Healthy bones for a healthy life

Many of us think of bones as the body’s frame—structural parts that can simply be mended if broken. But bones play a bigger part in our overall health than most of us may realize.

“Our bone structure provides support for our joints and muscles, and allows us to get around,” says Robert Zirschky, M.D., Orthopaedic’s Section Chief at Salem Hospital. “But our bone health is threatened by osteoporosis and inappropriate use. Over-use or under-use can lead to deterioration of the musculoskeletal system.”

Keeping bones healthy
Staying active, maintaining a weight-bearing exercise program, and being a non-smoker help to ensure healthy bones. “It’s critically important to be at your optimal Body Mass Index, because for every extra pound of weight you carry, it’s more force and wear on the joints,” says Harold Boyd, M.D., of Orthopaedic Associates.

Good nutrition is also essential. Calcium and vitamin D—the building blocks of bones—should be part of everyone’s diet.

Denise Cedar, a Registered Dietitian at Salem Hospital, teaches that drinking low- or non-fat milk is an excellent way to ensure strong bones. Children need the equivalent of three to four cups a day, and adults need two to three cups a day. Lactose-intolerant people can often tolerate yogurt, low-fat cheese, small amounts of milk, and calcium-fortified soy or rice milk. Calcium supplements are another great way to get your daily intake.

It’s never too late to take care of your bones—start today for a stronger tomorrow!

Preventing bone and joint injuries

No matter how advanced emergency care and rehabilitation programs become, medical professionals still agree that the best way to beat an injury is to avoid it.

You can prevent injuries and stay in the game—whether on the playing field or life in general—by paying attention to your body and how you are using it.

Know your body mechanics
It all starts with knowledge of your body (and its limits) and a commitment to general health through proper nutrition, good posture, and regular exercise. As Salem Hospital’s Jennifer Truax, physical therapist and certified athletic trainer, says, “Making strength and flexibility a priority is important.” The stronger and more flexible you are, the less prone to injury you will be.

A common cause of injuries is impatience. “Injuries often happen when people try to push themselves too far too fast,” says David Thorsett, M.D., an orthopaedic surgeon with Western Orthopaedic Surgery and Sports Medicine and a team physician at Willamette University in Salem and McNary High School in Keizer.

“Many back injuries occur because people are trying to save time,” warns David Hook, M.D., Ph.D., Medical Director of Salem Hospital’s Regional Rehabilitation Center. “For example, they’ll bend at the waist instead of at the legs.”

You can avoid many bone and joint injuries by maintaining proper body mechanics. Dr. Hook offers this advice for maintaining proper body mechanics when exercising or being active:

• Pick up items (whether free weights or a full laundry basket) close to your body, not at arm’s length.
• Bend at the knees instead of at the back.
• Avoid repetitive motions.

“Preventing injuries before they occur is a smart approach,” says Truax.

What is orthopaedics?

Orthopaedics is the branch of medicine concerned with diseases, injuries, and conditions of the body’s muscles, skeleton, joints, ligaments, tendons, and nerves. Orthopaedic conditions are treated by a multidisciplinary team of primary care physicians, orthopaedic surgeons, rheumatologists, physical therapists, occupational therapists, and physiatrists.

Learn more about orthopaedics and bone health by visiting these Web sites:

• Health Source: Adult Orthopaedics
• Health Source: Pediatric Orthopaedics
• American Academy of Orthopaedic Surgeons
• National Institutes of Health
• National Osteoporosis Foundation Web site

Athletic trainers, physical therapists, occupational therapists, and more are available to help you. Contact:

Salem Hospital Regional Rehabilitation Center in Salem 503-561-5986

West Valley Hospital Rehabilitation Services in Dallas 503-623-7305

West Valley Hospital Rehabilitation Services in Monmouth 503-838-1388

Giving new life to old joints
Total joint replacement allows people to resume active lives

When Millie Duprau checked into Salem Hospital for the first of her two knee-replacement surgeries, she didn’t realize her experience would inspire her to become a hospital volunteer.

