Selasa, 16 Mei 2017

how to treat osteopenia

how to treat osteopenia

margaret: hi. i'm margaret at melioguide,and today i have a special guest. brenda is here to share with all the viewers her lifewith compression fracture. i initially asked brenda to share her story because out of allthe individuals that i've worked with with compression fractures, despite the fact thatshe has several compression fractures, she is very positive, she is so perseverant, shedoes every single exercise i ask her to do and more. and she comes back with her checklistall done up and and asking me really specific questions. however, when i asked her...sheis so fastidious about everything she does. when i asked her to prepare for today's talk,she wrote everything out. and it wasn't until she wrote down her story that i realized howfrustrated and how much despair and anger

there was in her dialogue. so i've asked notto share so much that part, but rather the parts that have worked and that have helpedher. and so today's story, is in sharing brenda's story, is to help all of those individuals,men and women, with compression fractures who are suffering in silence. brenda is a retired teacher. she has alwaysenjoyed gardening, bi-weekly exercise classes, walking every day. she realized as early asin her 30s that she needed to look after her bones. her mom had fractured both hips andher pelvis, so brenda already had a bit of a red flag against her in terms of her bones,but when it comes to genetics. a routine dexa, in 2011, showed that brenda had some boneloss. she was diagnosed with osteopenia, and

so she began to even be more careful, watchingthe calcium in her diet, vitamin d, continuing her exercise classes. her gp considered herfor bisphosphonates, but she couldn't tolerate them, so then she was switched to prolia.she was on prolia for four years, and a repeat dexa showed that she had improved, so shewas discontinued in the spring of 2015. so she was excited. she was going to start planninga big trip that her and her husband had hoped to always do to africa, and so it was theirdream holiday, a five week trip. unfortunately, that dream holiday soon became a nightmare.and on day one, when she was moving the heavy bags, she got some severe back pain. she wasable to manage it. she had taken some over-the-counter pain medication with her, and by the timethe trip ended, she was in severe pain. the

more potholes she hit, the worse her paingot. and so as soon as she returned to canada, she got in to see her doctor. unfortunately,he diagnosed her with a strained back, but the therapist that she saw within the fewdays suggested a second opinion, suggested x-rays, both of which she went on to do, andwas diagnosed with a 70% compression fracture of t9 and four other vertebrate having somelevel of compression. and so brenda is here to share with us the things that have helpedher and her journey with compression fractures. margaret: so brenda, my first question foryou to share with the audience is what was the treatment that you received after youdid get the diagnosis of t9 fracture, or fractures, i should say?

brenda: initially, i was given much strongerpainkillers, and that really helped with the managing the pain, but it also allowed meto sleep with just... i was not knocked out, basically. and then the second thing or theinitial physiotherapy that i had, also helped again with the pain management. i had hotpads, i had those little electrical pulses that stimulate the muscles, acupuncture, andthen there was a minimal amount of ultrasound. and that initially helped with just the generalpain. margaret: and either your physician that yousaw that gave you the diagnosis or the initial therapist...did anybody share with you thatyour compression fractures could actually get worse by how you moved?

brenda: no, no. and i didn't even know thatwith my t9, that i had lost 70%, that it couldn't be fixed either. margaret: yeah. and that fixing of your t9,by the way, which could have been an option, but only generates an option within the firstsix to eight weeks after a compression fracture, is something called a vertebral kyphoplasty,where they reinflate the vertebra with kyphoplasty, and then inject a form of cement into thevertebral body. but a lot of people don't know, although it can give you pain relief,it doesn't actually stop the progression of further fractures. so you're...the importanceof good body mechanics and being diligent with your exercises is still really important,despite having that type of intervention.

