Not Ready for Surgery?

Before considering surgery, it is advisable to try conservative measures such as avoiding prolonged periods of walking or standing, and taking frequent breaks to rest and elevate your feet. “In addition to altering their activities, I advise patients to wear wide shoes that have a high toe box so the foot is not squeezed,” says John J. Doolan, DPM, FAC-FAS, clinical assistant professor of podiatry in surgery at Weill Cornell Medicine. “I usually recommend sneakers, and also suggest that the person consider an orthotic, which can reduce pressure and pain on the affected area,” says Dr. Doolan.

By making these adjustments, women can help manage bunion symptoms, reduce pain, and potentially slow the progression of the condition, thereby delaying or avoiding the need for surgery. “When conservative measures fail to alleviate pain or the pain interferes with your ability to function, surgery should be considered,” says Dr. Doolan.

Traditional Bunion Surgery

Bunions are caused by a deformity between the first and second metatarsal bones in the foot.

Traditional bunionectomy surgery involves a sizable incision—2 inches to 4 inches—to access the bone and joint. This approach provides a direct view of the entire joint to ensure that all aspects of the bunion are corrected. The comprehensive correction offered by traditional surgery often yields lasting results, significantly relieving pain and improving foot function. This method can be adapted to various bunion severities, making it particularly effective for advanced cases requiring significant bone realignment.

However, traditional bunion surgery also has drawbacks. The large incision and extensive manipulation of the foot structures required in this surgery mean that recovery can be lengthy. People need to be non-weight bearing—meaning they need to stay off their feet—for several weeks, and they may experience swelling and discomfort for months. “It is important for the patient to understand the recovery time associated with the procedure and for the expectations of both the patient and the surgeon to be aligned,” says Dr. Doolan.

Minimally Invasive and 3D Surgery

“Traditional bunion surgery works fine; however, advances in surgical techniques and understanding over the last few years have resulted in two new methods. One is minimally invasive surgery (MIS), and the other is 3D Lapidus,” says Dr. Doolan.

The MIS procedure involves smaller incisions and less disruption to the surrounding tissues, resulting in a faster recovery time. People can often walk immediately after the procedure and return to normal activities sooner than they would with traditional bunionectomy. The smaller incisions and less invasive nature of MIS generally lead to reduced postoperative pain and swelling. MIS is most effective for mild-to-moderate bunion deformities and may not provide sufficient correction for more severe cases. Furthermore, due to less direct visualization of the joint because of the smaller incision, there is a risk of incomplete correction, and this could require additional procedures in the future.

3D Lapidus is the newest bunion surgery technique. With this procedure, the surgeon rotates the metatarsal bone back into proper alignment and secures it with titanium plates. The 3D Lapidus procedure results in significantly less postoperative pain and much faster recovery than a traditional bunionectomy. And, people can often bear weight on their foot within just a few days, compared with the weeks or months it takes with traditional surgery. This new method also lowers the risk of a bunion recurrence and the need for additional surgery by correcting the underlying deformity.

Different Techniques; Same Goals

Deciding among traditional, MIS, and 3D Lapidus procedures should take into account the severity of the bunion, a person’s overall health, your lifestyle, and your personal preferences. Consulting with a foot and ankle specialist can provide valuable insights tailored to your specific condition. However, regardless of which type of surgery you choose, the goal is the same—you want to alleviate pain, improve function, and enhance your overall quality of life.

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If tingling, numbness, or pain in your hand, as a result of carpal tunnel syndrome, is affecting your ability to sew, garden, or do other hands-on activities, there are several treatment options to consider. The primary goal is to relieve pressure on the median nerve, which runs through the carpal tunnel in your wrist.

Conservative treatments are usually recommended first. Splinting with a wrist brace, especially at night, prevents further irritation of the median nerve. The brace looks like a fingerless glove that has a rigid support that keeps the wrist in a neutral position. You can buy one at your local drug store, which makes it an excellent first step. However, it may take weeks to see improvement, and the relief might be minimal. Corticosteroid injections offer a more direct approach by reducing inflammation and swelling in the carpal tunnel. These injections can provide significant relief; however, the effects can be temporary, and repeated injections are generally not recommended due to potential side effects like weakening of the surrounding tissues. Acupuncture can also be an effective alternative for managing carpal tunnel syndrome; however, it is generally considered less predictable compared with traditional methods.

For persistent or severe cases, surgical intervention might be warranted. Carpal tunnel release surgery involves cutting the ligament pressing on the median nerve, thereby relieving pressure. This procedure has a high success rate and can provide long-term relief, but it may take several months for full strength and sensation to return.

Ultimately, the best treatment depends on the severity of your symptoms and how they affect your daily life. Discuss your options with an orthopedic specialist, who can tailor a treatment plan that’s best for you, ensuring that you can continue to enjoy your activities pain-free.

I generally take care of my feet, but no matter what I do I cannot escape an ingrown toenail on the third toe of my left foot that keeps coming back. What can I do?

A recurring ingrown toenail despite a diligent foot-care routine can be frustrating and painful. The primary reason for this persistent issue often lies in the way the nail grows or how pressure is applied to the toe. Factors like tight-fitting shoes, improper nail trimming, or even genetic predispositions can contribute to the problem. In some cases, repeated activities that put stress on the nails—such as an exercise routine that includes running—can exacerbate the condition.

