The danger of gestational diabetes, birth injuries and miscarriage is greater for pregnant women who are obese, according to a “Healthy Moms” study published in the journal Obesity.
The Kaiser Permanente Center for Health Research in Portland, Ore., also found that overweight mothers are more likely to require C-sections, and that their babies are prone to becoming obese children and adults.
The researchers concluded that obese women can lower the risk of complications by maintaining their regular weight, or gaining just a few pounds, during pregnancy. The Institute of Medicine recommends a weight gain of 25-35 pounds for most women, but only 11-20 for those who are overweight.
The study involved 114 women with body-mass indexes of 30 or higher. Half of the participants took part in a weight-management program entailing diet and exercise. The others merely got some nutritional advice from a dietician.
Those in the program gained an average of seven fewer pounds during their pregnancies. Two weeks after their deliveries, they weighed six pounds less than when the study began. The women who were not in the weight-management program were an average of three pounds heavier.
Keeping fit is especially challenging for women because their metabolisms are slower. That means they burn fat at a lower rate. A good deal of discipline is required to adopt a consistent, balanced diet; and engage in regular, daily exercise.
Nutritionists recommend meals that feature predominately vegetables and fruits. Protein and whole grains also are vital. These foods contain the vitamins, minerals, fiber and good fats necessary for fitness and health. To keep the pounds off, a woman must limit her consumption of carbohydrates, which the body stores as fat.
Green, leafy vegetables like spinach actually burn fat. The avocado contains a sugar that slows the release of insulin, too much of which promotes the storage of fat. Also helpful are hot chilies and ginger, which boost metabolism; and caffeine, a proven fat fighter. Omega-3 fatty acids, found in salmon and other fish, also have been shown to aid in reducing fat.
Exercise is the other critical component of weight management. Cardio workouts, so called because they are intense enough to sustain an elevated heart rate for 20 minutes, are the most effective. However, any physical activity is beneficial.
Fitness experts stress that beginners should start slowly, with stretching exercises or daily walks. Other options include jogging, bicycling, swimming, and playing golf or tennis. Among the many types of cardio workouts that don’t require exercise equipment are aerobics, jumping jacks, stair climbing and core-power yoga.
Treadmills, stationary bicycles, elliptical trainers, weight machines, resistance bands and free weights may be purchased and used at home. They also are available at gyms, some of which offer fitness training, yoga and aerobics classes, and other services.
Consistency, persistence and patience are required to maintain a healthy weight. It takes time for an obese person to accomplish fitness goals. The process can be frustrating, as weight loss does not always happen in the parts of the body that a women wants to see shrink. Experts suggest eating home-cooked meals, buying only nutritious food at the grocery store, and avoiding sugar and saturated fats.
CLASSIC LIST
Our hips are comprised of ball and socket joints which means a joint with a round head fits snugly into a cavity, allowing the joint to move more freely. The hips are weight bearing joints and are used all day for standing, walking, running, sitting, and other activities. It should be no surprise that the cartilage (the cushion in between the joints) in our hips wear down quicker than in other joints, mostly due to time, wear and tear, and repetitive motion.
When the cartilage wears down, muscles and tendons can become overused, and the hip pain begins. Hip replacements are becoming common, especially in older patients. In the U.S. alone, there were 332,000 total hip replacements in 2010. Science and medicine have made great strides in hip replacements. What used to be a 9 day hospital stay, 20 years ago, is now a 3-4 day stay. While most replacements occur in those between the ages of 50 and 80, there is no age limit for the surgery.
There are three kinds of hip replacement techniques: cemented, cementless and a hybrid. A total hip replacement requires an artificial hip, or prosthesis, to replace the damaged one. This implant is made with plastic and metal. Orthopedic surgeons use cement to secure the prosthesis into place. Cemented hip replacements are usually reserved for older patients with weaker bones and who do not lead a very active lifestyle.
A cementless hip replacement uses a prosthesis that is porous, and allows the bone that is already there to grow into the microscopic areas. This allows the patient’s own bones to hold the replacement in place. This is usually a better choice for the younger patient who has stronger bones and leads a more active lifestyle. A hybrid replacement is a combination where only a part of the prosthesis is fixed with cement.
