeled ‘D, L’ while the natural form is labeled
‘D’. The synthetic form is only half as active as the
natural form.”
Dosage and Potential Side Effects
Natural sources can be found in wheat germ, veg-
etable oils, and nuts, but packaged products seldom
list available amounts. Also, people on a low-fat
diet may not get enough vitamin E. Since the body
stores this vitamin in fat, however, too much E
may accumulate. Therefore, the previously men-
tioned Fact Sheet advised that “the Food and Nutri-
tion Board of the Institute of Medicine has set an
upper tolerable intake level (UL) for vitamin E at
1,000 mg (1,500 IU) for any form of supplementary
alpha-tocopherol per day. Based for the most part
on the result of animal studies, the Board decided
that because vitamin E can act as an anticoagulant
and may increase the risk of bleeding problems this
UL is the highest dose unlikely to result in bleed-
ing problems.” Although upper limits have not
been established for
INFANTS, CHILDREN under three
should not exceed 200 mg, while 800 mg is the
maximum for
ADOLESCENTS.
Statistics and Studies
According to the Linus Pauling Institute, “a recent
meta-analysis that combined the results of 19 clini-
cal trials of vitamin E supplementation for various
diseases . . . reported that adults who took supple-
ments of 400 IU/day or more were 6% more likely
to die from any cause than those who did not take
vitamin E supplements. However, further break-
down of the risk by vitamin E dose and adjust-
ment for other vitamin and mineral supplements
revealed that the increased risk of death was sta-
tistically significant only at a dose of 2,000 IU/day,
which is higher than the UL for adults.”
Higdon, Jane. “Vitamin E,” Linus Pauling Institute, Ore-
gon State University. Available online. URL: http://lpi.
oregonstate.edu/infocenter/vitamins/vitaminE/index.
html. Downloaded May 15, 2006.
Office of Dietary Supplements. “Dietary Supplement Fact
Sheet: Vitamin E,” National Institutes of Health. Avail-
able online. URL: http://ods.od.nih.gov/factsheets/
vitamine.asp. Downloaded May 15, 2006.
vitamin K Primarily known for its ability to clot
the blood, this nutrient also aids bone health. As
occurs with other fat-soluble vitamins, the body
stores vitamin K but not in significant amounts.
Therefore, most people need to replenish K each
day through their choices in
NUTRITION.
Dosage and Potential Side Effects
Multivitamins contain various amounts of vitamin
K, with the highest numbers usually found in sup-
plements labeled or lauded as bone supplements.
Reading product labels is particularly important
for patients who take blood-thinning medications.
More subtle conflicts also occur among natural food
sources where the highest amounts of K arrive in
such dark green leafy vegetables as kale or collard
greens. Lesser amounts occur next in broccoli, let-
tuce, and asparagus. For those determined to eat
their spinach, the U.S. Department of Agriculture
showed that a cup of raw spinach has half again as
much vitamin K as a cup of raw broccoli. However,
vitamin K 309
a cup of cooked collard greens, kale, or spinach
that has been previously frozen contains almost
five times as much vitamin K as a cup of cooked
broccoli.
Statistics and Studies
Information from the Linus Pauling Institute
reported, “The discovery of vitamin K-dependent
proteins in bone has led to research on the role
of vitamin K in maintaining bone health.” For
instance, “osteocalcin, a bone-related protein that
circulates in the blood, has been shown to be a sen-
sitive marker of bone formation.” Nevertheless, “in
the absence of long-term intervention studies using
nutritionally optimal doses of vitamin K, evidence
of a relationship between vitamin K nutritional sta-
tus and bone health in adults is considered weak.
Further investigation is required to determine the
physiological function of vitamin K-dependent pro-
teins in bone and the mechanisms by which vita-
min K affects bone health and osteoporotic fracture
risk.”
Higdon, Jane. “Vitamin K,” Linus Pauling Institute, Ore-
gon State University. Available online. URL: http://
lpi.oregonstate.edu/infocenter/vitamins/vitaminK/
index.html. Downloaded May 16, 2006.
