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.

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.

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.”

by Jose Sonik
The more aggressively you screen for and try to prevent osteoporosis, the lower your risk of a hip fracture is, studies show.
Hip fractures are common in the elderly, especially women, who lose essential calcium during pregnancy and menopause.
Kaiser Southern California has developed a three-step action plan that they say can reduce hip fractures by as much as 25%.
The three steps are as follows:
Bone scans: Kaiser recommends x-ray absotiometry, the best bone density test available. The tests should be taken by all women over 65, all men over 70, everyone on high dosages of medicines that leach calcium from the bones, and anyone over 50 with a history of fragility fractures. These are the high-risk populations, and a scan could catch a weakening bone before it becomes a fracture.
Education and treatment: Learning and teaching about osteoporosis helps people help themselves. The more you know about osteoporosis, the better you can protect yourself from fractures. Kaiser found that patients who understood their treatment opted for more than just drug treatment: they got home safety checks to help prevent falls. Slippery bathtubs, cords across the room, and loose rugs are all tripping hazards that can snap a fragile bone.
Fall Prevention: If you’re at risk for a fall, consider learning fall-reduction techniques, that will lower your risk for a fall. Physical therapy can improve balance and coordination, reducing the risk still further.
Kaiser ran a three-part program with 620,000 patients in Southwestern United States, and found an overall reduction of hip fractures by 35%. Why wait for them to test it in your neighborhood? Start your own three-part program today.

by Edna Milay
Sometimes it seems like everything causes cancer. Then it seems like everything prevents it. What advice should you follow and what can you regard skeptically until further research actually proves something? Here are a few lifestyle tips for cancer prevention. All are well proven to correlate with reduced cancer risks.
1. A little alcohol affects men and women differently. Men actually benefit from a small daily intake of spirits, while women should not exceed a single drink a day, if even that much.
2. Avoid processed meats at all cost, and limit your consumption of all red meat. Fish and fowl are rich in all the proteins you need without the unhealthy fats that come along with.
3. Along the same lines, try to avoid overdosing on sodium and salt, which most people do. The average salt intake is already well above the necessary limit, so any reduction on your part can only be good.
4. Whole, unprocessed foods are your best bet. Fruits, veggies, and things that grow from the ground are healthy. Foods with ingredients you can’t pronounce or that don’t resemble any naturally occurring edible should be shunned. And while you’re at it, aim for a variety of veggies and fruits. Different foods have different vitamins and minerals, so take in as much as possible.
5.  Exercise. About 30 minutes of activity per day, enough to get your heart rate up, should do the trick.
6. Avoid fat, especially saturated and hydrogenated. Hydrogenated fats, found in margarine and most junk foods, are directly linked to cancer risks. Processed sugar is also a known evil. Reduce your calorie intake as much as possible, a strategy linked to longer life overall.