Only 6,000 steps a day will help osteoarthritis of the knee

Lately we've been hearing a lot about taking 10,000 steps per day for a minimum of physical activity. People are using pedometers, smart bracelets and smart phones to keep track of their steps, and pushing to get in at least the 10K. It can be fun and challenging to do this, particularly if you have a sedentary job or lifestyle.

Now there's good news for people who may want to walk more but may not be able to get in the recommended 10K steps: According to a new study published in the journal Arthritis Care & Research, as few as 6,000 steps a day may help protect people with or at risk of developing osteoarthritis of the knee from developing problems with movement, such s climbing stairs or even getting up from a chair.

Researchers looked at the daily step count of 1,788 people who either had osteoarthritis of the knee or who were at risk of developing it. They found that for every 1,000 steps taken, there was a 16% to 18% lower reduction in impaired knee movement and 6,000 steps was the best threshold where the differences were significant.

"Walking is an inexpensive activity and despite the common popular goal of walking 10,000 steps per day, our study finds only 6,000 steps are necessary to realize benefits. We encourage those with or at risk of knee OA to walk at least 3,000 or more steps each day, and ultimately progress to 6,000 steps daily to minimize the risk of developing difficulty with mobility," said Daniel White, PT, ScD, in a release.

Osteoarthritis is frequently called the wear-and-tear arthritis. It often affects the joints that that take the brunt of every day life, such as the hips, knees, and feet - although it can happen in other joints as well. The cartilage, which cushions the bones in the joints, deteriorates and this causes pain and joint stiffness. There is no cure for osteoarthritis, although medication and physiotherapy may be helpful. People who are overweight or obese are usually encouraged to lose weight as this can help reduce the pain as well. In severe cases, a joint replacement may be needed.

Diabetes numbers rising in U.S.

New statistics have been released about diabetes in the United States and the numbers are not good. According to the National Diabetes Statistics Report, released on June 10, 2014, 29.1 million people (9.3% of the population) in the U.S. have diabetes. Can this number be worse? Yes, it can and it is. Of those 29.1 million people, 8.1 million (27.8%) are undiagnosed - they don't know they have diabetes. These numbers have risen since the last report in 2010 when 18.8 million of Americans had diabetes; 7 million were not diagnosed.

Why should we be concerned? There is no cure for diabetes, only management. People with insulin dependent diabetes have to take daily injections of insulin to help control their blood glucose (sugar) levels. Non-insulin dependent diabetes is controlled with oral medications, diet, and exercise. But diabetes isn't just a disease that causes your body to have too much glucose in the blood. The high levels of glucose end up damaging the rest of your body, from your eyes to the nerves in your toes. For example, people with diabetes are at higher risk of heart disease, kidney disease, and more. Cuts and sores can take longer to heal, which increases the risk of infection and sepsis. The damage in the blood vessels in the eyes can lead to blindness.

Type 1 diabetes, what used to be called juvenile diabetes, is not preventable. Scientists don't yet know what causes it, but the pancreas stops producing insulin, which breaks down the blood glucose. Because insulin can't be taken in pill form (it won't work through the digestive system), people with type 1 diabetes must inject themselves with insulin, watch their diet, and keep as healthy as possible for the rest of their life.

Type 2 diabetes, what used to be called adult onset diabetes, is frequently - but not always - preventable. Often people who are diagnosed with type 2 diabetes or prediabetes, with high blood glucose levels but not high enough for a diagnosis of diabetes, are advised to modify their diet, lose weight, and reduce stress as much as possible. The combination of these three lifestyle modifications may help reverse the high glucose levels. However, if this doesn't help manage the diabetes, oral medications usually do the trick. Unlike type 1 diabetes, with type 2 diabetes, the pancreas is still usually producing and secreting insulin, but the body is not using it effectively. The medications work to correct this. If these medications don't work, then insulin may be needed.

Check to see if you are at risk of developing diabetes over at the ADA website or at the Canadian Diabetes Association. If you think you are, perhaps a visit to the doctor or nurse practitioner may be a good next step.

Are breast density notification laws helpful?