brenda: yes, and i was told that it couldbe detrimental as well because it would make one strong section with weaker bones aroundit, so that was just a reality check. margaret: yes. how have your vertebral fractureschanged your lifestyle? brenda: well, i went from white to black,100% change in my life. as you said, i was the energizer bunny. i was involved in thecommunity association, university women's group. i did things at home like refinishingfurniture for my daughter. i was just engaged in lots and lots of activities, and i coulddo nothing but sleep either in the bed or on a chair. it was 100% change because ofthe pain. in terms of gardening, i've had to hire some young women to help me with thegarden now because gardening is hauling, and

lifting, and lifting, and more lifting, andheaving, and shoveling, and all those things that are bad for your back, which i probablydidn't help my back previously. but all i can do now is dead head plants. so it wasa stress reliever before, now it's a stress. and i'm one of those odd people that likesto clean. again, it's sort of a feel good thing, but i've had to hire a cleaning ladyto help me with the heavy stuff, the vacuuming, the washing of floors, the toilets, all thosethings that put extra strain on my back. i can do a little laundry now, but ironing isreally, really hard, so i've embraced the rumpled linen look. if you can't beat them,join them, right? driving...i basically could not drive. i could not hardly get into thecar out of the car when i had to go to various

appointments. and it's only been in the lastthree weeks that i felt comfortable enough to drive, but i'm much lower now in the seatof the car, three inches, so it it makes a difference. you don't realize it until youactually start driving. margaret: and last three weeks, so you'renow nine months technically post...so it took nine months from the time of your initialsevere pain? brenda: right. in terms of food preparation,initially...my husband has health issues of his own, so he is very limited in what hecan do, so the food prep was a lot of semi-prepared or prepared stuff at the beginning. in orderto peel a potato or a carrot, i had to put both my forearms on the counter to do that,and could not lift a dish in or out of the

oven. so i can do that now one arm. anythingthat's heavier than one arm that i can lift, i don't do. and grocery shopping, i had toleave that up to my husband. i had to use a walker for the first time ever in my life,and that was just to get out of bed and to the bathroom in the morning, and i haven'thad to use a walker now for, again, about the last three weeks. so that's a big plusin my life. clothing, well, as i said, i'm now embracing the rumpled look, but everythinghurts around the middle, and even with my broad back, things press on that bone thatis protruding in my back, so that i have to be aware of that. so again, from white toblack. margaret: you probably know that this blogis listened to by both professionals and lay

individuals, and so on both sides that theywould probably be quite interested to know what kind of therapy has helped you? whatkind of things have we done together that you found beneficial? because when you startedyou were still on a lot of pretty strong medication for both handling the pain and for the musclespasms. and i'm excited for you that you've come off of that medication now because itclears the mind and lets you feel like you're in control again. and so, if you don't mindsharing the therapies that you have found most helpful. brenda: the best one is the myofascial release.it has helped with the initial spasms and then after the spasms, i had these reallybad vice-like grips around my right hip, and

that has taken that away completely. also,with the tightness in my chest, i feel that i'm a little bit more erect. i don't havethat same pulling forward sensation that i had. so that's really been beneficial. thetargeted stretches, i never go a day without doing them. they are really, really helpful.they relieve my pain or my aches. and they just help me with fighting this gravitationalpull that i have from morning till night. margaret: the stretches you're doing, you'reholding them a lot longer than i have recommended in the book. you're holding them as a fascialstretch. correct? brenda: yes. margaret: so you'll hold them sometimes aslong as 10 minutes?

brenda: yes, and the one takes the 10 minutesfor my body to sort of release and relax into it, so i don't cut back on that because itfeels good. the dynamic tape is another kind of little miracle worker. i couldn't believethat it actually works, but when it's not there, i can really feel the difference. andthat has really helped with that long, long muscle in my back that is just so strained,basically. the strengthening exercises, i think because i was physically fit more orless before, my muscle memory is coming back. so every time i improve in my exercises mymuscles are activated, and every time those muscles are activated, i'm stronger in whateveri do, whether it's getting off the toilet, or getting out of a chair, getting out ofbed in one smooth motion is a big, big step.