First, ensure proper nail care. Trim your nails straight across, avoiding rounded corners, which can encourage the nail to grow into the skin. Opt for comfortable, well-fitting shoes that provide ample toe space. If these measures do not resolve the problem, soak your foot in warm water several times a day to help reduce swelling and alleviate pain.

If you have tried all of these measures and none are effective, it’s probably time to consult a foot specialist. A podiatrist can assess the situation and may recommend procedures like lifting the nail to allow it to grow out properly or, in more severe cases, removing part or all of the nail in a minor surgical procedure called a partial nail avulsion. This involves removing the problematic section of the nail and sometimes the underlying nail bed to prevent regrowth in that area. The procedure is quick and done under local anesthesia, providing long-term relief with minimal risk. Consistent follow-up care and adhering to your podiatrist’s advice can help prevent future occurrences.

The post Ask Dr. Etingin: Carpal tunnel syndrome; Ingrown toenail solutions appeared first on University Health News.

In a relatively small randomized, crossover, controlled trial, time-restricted eating (also known as intermittent fasting) did not lead to improvements in weight or other selected health parameters compared to participants’ regular eating patterns. For four weeks, the 12 women and five men (average age of 26 years) with overweight or obesity ate whatever they wanted from 7:00 am to 3:00 pm and fasted the rest of the day. For another four weeks, they ate as they wanted.

The researchers measured body weight, waist and hip circumference, body composition, and blood pressure, and did blood tests to measure fasting blood glucose, cholesterol, triglyceride, and insulin concentrations. They also asked the participants to rate their hunger.

Overall, the researchers found no significant changes in body weight or other parameters, however, when analyzed separately, the women did lose some weight (about two pounds) during the intervention.

Some studies have reported benefits of time-restricted eating on weight, blood sugar control, blood triglyceride levels, and appetite, but others (like this study) have not. There are a lot of variables to consider when conducting research like this (including age, weight, and health of participants, the length of the study, and the length and timing of the fasting period). Currently, it appears that time-restricted eating patterns are pretty much equivalent to traditional caloric restriction for weight and health. Some people may find the approach helpful, while others may not. As with most approaches to achieve your health goals, find something that’s right for you.

Recurrent Low Back Pain? Try Walking

A randomized controlled trial in Australia found an intervention that encouraged walking reduced the occurrence of low back pain compared to no intervention. The study enrolled 701 participants 18 and older (81 percent female, with an average age of 54 years) who were not already engaging in regular physical activity. In the previous six months, each participant had recovered from an episode of lowback pain that interfered with daily activities but did not have a specific, diagnosable cause (such as vertebral fracture or cancer).

The intervention group met with a physical therapist six times over a six-month period to develop a personalized progressive walking program and receive some education on pain science and low-back care. The goal was to be walking five times a week for at least 30 minutes a day by six months. Participants kept a walking diary and wore a pedometer, which measures step counts. At the three-month mark, they were asked to wear an accelerometer for seven days to measure daily step count, daily briskwalking steps, and minutes of moderate to vigorous physical activity.

The intervention group reported less episodes of low back pain (including activitylimiting pain) compared with the control group. The control group also sought the help of massage therapists, physical therapists, and chiropractors more often than the walking group.

If you suffer from recurrent low-back pain, regular walking may be helpful and is beneficial for overall health. (Make sure your healthcare provider approves.) Start slowly and work your way up to walking on most days.

Join the Trend—Improve Your Diet Quality

A survey of 51,703 adults from 1999 to 2020 found that diet quality in the U.S. improved a bit, at least in people who don’t struggle to get enough to eat.

Participants were surveyed on their typical dietary intake. Their responses were compared to the American Heart Association (AHA) 2020 continuous diet score (which is based on higher intake of vegetables, fruits, legumes, whole grains, nuts/seeds, and fish and shellfish). Less than 40 percent adherence to the AHA score was considered poor diet quality, 40 to 79.9 percent was intermediate, and at least 80 percent adherence was ideal.

The proportion of U.S. adults with poor diet quality decreased from 48.9 percent in 1999 to 37.4 percent in 2020. The proportion with intermediate quality diets increased from 50.6 to 61.1 percent. The proportion of U.S. adults reporting eating an ideal diet more than doubled (from 0.66 percent to 1.58 percent) but is still extremely low. Diet quality did not improve for people experiencing food insecurity.

We are headed in the right direction but have a long way to go. You can choose low or minimally processed plant foods and fish/ shellfish in place of less healthy, more processed choices more often. Let’s keep those percentages improving!

The post Newsbites: Time-restricted eating; back pain; improving diet quality appeared first on University Health News.

Dry Mouth

Dry mouth is not a normal part of aging, but it is a common concern for many older adults. Saliva is an unsung hero of digestion—it coats food particles with enzymes that initiate the breakdown of carbohydrates into smaller food molecules and moistens and softens food so that it is easier to swallow. Chewing stimulates saliva secretion from the salivary glands in the mouth, but your production of saliva can decrease in older age due to medications, including some drugs that treat high blood pressure and urinary incontinence; certain diseases, such as diabetes, Parkinson’s disease, and the autoimmune condition Sjogren’s syndrome (you are at greater risk for this if you have rheumatoid arthritis); and having had treatments for cancer, including radiation therapy. Environmental conditions, like dry heat, also can cause dry mouth.