A few years ago, some states in the U.S. began mandating that if a woman is found to have dense breast through a screening mammogram, she should be notified of this. Dense breasts can make it more difficult to detect tumors and, for some women, may increase the risk of developing breast cancer.

The intent was that this type of notification would give women the information they need to have a discussion with their physician about if they should undergo further testing. However, many questions have come up about the utility of such a law and how it is implemented.

Currently, 17 states have breast density notification laws and 15 are working on passing such a law. But not all states send out the same type of information letter and that is where there may be problems. I wrote an article for Diagnostic Imaging, a website for radiologists, for which I interviewed Richard Frank, MD, PhD, who is a founding member of the Qualitative Imaging Biomarkers Alliance of the Radiological Society of North America. In the article, Dr. Frank said that some states are doing a much better job of notifying women than others. There are letters that may cause more confusion than anything else:

Such letters say, “If you have dense breasts, and then what the options are. So the woman is going to look at that letter and say, ‘why did I receive this letter?’” It doesn’t tell her if she does or doesn’t have dense breasts, nor does it inform her of her particular situation."

However other states, such as Michigan, distribute much clearer letters:

“You’re receiving this letter because your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer through a mammogram” 

As Dr. Frank said, this type of letter is direct, it explains why the woman is receiving the letter and gives her information on what steps she may want to take given that she now has been informed of the situation and risks. Dr. Frank believes that a federal letter, the same letter sent to all women regardless of their state, is what is needed for this type of program to be successful.

Have you ever received such a letter? Was it helpful?

To find out where your state stands in terms of breast density notification laws, you can visit Are You Dense, where there is an interactive map that details which states are actively pursuing such a law or have enacted one.

Back pain - medical interventions and surgery aren't always the answer.

Back pain is so common that we all know someone who has experienced it - if we haven't ourselves (Low Back Pain Most Common Musculoskeletal Disorder). And while back pain can be extremely distressing and debilitating, most back pain is really benign - meaning that it's not caused by anything serious.

When we're in the throes of pain, we can imagine what the problem may be: slipped disks, fractures in the spine, pinched nerves, and so on. But most of the time, it's never anything close to being that serious. Colleague Jill U. Adams also addressed the issue in a recent Washington Post article, Going to the doctor for back pain can be a slippery slope.

I've experienced back pain for the past 30 years since I injured my back while lifting a patient. Since then, I've had back pain off and on - sometimes severe, sometimes nagging. Because of my initial injury and the severity of the pain, I assumed I was re-injuring my back, perhaps causing more damage. Then, this past January, I was hit with back pain like I'd not experienced in 30 years. I was flat on my back, in agony, unable to do anything that I wanted to do.

Two years ago, I started going to the gym and also cycling in the summer. I lost about 30 pounds and the exercise did help me feel better overall. After a year and a half of this, I started yoga. While doing the yoga, my back started to get progressively more painful. At Christmas, I felt my back getting worse and on January 5th, agony hit.

I finally went to get it checked a month or so later and I underwent x-rays and a CT scan. Both showed that there was nothing mechanically wrong with my back. My vertebrae were in place, disks were fine. Nothing could be seen that could be the cause of such pain. So I asked for a referral to see a physical therapist. If it wasn't structural - it had to be muscular, I thought. And I was right.

My physiotherapist put me through a series of tests and determined that my back was perfectly able to move and turn as it should - but my muscles weren't allowing it to do so. My right side was significantly stronger than my left, causing my body to be unbalanced and working unevenly. It seems that when I started going to the gym, the stronger part (the right side) continued to get stronger, leaving my left side in the dust, strength-wise. For example, when she asked me to stand straight, facing forward, I did - or so I thought. What was really happening was that my feet were facing forward and my head facing forward, but my torso was turned to the right. I could do movements that relied on the right side (abdominal and back muscles) but the ones that needed the left side weren't as successful.

What caused the pain though? When I was doing yoga and participating in spinning classes, both activities force you to use both sides of your body as equally as possible. My left side didn't like that, the muscles got irritated, causing the pain.