margaret: can i comment on the exercises inregards to you being fit before? because a lot of women don't exercise until somethinghappens, and their body doesn't have a positive association with exercise. but you did, andso even though sometimes the exercise that i gave you wasn't exactly what you neededand we would tweak it, but you always could sense that, "oh, that soreness is muscle soreness,"as opposed to, "oh, no, i have more pain or more soreness." so you always had a positiveassociation, which i think is very important. so to encourage listeners to exercise in aregular basis. brenda: yes, my fitness guru, as i calledhim, he was really very creative in his exercises, so we never got complacent. and so when hehad us do say a new exercise, you could feel

the difference in your body, so that's howi could identify that it was a new muscle that was being used that it hadn't been before.and the strengthening exercises, initially were really, really hard, even though i wasfit. i could hardly lift my head up off the floor. but i did 1, and then i did 3, andthen i did 5, and then i did 10. so it's baby steps kind of progress, and with my chart,that i'm fastidious about, i can see my progress as well, which is motivating. and if you understandintellectually what the exercise will do, then i'm really motivated in terms of my everydaylife. so that really, really has helped. and also i use the...you call them activator poles,like the nordic walking sticks with a little weighted vest, so i can now walk again. iused to walk five kilometers plus a day, and

after this, my initial walk was five housesand back, and that exhausted me. so now i'm up to three kilometers, snail's pace but ican do it with the polls and the vest because it keeps me in the proper position. margaret: okay, and just for listeners, thevest that brenda is speaking about, we'll show later on, but it is not a weighted vestas the ones that we would use for weighting yourself down for strength training, but ratherweighted kypho orthosis, which is more to help her counterbalance the weight of herhead and where her posture is taking her, so that she can walk more upright. and i understandyou're you're using that to do your meal preps now, as well.

brenda: yeah. because i can do more than peela carrot now. but i put it on if it takes a little longer because it just, again, helpsme stay more upright, because my body wants to go forward. that's the go-to position,and i have to fight that all the time. margaret: so brenda, one question, that actuallycame from richard, who is behind the camera all the time, and editing everything thatwe do, and i thought it was a great question, is what would you tell your younger self? brenda: it is a good question. and the firstthing i would tell my younger self, and i've actually told my daughters, is that you haveto be really fastidious, as much as you can be, about choosing your general practitioner,or your family doctor. he or she should be...well,

is your strongest advocate in the medicalsystem, and they should listen carefully, they should be able to communicate well toyou, so that if you don't understand the medical jargon, they break it down for you. they shouldbe able to answer the questions you have and to answer the questions that you don't have,that you should know. and you may have to be assertive to get your needs met. for methat's not such an easy thing to do, but one has to stand up for one's rights, and it'stheir professional duty to find out if they don't know. and they won't know everything.they're a generalist. but they do have a professional obligation to find out and to send you onto a specialist who does know. and i would say, along with the gp is that you shouldkeep a copy of all tests that you have, a

hard copy, even in this day and age of electroniccopies. and then have a file, so that you can trace back your health history. it wouldsave a lot of time. and if you need to, when you're in really severe pain, you need totake somebody with you, because the brain is fuzzy under pain, and you just are notoperating. the second thing i would say is don't be afraid to get a second opinion. itdoesn't hurt. the world is not going to fall apart. if it doesn't feel right, it probablyisn't right. you know your own body, and that's important to follow through. be bone healthaware in terms of not just milk, but other sources of calcium as well. and especiallyafter you've left home, and mothers and fathers aren't busy saying, "drink your three glassesof milk." you have to be your own calcium

conscience. and then the last one is to getfit, to be involved in exercises. but, which i didn't do, nor i think a lot of exercisefitness instructors, i was not aware of the kinds of exercises that were detrimental tomy spine, and i have to say i did them with gusto, as well. i'm now paying the price.so, that's about it. margaret: okay, thank you. on the nutrition,and only because i hear from our listeners a lot and just on the calcium and lookingat more of an overall alkaline diet, with lots of vegetables and balancing your protein...enoughprotein, because so many people will will go through an exercise program, and i seeit all the time, they just don't have enough protein, they don't have the building blocks.but if you have the protein, which is acidic,

to make sure you balance that with a goodalkaline diet. so sometimes we get busy in our sessions, and i might not even have sharedthat with you, so just making sure that that information is there. i know you've actually,before you even saw me, had a number of devices, and braces, and cushions, that you came upwith, that helped you get through your day. and so, if you don't mind sharing some ofthose, and we'll just do some photos of you afterwards with those. but what has helpedyou get through the first eight months? brenda: well, the one i have right now islike my teddy bear. i take this wherever i go. margaret: you can put little eyes on it.