U.S. Department of Agriculture. “USDA National Nutri-
ent Database for Standard Reference, Release 18,
Vitamin K . . . ,” USDA. Available online. URL: http://
www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/
sr18a430.pdf. Downloaded May 16, 2006.
310 vitamin K
311
water and spine health
With water as vital to
the body as air, everybody needs daily hydration
to survive. Indeed, a Boston Globe article reported,
“An average adult body is 50 to 65 percent water—
that’s roughly 45 quarts.” Generally, “men are
more watery than women. A man’s body is 60 to
65 percent water, compared to 50 to 60 percent for
a woman.” Apparently, this occurs because men
have more muscle mass, but “water content differs
throughout the body. Blood is made up of 83 per-
cent water, bones are 22 percent water, and muscle
is 75 percent water.” Those numbers increase in
value, though, as “water plays several crucial roles
in the body. It helps regulate temperature, carries
nutrients and oxygen, and removes waste. It also
cushions joints and organs.” However, strenuous
EXERCISE, climatic changes, and illness reduce water
content. Also, “planes are especially drying. It’s esti-
mated that you can lose up to two pounds of water
during a three-hour flight. . . . By the time you
notice the symptoms of dehydration—dry mouth,
dark urine, lightheadedness—you’re already very
dehydrated.”
To avoid dehydration, the American Dietetic
Association (ADA) recommended consuming eight
cups of liquids a day, with more fluids added during
heightened daily
ACTIVITY or hot weather. This does
not have to be water only though. Juice and other
healthful drinks count, as do fruits and vegetables
with high water content. For instance, the ADA
listed a half-cup of lettuce as containing 95 percent
water, a half-cup of watermelon 92 percent, and a
medium apple 84 percent.
Risks and Complications
While raw fruits and veggies may themselves sip up
the adverse effects of such
ENVIRONMENTAL INFLU-
ENCES as bug sprays, they generally provide an
unpolluted water source that could be crucial for
survivors of a disaster, natural or otherwise. Usu-
ally though, tap water has been well-treated to
treat a body well. If, however, a person has a sensi-
tivity to fluorides or other additives, charcoal filter-
ing devices may be useful. To remove worrisome
microbes, distillation does the job, but this process
also removes
CALCIUM, MAGNESIUM, and other nutri-
ents needed for
MINERAL BALANCE.
Along that flow of thought, the World Health
Organization (WHO) reported, “Drinking-water
may be contaminated by a range of chemical, micro-
bial and physical hazards that could pose risks to
health if they are present at high levels. Examples
of chemical hazards include lead, arsenic and ben-
zene. Microbial hazards include bacteria, viruses
and parasites, such as Vibrio cholerae, hepatitis A virus,
and Crytosporidium parvum, respectively. Physical
hazards include glass chips and metal fragments.
Because of the large number of possible hazards in
drinking-water, the development of standards for
drinking-water requires significant resources and
expertise.” Bottling standards may be high, but
“contrary to this, some substances may prove more
difficult to manage in bottled than tap water. This
is generally because bottled water is stored for lon-
ger periods and at higher temperatures than water
distributed in piped distribution systems. Control
of materials used in containers and closures for
bottled waters is, therefore, of special concern. In
addition, some micro-organisms, which are nor-
mally of little or no public health significance, may
grow to higher levels in bottled waters. This growth
appears to occur less frequently in gasified water
and in water bottled in glass containers compared
to still water and water bottled in plastic contain-
ers. However, the public health significance of this
remains little understood, especially for vulnerable
W
individuals, such as infants and children, pregnant
women, immuno-compromised individuals and
the elderly. In regard to infants, as bottled water is
not sterile, it should be disinfected—for example,
by boiling for one minute—prior to its use in the
preparation of infant formula.”
Statistics and Studies
Researchers from the University of Texas studied
“The Influence of Water Removal on the Strength
and Toughness of Cortical Bone,” which involves
the hard outer layer or protective bone surface.
