Blog - May 2016

Bones: Everyone Has Them, Everyone Needs Take Care!

Posted on May 17, 2016 in bone health

Bone Health- it’s not just for little old women!

 

If the word osteoporosis conjures images of stooped women walking with canes and implies "This is something I don't have to worry about now" - think again!

 

Osteoporosis is the condition of thinned bones or low bone density which places millions of women and men (yes, men too!) at risk for fractures. Fractures can lead to significant disability - only 15% of patients will be able to walk unaided 6 months after a hip fracture- and even death- 24% of hip fracture patients over the age of 50 die in the year following the fracture - scary facts courtesy of the National Osteoporosis Foundation.

 

Got your attention?

Maybe not until you realize your bone density and bone health are built in your youth.  Diet and exercise can help when you are older (although how much help is debated), but the real time to make healthy, strong bones is before the age of 28. In terms of bone density it’s all downhill after that!

 

Building good strong bones means a healthy you with a healthy diet with enough calcium and vitamin D and regular exercise including strength training exercises. A bone healthy diet includes dairy, fortified juices or other calcium fortified foods and many leafy greens, like broccoli rabe and kale. If you cannot tolerate dairy, you must be extra vigilant to make sure you are getting enough calcium.

 

Knowing your risk for osteoporosis is also key. The following can increase your risk for osteoporosis:

  • Genetics - it does run in families
  • Medications including long term steroid use, some drugs used to treat heartburn, anti-seizure medications and some drugs used to treat breast cancer and prostate cancer
  • Diabetes
  • Smoking (yep, even affects bone health!)
  • Alcohol
  • Arthritis, including rheumatoid arthritis and lupus
  • Malabsorption syndromes, including those from weight loss surgeries
  • Chronic kidney and chronic liver disease

 

If you are at risk for osteoporosis based on your age or any of the above factors, ask your doctor about getting tested. DEXA is the gold standard in determining your bone mineral density. It is a quick, easy test using low levels of radiation. Your bone density is assessed usually at your spine and hips and compared to healthy young adults and healthy adults your age. Your results will fall in one of three categories: normal (way to go!), osteopenia (which means bone loss but not quite to the level of osteoporosis) or osteoporosis.

 

So during this month of May and National Osteoporosis Awareness Month, we ask you to spread the word. Bone health is important throughout your life with the foundation for bone health set in your teens and twenties. A healthy diet and regular exercise mean healthy bodies - and strong bones, but starting young is key for your bones!

 

 

 

(Image credit: public domain, via Pixabay)

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Second Looks

Posted on May 12, 2016 in mammography

The other day while driving out in our fair city on a familiar path, I did a double take.  The path I knew had changed with a new building half built where an empty field once stood. The double take and second more detailed look was instantaneous - and helped answer the questions (how did that happen? What is it?) initiated by the change in the familiar. And it got me to thinking about how often second looks happen in my day to day mammography practice.

 

Second looks are a common occurrence in breast imaging. This can come in many forms- a second look by a computer as another final check for subtle signs of breast cancer, a second look by a colleague to discuss a subtle point or a second look with additional imaging to sort out an area of concern.

 

In the field of breast imaging, looking for change, analyzing various shades of grey and white is the norm. Science guides us, yes, but there is still an art to interpretation. For those of us who make this our job, we recognize that a second look is not only commonplace but also a beneficial thing. That second glance through the images may find what we dismissed the first go-around.

 

One of the so-called harms of screening mammography identified by the United States Preventive Services Task Force is anxiety and stress from additional work-up that may be necessary after a screening study. So, I thought it may be of benefit to review the use of second looks and additional imaging in screening breast studies.

 

First off, know that a request for additional views or needing further work-up does not mean the worst. The changes that can signal the presence of breast cancer are subtle and can mimic normal tissue in many ways. We use additional views to help sort out normal from abnormal and to assess areas that look different from year to year.

 

Extra views does not equal certain breast cancer!

 

If we look at the numbers roughly, out of 1000 women getting a screening mammogram:

  • 900 (or slightly more with 3D mammography) will be normal (see you next year!)
  • 100 will need further work-up
  • Of those 100, most will need either additional mammographic views, ultrasound or less frequently MRI
  • 20 of those women will receive a recommendation for a breast biopsy
  • Only 5 or so women will ultimately be found to have breast cancer (¾ of the biopsies will be benign or non-cancerous findings)

 

So, if we tell you you need additional diagnostic work-up, take a deep breath. Realize a second look in most cases answers the question and only rarely will mean having to undergo a biopsy.  At our practice, if additional work-up views or breast ultrasound are required, those diagnostic studies can be completed immediately following your screening test. We think this lessens anxiety (no waiting around for results or having to take additional time for another appointment). One of the ways our practice centers on what’s best for you, our patients!

 

Second looks - a common theme, and not one to dread. We hope this explanation lessens anxiety. Fear of screening should not be a barrier!



(Image credit: Baby Twins 100 days photo, by kangheungbo via Pixabay, Copyright Public Domain.)

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