Dry mouth is uncomfortable, and not having enough saliva to moisten food can make it more difficult to swallow. Dry mouth also increases the risk of tooth decay and other oral infections because another one of saliva’s primary jobs is to kill bacteria. For this reason, it is important to see your doctor or dentist to determine what might be causing dry mouth. Self-help measures include sucking on sugar-free lozenges or chewing sugarless gum to stimulate saliva production—you also may want to try Salivart, an “artificial saliva,” that is available over the counter at pharmacies. Avoid mouthwashes that contain alcohol, as these can worsen dryness.

Coughing While Eating

Coughing during a meal is a sign that you’re having to clear your throat while you eat or drink. You’re doing this to avoid aspirating food or fluids into your lungs.

Eating and breathing share space in the back of the throat, or pharynx (see image, right). Food enters the esophagus (the muscular tube that leads to the stomach) through the pharynx while air is diverted into the trachea (windpipe) and lungs. The epiglottis—a small flap of cartilage attached to the larynx—plays a key role in this process of diversion by staying open during breathing and closing during swallowing. You need intact neuromuscular reflexes for the epiglottis to function correctly, but with aging, some of these reflexes become less effective. They also may be impacted by esophageal dysphagia (difficulty swallowing food due to inflammation or narrowing of the esophagus), stroke, dementia, and Parkinson’s disease. The result is that it becomes easier for food and drinks to “go down the wrong pipe.” The coughing and sputtering that accompanies this is uncomfortable and embarrassing if it occurs when you are eating out. But aspiration also can cause inflammation of the lungs (pneumonitis), pneumonia, and choking, so it is important to get evaluated by an ear, nose and throat specialist if you think you may be aspirating food. Interventions that may help include exercises, dietary modifications, or adopting different eating positions.

Difficulty Taking Medication

Pill esophagitis, which is when a drug gets stuck in the esophagus, occurs more often in older adults and can cause inflammation, injury, and pain. You may be able to prevent it by taking medications with plenty of water, while sitting up—also avoid lying down for about 30 minutes afterward. If you’re still having trouble it may be possible to split pills in half, but check with your doctor or pharmacist, since some tablets should not be split. If you get the go-ahead, use a proper pill-splitter (you can purchase them at most pharmacies). If your medication comes

in capsule form only, or tablets cannot be safely split, ask your doctor or pharmacist if a liquid version of the drug is available. If none of these approaches help, you may need to see a specialist who can check that your esophagus is functioning correctly.

Can’t Go, Won’t Go

The frequency of bowel movements considered normal ranges from three times a day to three times a week. In general, bowel transit time—the time it takes for food to move through the digestive tract—is about three days. But if you have chronic constipation, transit time can increase to four to nine days, and, if you are bedridden, up to two weeks. This increase in transit time is common in older adults due to a decline in peristalsis (involuntary muscle contractions that propel food through the intestines). If peristalsis is sluggish, stool moves too slowly through the colon. Slow passage means that more water is absorbed from food, and this results in hard, dry stools that contribue to constipation.

If you frequently suffer from constipation, eating more fiber and drinking plenty of fluids will help your colon make bulkier stools that are easier to pass. Also get plenty of exercise, since this can help food move through the gastrointestinal tract. Whenever you have the urge to move your bowels, go to the bathroom. Ignoring the urge allows stool to remain in the colon for longer and this means that more water will be absorbed from it, resulting in hard stools that are more difficult to expel. Also try to have a bowel movement after you’ve eaten a meal. After you eat, your stomach stretches, triggering what is known as the gastrocolic reflex. This reflex increases the movement of ingested food toward the rectum, increasing rectal pressure and stimulating a bowel movement.

If these measures don’t bring relief, ask your doctor if an undiagnosed health condition (for example, untreated thyroid disease—see last month’s issue for more on thyroid disease) might be contributing to your constipation. He or she also will be able to check if you take any medications that raise the risk of constipation (opioids are known to worsen constipation, and laxatives should always be prescribed when opioids are prescribed). Your doctor may suggest using a laxative and can advise on which option will suit you best.

Burning Fluid at the Back of the Throat

If you get this often, you likely have gastroesophageal reflux disease (GERD), a condition in which stomach acid refluxes (flows backward) from the stomach into the esophagus. The lower esophageal sphincter (LES), a muscular valve that separates the esophagus from the stomach, should prevent reflux, but if it has decreased resting pressure, it may not close properly between meals. LES pressure naturally decreases with age and may be affected by excess weight and a range of medications often taken by older adults, including some blood pressure drugs, statins, antidepressants, and bisphosphonates (used to treat osteoporosis).

GERD typically causes heartburn (a burning sensation in the chest), but older adults may not experience this because the older esophagus is less able to feel pain. Instead, they taste stomach acid at the back of their throat. Other GERD symptoms often reported by older adults include difficulty keeping food down after meals, a dry cough at night, a persistent sore throat, and a repeated need to clear their throat when they get up in the morning.