brenda: it's nice and squishy, so i put iton my spine because it absorbs shocks, potholes in all the roads that we have in canada. andeven like sitting in a chair, it just helps as well as a cushion in the lumbar area. iuse out in the garden... margaret: which she has right now, but shedoesn't want to take it out because it's nice and comfortable. so that's good. okay. brenda: in the garden, even though i can'tgarden i had to supervise my garden girls, and i wear this really heavy-duty lumbar support.i cannot do anything in that. i cannot bend, i cannot twist, i can't even pick up a stick.and it's there so i don't do any of those things. i have to retrain my brain in termsof what is a safe way to move, as opposed

to what i used to do so easily and withoutthinking. i have a smaller lumbar brace that i wear even for things like dusting, or doingthe laundry. again, it's not so much as a support, as a reminder, "don't do bad moves."the little weighted vest thing that i like, i use that for walking, but i use it for foodprep or anything where i'm standing around a long time. like the other day, my housecleaner does all the hard stuff, but i like to dust, so i wear it for that, and that justkeeps me upright. it's a reminder. i also use my heating pad a lot. when i start tofeel achy, i just go and sit down for 15 minutes and put it on, and it just helps take theache away. and when i do my stretching exercises, i have it underneath me as well, and it feelsgood. also, a friend of mine loaned me her

picker-upper. it's a terrific little deviceas long as you have it right beside you, because oftentimes it was across the room, and i lookedat it, and needed a long string. but it was very, very handy in the initial stages becauseeverything seems to drop when you don't want it to drop. and i think they have stuff likethat even for the garden, so i was thinking of getting something like that for just sticks.and then the other thing is now i can go grocery shopping with my husband, but some of thesebig box stores, you're walking football field lengths, and it just is exhausting, so i leanon the cart handle just to take some of the pressure off my back. or sometimes i'll putmy purse... i'll just swing it around and put it in my back, and adjust it so it's inthe small of my back, so it operates kind

of like that little vest. so i think thoseare basically the things that i found helpful. margaret: great. well, thank you so much forsharing. in regards to braces, and you have used them appropriately, but for listeners,sometimes we get used to the braces, and then we almost don't want to take them off, butthey are exactly that. they are braces, and so if you wear them or use them all the time,from the time you get up till the time you go to bed, they actually make you weaker.and that's actually been shown. so using them really appropriately the way you're usingthem, when tasks that you actually need reminders not to do, and you just need that extra supportfor the garden. perfect. now every person's compression fracture is going to be different.some people actually get compression fractures...i

have quite a few clients that have compressionfractures that don't even know they ever had them. i'll suspect them, i'll ask them toget x-rays because i'm trying to convince them to move safer. and i'll have things thatwill trigger me to suspect these compression fractures, but they might have had a bit ofback pain, a little tweak that goes after six to eight weeks. they're the lucky ones.now their compressions factors may not always stay like that, and so you might have hadseveral of your compression fractures before your travels. brenda: yeah, i probably did and didn't knowit. margaret: yeah. and so that's just somethingfor people to be aware of. either way, as

you mentioned, one of your first suggestionsis to find a health practitioner that you trust, that has knowledge in osteoporosis.that's so critical, and together know that there's always light at the end the tunnel,that there's a lot of strategies that can be tried. we've gone through a route thathas given you an opportunity to move better, but we'll keep finding more ways and keepprogressing your strength program. so, although it doesn't bring you back to where you werebefore the compression fractures, all of these strategies can make life easier, and so ihope that this blog does help make the life of listeners a little bit easier out there,and if anybody wants to add their comments at the end the blog, feel free to do so. thankyou again, brenda.

brenda: you're welcome.

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