Sea Crest Health Care Center

806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years.  That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

An age old dilemma, – which is more powerful and important – brains or beauty?  Would you rather be hideously ugly and brilliant, or stunningly beautiful and unable to carry a conversation?

Of course none of us really wants to be either of those things.  We want to be brilliant and stunningly beautiful.  And rich.  And happy.  And living on an island with a cabana boy named Juan who fulfills our every desire…

Maybe that part is just me.

We have all been lead to believe that we should want it all and that we can get it all and if we don’t want and have it all, there is something wrong with us.  However, I now have some scientific proof that the choice between brains and beauty is more real than you may have thought!

In late April, the Wall Street Journal published an article, entitled “A Case for those Extra 10 Pounds”, that said that, while the recommendations are to control calories and make healthy diet choices, it seems that there is actually some benefit that comes from being 10-15 pounds overweight.  A little extra weight can lead to a lower risk of osteoporosis and even make you look younger.

Bring on the ice cream!

Just as I was really settling into my celebration of the joys of science, a new study came out that says that extra fat is linked to smaller brain volume, and potentially linked to Alzheimer’s Disease.  Lucky for me and my desire to continue to eat ice cream, it is unclear whether smaller brains lead to extra fat or vice versa.  I am pulling for the first one.  The idea of fat causing my brain to shrink is disturbing in more ways than one.

So extra fat causes Alzheimer’s, and too little fat causes osteoporosis.  A little extra fat will keep my face unlined and youthfully full, but may cause me to eventually forget my name. Am I willing to give up the ice cream to reduce the risk of dementia?

Is it wrong that I am not sure which way to go on this?

As one who passionately builds brands for a living, it saddens me when I am forced to bear witness to the downward spiral of a once-strong brand.  The recent troubles faced by Tylenol and other huge brands from McNeil Consumer Healthcare bear witness to the fact that, while the identity of a brand can help bring a product to the heights of popularity, that same identity, when linked to negative events, can bring the product crashing down in the minds of consumers.

Tylenol has a long history of bumps in the road, starting with drug-tampering problems back in 1982, which resulted in the brand being held up as an example of what to do when disaster strikes your product.  Take responsibility.  Take Action.  Don’t make excuses.

The public was reassured by how the Tylenol scare was handled and sales eventually returned to the brand.  Tylenol came to mean a trusted and safe product once again.  And in a market with unimaginable generic competition, that trust went a long way toward making consumers feel like the branded choice was the right choice.

More recent troubles, however, cannot be blamed on nameless and faceless culprits who are threatening the safety of the American public.  This time the responsibility for manufacturing irregularities fall solidly in the lap of McNeil.  There is no denying that they must take responsibility, there is nowhere else to put it.  But the public is not so quick to forgive this time.

Part of the difference is that this time McNeil is truly to blame for the issue.  And the other part of the difference comes from how the world has changed in those intervening 28 years.  In the world of 1982, the news of the recall and corrective action came through formal channels and gossip about the problem was contained within neighborhoods.  In the world of 2010, news of the recall hit Twitter and Facebook long before it made the front pages of the newspaper or local news broadcasts.  Along with the immediacy of informing the public, McNeil was unable to control the message, and unprepared to deal with the fallout.  Their customer service resources were inadequate, their recall website not up to date, their response times were not up to snuff.

So now, in addition to being worried about the threat that recalled medications might hold for their families, people are angry that McNeil isn’t managing the situation as well as they could.  The brand is breaking.

As the process of restocking medicine cabinets with generic versions of McNeil’s recalled drugs is documented in minute detail via social media networks, more and more people see that generics offer safe, cost-effective alternatives to the branded drugs.  The more social proof that consumers see that the generics are just as effective, the more likely they will be to continue to eschew the branded products.  There is no upside of going back to Tylenol or Benedryl.  Those names are tainted with both the manufacturing issues (real or imagined, it makes no difference) and the customer service disappointments.

The bar for what consumers expect from a generic drug is much lower.  Does it work?  Does it cost less than the branded product?  Is it safe?  Customer service and advertising and image don’t enter into the equation for these purposes.

By dropping the ball so many times, McNeil is training consumers to be satisfied with a less impressive package.  It will be interesting to see if they are able to resolve and recover from this current crisis situation.  As surprised as I am to say this, my bets in this case are against the brand.

I am admittedly not the trendiest girl around.  I don’t have designer shoes or a luxury car or get my hair blown out.  Actually, where I live getting your hair blown out means you drove with a window open, but I don’t do that much either.  The NYC crowd would have a field day with how un-cool I am with my suburban clothes and addiction to Dunkin’ Donuts iced coffee.  I am about as mainstream as they come, and for this I am generally unapologetic.  It’s who I am and I’m OK with that.

Although un-hip, I am quite interested in doing things to keep myself and my family healthy.  I try mightily to get my children to willingly eat vegetables. I don’t cook red meat. I choose fresh ingredients rather than food-in-a-box whenever possible.  I am embarking on an experiment to be a vegetarian, and I recently gave up caffeine for a month.  I am willing to try new things – within reason.