GERD is associated with potentially serious complications, so if you think you may have the condition, tell your doctor. He or she may prescribe drugs to ease the symptoms and should review your regular medications to ensure they aren’t contributing to the problem. Self-help strategies include eating smaller, more frequent meals instead of fewer large ones, avoiding foods that may trigger symptoms (such as fatty and spicy foods, citrus fruits, garlic, chocolate, and peppermint), limiting your alcohol intake, and not eating in the two to three hours prior to bedtime. Minimize pressure on your stomach by wearing loose-fitting clothing and avoiding tightly belted outfits. If you are overweight, losing weight may help, since excess belly fat places pressure on the stomach.

Gas and Stool Leakage

The tone and strength of the internal anal sphincter (a ring of muscle that prevents stools from leaking through the anus) decline in older age. The pelvic floor (a group of muscles that support the bowel and bladder) also may weaken, particularly in women who have experienced pregnancy and childbirth. These factors make flatulence and stool leakage more likely.

You may be able to reduce your production of gas by cutting back on certain gas-producing foods, such as onions, broccoli, cabbage, and beans. As to stool leakage, the more completely you empty your bowels the less there will be to leak, so be sure to take sufficient time on the toilet. Raising your feet eight to 12 inches (rest them on a pile of books or a box) while going to the bathroom may help you empty more completely.

Kegel exercises, which can help prevent urinary incontinence, also may help with stool leakage, since they strengthen the pelvic floor muscles. Your pelvic floor muscles are the same ones you may have been using to keep you from passing gas. To exercise them, slowly pull them up (imagine they are an elevator stopping on every floor of an apartment block), hold for three seconds, and then release them equally slowly. Work up to a set of 10 contractions and repeat each batch of 10 three times a day. Also reduce your intake of caffeine, lactose, and artificial sweeteners, as these can loosen stools. If these strategies don’t work, mention the problem to your doctor (try not to be embarrassed— we really have heard it all before!).

The post Gut Feelings: Your Digestion in Older Age appeared first on University Health News.

Troubling Shortfall

The research, led by a team from the University of Michigan Health Frankel Cardiovascular Center, tracked nearly 150,000 people who were seen at hospitals for serious heart conditions (including heart attack and heart failure) between late 2015 and early 2020. The analysis (Journal of the Academy of Nutrition and Dietetics, July) showed that clinicians documented providing dietary counseling in just 23 percent of cases within 90 days of hospitalization. Women, adults ages 65 and older, and people with chronic kidney disease were least likely to receive counseling.

Getting Help

Nutrition counseling is included in cardiac rehabilitation programs, and also can be obtained via a separate kind of care called medical nutrition therapy. “Cardiac rehabilitation programs counsel participants on diet, exercise and behavior modifications, with the aim of improving health outcomes in people with cardiovascular disease,” Dr. Darrow says. “These programs have been shown to boost physical function and reduce the risk of hospitalization and death for older adults with heart failure.” Medicare Part B covers cardiac rehabilitation for enrollees who have had a heart attack in the previous 12 months and those who have stable angina (chest pain caused by blocked heart arteries) or chronic heart failure. People who have undergone cerain heart procedures also are covered—the Medicare website has details (www.cms.gov). “Medical nutrition therapy involves working with a registered dietitian to build an eating plan tailored to your individual health needs,” Dr. Darrow says. The therapy is covered by Medicare Part B for certain individuals (check at the Medicare website). You need a doctor’s referral to utilize the program.

Eating to Support Heart Health

Dr. Darrow provides nutrition guidance to his patients just in case they are not able to attend a cardiac rehabilitation program or get medical nutrition therapy. He recommends people who have cardiovascular disease or have suffered a heart-related event follow an eating plan that is low in sodium and fat, such as the Mediterranean diet (see our chart) or DASH (Dietary Approaches to Stop Hypertension) diet. “Both diets are high in fruits, vegetables, whole grains and healthy fats, and limit the saturated fats that can contribute to elevated blood pressure and cholesterol,” he says. “They also permit enough of what you enjoy that it doesn’t feel like you are depriving yourself at every meal.”

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Special Functions. Bromelain has been established as a natural means to increase antibiotic potency. This has been documented in several clinical studies, but there is no standard dosage or standard of care for this specific use.

Bromelain may help improve sinus inflammation and manage pain when consumed orally.

More recently, bromelain has been explored for its use in managing the COVID-19 infection. While the laboratory and animal research are promising, there are no human data to support its use.  The research on bromelain for improvement of cardiovascular disease risk factors is mixed, with not enough evidence to warrant a recommendation at this time.

Recommended Intakes & Toxicity. Suggested doses in adults range from 40 to 400 milligrams (mg) per day and is dependent on the purity of the supplement. Safety has been confirmed for daily oral intake of up to 240 mg per day. Some bromelain doses may include Rorer units, a direct measure of the enzyme’s activity or potency. A common dosage is 50,000 Rorer units.

Oral intake is not associated with significant safety concerns. Minor side effects such as digestive discomfort and headache have been reported. Although rare, some people exhibit allergic reactions to bromelain.

Bromelain exhibits anticoagulation effects in blood, and caution should be exercised if blood thinning medications are also used.