According to the report in the Journal of Biome-
chanics, “bone strength increased with a 5% loss of
water by weight . . . ,” but “with water loss exceed-
ing 9% . . . , strength actually decreased.” Also,
“stiffness . . . increased with an increase in water
loss. . . . Therefore, we speculate that loss of water
in the collagen phase decreases the toughness of
bone, whereas loss of water associated with the
mineral phase decreases both bone strength and
toughness.”
When dry bones become stiff and brittle, the
BACK and SPINE gradually feel those changes, but
a dry body in general exhibits the sort of changes
often associated with disease. Indeed, a 2003 Nobel
Prize resulted from
RESEARCH into those changes,
which can now be detected and monitored with
MAGNETIC RESONANCE IMAGING (MRI). As the Nobel-
prize.org Web site explained, water molecules con-
tain oxygen with twice as much hydrogen that act
“as microscopic compass needles. When the body is
exposed to a strong magnetic field, the . . . hydro-
gen atoms are directed into order—stand ‘at atten-
tion.’ ” With waves pulsing from an MRI, “the small
differences in the oscillations . . . are detected. By
advanced computer processing, it is possible to
build up a three-dimensional image that reflects
the chemical structure of the tissue, including dif-
ferences in the water content and in movements of
the water molecules. This results in a very detailed
image of tissues and organs in the investigated area
of the body.” Such a finding can have enormous
impact in diagnosing and monitoring musculoskel-
etal conditions, because “in many diseases the . . .
process results in changes of the water content, and
this is reflected in the MR image.”
American Dietetic Association. “Water, Water Every-
where. How Much Should You Drink?” ADA, January
17, 2005 Release. Available online. URL: http://www.
eatright.org/cps/rde/xchg/ada/hs.xsl/media_3173_
ENU_HTML.htm. Downloaded May 16, 2006.
Mansfield, D. A. “What Percentage of the Human Body Is
Water, and How Is This Determined?” The Boston Globe.
Available online. URL: http://www.boston.com/globe/
search/stories/health/how_and_why/011298.htm.
Downloaded May 16, 2006.
Nobelprize.org. “Press Release: The 2003 Nobel Prize
in Physiology or Medicine,” The Official Web site of
the Nobel Foundation. Available online. URL: http://
nobelprize.org/medicine/laureates/2003/press.html.
Last updated November 8, 2004.
Nyman, J. S., A. Roy, X. Shen, R. L. Acuna, J. H. Tyler,
and X. Wang. “The Influence of Water Removal on the
Strength and Toughness of Cortical Bone,” Journal of
Biomechanics 39, no. 5 (2006): 931–938.
World Health Organization. “Bottled Drinking Water,”
WHO media centre. Available online. URL: http://
www.who.int/mediacentre/factsheets/fs256/en/.
Downloaded May 16, 2006.
weight-bearing exercise To define this special
type of
EXERCISE, the American Academy of Ortho-
paedic Surgeons (AAOS) said, “Weight-bearing
describes any activity you do on your feet that
works your bones and muscles against gravity.
Bone is living tissue that constantly breaks down
and reforms. When you do regular weight-bearing
exercise, your bone adapts to the impact of weight
and pull of muscle by building more cells and
becoming stronger.” Although swimming can be
ideal for patients with
OSTEOARTHRITIS or DEGEN-
ERATIVE DISC DISEASE to move around without
stressing their joints, the water bears the weight
rather than the body. Similarly, riding a bicycle
provides a healthful daily
ACTIVITY, but then bike
tires, not bones, bear the body weight. Therefore,
the AAOS suggested such
BONE BUILDING activities
as ball playing, hiking, skiing, or pushing a lawn
mower. For indoor adventures, weight-bearing
exercises include weight lifting, dancing, bowl-
ing, stair climbing, and taking a long walk in an
enclosed mall.
312 weight-bearing exercise
Risks and Complications
Weight-bearing exercise may be ill-advised for some
people, such as
ELDERLY patients with OSTEOPORO-
SIS and CHILDREN with OSTEOGENESIS IMPERFECTA or
severe
POSTURE problems. When the consent of a
doctor has been obtained, each session should begin
with warm-ups to avoid risk of muscle
STRAIN or
SPRAIN. Also, dehydration can cause muscle spasm,
so
WATER intake should proportionately increase.
