1.

Article for Newsletter -

Health Care Spending Tops 1.4 Trillion Dollars in 2001

In the January/February 2003 issue of the journal "Health Affairs" an article appeared indicating that health care in the United States in the year 2001 cost 1.424 trillion dollars.

This information was widely publicized in the print media and reported in several daily newspapers.

The article and the report, which are done on an annual basis, examined all spending for health care both in the private and public sectors.

In 2001 the percentage growth rate of health care was 15.7% per year and the previous year it was 16.4%. It was also reported that health insurance premiums grew 10.5% in the same year.

All of this meant that health care spending averaged $5,035 per person in the United States. Prescription drug spending accounted for 140.6 billion dollars of the total.

Health care spending consumes 14.1% of the gross national product of the United States.

Comment - There is no other country in the world that even comes close to what the United States spends on health care. If this spending continues at its present rate, health care will one day be the largest industry in the country.

The problem is that health care, because it is so incredibly expensive, has become unavailable to a large percent of our population. As the price of health care goes higher and higher even more people will be left behind and unable to afford insurance. As an employer, I am finding it increasingly difficult to pay for the full health care coverage for my employees.

What will we do when health care becomes so expensive that the majority of the population cannot afford to have insurance coverage?

The number of the uninsured is usually estimated to be in the neighborhood of 30-35% of our population. One of the problems is that in the United States there actually is no budget for health care expenditures. Until there is some means to decide exactly what we can afford to spend on health care as a country and live within that budget, this runaway spending can never be controlled.

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2.

Joe, this needs to be promoted somewhere prominently on the web site. I will send you a little graphic of this that you can also use on the web site. This is the announcement of an important book on musculoskeletal health. The title of the book is

The 2003 Body Almanac Your Personal Guide to Bone and Joint Health at Any Age.

The American Academy of Orthopaedic Surgeons has published a very important new book entitled The 2003 Body Almanac-Your Personal Guide to Bone and Joint Health at Any Age.

The American Academy of Orthopaedic Surgeons has never published a book for the retail consumer before. The Academy has published countless books for the education of orthopaedic surgeons, but has never published anything before for patients.

This publication is a new musculoskeletal self-help book that is said to demystify bone and joint health for the general public. It employs an easy to follow question and answer format. The guide defines dozens of common musculoskeletal conditions and for every condition listed the reader is provided with a wide range of helpful and concise information such as signs and symptoms, treatments, pain expectations, when it's time to call a doctor, follow up care, illustrated exercises, buying guides, anatomical diagrams, check list, safety and prevention tips.

This soft cover guide to bone and joint health is priced at $19.95. The American Academy of Orthopaedic Surgeons is one of, if not the leading specialty education organization in the world today.

I am proud to be a member of this organization, which has done so much for the post-graduate education of countless M.D. orthopaedic surgeons.

Consumers can be very confident that the content of the guide has been researched and is very unbiased.

The goal was to produce a book that could be on the shelf in every household in America and used when any musculoskeletal concern arises.

The American Academy of Orthopaedic Surgeons is confident that nothing else similar to it exists in print at this time. A very great public service is being provided at an economical price.

I think this publication helps to prove what I have said and known all along, that as an orthopaedic surgeon member of the American Academy of Orthopaedic surgeons I am genuinely interested in the overall musculoskeletal health of my patients, not just in performing surgery.

It has taken over four years to develop the content and concept of the book.

The Body Almanac features the top one hundred musculoskeletal conditions seen at a doctor's office, and is divided into eight anatomical areas. The book is very reader friendly.

The book is really multi-generational in that it contains information on conditions affecting every age group not just aging baby boomers.

Baby boomers are called the sandwich generation, because not only are they experiencing new aches and pains of their own, but many of them are caring for children as well as elderly parents or other relatives. The guide empowers readers to become involved in the entire family's bone and joint health.