Most clinical research has been conducted on adults, with very few studies conducted on children, pregnant and lactating women, and older adults. Thus, the current intake recommendations and safety assessment is valid for adults, but not other life stage groups.

Sources. Bromelain is found naturally occurring in pineapple.  It’s found in the fruit, the stems, and the leaves. However, the concentration of bromelain in pineapple fruit is too low for the food source to provide a therapeutic benefit.  Supplements in tablet and capsule form can deliver a range of bromelain dosages. There is currently no industry standard for bromelain dosage in supplements.

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The disease can take significant toll on emotional and social well-being. For example, people who have chronic OA pain may have to give up doing things they love, such as pickleball, gardening, or playing instruments. Difficulty participating in social and recreational activities can lead to feelings of isolation and loneliness. All this can spiral down into a sedentary life, raising risk for obesity, heart disease and diabetes. Chronic pain and physical limitations also can lead to feelings of frustration, sadness, anxiety, and depression. For these reasons and others, researchers at UCLA and elsewhere have been striving to find better treatments and cures for OA.

“There is the obvious challenge of optimizing the science of the treatment to make sure it is effective in all types of patients. But this process also requires obtaining funding in a fiercely competitive funding landscape, navigating the regulatory environment, and making the therapy available in the relatively near-term future,” explains Thomas Kremen, MD, an orthopedic surgeon, and clinician-scientist faculty member at UCLA’s David Geffen School of Medicine. “The commitment of significant funding greatly accelerates the pace of the research and allows for the implementation of therapies in my patients much faster than the traditional timeline for developing novel therapeutics.”

A MultiCenter Effort

UCLA Health is part of a multi-institution research team receiving the contract for up to $33 million from the federal Advanced Research Projects Agency for Health (ARPH-A) for the development of new treatments specifically focused on joint regeneration for OA. UCLA’s portion of the award will support the development of novel therapies, with the goal of completing an FDA phase 1 clinical trial within the next five years.

This multi-institution team, which also includes researchers from Duke University and Boston Children’s Hospital, is one of five selected to develop innovative forms of regenerative medicine–including affordable injectable and implantable therapies – that can regenerate joint tissue damaged by OA.

More Than Wear and Tear

The cause of OA has primarily been thought to be physical wear and tear, but it’s more complicated than that. “OA is multifactorial with contributions from our genetic backgrounds, environmental exposures, history of traumatic injuries, each patient’s individual activity level, medical comorbidities, and age,” explains Dr. Kremen. “While high-impact activities are generally thought to increase wear and tear in the joint, a lack of activity is also associated with joint degradation and progression of symptoms.”

Current recommendations to slow progression of OA include lifestyle behaviors such as not smoking, losing weight, and treating medical comorbidities such as diabetes. “As challenging as it is to lose weight, for each pound we lose that equates to 4 pounds of force removed from each knee joint, and patients really notice improved mobility and decreased joint pain when they do lose weight.”

While pain and stiffness also are symptoms of rheumatoid arthritis (RA), it is far less common than OA and a distinctly different disease process. RA affects about 1.3 million adults, women more than men, and tends to begin between the ages of 30 and 50.  Neither OA nor RA currently has a cure.

“With rheumatoid arthritis, an autoimmune disease in which the abnormal biology is more easily defined, there have been all sorts of advances in the last 20 years. With osteoarthritis, we haven’t made any progress,” says Dr. Kremen.

Joint replacement and surgeries for OA offer imperfect treatments. While there is no age limit for joint replacement per se, preexisting conditions may make the process and recovery more complicated for older adults. Joint injections work for some people, others not so much. And then there’s all the marketing hype surrounding regenerative stem cell treatments, of  which none are currently FDA-approved.

“We have much work to do to characterize the mechanisms by which these cells may influence the biology of healing,” says Dr. Kremen. “Like many things in life, if what a clinician is claiming about a cell-based therapy sounds too good to be true, then it probably is not true. If you are being offered a stem cell therapy or a birth product-based therapy (e.g. umbilical cord blood, placental tissue, or amniotic membrane derived products), this should only be done in the setting of a clinical trial.”

Insights Into Cartilage Regeneration

Tissue regeneration is a burgeoning field. Working alongside Dr. Kremen, the UCLA Department of Orthopaedic Surgery research team also includes Karen Lyons, PhD, professor, and vice-chair for research, and Weiguang Wang, PhD, an assistant research faculty member. All three of these investigators have developed innovative technologies that, when combined, lead to a novel multimodal treatment approach.

In the lab of Dr. Lyons, who is a developmental biologist, researchers have been studying the signaling pathways that cause cartilage to develop in utero during early development. Once Drs. Lyons, Wang and Kremen connected, the scientists wondered if they could target the same pathways to regenerate damaged cartilage and bone tissue in adult patients suffering from osteoarthritis.

“Many of the same pathways that were used during early development are redeployed when tissues try to repair themselves,” Dr. Lyons says.

While developmental biology studies offer important clues about which pathways might be best targeted to treat osteoarthritis, there are significant differences between newly formed joints and adult joints. Those include barriers like inflammatory pathways and a diminished pool of cells capable of regeneration and repair in adults.