Adequate
SLEEP before exercising can help to pre-
vent injuries too.
Perhaps the greatest risk comes when people
refrain from exercise. As the National Institute of
Arthritis and Musculoskeletal and Skin Diseases
(NIAMS) explained, “While weight-bearing activi-
ties contribute to the development and mainte-
nance of bone mass, weightlessness and immobility
can result in bone loss.” For instance, “Astronauts
exposed to the microgravity of space experience
significant bone loss, leaving their bones weak and
less able to support the body’s weight and move-
ment upon return to Earth.”
Statistics and Studies
According to the NIAMS, “in general, healthy peo-
ple who undergo prolonged periods of bed rest or
immobilization can regain bone mass when they
resume weight-bearing activities. Studies suggest
that there is a good chance to fully recover the lost
bone if the immobilization period is limited to 5
to 10 weeks. Additionally, even brief intervals of
weight-bearing activity during periods of limited
mobility or bed rest can help lessen bone loss.”
Conversely, “those who cannot resume weight-
bearing exercise are at significant risk for osteo-
porosis.” Therefore, “researchers are investigating
ways for this population to protect bone mass. Until
scientists know more, the best advice is to reduce or
eliminate other risk factors for osteoporosis, such as
smoking and excessive alcohol consumption, and
to eat a diet rich in calcium and vitamin D. Taking
an osteoporosis medication may also be an option
to minimize bone loss.”
Special Aids and Adaptations
To adapt the musculoskeletal system gradually to
an optimal amount of weight-bearing exercise, the
AAOS recommended, “You should exercise for at
least 30 minutes a day, four or more days a week.
Besides improving bone strength, regular exercise
also increases muscle strength, improves coor-
dination and balance and leads to better overall
health. To sustain the bone strengthening benefit
of weight-bearing activity, you must increase the
intensity, duration and amount of stress applied to
bone over time.”
Similarly, the online article “Fitness and Bone
Health” said, “Weight-bearing activities improve bone
health for many reasons. First, weight-bearing exer-
cise appears to stimulate bone formation. Second, it
strengthens muscles that in turn pull or tug on bones.
This action keeps bones strong. And third, physical
activity improves your strength, balance, and coor-
dination—all of which help reduce your risk of falls
and bone injuries.” Well-balanced
NUTRITION with
natural forms of
CALCIUM aid these endeavors too.
American Academy of Orthopaedic Surgeons. “Weight-
Bearing Exercise for Girls and Young Women,” AAOS.
Available online. URL: http://orthoinfo.aaos.org/fact/
thr_report.cfm?Thread_ID=328&topcategory=Women.
Downloaded May 17, 2006.
Fitness Jumpsite ™, The. “Fitness and Bone Health.”
Available online. URL: http://www.primusweb.com/
fitnesspartner/library/activity/bonehlth.htm. Down-
loaded May 17, 2006.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases. “Bed Rest and Immobilization: Risk
Factors for Bone Loss,” NIAMS. Available online. URL:
http://www.niams.nih.gov/bone/hi/bed_rest.htm.
Downloaded May 17, 2006.
weight, effects of With over 60 million Americans
exceeding their optimal body weight, the media
has often focused on health consequences such as
heart disease. In 2005, however, the North Ameri-
can Spine Society (NASS) began its own campaign,
called “Take a Load off Your Back!” to educate the
public. As the NASS Web site reported, this educa-
tional effort intends “to focus widespread attention
on the debilitating effects of obesity on Americans’
spines.” With
SPINE problems “up nearly 67 percent
from just five years ago,” NASS conducted a survey
weight, effects of 313
of spine care professionals and found that “44 per-
cent of the patients they see are considered obese.”
Risks and Complications
According to the NASS survey, “the three most
common diagnoses in obese patients include
degenerative disc disease, which includes wear
and tear of the disc itself; spondylolisthesis, which
is a slippage” of the
VERTEBRAE “in the lower back
from wear and tear; and a disc rupture or hernia-
tion. Obese patients are also at an increased risk of
developing spondylolysis, a fracture in the verte-
brae, and spinal stenosis, which is narrowing of the
spinal canal.”