We would advise everyone to take advantage of this fairly inexpensive resource, which will promote bone and joint health for the general population.

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3.

Website Article - Orthopaedic Conditions

Achilles Tendinitis

The achilles tendon is the largest tendon in the body. It is huge compared with other tendons and it can be easily felt on the back of the ankle above the heel.

The achilles tendon is also extremely strong and has been tested to withstand tremendous forces. The calf muscles, gastrocnemius and soleus, are connected to the heel bone or calcaneus by the span of the achilles tendon.

It is paradoxical that this largest and strongest tendon is also the one that is most frequently ruptured.

Inflammation of the tendon -

No one knows for certain exactly why achilles tendons become inflamed, but there are several theories which include trauma caused by a hard contraction of the calf muscles, increase in running speed or mileage in runners, and starting up too quickly after a lay off.

Signs -

Some people are fortunate in that their achilles tendon will begin to complain and they will experience mild pain after exercise or running. This discomfort can gradually worsen.

The pain can be more severe and sometimes diffuse.

Stiffness and tenderness in the morning in the tendon, one or two inches above its attachment to the heel is frequent. Some swelling in the region of the tendon can occur. However, in my practice experience, the tendon usually will rupture practically without warning. The tendon ruptures in males many times more often than females. The typical person that this happens to is in his thirties or forties and might be playing recreational basketball.

The person feels an intense, sudden pain in the achilles tendon area that is often described as feeling as if they were shot in the area.

Treatment -

The typical torn or ruptured achilles tendon is repaired surgically as soon as it is practical to do so. While it is not an emergency it should be repaired in the first several days after the injury if at all possible for best results.

For those fortunate few who experience symptoms before the tendon actually ruptures, rest for a week can be very helpful.

Sometimes we prescribe anti-inflammatory medication such as Motrin or any of the other popular medications.

A simple heel pad or heel lift in the shoe from 1/4 to 1/2 inch can reduce stress on the achilles tendon significantly and make the person more comfortable.

Physical therapists often employ stretching and appropriate exercises for the calf muscles as well as the muscles in the front of the leg. Whirlpool and ultrasound also can be helpful sometimes combined with a type of cortisone cream, which the ultrasound can propel into the tissues (iontophoresis).

Prevention -

It is hard to get people to do things to prevent injury in my experience. If they are not having any symptoms in a particular area it is fairly difficult to get people to do things to try to prevent something from happening.

If you are a runner you should probably get the best running shoes you can afford. Some people require professionally made orthotics to provide proper foot and heel alignment. Walking and stretching to warm up are always suggested, but seldom done.

Calf stretching exercises done on a regular basis, even though you may not feel that you need to do this, can't be beat. Avoid hill running and unaccustomed sprinting. Increase your running distance or sports activities very gradually.

These are all very good suggestions, but unfortunately hardly anyone will do them.

Anyone who experiences achilles tendon rupture or even achilles tendinitis, develops an appreciation of the Greek god, Achilles, who was vulnerable only at his heel.

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4.

Addendum to the article ACL Injuries in Women -

Continued careful observation and research into the problem of anterior cruciate ligament injuries in women are revealing some interesting patterns.

The increased incidence of anterior cruciate ligament injuries in women compared with men participating in athletics is a very complicated subject. Nonetheless, it is beginning to appear that some fundamental differences in the body mechanics of women and men are primarily at fault.

It has been known for some time that in jumping activities women land with their knees much more extended coming down from a jump.

The classic example is a female gymnast jumping down from a mount landing with the knees nearly fully extended. This has been recorded innumerable times on videotape. As a girl lands in this position she stops suddenly with her arms still up in the air over her head and then either collapses to the ground or takes a few steps awkwardly, being able to bear very little weight on the injured knee. There goes another anterior cruciate ligament. The sport could just as easily be basketball or soccer. Women not only seem to land in a knee extended position, but also pivot in that position when they land. Both of these things can put much greater strain on the anterior cruciate ligament than landing more in a crouch with the knees and hips both flexed.