These replacements have similar end results, and the new hips can last from 15 to 20 years. Younger patients who move around may find their replacements wear down faster, however, and could be candidates for revision surgery.
Even though cementless hip replacements are usually for those with stronger bones, older patients can be eligible for the surgery. A study in Finland, however, showed that those between the ages of 80-89 have a high early failure rate with this type of surgery. Between 1998 and 2009 there were 4,509 octogenarian patients given a cementless hip replacement. Within one year, a revision was necessary, mostly for women, for more than twice the amount of patients receiving the cementless replacement as opposed to those having a cemented hip replacement. The main cause was a periprosthetic fracture, which is a break around the implant, and is a serious complication.
This study also showed that patient’s with a cementless replacement had a slightly lower 10 year survival rate compared with those that had a cement or hybrid replacement. Time and studies will show if this trend continues.
This blog is dedicated to the novice and the elite triathlete in Carlsbad and the rest of North County San Diego that run under the beautiful Southern California Sun. Many people do not realize the importance of remaining hydrated when exercising. When your mouth feels like a desert it is obvious that some sort of liquid refreshment is needed. You shouldn’t wait until your tongue is so dry it sticks to the roof of your mouth, however, before replenishing fluids.
There are many factors that influence the amount of water you lose when exercising. The type of clothes we wear, the surrounding temperature, the duration of activity, our body mass, and metabolism all contribute to our personal amount of sweat production. While it’s probably a given that running a 25 mile marathon will produce more sweat than playing a game of backyard football, hydration is still essential.
Sweating is very important as it releases toxins that build up in our systems. It also cools down the body by regulating our temperature. Moving causes the muscles to exert themselves which causes the temperature to rise. We all know of people who do not seem to sweat much (or rather just glisten) and those people are more prone to overheating and not having the endurance as those who easily sweat.
We should replenish the fluids we lose ounce for ounce, which can be difficult to determine. Athletes that train for hours can sweat from 1 to 2.5 liters an hour, and even up to 3 if the training takes place in a hotter environment. That is at the minimum of 4 cups of sweat per hour. This article demonstrates the actual calculations used to determine the amount of sweat needed for least amount of cooling for intense workouts and exercise.
The body can withstand a 2% fluid loss if the temperature is lower. In hot environments, a 2% fluid loss can be a health risk causing dehydration – which can result in headaches, dizziness, nausea, vomiting, and cramps at the minimum. Our thirst mechanism, unfortunately, is a bit lazy and does not have the gumption to drink as much as we lose, so sometimes we need to force ourselves to hydrate.
When we sweat, we also lose electrolytes. Electrolytes are, simply put, salt ions. Some ions are negatively charged, while others are positively charged. The body uses these ions to carry electrical impulses around the body. It’s akin to the body being run by rechargeable batteries. When the batteries are drained (sweated out) they need recharged. Drinks such as Gatorade, Powerade, and Allsport contain some added sodium to replenish electrolytes.
It is important to note that drinking too much of just water can actually be harmful to the body when exercising. While drinking water daily is a great habit to start and maintain, those who exercise often, or intensely, can cause an imbalance in the system if they do not need to supplement water with a drink that replenishes the sodium we lose in our sweat. Disclaimer: the water you drink daily for your health does not count towards the water you need to rehydrate when being active.