Millie visits knee-replacement patients and their families to provide reassurance and answer questions after surgery. “A lot of people who have joint-replacement surgery think they can never do their activities again—and I encourage them to believe they can,” says Millie. “This is not the end of their life.”

Many people have come to see total joint replacement the way Millie does. Such surgeries are becoming increasingly common. In fact, more than 435,000 joint replacements are performed in the U.S. each year.

What is total joint replacement?
David Thorsett, M.D., of Western Orthopaedic Surgery and Sports Medicine compares the surgery to replacing a tire on a car. “It’s kind of like wearing out the tread on a tire,” he says. “You get a certain amount of tread, and when it’s gone, it’s time to replace the tire.”

During the surgery the orthopaedic surgeon first removes the damaged bone and cartilage, and then inserts an artificial joint. Artificial joints are typically made of metal, plastic, or ceramics. “Basically what we’re doing is creating a mechanical joint,” Dr. Thorsett explains. “If it’s a knee, it’s a mechanical hinge joint, and if it’s a hip, it’s a mechanical ball-and-socket joint.”

Although the length of each procedure varies, hip- replacement surgeries usually last a few hours, while knee replacements tend to be quicker.

Making the choice
A person’s decision to undergo total joint replacement is personal, based on many factors, including pain levels before surgery and lifestyle needs.

“If a patient’s arthritis is affecting his lifestyle and impairing his ability to do the things he enjoys, exploring total joint replacement is reasonable,” says Dr. Thorsett.

Who should consider total joint replacement?
Harold Boyd, M.D., of Orthopaedic Associates, says strong candidates for joint replacement are people who struggle to walk, have decreased function in daily activities, are increasing their use of pain medication, or are losing range of motion in the joint. These characteristics are all measurable and are part of a 100-point rating scale used before and after surgery to determine the level of joint functioning.

In January, Louise Larsen of Salem met with Dr. Boyd about one of her hips, and they decided she was a good candidate for hip-replacement surgery. “I had been in bad shape for about eight years, taking glucosamine, and it didn’t help,” Louise says. “Nobody wants to wake up every morning wondering if they are going to be able to get around easily.”

Care Manager Dana Hawkes of Salem Hospital facilitates the care of dozens of total-joint-replacement patients like Louise each year. “Usually the patients have been in pain for years. After the surgery, some of them have never felt so good,” she says.

Thorough care experience
Dana says a lot of people focus on the surgery itself, but don’t think about the reality of returning home. “They’re going home in a different capacity than when they left, and they need to prepare and have the resources available to help them do everything they need—from grocery shopping to showering,” she says.

Discharge Coordinator Kristin Kuenz works with patients prior to surgery to assess their needs and support system, and to develop a plan for recovery at home. “Understanding the process helps them feel better,” Kristin says. “It gives the patients peace of mind to know that there’s a plan.”

Orthopaedic surgeons stress the importance of this preparation. And patients who have had the experience agree. “The hospital experience was exceptional,” says Louise Larsen. “A month before the surgery, I knew my entire itinerary. And the whole prep process was positively cozy.”

After her two knee replacements, Millie Duprau approached her orthopaedic surgeon’s office to volunteer her time for knee-replacement patients. In her work, Millie visits the family during the surgery and answers questions for patients after surgery.

“Many of the women like to see my scars,” Millie says, “and I show them some ways I keep my knees flexible. I consider myself a motivational speaker because some people are scared to death, and I’m a very active person,” she says.

Making the decision to have total joint replacement requires a good deal of thought and consultation with an orthopaedic specialist. Melissa Berry, Therapy Supervisor for Acute Rehabilitation Services at Salem Hospital, sums it up best. “If joint replacement is an appropriate avenue for you to take, it can give you a new lease on life,” she says. “But you have to be dedicated to the recovery afterwards.”