While older adults and
ELDERLY patients may
carry a heftier risk of developing
SPINAL STENOSIS,
SPONDYLOLISTHESIS, or DEGENERATIVE DISC DISEASE,
teenagers often crave slimness. If this desire carries
too much weight in their lives, risks greatly increase
for developing
EATING DISORDERS. However, a more
common risk occurs when a person of any age
snacks on packaged foods or continuously craves
sedentary pursuits, such as impulse eating.
Statistics and Studies
As reported by the Child Health News, one of the larg-
est studies ever conducted of
ADOLESCENTS assessed
NUTRITION and daily ACTIVITY then found “lack of
vigorous physical activity is the main contributor
to obesity in adolescents ages 11 to 15. . . . In ana-
lyzing dietary factors, the researchers found that
fiber intake, and not fat calories, was most closely
related to an individual’s weight. While the per-
centage of calories consumed from fat did not dif-
fer significantly between a group of normal-weight
adolescents and those identified as being at-risk for
obesity, or already overweight, the normal-weight
adolescents consistently reported higher intake of
fibrous foods such as whole grains, fruits and veg-
etables, as compared to the at-risk and overweight
children.”
Special Aids and Adaptations
A Nutrition Journal article reported “childhood
obesity has reached epidemic levels in developed
countries. Twenty-five percent of children in the
U.S. are overweight and 11% are obese. About
70% of obese adolescents grow up to become obese
adults.” To aid
CHILDREN in adapting a healthier
lifestyle, “a number of potential effective plans
can be implemented to target built environment,
physical activity, and diet. These strategies can be
initiated at home and in preschool institutions,
schools or after-school care services as natural set-
ting for influencing the diet and physical activity
and at home and work for adults.” For instance,
“increases in sports participation and/or physical
education time would need policy-based changes
at both school and education sector levels. Simi-
larly, increases in active modes of transport to and
from school (walking, cycling, and public transport)
would require policy changes at the school and
local government levels, as well as support from
parents and the community. In some communities
a variety of such programs have been implemented
e.g. road crossings, ‘walking bus’, and designated
safe walking and cycling routes.”
For persons of all ages, the U.S. Food and Drug
Administration advised, “To lose weight safely and
keep it off requires long-term changes in daily eat-
ing and exercise habits. Many experts recommend
a goal of losing about a pound a week. A modest
reduction of 500 calories per day will achieve this
goal, since a total reduction of 3,500 calories is
required to lose a pound of fat. An important way
to lower your calorie intake is to learn and practice
healthy eating habits.”
A healthy habit of
BONE BUILDING commonly
includes
CALCIUM, which also aids weight loss. As
the article “The Role of Dairy Foods in Weight Man-
agement” reported in the Journal of the American Col-
lege of Nutrition, “Dietary calcium appears to play a
pivotal role in the regulation of energy metabolism
and obesity risk. High calcium diets attenuate body
fat accumulation and weight gain during periods of
over-consumption of an energy-dense diet and . . .
increase fat breakdown and preserve metabolism
during caloric restriction, thereby markedly accel-
erating weight and fat loss.” While calcium supple-
ments may carry weight in strengthening bone,
whey sways a body toward milk and dairy products
with three servings recommended per day.
V
ITAMIN C may also be key. In another issue of
the Journal of the American College of Nutrition, an
article entitled “Strategies for Healthy Weight Loss:
From Vitamin C to the Glycemic Response” said,
314 weight, effects of
“Individuals with adequate vitamin C status oxidize
30% more fat during a moderate exercise bout than
individuals with low vitamin C status; thus, vitamin
C depleted individuals may be more resistant to fat
mass loss.” Besides that nutrient, “food choices can
impact post-meal satiety and hunger. . . . High-
protein foods promote . . . greater satiety as com-
pared to high-carbohydrate, low-fat foods; thus,
diet regimens high in protein foods may improve
diet compliance and diet effectiveness.” Also, “vin-
egar and peanut ingestion can reduce the glyce-
mic effect of a meal, a phenomenon that has been
related to satiety and reduced food consumption.”