I also saw the group's athletic therapist, who put me through even more movement tests. She agreed - I was physically able to do everything, but my muscles weren't allowing me to. So, between the physiotherapist who worked on my back and the athletic therapist who gave me tailored exercises (and a gym embargo of a few months), I worked those lazier muscles and forced my body to do what it was supposed to be doing.

The first few weeks didn't give me much relief. I was still in pain and maybe even achier than before. But after almost six weeks of work, I noticed last week that I had minimal pain, minimal aching - despite taking two four-hour flights and resuming some gym work. The physiotherapist said my body is more even and the athletic therapist said that my muscles were stronger and working more in synch than they had been. She was happy with the progress.

I still have work to do, but if this is what was the cause of my back pain all these years, I'm not happy that I waited so long to do something that should have been so obvious. Physical therapists are the experts in muscular movement - that is what they do all day. I should have thought to go that route a long time ago. But, it's not too late. At least now I know that when my back does hurt, unless I re-injure it, it is just muscle pain and not something more serious.

If you're experiencing back pain and there seems to be no mechanical cause, you may want to consider seeing if a physical therapist can be helpful. It may make all the difference.

Should healthcare workers be forced to receive flu vaccine?

This question comes up every year - should healthcare workers be mandated to receive the influenza vaccine? A recent study suggests they should - but would this be a good idea or even enforceable? It's tricky.

Readers of this blog probably know that I am pro-vaccine. I've been vaccinated with all recommended vaccines, as were my children. I do receive the flu vaccine every year and have since

it became widely available. I also believe that people should be vaccinated against preventable and potentially fatal illnesses whenever possible. We also need to keep in mind that there are already vaccines that are mandatory in various professions. For example, when I was studying nursing, we had to prove we had been vaccinated against the childhood diseases before we were allowed to do our pediatric rotation. We had to be tested for TB before we were allowed to set foot in any hospital - adult or pediatric. If we didn't agree to this, we were not permitted to study nursing - and ultimately practice as nurses. So is the influenza vaccine any different? Perhaps.

Most other vaccines are either one-time doses or vaccines that need top ups every so often. The flu vaccine is a different one every year. The "regular" vaccines seem to have a higher rate of preventing illness than does the flu vaccine, but there are a lot of variables that can go into a flu shot's effectiveness, such as the vaccine doesn't always accurately target the year's flu strain, or it may be received around the same time the recipient has been exposed to the flu, which means it won't be able to prevent the infection.

Study says...

A study presented at the 2014 Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) looked at public health data from 2009 to 2012 in California to see how many people contracted the flu. The researchers found that for every 15 healthcare workers who did receive the flu vaccine, there was one fewer person in the community who became ill with influenza.

Last year, 12 counties in California, including Los Angeles, required that healthcare personnel receive the flu vaccine. Those who refused were required to wear a protective mask.

"This study suggests that there is a strong connection between how many healthcare personnel are vaccinated against the flu and how many cases of influenza-like illnesses are reported in the community," said James F. Marx, PhD, RN, CIC, investigator and founder of Broad Street Solutions, an infection prevention consultancy, in a release. "More research would be helpful to further understand the impact of vaccinating healthcare workers on community influenza rates."

Those who argue for mandatory vaccinations say that healthcare workers are dealing with the most vulnerable of the population, those who would be most adversely affected by being exposed to a virus like influenza. Those who are against it say that something like a vaccine cannot be forced on someone. What do you think?

Casey Kasem, his family's public battle, and the importance of planning

Aging is difficult enough when a chronic illness makes you unable to care for yourself, but the sad story of radio personality Casey Kasem and his family brings forward the absolute need to have your desires put into writing - so everyone knows what it is you want and, if possible, how it should be done.* The Kasems aren't the first family to go through such drama and they'll hardly be the last. But it doesn't have to be that way.

Casey Kasem is 82 years old and for years was a radio personality, actor, and musician. He's likely best known for voicing Shaggy in the cartoon Scooby-doo, or hosting the long-running American Top 40 Countdown. Kasem was diagnosed a year ago with Parkinson's disease, although news articles say that the diagnosis is really Lewy body dementia. According to reports, Kasem's illness has progressed to the point that he needs complete care, including tube feeding. And now, he has been hospitalized, reportedly with an infected bedsore (Casey Kasem in critical condition as his family gathers at the hospital but continues the legal battle over star's care). An infected bedsore, which developed into sepsis, is what led to actor Christopher Reeve's death.