Rehabilitation after joint replacement

Sports-related injuries aren’t the only conditions that require rehabilitation. As we get older, many people need new joints to maintain mobility and health, and rehabilitation is necessary after joint-replacement surgery.

“The rehabilitation process after joint replacement is fairly involved. It’s about a three-month process, requiring a lot of therapy to recondition the joint and the muscles,” says David Thorsett, M.D., of Western Orthopaedic Surgery and Sports Medicine.

Hip- and knee-replacement surgeries usually require a hospital stay of several days, during which patients begin physical therapy exercises.

“The physical therapist starts working with the patient the day after surgery, focusing on range of motion and strength,” says Melissa Berry, Therapy Supervisor for Acute Rehabilitation Services at Salem Hospital. “Their work together focuses on the musculature around the joint—bending and straightening, standing, et cetera.”

Recreational activities and childhood injuries

Recreational injuries can have a lasting impact on a child's health and development. The American Society of Orthopaedic Surgeons identified four activities with the most injuries to bones and muscles and suggests the following prevention steps.

Understanding osteoporosis and osteoarthritis

Nearly 70 million Americans have arthritis, making it the leading cause of disability in the U.S. Osteoporosis affects 10 million Americans over age 50, and the Surgeon General warned that half of all Americans over 50 will be at risk for fractures caused by low bone density or osteoporosis.

“These two diseases not only produce pain, but also impact our abilities and affect our overall health,” says Robert Zirschky, M.D., Orthopaedic’s Section Chief at Salem Hospital, who urges you to learn about these diseases and how they can affect you.

Osteoporosis is a progressive condition in which bone density is lost. It weakens the bones and makes them more susceptible to fractures.

Osteoarthritis, the most common form of arthritis, is a chronic, degenerative joint disease that is characterized by the breakdown of joint cartilage and adjacent bone in the neck, lower back, knees, hips, or fingers.

Symptoms
Bone diseases such as osteoporosis and osteoarthritis can be difficult to diagnose in their early stages, as there may be few specific symptoms other than general pain in the bones and muscles. As David Hook, M.D., Ph.D., Medical Director of Salem Hospital’s Regional Rehabilitation Center, says “Osteoporosis is usually painless until late in its development or until it’s associated with a fracture.”

Nonetheless, it’s important to recognize signs of bone disease. Symptoms usually develop slowly over many years and may resemble other medical conditions. Harold Boyd, M.D., of Orthopaedic Associates agrees. “A primary warning sign for bone disease is joint discomfort after activity,” especially in the hips, knees, fingers, feet, and spine.

Treatment
The goals of managing osteoporosis are to decrease pain, prevent fractures, and minimize further bone loss. Treatment methods often include:

• Maintaining an appropriate body weight.
• Increasing walking and other weight-bearing exercises to three hours per week.
• Minimizing caffeine and alcohol consumption.
• Stopping smoking.
• Maintaining an adequate intake of calcium and vitamin D.

Treatments for osteoarthritis are aimed at reducing joint pain and stiffness, and improving joint movement. Physicians often achieve this through a treatment plan involving aerobic exercise, stretching and strengthening exercises, physical and occupational therapy, and weight-loss programs.

Take the first step to conquering osteoporosis and osteoarthritis—maintain an active lifestyle and a balanced diet that will prevent your bones and joints from weakening.

Bouncing back from surgery or an injury
Whenever possible, it’s best to prevent bone and joint injuries from happening. But when they are unavoidable, or when you have surgery on a joint, you’ll want to get back to full strength and mobility as soon as possible. Proper rehabilitation can help you get back into the swing of things.

Defining rehab
Rehabilitation optimally involves a physician directing a team of therapists working with you to improve functional capacity, reduce symptoms, and improve well being following an injury or surgery.