There was a recent article in the New York Times about the popularity of a fermented tea drink called kombucha.  Apparently this tea can do all kinds of magical things like re-growing hair, calming digestive issues and curing hangovers.  Those who drink it claim that it is quite delish.  Sounds good, right?  I’m in! I could be the first one in the suburbs to partake of this delightful elixir!  How do I get it?

This is where things get a little hairy for me.  Because kombucha is made by immersing a disk of bacteria into brewed tea and letting it sit, unrefrigerated, for up to two weeks.

A disk of bacteria.

In your tea.

On purpose.

I am so not down with that.

I understand the benefits of probiotics.  I eat yogurt (from the refrigerator, thank you very much).  But, I have to admit that I wouldn’t even drink the plain tea if it sat out for two weeks – and the introduction of the bacteria disk into the equation does nothing to improve the situation for me.

I suppose the nature of kombucha is essentially similar to beer.  Fermented substances in a drink are not that uncommon.  And yet, I can’t quite get my head around voluntarily introducing bacteria into a completely acceptable drink like tea.  I guess I don’t brew my own beer either, although I do enjoy drinking it.

There are packaged versions of kombucha available, including one made by Red Bull.  I am slightly more comfortable with the manufactured versions, mostly because I work under the assumption that beverage manufacturers are as terrified of being sued as I am of dying of kombucha poisoning.

I am a big sucker for slick marketing and putting anything, even something utterly disgusting, in a pretty bottle and giving it a fun name goes a long way to drawing my interest.  If I actually went out and purchased a Carpe Diem Kombucha, it would be an ultimate marking success for them.

Ooooo…pretty bottle….fancy name…who cares what’s in it?  I must have it!

I want to be cool and brave enough to jump on this bandwagon and give kombucha a try.  But the reality is that it’s probably beyond my capabilities to be that cool and brave.  And the Dunkin’ Donuts coffee is working just fine for me, thanks!

Stress is a part and parcel of our frenetic lives, but chronic stress is not what the doctor ordered. Too much stress hikes up your blood pressure, causes body inflammation and can result in heart problems.

So what do we do to slow down? Here are some ways to manage your stress.

• Be realistic about your goals and keep things simple. If you offer to host the annual family Holiday party, don’t go over the top and self cater the entire thing. Take-out side dishes and salads are great fill-ins.

• Express your thoughts in writing. Keeping a journal, blog or diary can be very therapeutic. And if you are not keen of the pen, try recording yourself via a digital voice or video recorder.

• Incorporate some form of exercise into your day and be consistent about it. You don’t have to run the marathon; take a walk with a friend, join the pool at the local Y or shoot some hoops with your kids.

• Massages are the ultimate relaxant. If you don’t believe me, try one for yourself. An aside, did you know that despite the gloomy economy – massage therapy has remained quite popular according to a recent survey from the American Massage Therapy Association?

• Find out if your workplace has any stress-fighting resources in place. Many Employee-Assistance Programs (EAP), wellness programs or health plans provide confidential personal stress-relief plans.

With the number of U.S. seniors with Alzheimer’s skyrocketing, much research is underway to determine how to stave off this mental deterioration, keeping people physically and mentally sound as they age.

A recent report in the December Journals of Gerontology: Medical Sciences found that older women who volunteered for Experience Corps – tutoring elementary school children, had increased brain activity  in regions important to cognitive function after a period of six months.

What was exciting about these results, is that it shows a direct correlation between community-based programs and improved cognitive functions. Until now, much study has been done on the brain-boosting power of cognitive, physical and social leisure activities, but little was known about the effectiveness of community-based service.

“This finding is best captured by a personal observation from one of the volunteers, who stated that ‘it [Experience Corps] removed the cobwebs from my brain.” wrote Michelle C. Carlson, of Johns Hopkins Bloomberg School of Public Health.

The seventeen women enrolled in this study were low-income African-Americans with little education, aged 65 and older, and deemed high-risk for cognitive declines, based on a mental state evaluation. Eight of the women actually participated in the tutoring program in Baltimore elementary schools, while the other nine served as the control.

Via functional magnetic resonance imaging, researchers assessed neural activity in the brain prior to the volunteering experience, and again after six months. Based on the fMRI assessment, the women who actively participated in Experience Corps saw improvements in mental function compared with those in the control group.

There you have it, doing your civic duty and assisting others is highly rewarding to all participants. These meaningful activities seem to be more enriching than highly stimulating activities performed alone

There is a definite association between “covert coping” in the face of unfair treatment in the workplace. Men who tend to walk away from conflict at work could be setting themselves up for a myocardial infarction and cardiac death.