At least one time in our sports-watching lifetimes we have seen a player go down hard, wrenching a gut reaction of “Oooh! That’s not good!” from the fans. We wait breathlessly to see if the player can stand on his own or if he needs help from a stretcher. Once the player leaves the field for concussion and broken bone tests, we, the armchair doctors, debate the medical condition, and what it could mean for the team. Each team has their own doctor that determines the extent of the injury, healing time, and when the player can return to the game. Sometimes, a player returns to the field earlier than expected which leads one to wonder if it is safe for him to do so. Unfortunately, with the objective of winning games, if a star player is injured, it affects the team, the owners, and the fans, and it’s imperative to hear a good prognosis for the injured player, as fast as possible. Pressure from outside influences, on professional sports teams, in particular, can lead to a player being released back into the field too early. We have all heard stories of sports doctors threatened with firing if a player isn’t returning quick enough, but is this ethical, fair, or expected? Sports teams hire their own doctors which is beneficial and at the same time potentially harmful. The sports doctor gets to know the players history. He learns over time what each player can handle, and can assess that what might seem like a bad injury to others may only be minor and release the player back into the field sooner, rather than later. The drawbacks to having a more personal relationship are pressures from the player, himself, on the doctor, insisting he is “fine” or well enough to go back in. Allowing this could cause even worse injury down the road. Pressures from the coach and the owners on the doctor may also allow a player to be hurt in the long run. An alternative to having a personal doctor for the team would be for the leagues to hire a doctor for them. He would be a neutral, non-partisan employee. This doctor would be on the league medical staff, rather than a personal team doctor. This doctor would not be required to report to the coach or owners, but to higher up medical personnel in the league itself. With appointing league doctors, however, it could prove difficult to have one medical standard for all to follow. Will the doctors rotate teams to avoid partiality? If Doctor A thinks Player 1 can go back to the field, but Doctor B does not, who is right? Will a third doctor need to weigh in? Will the players have any say in their recovery? Both scenarios have positive benefits and negative aspects that need addressed. The only thing that should matter is the health and safety of all the team members. I don’t advocate for or against the present day situation. My goal is to shed light on a potential situation that may present with perceived conflict of interest.
Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) have always been considered inpatient surgical procedures. Questions have been asked whether, due to recent advances such as minimally invasive techniques and improved operative anaesthesia protocols, these surgeries can be successfully performed on an outpatient basis.
A study was presented to the American Academy of Orthopedic Surgery which focused on the feasibility of outpatient Total Knee Arthroplasty and unicompartmental knee arthroplasty (UKA) surgery. It was agreed that only certain patients would be suitable for this surgery and that only those who met the criteria be considered for same-day discharge.
However, even if a patient was considered to be an ideal candidate for surgery on an outpatient basis, there is still a danger of complications which could require readmission to hospital.
What sort of criteria would a patient have to meet?
- Orthopedic assessment. This will include the physical history and the reason for the surgical intervention. Patients might have to be motivated for Total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) outpatient treatment, and the home situation would also need to be evaluated.
- Preoperative medical clearance. A thorough medical clearance reduces post-operative risks and visits to the ER. In addition the medical team selected has to be a team which is absolutely familiar with outpatient procedures.
- Preoperative patient education. Information about what to expect during the procedure, how to manage pain and move about after the operation helps to reduce fear and anxiety.
- The patient’s vital signs, such as blood pressure, heart rate, respiratory rate and temperature need to be stable before being considered for home discharge.
This study also demonstrates that for selected patients who meet all the criteria, outpatient Total knee arthroplasty (TKA) and UKA is safe with very few short-term complications or hospital readmissions.
Are there still concerns about outpatient TKA and UKA?
Although new protocols have been designed for outpatient knee surgery, concerns still exist for potential complications. A different study concluded that people who had outpatient surgery often returned to the ER for pain related issues, most without readmission to hospital being necessary. Unfortunately though, a small number of these cases suffered complications which required readmission to hospital.
It was also noted that patients who spent one or two nights in hospital had more or less the same readmission rates as those who had same day procedures.
No recommendations either way for outpatient TKA and UKA.
Outpatient surgery does have cost saving potential, but the possibility of readmission to hospital or the ER could quickly negate this.
There is actually no guarantee that even the most suitable of selected patients, who meet every single criteria perfectly, will have a complication-free outpatient surgical procedure.
The study included the fact that the smallest error on the part of the team performing an outpatient TKA or UKA operation could result in the patient having to spend at least one night in hospital.
At this stage it would be fair to conclude that the jury is still out concerning the feasibility and success of outpatient TKA and UKA. A big part of the decision whether to undergo the procedure depends on the eligibility of the patient, and the advice of the surgeon concerned.
Carlsbad, Platelet Rich Plasma and Rotator Cuff Tears. According to researchers, the injection of platelet rich plasma could be an effective treatment for rotator cuff injuries and rotator cuff tears. However, scientific studies to date have not been able to corroborate this theory.