While we can't know what is really going on behind closed doors, Kasem's oldest daughter is accusing Kasem's second wife, Jean, of keeping Kasem from his children from his first marriage. She also claims that her step-mother has been mistreating him, something that Jean Kasem vehemently denies.

Not many of us have the large bank accounts that Kasem has, but complicated family issues aren't restricted to the famous or wealthy. And even the most stable of families can become upset and dysfunctional when a parent becomes ill, particularly if it is a drawn out illness. For this reason, it's essential that everyone in the family know the parents' wishes and that these wishes be documented. Misunderstandings become all too easily part of life during stressful situations. Someone may remember a conversation differently than someone else, or they may have interpreted a comment in a different way. Documentation doesn't always avoid conflict, but it can minimize it.

So what needs to be discussed?

• Decision making. If you are incapable of making your own decisions - medical, financial, living - who can make those decisions for you? Who would the back up person be if the one you chose is unavailable?

• Access. Who has access to your records, both medical and financial?

• Advanced directives. What do you want done? Do you want to be fed through a tube if you cannot swallow on your own? Do you want to be put on life support? Do you want a DNR (do not resuscitate) order?

• Living arrangements. Is there a particular place you would rather live your final years if it is possible and practical?

• Funeral arrangements. What would you like to be done after you have died, and how?

Are you prepared? Do you need to have this type of conversation with your parents?

*edited to add: It seems that Kasem had tried to put his affairs in order before he became too ill to do so himself. There were reports that he had previously signed papers assigning his oldest daughter the right to make his medical decisions. According to news accounts, Kasem's wife had this changed and she was then put in charge.

First week blogathon roundup

And week one of this year's month-long blogathon is done! Those past seven days went by quickly and I've gotten some great feedback on social media about some of the posts.

After my blogathon introduction post on June 1, on June 2 I wrote about pushing yourself (Push yourself - you may be surprised at what you can do). The point of that post was to encourage people to think about things they want to do but may be too afraid or reluctant to try. I look at people around me who push themselves. One friend who is my age, went into body building a few years ago and she looks fantastic. She loves what she is doing and it shows. Another friend, a quilter, has pushed herself way beyond traditional quilting to develop a whole new style of her own. My daughter traveled for seven weeks in countries that not many people here visit. One son changed direction in his education that seems to go against the flow these days. I hope that someone reading my blog may decide to take a chance, to push through a "I can't" to make it a "I did!"

June 3rd's blog post was about bilingualism and aging (Bilingualism helps aging brains). I love language. I love listening to different languages and trying to read unfamiliar ones. I always feel a bit of a thrill if I can figure out some words, find similarities. With so many people living longer, any advantage to help retain memory and cognitive ability can only be a plus.

On June 4, I wrote about online health quizzes (Online health quizzes - are they worth taking?). I'm a quiz junkie. I like taking quizzes, ticking off boxes, and filling out forms. I'm just a bit concerned about how health quizzes could allow unscrupulous people to take advantage of those who may not be as Internet-savvy as others.

June 5th's entry was about exercise and perhaps unnecessary studies (Exercise benefits seniors - did we really need a study about that?) While this doesn't quite qualify (in my books) as a Duh Study, I do wonder why this type of study was needed. If exercise is beneficial for people in their 50s and 60s, why would this be any different for people in their 70s and 80s?

The next blog post was a discussion about the utility of awareness months, weeks, and days (June is ... Awareness Month). I listed observances in both the United States and Canada.

Finally, yesterday's post was about the importance of colorectal cancer screening and its effectiveness (Screening prevents thousands of colorectal cancers). There is often debate about how effective screening programs for cancer are, but in the case of colorectal cancer, it seems pretty clear that screening does save lives.

So, now on to next week. What will the news bring?
Thank you for reading my blog.