David Hook, M.D., Ph.D., Medical Director of Salem Hospital’s Regional Rehabilitation Center, compares the stages of rehabilitation to running the bases of a baseball diamond. “Getting to first base is relieving pain,” he explains. “Second base is restoring the full range of motion. Third base is restoring strength, and home base is getting back to full functionality.”

Thirteen-year-old Sara Coates of Salem can appreciate that analogy. An active softball player, Sara often plays two or three games per weekend at catcher and third base.

Last fall, Sara noticed her arm strength declining. “My arm started getting weak, and it just kept getting worse,” she says. In January,

Sara had surgery on a damaged shoulder, and has been gaining her strength back in weekly physical therapy sessions.

Successful rehab
To be successful in sports—whether T-ball or hockey—you have to know the rules of the game and how to safely carry out the moves. Then you have to actively participate.

Successful rehabilitation is similar. At your first rehab appointment, the physical therapist will ask questions to understand your lifestyle and quality-of-life goals. Then you and the therapist will develop a game plan. While carrying out that plan, the therapist will provide education and guidance to help your recovery process occur more quickly—and you will actively participate in physical therapy.

According to Jennifer Truax, a physical therapist at Salem Hospital, “Successful rehab is a team effort between the therapist and the patient, and the best successes come from an individual’s commitment to her own recovery.”

Sara Coates has enjoyed that team effort. Today, as a result of her experience at Salem Hospital, she wants to become a doctor or a physical therapist. “The people you work with [during rehab], you get so close to them,” she says. “If I had someone who didn’t care about me, physical therapy would be really hard.”

Sports injuries and baby boomers

The American Orthopaedic Society for Sports Medicine and the American Academy or Orthopaedic Surgeons suggest that people over age 50 take the following steps to avoid sports injuries.

• Always warm up and stretch before physical activity.
• Don’t be a weekend warrior – get at least 30 minutes of moderate physical activity every day.
• Take lessons and invest in good equipment. Proper form and instruction reduce the risk of injury.
• Listen to your body. As you age, you may find you are not as flexible as you once were, or you cannot tolerate the types of activities you used to.
• If you have had a sports or orthopaedic injury such as tendonitis, arthritis, stress fracture, or low back pain, consult an orthopaedic surgeon before exercising.

Home Cooking: Broccoli-stuffed pasta shells

What your mother told you is true: Calcium helps build strong bones. You’ll get lots of calcium (close to half the daily requirement for an adult) from the three cheeses in this recipe, developed by Salem Hospital dietitians. We think you’ll enjoy eating it, too!

Ingredients:

6 ounces (18–20) jumbo pasta shells
1 16-ounce bag frozen chopped broccoli, thawed
1 pound low-fat (1%) cottage cheese
6 ounces (1 2/3 cups) shredded part-skim mozzarella cheese
1/2 cup grated Parmesan cheese
1 tablespoon grated onion
1/2 teaspoon ground black pepper
2 cloves crushed garlic or 1 teaspoon garlic powder
2 15 1/2 – ounce jars reduced-sodium marinara sauce (or spaghetti sauce)

Directions:

1. Cook pasta according to package directions. Drain.
2. Combine broccoli, cottage cheese, 1 cup mozzarella cheese, Parmesan cheese, onion, pepper, and garlic in a large bowl. Mix together well.
3. Fill shells with cheese-broccoli mixture.
4. Spoon enough marinara sauce into the bottom of a 9 x 13-inch baking pan to cover the bottom.
5. Arrange shells in a single layer; spoon remaining sauce over shells. Sprinkle the rest of the mozzarella cheese on top.
6. Cover pan with foil and bake at 375 degrees for 15 minutes. Remove the foil and bake for 15 more minutes, until heated thoroughly.

Yield: 6 servings

Nutritional analysis per serving: 445 calories, 432 mg calcium, 36 gm total carbohydrate, 5 gm fiber, 18 gm total fat (including 6 gm saturated fat), 600 mg sodium, 28 gm protein.

Print This Recipe: Broccoli-stuffed pasta shells