The shoulder’s rotator cuff, a cluster of four muscles that function as tendons, enables a person to lift and rotate the arm. The cuff connects the upper arm bone (humerus) to the shoulder blade. A gel-like substance called bursa, which lubricates the tendons, can become inflamed due to injury, overuse or long-term degeneration. Eventually, the tendons may fray and develop partial or complete tears, developing into a full thickness rotator cuff tear.
Doctors typically prescribe medications and physical therapy, and conduct surgery in advanced cases. Now, a recent study seems to indicate a mild effectiveness of platelet-rich plasma as an effective treatment for tears and other injuries to the rotator cuff.
Platelet Rich Plasma is a concentration of a naturally occurring substance drawn from the blood. A doctor rotates it in a centrifuge to separate platelets from red blood cells, then injects it into the damaged joint. The treatments stimulate the body’s growth and healing abilities, allowing tissues to mend and inflammation to subside. In one study, Platelet Rich Plasma shots decreased pain and improved knee function in 73 percent of osteoarthritis patients.
Though Platelet Rich Plasma had previously been used clinically to repair rotator cuffs, few researchers had attempted to document the therapy’s effectiveness. Doctors recently conducted a randomized, double-blind study of 27 patients with rotator cuff tears. The PhDs included Eduardo Angeli Malavolta and his colleagues.
All the patients underwent arthroscopic surgery. Some of them also received Platelet Rich Plasma injections, while the others served in a control group. Both groups of patients reportedly experienced “significant” improvements. The patients had less pain and greater flexibility in their shoulders.
The University of California at Los Angeles assessed the study’s results, monitoring patients’ pain levels and physical changes for two years. Both groups exhibited gains, with 5 percent average improvement. Members of the control group experienced one complete retear and four partial retears. Only two cases of partial retears occurred in the Platelet Rich Plasma group.
While more research is needed to confirm the efficacy of Platelet Rich Plasma therapy for rotator cuff injuries, the study gives hope to patients looking for ways to relieve their discomfort and regain range of motion in the shoulders.
Carlsbad, Healthy Life Style. A sedentary lifestyle is not necessarily orthopedics but I feel it is sufficiently relevant to the values of healthy living, which I certainly promote. Research concerning the impacts of sedentary behavior suggests that inactive seniors are more vulnerable to obesity, diabetes, cardiovascular disease and possibly other conditions. Such patients are at increased risk of premature death.
Adults 60 years of age and older tend to get insufficient exercise. Most of their activities involve sitting. The ever-growing senior population is expected to make up 22% of the world’s population by 2050; this will have a substantial effect on health-care needs.
The World Health Organization has issued many recommendations regarding lifestyle changes for seniors. Authorities are convinced that physical activity helps prevent disability and chronic diseases. Sedentary seniors are more susceptible to metabolic syndromes, which can include diabetes, heart disease and increased waist size. They also are prone to musculoskeletal diseases and accidental falls.
No single clinical trial has measured the health effects of sedentary lifestyles on the elderly population. However, researchers recently obtained some insight by reviewing studies published by Medline, Excerpta Medica, Web of Science, SPORTDiscus, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciencias da Sa˙de, and the Sedentary Behavior Research Database.
A recent publication by Rezende et al in BMC Public Health showed that researchers in the United States and Europe confirmed that sedentary time increases with age. They found that people over the age of 60 are inactive 80 percent of the time they are awake:
- A study involving subjects from more than 60 countries indicated that the elderly had the most sitting time.
- People who spent less than eight hours per day sitting had a lower risk of all-cause mortality than those who were sedentary for longer periods.
- For each hour per day spent sitting, the risk of all-cause mortality increased 3 percent.
- Patients classified as “newly” or “formerly” sedentary were less vulnerable to all-cause mortality than those rated as “consistently” sedentary.
- Among survivors of colorectal cancer, those who spent more than six hours a day sitting had a higher risk of all-cause mortality than those who sat fewer than three hours.
- People who sat more than three hours per day were more susceptible to metabolic syndromes. Women taking part in the trial who watched the most television had a 42% greater risk.