To test how well these pathways might be employed to repair joint degeneration, the UCLA research team has used both genetic and pharmacologic approaches in mouse models to identify several drugs that have the potential to repair articular cartilage and its underlying bone.

In addition to using animal models, the researchers will be testing their strategies on a so-called “joint-on-a-chip” platform, which mimics the healthy or diseased features of joints inside of the body.

Moving Forward

Ultimately, the research team plans to develop three separate types of injectables that patients would receive once per year: one that targets joint tissues; another that targets adjacent bone; and a systemically administered drug that could treat cartilage tissues in patients who have OA in multiple joints.

At the end of five years, Dr. Kremen says, the researchers plan to have completed the testing of these treatments in phase I clinical trials, which will be conducted at UCLA.

“ARPA-H is really focused on commercialization and affordability,” Dr. Kremen says. “They have an ambitious timeline, because they, and we, want to get these therapies into people as soon as possible.”

“You gain immediate feedback from a knowledgeable physical therapy professional,” says Dr. Kremen.

Physical activity strengthens muscles and bones. If you have pain with one activity, Dr. Kreman suggests trying another activity that is known to be lower impact. For example, instead of running you try brisk walking, biking, or an elliptical machine. If those cause pain that is not tolerable, try something even lower impact like swimming or walking in the pool. 

The post A Cure for Osteoarthritis? appeared first on University Health News.

Grief can be like that. It also can manifest as deep sorrow, hostility, guilt, confusion, and fatigue. It’s a process that waxes and wanes and an experience that varies from person to person. There’s no absolute timeline or way to grieve, but most people start to return to a sense of normalcy in about six to 12 months.

Grief occurs not only when a loved one passes but also can happen with a terminal diagnosis, such as cancer or Alzheimer’s disease. Known as “anticipatory” grief, it affects both the diagnosed person and loved ones.

Grief’s Impact on Health

The grieving process can lead to everything from bodily pain and a weakened immune system to stomach upset and insomnia. According to George Slavich, PhD, director of the Laboratory for Stress Assessment and Research at the Semel Institute for Neuroscience and Human Behavior at UCLA, the root of these symptoms can be traced back to our evolutionary response to the loss of a social connection.

“As humans, we are strongly motivated to seek out social bonds that are warm, dependable, friendly and supportive,” says Slavich. “Losing someone close to us terminates that bond and the social and physical protection they provided, which historically could have put the body at an increased risk of physical danger.”

When you lose someone that you’ve been with for a long time, the body and brain go on high alert to protect you from potential dangers. Your immune system ramps up and sends immune cells throughout the body to deal with possible physical wounds that might occur. At the same time, however, your immune system lowers its antiviral defense system, making your body more vulnerable to viral infections. “If you’ve ever come down with a cold after a stressful time, you may have experienced this response,” says Slavich.

The grieving process can cause prolonged inflammation and lead to psychological and behavioral symptoms such as fatigue, loss of pleasure, and social withdrawal. If these symptoms persist beyond six months, it may indicate prolonged grief, which can have serious health implications.

Prolonged Grief

This type of grief is marked by persistent and pervasive feelings of longing, sadness, and preoccupation with the deceased. It can significantly interfere with a person’s daily functioning and quality of life. Common symptoms include an inability to accept the loss, numbness, bitterness, difficulty engaging in life, and a feeling that life is meaningless without the deceased.

Prolonged grief is associated with increased cancer risk, cardiovascular problems, and early mortality. It may lead to heart attacks, especially in people who already have a higher risk of heart disease.

Takotsubo cardiomyopathy, also known as broken heart syndrome or stress cardiomyopathy, can be triggered by intense grief. This condition temporarily weakens the heart’s left ventricle and can mimic a heart attack, even in those who do not have cardiovascular disease. It tends to affect postmenopausal women much more than men. Recovery from this transient condition can take days or weeks. However, this doesn’t mean the condition should be ignored or untreated, because there can be long-term consequences.

Anticipatory Grief

Anticipatory grief is the emotional response experienced when a loss is expected but has not yet occurred, such as with a terminal illness diagnosis. Key characteristics of anticipatory grief include feelings of sadness, anxiety, anger, and helplessness. It affects both the diagnosed and loved ones. For example, loved ones can become consumed with imagining life after the loss and worrying about how to cope. It may change how an individual interacts with the dying person, such as increased closeness or emotional distancing as a protective measure.

Stress and anxiety can lead to physical symptoms like fatigue, changes in appetite, and sleep disturbances. Feelings of relief or guilt also can be part of anticipatory grief, especially if the loved one has been suffering. Understanding and acknowledging anticipatory grief can help in the processing of emotions and better prepare for the eventual loss.

Patience, Acceptance, and Self-Care

It’s important to accept that it is normal to grieve and give yourself permission to experience the full range of emotions. Surrounding yourself with supportive friends and family with whom you can share your feelings can provide comfort and validation. Support groups, both in-person and online, can also offer a sense of community and understanding. Sometimes, the intensity of grief requires professional intervention. Therapists or counselors specializing in grief can provide strategies and support to navigate the emotional turmoil.

After losing a loved one, thoughts can constantly drift between the past and the future. Practicing mindfulness meditation is one way of becoming aware of your thoughts, grounding your awareness in the present, and reducing overall psychological stress.