With that in mind, a teaspoon of vinegar in
WATER
at meals may help to keep down pounds.
Dehghan, Mahshid, Noori Akhtar-Danesh, and Anwar
T. Merchant. “Childhood Obesity, Prevalence and
Prevention,” Nutrition Journal 4, no. 24 (September
2005). Available online. URL: http://www.nutritionj.
com/content/4/1/24. Downloaded May 16, 2006.
Johnston, Carol S. “Strategies for Healthy Weight Loss:
From Vitamin C to the Glycemic Response,” Journal
of the American College of Nutrition 24, no. 3 (2005):
158–165.
News-Medical.Net. “Lack of Vigorous Physical Activity Is
the Main Contributor to Obesity in Adolescents Ages
11 to 15,” Child Health News, published April 6, 2004.
Available online. URL: http://www.news-medical.net/
?id=331. Downloaded May 16, 2006.
North American Spine Society. “North American Spine
Society Unveils 2005 Patient Education Campaign—
Take a Load Off Your Back!” NASS. Available online.
URL: http://www.spine.org/fsp/sh05.cfm. Last updated
June 28, 2005.
U.S. Food and Drug Administration. “The Facts About
Weight Loss Products and Programs,” FDA. Available
online. URL: http://www.cfsan.fda.gov/~dms/wgtloss.
html. Downloaded May 16, 2006.
Zemel, Michael B. “The Role of Dairy Foods in Weight
Management,” Journal of the American College of Nutri-
tion 24, no. 90006 (2005): 537S–546S.
Werdnig-Hoffman disease Also known as Spinal
Muscular Atrophy (SMA), this rare disorder usu-
ally begins in
INFANTS then progressively worsens.
In addressing the
GENETIC FACTORS involved in this
condition, the SMA Support Web site explained,
“SMA is a muscular disease passed on genetically
to children by their parents. . . . It is a ‘Recessive’
genetic disease, meaning that BOTH parents must
carry a copy of the recessive SMA gene. There is
only a 25% chance each pregnancy of the child
having SMA and a 75% chance each pregnancy
that the child will be healthy. One out of 40 people
is a carrier of this recessive gene.” Gradually, “SMA
affects a child’s muscular development, and the
severity depends on what ‘type’ of SMA the child
has. There are four ‘Types’ of SMA, Type 1, 2, 3 &
4. . . . Type 4 is the least severe, affecting adults.”
Symptoms and Diagnostic Path
According to the National Organization for Rare
Disorders (NORD), “approximately 80% of SMA
falls into the severe category (SMA1). Infants with
SMA1 experience severe weakness before 6 months
of age, and the patient never achieves the ability to
sit independently when placed. Muscle weakness,
lack of motor development and poor muscle tone
are the major clinical manifestations of SMA1. . . .
Muscle weakness occurs on both sides of the body
and the ocular muscles are not affected.”
Regarding other types, information from the
SMA Support Web site said, “Type 2 children are
diagnosed before 2 years of age, usually more
like 15 months. These children are usually able
to be in a sitting position without support, but
often can not get there by themselves. They can
sometimes crawl with bracing and therapy, and
on occasion may stand with braces. . . . They will
usually never walk.” Type 3 symptoms may begin
in very young
CHILDREN or ADOLESCENTS. “In the
beginning these children are able to stand and
walk but usually have difficulty doing so. They
typically have a normal lifespan; however, as
with all forms of SMA, weakness gets progres-
sively worse and they usually will be wheelchair
bound.” Type 4 begins in adults “around age 35.
They also usually have a normal lifespan; though,
as with all forms of SMA, weakness gets progres-
sively worse.” At any age though, intelligence is
not affected, so caretakers must take care to treat
the person in an age-appropriate manner. To con-
firm the diagnosis, a blood test,
ELECTROMYOGRAM,
and biopsy will usually be required.
Werdnig-Hoffman disease 315
Соседние файлы в папке Библиотека им академика М.И. Перельмана