- Patients who watched TV more than seven hours per day were much more vulnerable to metabolic syndromes than those who clocked less than an hour. For each hour of TV watching, there was an increase of 19% in the odds. Bankoski et al reached similar conclusions.
- Excessive sitting time increased the risk of abdominal obesity by 80%. Gennuso et al, Stamatakis et al and Gao et al also linked sedentary behavior with expanded waist circumference.
- Six other studies have revealed a link between sedentary behavior and high blood pressure and cholesterol levels.
Some studies have suggested that inactivity also adversely affects mental health and could increase the risk of certain cancers. However, authorities say more research, featuring higher methodological quality, is needed to fully assess the effects of sedentary behavior on seniors.
Avoid Knee pain and injury by optimizing your training technique. Jogging or running is a popular exercise and often recommended for cardiovascular health. Sprinting, the big brother of those two, is usually a bout of running at maximum pace and speed. Sprinting has proven to be more beneficial than jogging/running, with respect to body composition and lean mass. Next time there’s a sprinting event on TV, check out the bodies of the sprinters and compare them with the average runner. It is clear that sprinters tend to be more lean.
Like with any other sport, there are exercise regimens meant for beginners and then there are those for the elite. This article will show you a variety of “workouts” to help you create some variety in your cardiovascular routines.
Protocol 1: an eight second sprint, 12 second rest, repeated for 20 minutes.
According to the Journal of Obesity, this type of exercise usually referred to as interval training, was found to lower insulin resistance, reduce fat and improve lean body mass. (1)
It is no surprise that I would recommend you initiate your interval training with a more modest goal of maybe 5 or 10 minutes. 20 minutes might be a little difficult to achieve for the novice. Keep working towards that goal and once you can hit that 20 minute mark easily, you should start aiming for more.
Protocol 2: Tabata training (4 minutes total)
This training program targets those Type A executives out there that “don’t have time to exercise”. This routine is short and focused. It is for those who want to get maximum efficiency from a short workout. This type of training will ramp up your metabolism; improve cardiovascular health, and insulin sensitivity.
This protocol, meant for intermediate level sprinters is very simple: a 20 second intense activity followed by 10 seconds of rest. Keeping this up for 4 minutes is not as easy as it seems, you need to be mentally prepared for the physical effort that’s required. The benefits from this type of exercise will be definitely worth it though.
Protocol 3: The famous Wingate protocol
This is extremely beneficial for fat loss, improved athletic endurance, and overall cardiovascular health. The Wingate protocol is also directed towards intermediate level sprinters; it helps to get you back in shape quickly after a set-back or exercise hiatus. The resulting benefits of this routine are lean muscle mass. It is a good and steady calorie burner. It consists of a 30 second maximum interval; this routine is completed 4 to 6 times in a timeframe of choice (the shorter, the better). (2)
Protocol 4:
Pyramid training starts with low intensity then slowly surges the intensity to maximum level and gradually returns back to the initial warm up intensity. This gradual advancement requires a strong endurance capability. This type of training can induce maximal oxygen intake and improve stamina and work capacity significantly.
Protocol 5: Long intervals with 1:1 ratio
To increase your endurance, this should be your exercise of choice. Like it’s name implies, you will be doing long intervals (85% of your maximum strength for 2-3 minutes) followed by a similar period of rest.
Great for weight loss and overall well-being.
References:
1) http://www.hindawi.com/journals/jobe/2011/868305/abs/
2) http://www.nature.com/ijo/journal/vaop/ncurrent/full/0803781a.html
Strontium ranelate has been proven effective as a treatment for osteoporosis. Now, it appears that the compound also is helpful for some knee osteoarthritis sufferers.
Medscape.com reported that researchers spent three years tracking the progress of 1,371 people diagnosed with Grade 2 or Grade 3 knee osteoarthritis. The patients received daily treatments of strontium ranelate. Many of them experienced reduced narrowing of joint space, less pain and better health. There was evidence of enhanced bone strength and cartilage growth. Researchers cautioned, however, that the benefits were “moderate” in most cases.