Sleep may become challenging. It may be difficult to fall and stay asleep. And a sense of purposelessness can make it hard to get out of bed up in the morning. However, “sleep is one of the strongest drivers of immune activity,” Slavich says, and “having a standard sleep schedule is really important for properly regulating your immune system.”

Along with quality sleep, a healthy diet and regular exercise are recommended for self-care. Choose nutritious foods daily. Include lean proteins, fruits, vegetables, healthy oils and leafy greens. These choices help reduce inflammation. Likewise, moving your body regularly supports brain and immune health. Breaking a sweat helps decrease feelings of stress and anxiety. Exercise triggers the release of dopamine and serotonin; two brain neurotransmitters that play a pivotal role in maintaining positive mood. Exercise also slows the release of cortisol, the hormone that can wreak havoc when it flows unabated under chronic stress.

“Each of these strategies can help promote resilience following interpersonal loss,” Slavich says, “but the most important thing is to begin with the strategy that you know you’ll actually follow through with.” He also recommends telling your healthcare provider about your loss. This will enable your provider to take your personal situation into consideration and to understand how your grief may be involved in any symptoms you may be experiencing.

Coming up with the best strategy for dealing with grief needs to be a team effort between you and your healthcare provider, Slavich says, but “if they don’t know what’s going on in your life, they won’t be able to help.”

Creating a memorial or engaging in rituals to honor the person you’ve lost can help with healing and acceptance. This could be through a dedicated space in your home, a scrapbook, or participating in activities that the deceased loved. It helps keep their memory alive and allows you to celebrate their life.

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“Oxygen is carried to the heart muscle in blood through the coronary arteries,” says Samuel Stone, MD, cardiology fellow at Tufts Medical Center. “When the flow of blood and oxygen is limited, damage to the heart muscle occurs. If oxygen is unable to reach the heart muscle for significant periods of time, muscle cells die.”

Atherosclerosis (the buildup of cholesterol- laden plaque lining the walls of arteries) is the main culprit behind heart attacks. “If plaque ruptures, it can cause a clot to form,” says Stone. “If this happens in a coronary artery, it cuts off oxygen from a portion of the heart muscle, leading to a myocardial infarction (heart attack).” If the clot is in an artery in the brain, the resulting death of brain cells is called a stroke.

Risk Factors.

“There are two categories of risk factors for a heart attack,” says Stone, “non-modifiable and modifiable. Non-modifiable risk factors are things we cannot control, such as age, sex, and family history. For example, men over the age of 45 and women over the age of 55 are more likely than younger men and women to have heart disease. Having close relatives who had heart attacks at a young age is also a risk factor.” Black and Mexican Americans, American Indians, native Hawaiians, and some Asian Americans are at higher risk, although this may be due at least in part to modifiable societal disparities that impact their overall health, rather than genetics.

“Modifiable risk factors are things that individuals can control or that can be treated,” Stone explains, “including tobacco use, high blood pressure, high cholesterol, diabetes, obesity, metabolic syndrome, poor diet, lack of exercise, and chronic stress.” Additionally, you may be at increased risk if you have chronic kidney disease, blood triglyceride levels of 175 mg/dL or higher, chronic inflammatory conditions like rheumatoid arthritis or psoriasis, or a history of preeclampsia or early menopause. Regularly getting less than seven hours of quality sleep a night and excessive alcohol use also play a role in the development of heart disease and can increase heart attack risk.

Prevention.

You can protect your heart by taking control of the modifiable risk factors mentioned above. A healthy dietary pattern is key. Replace most animal fats (especially red meats, full fat dairy products, and butter) with sources of unsaturated fatty acids (like fish and non-tropical plant oils); cut back on sweet or salty packaged (usually ultraprocessed) foods and beverages; lower sodium intake; and choose whole grain over refined grain products.

“Follow up routinely with primary care for blood pressure and cholesterol screening, as well as clinical evaluation for other risk factors and symptoms of heart disease,” says Stone. “This is particularly essential for those with family history or other risk factors for heart disease. For those with elevated blood pressure or high LDL cholesterol levels, we recommend treatment with lifestyle modifications and medication when needed.”

During…and After.

It’s important to know the warning signs of a heart attack and seek help immediately for yourself or someone else. Getting treatment quickly can save a life and may limit long-term damage. If you suspect you or someone around you is experiencing a heart attack, don’t wait to see if the symptoms improve—call 911. Not all heart attacks present as chest pain. See “Heart Attack Warning Signs” to learn what to look for.

About 25 percent of heart attacks in the U.S. occur in people who have suffered a previous attack. Individuals who have had a heart attack should follow their healthcare providers’ recommendations for medications, rehabilitation, and lifestyle changes to maximize their recovery and minimize their risk for another attack in the future. Whether you have had a heart attack or not, do what you can to protect your heart. “A healthy lifestyle, along with detection and treatment of modifiable risk factors, can greatly decrease your risk for heart disease and a heart attack,” says Stone.

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Hyper vs. Hypo

The thyroid is a small butterfly-shaped gland situated in the neck, just below the larynx. Its function is to absorb iodine, an element that occurs mainly in salt, bread, and fish, and convert it into triiodothyronine (T3) and thyroxine (T4). These hormones control your metabolism, influencing everything from the speed at which you digest fats and carbohydrates, to the rate at which your heart beats.