In a prospective study of Swedish workers, those who used “covert coping” techniques when they felt they had been unfairly treated were more likely to have an MI or die of ischemic heart disease. Constanze Leineweber, PhD, of Stockholm University in Sweden, and colleagues  in the Journal of Epidemiology and Community Health, expanded on research indicating  that covert coping – or  walking away from a conflict and dealing with the anger “indirectly and introvertly” – increases cardiovascular risk factors. They cautioned that the study didn’t pin down a causal relationship between covert coping and cardiovascular disease. Instead, they said, it raises “an interesting hypothesis, which needs to be confirmed or refuted by future studies.” The researchers analyzed data from a long-running prospective cohort study in Stockholm, the Work, Lipids, and Fibrinogen study, dubbed WOLF for short.

Covert coping was measured by questionnaire, in which the participant was asked about how he or she dealt with unfair treatment from either a boss or a fellow worker. The questionnaire did not measure whether or not the participant experienced unfair treatment at work nor how often covert coping mechanisms were used.

The participants were asked whether they sometimes, often, seldom, or never:

Let things pass without saying anything
Walk away
Feel bad — developing a headache, for instance
Get into a bad temper at home

The results yielded a covert coping score that could range from 8 to 32; the researchers stratified covert coping as low if the score was 8 through 14, medium if it was 15 through 18, and high if it was 19 or more.

They also categorized immediate responses – to the first two options – as low, medium, or high.

Compared with those who had low covert coping scores, the researchers found:

When the unfair treatment came from a boss, those who sometimes or often walked away were three times as likely to have an MI or ischemic death. (The hazard ratio was 3.05, with a 95% confidence interval from 1.23 to 7.58.).

Letting things pass showed a nonsignificant trend to more cardiovascular outcomes for those who did so more often. When the unfair treatment came from a co-worker, the pattern was similar, except that those who said they seldom walked away also had a significant risk for cardiovascular outcomes. The hazard ratio for those who seldom walked away was 4.08, compared with 4.45 for those who said they did so sometimes or often. Both ratios were statistically significant. Neither of the delayed reactions had any association with cardiovascular outcomes – feeling bad or becoming ill-tempered at home – either for unfair treatment from a boss or a co-worker.

Future research, Leineweber and colleagues said, should look at “whether interventions designed to reduce covert coping would alter risk of myocardial infarction and cardiac death.”

The current recession is taking a toll on the mental health of the ranks of unemployed and underemployed. The risk of severe depression is four times greater for those without a job than those who are working – according to a recent national survey conducted by Mental Health America, the National Alliance on Mental Illness and the Depression Is Real Coalition. And those people still lucky enough to be employed, but who were coerced into reduced hours or pay cuts, were twice as likely to have symptoms.

The findings were released during Mental Illness Awareness Week that recently took place on Oct. 4-10.

According to Michael J. Fitzpatrick, Executive Director of the National Alliance on Mental Illness, “Unemployment today stands at almost 10 percent. Nationwide, we face a mental health crisis as well as an economic crisis.”

Approximately 15 million U.S. adults (5 percent to 8 percent of the adult population) are affected by major depression each year, and only 50% seek treatment, regardless of their economic or employment situation the survey found.

Everyone knows that breakfast’s good for you. How good just became a little clearer. A team of British Researchers have pinpointed scientifically how your brain craves high calorie food when you skip your morning meal.

Utilizing MRI’s of the brain, they studied 20 healthy, thin people who went without breakfast that day.?When those people were exposed to an array of food photos, both high and low fat, their brains become more active at the sight of the high-calorie options than when they saw low calorie foods. When this test was repeated on another day 90 minutes after they ate breakfast, there was no significant difference in their brain’s reaction to different caloric foods

Corresponding to the MRI findings, were ratings of appealing food pictures. After skipping breakfast, participants found calorie laden food choices to be much more tempting.  After eating, however, the group did not show a strong preference for the high-calorie foods.

According to Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London, “Our results support the advice for eating a healthy breakfast as part of the dietary prevention and treatment of obesity, When people skip meals, especially breakfast, changes in brain activity in response to food may hinder weight loss and even promote weight gain.”

It starts with neglecting one’s hygiene, nutrition and medications, and can lead to death within the year. According to data compiled by the Chicago Health and Aging Project (CHAP), an older person’s risk of dying within the year increases six-fold when he or she starts to ignore his or her physical and medical needs.

The CHAP?study took place from 1993-2005 in three Chicago neighborhoods and the 9,318 participants were ages 65 or older. Among that population there were 1,544 reported cases of self-neglect (mean age of 73.2 years old) and in the average follow-up within almost a year, there were 927 deaths (47.8%) in that group.

Elder abuse of any kind also generated a greater mortality rate, with a 61.6% death rate within an average of 2.7 years.

By the self neglect cases,  the increased mortality rate wasn’t affected by whether or not the senior’s cognitive or physical functions were impaired. However by confirmed abuse cases there was a significant difference – increased mortality was not associated with elder abuse of high functioning seniors, demonstrating that this group was more likely to recognize abuse and seek help.