Patients involved in the double-blind, randomized, placebo-controlled study (called SEKOIA) began with joint space widths between 2.5 and 5 millimeters. Strontium ranelate treatments, at daily doses of 1 or 2 grams, were “associated with a significant reduction in progression of radiographic joint space width,” the researchers wrote. The therapy also reportedly had a positive effect on “overall health associated with knee osteoarthritis.”
Though allergic reactions and thrombosis sometimes result from strontium treatments, the study found little difference in such outcomes between the patients who received the therapy and those in the control group.
Knee Osteoarthritis is the most common form of arthritis and a leading cause of disability. Early treatment typically involves physical therapy and nonsteroidal anti-inflammatory drugs. Joint replacement and surgery are options in more advanced cases. The SEKIOA study offers hope that strontium ranelate might provide the first disease-modifying therapy for knee osteoarthritis.
Further research is necessary before authorities endorse widespread use of the compound. While the study detected bone and cartilage improvements, strontium ranelate is not known to reduce pain in muscles and tendons around the joints. That means the substance may not benefit some patients, including those in advanced stages of the disease. Strontium ranelate seems to have the greatest effect when it is administered before a joint sustains substantial damage.
Over the last decade, there has been a tremendous amount of controversy over the research and the use of stem cells in medicine. While there is still some debate about it, the world of modern medicine has begun to embrace the potential healing powers of stem cells—right or wrong. Stem cells are essentially non-specialized cells capable of giving rise to new cells to replace degenerated cells. By non-specialized we mean that stem cells can give rise to any number of specialized cell types such as brain, ligaments, bone, and many more types. This, in theory, means that injection or infusion of stem cells into a damaged ligament, tendon or bone can actually result in more effective and efficient healing.
Stem cell injections are different from PRP injections. Please see some of my prior blogs for details of PRP. However, simply said, PRP is a concentrated volume of platelets that normally circulate in our blood. Platelets contain factors that initiate a healing response. So when I inject PRP into a tendon, I am initiating a healing response. Stem cells are different. Stem cell injections try to infuse the area with baby cells that we try to get to grow up into the mature cells in the area, to recreate the desired tissue.
The debate over stem cells very well could be over as new procedures to harvest stem cells have come to fruition. Previously there were ethical questions regarding the harvesting of stem cells from embryos. Now, stem cells are acquired from an internal source (the patient) that has bountiful reserves of stem cells. The location: the marrow cavity of bones, skin (Aesthetic Pittsburgh), the fat below the skin, etc. The most useful and easiest place to harvest stem cells is from the back of the hip (iliac bone). Stem cells are harvested by removing bone marrow blood with a specialized needle. This procedure is considered painless and non-threatening and can be done in just a few minutes. Once the blood is acquired it is taken to the lab to be separated to leave a concentrated amount of stem cells. In addition growth factors are gathered through this process in order to allow for stem cell activation.
Above: The Iliac bone is utilized to harvest stem cells from bone marrow blood.
Stem cell injections have taken on a particularly large roll in sports-related injuries. Professional athletes rely on their bodies for their livelihood. So when an injury does occur, the typical goal is to have the most efficient recovery, one that is both fast and thorough. In theory, the use of stem cells can help assure the efficiency of recovery and that is why so many athletes are opting for this relatively controversial treatment option. One such athlete who has recently opted for this procedure is Cincinnati Reds relief pitcher Sean Marshall. Marshall had been struggling with pain and inflammation for the better part of two years and has witnessed an epic drop in his performance. Non-surgical treatment such as shoulder strengthening exercises had shown little benefit, so Marshall opted for surgery to clean out his shoulder; this procedure is called an arthroscopic subacromial decompression and glenohumeral debridement. Marshall was also given stem cell infusions to aid in the healing process. Marshall is scheduled to miss the rest of the season so the hope is that he can return to form as soon as next year, and with the use of stem cell infusions he could be ahead of schedule.
The use of stem cells in medicine and especially sports medicine has taken a large spike over the last few years. The reason behind this spike is that new procedures have discredited arguments on the ethicality of stem cells. It is reasonable to expect that stem cell treatment will continue to become more predominant in medical facilities around the world.