Another hormone—thyroid stimulating hormone (TSH)— also plays an important role in thyroid function. TSH stimulates the thyroid to produce T3 and T4. As such, measuring the level of TSH in the blood can flag underlying thyroid issues. High TSH levels may indicate that the thyroid is not producing enough thyroid hormone (hypothyroidism, which also is known as underactive thyroid), while low TSH levels may mean that your thyroid is producing too much thyroid hormone (hyperthyroidism, or overactive thyroid).

Hypothyroidism

This is the most common thyroid disorder and occurs when T4 levels are too low. Low T4 levels cause body processes to slow down— as such, symptoms typically include fatigue, weight gain, sluggish bowel movements, and increased sensitivity to cold. However, in older adults, these symptoms are less common—instead, an underactive thyroid may cause depression, loss of appetite, weight loss, and joint pain. Since these symptoms are associated with other diseases that are common in older age, recognizing hypothyroidism is challenging. Dr. Arakawa adds that it also is possible to develop subclinical hypothyroidism, in which TSH levels are only slightly elevated while levels of T3 and T4 are normal. “People who have subclinical hypothyroidism may report nonspecific symptoms, such as an altered mood and cognitive impairment, while many don’t have any symptoms,” she says.

HYPOTHYROIDISM RISK FACTORS

You are at increased risk for underactive thyroid if you have a family history of thyroid disease, have been treated for an overactive thyroid, and/or have had extensive surgery or radiotherapy to your neck. Some medications also raise the risk— for example, the cancer drugs sunitinib (Sutent®) and imatinib (Gleevec®) can cause or worsen an underactive thyroid, as can amiodarone (Corderone®, Pacerone®), which is used to treat heart arrhythmias.

It also is possible for underactive thyroid disease to arise from an autoimmune condition called Hashimoto’s thyroiditis, which impedes the thyroid gland from secreting hormones. Hashimoto’s usually causes a goiter, which is a swelling in the neck arising from enlargement of the thyroid gland.

TREATING HYPOTHYROIDISM

Dr. Arakawa emphasizes that treatment has not been shown to have a significant impact on symptoms in older adults with subclinical hypothyroidism. Although subclinical hypothyroidism is associated with an increased risk for progression to overt hypothyroidism and adverse cardiovascular events, the policy is to monitor people with subclinical disease and initiate treatment only if overt hypothyroidism occurs.

Treatment for overt hypothyroidism is a synthetic version of thyroid hormone called levothyroxine (Synthroid®, Levoxyl®). The drug is one of the most prescribed medications in the United States, but overusing it is known to increase the risk of osteoporosis. Recent research suggests that levothyroxine overuse also may increase the risk of cognitive issues in older adults. The 2023 study (JAMA Internal Medicine, Oct. 23) included 65,931 older adults and focused on thyrotoxicosis (excess T3 and /or T4 levels in the body). The new study suggests that thyrotoxicosis caused by medication raises the risk of cognitive decline. Dr. Arakawa says the data are a useful reminder for doctors to be cautious when prescribing thyroid hormone to older adults. “It’s important to regularly monitor people who are taking levothyroxine and decrease the dose if needed,” she notes.

Hyperthyroidism

This occurs when the thyroid releases too much T3 and T4, and it causes the body to “speed up.” Younger people may experience symptoms like an increased appetite, palpitations (the sense your heart is “skipping” beats), a tremor in the hands and arms, more frequent bowel movements, excessive perspiration, anxiety, and insomnia. But—as with hypothyroidism—overactive thyroid symptoms may be different in older adults, who “tend to present more nonspecifically, with fatigue, weight loss, and mood changes,” according to Dr. Arakawa. “Cardiovascular manifestations of hyperthyroidism also tend to predominate, particularly the abnormal heart rhythm atrial fibrillation,” she adds.

HYPERTHYROIDISM RISK FACTORS

In older adults, hyperthyroidism usually is related to abnormal growths that form in the thyroid gland. Called thyroid nodules, these can produce more T3 and T4, which is what makes the thyroid overactive. An overactive thyroid also can be caused by an autoimmune condition (Grave’s disease). Studies have linked Grave’s disease to an increased risk of cognitive decline. In other cases, drugs may trigger thyroid overactivity— for example, amiodarone, which can trigger both overactive and underactive thyroid disease.

TREATING HYPERTHYROIDISM

Untreated hyperthyroidism is known to increase the risk of developing osteoporosis, a condition that raises the risk of fractures. “Hyperthyroidism also can impact the pumping and rhythm functions of the heart, which may lead to conditions such as heart failure and atrial fibrillation,” Dr. Arakawa says. “These risks are augmented in people ages 65 and older, so treatment is recommended to correct hyperthyroidism.”

Treatment options include anti-thyroid medications, such as methimazole (Tapazole ®), which blocks the production of thyroid hormones. Alternatively, radioactive iodine can destroy the overactive thyroid cells, rapidly shrinking an enlarged thyroid gland. This can leave the thyroid unable to produce any hormone, and it’s likely you’ll eventually become hypothyroid and require treatment for that.

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