No one can do the slightest thing to strengthen his or her anterior cruciate ligament. The athlete can, however, strengthen and condition the muscle groups pertaining to the hip, the knee and the ankle.

It is beyond the scope of this article to teach proper body mechanics and exercises.

A physical therapist or athletic trainer familiar with the anterior cruciate ligament and the muscle groups that compliment it, are very familiar with body mechanics and exercises needed to prevent ACL injuries.

The muscle groups may actually need to be retrained to act correctly to be a force in preventing injury.

We are still amazed that the great majority of women athletes are unaware of these differences and therefore, completely unaware of any techniques that could substantially reduce their possibility of injury.

The American Academy of Orthopaedic Surgeons has attempted in some initial ways to begin to bring this problem to the attention of athletes and their coaches, but I'm afraid we still have a long way to go.

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5.

Addendum to the "Fosamax once weekly dose is effective" article on the web site -

A recent article in the Journal of Bone and Mineral Research studied 1,258 women using a once weekly dose of Alendronate or Fosamax, which is the trade name.

The article pointed out that the mineral density of the spine increased 6.8% during the period of the study. The instance of side effects was similar in those taking the medication on a daily basis or twice per week.

We are beginning to have very substantial evidence of the effectiveness of Fosamax in increasing bone mineral density in the spine and certainly in other areas as well.

As the bone mineral density increases in women with osteoporosis there will be a major reduction in vertebral compression fractures, hip fractures, and wrist fractures. End of this item

6.

Web site article - Osteoporosis

Osteoporosis Treatment With Teriparatide

The United States Food and Drug Administration has approved Teriparatide for the treatment of osteoporosis in post- menopausal women at high risk of having a fracture.

TERIPARATIDE IS THE FIRST APPROVED AGENT FOR THE TREATMENT OF OSTEOPOROSIS THAT STIMULATES NEW BONE FORMATION.

I have capitalized the previous sentence because it is the entire essence of this article. All the other measures that we have to treat osteoporosis and hopefully increase bone mineral density are treatments that slow the loss of bone. Treatment with Teriparatide actually increases, that is stimulates the formation of new bone.

This medication is administered by injection once a day in the thigh or the abdomen.

Teriparatide is a portion of human parathyroid hormone (PTH) which regulates calcium and phosphate metabolism in bones. Clinical trials have demonstrated a definite reduction in the risk of vertebral and other fractures in post-menopausal women.

No reports of tumor production were made in the human studies although animal studies showed an increased risk.

While this treatment is not, at this time, available in the office of every physician treating osteoporosis, it does give hope for the future that this agent and others will actually be able to stimulate new bone formation.

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7.

Web site article- Women's Health and General Information. Put it in both places.

Activity - The Best Treatment For Aging

The science of aging is alive and well. The challenge before us is to link the progress and the basic science of aging and clinical research to provide evidence based care for the growing number of older people.

While this article is directed towards the musculoskeletal system an example from neuroscience is necessary. While a relatively healthy musculoskeletal system is important to independence, productivity and quality of life, cognitive and emotional function is also linked to those factors.

The brain is probably the major organ of interest as people age. Simple cognitive exercises have been demonstrated in studies to improve memory. The implication of this for healthy aging is obviously enormous.

We return to the musculoskeletal system in our discussion. U.S. consumers spend more than twenty billion dollars per year on complementary and alternative medicine therapies that promise to slow the process of aging and its associated ailments. (See Online Orthopaedics Complementary and Alternative Medicine library article.)

Men and women have shown great interest in hormone therapy to slow or reverse the aging process. For men the hope that testosterone therapy might restore vitality in aging has been somewhat disappointing. For women, estrogen seemed to promise a similar ability to avoid aging, but recent studies have challenged the presumed positive effects of hormone replacement therapy for preventing heart disease and have raised other fears of breast cancer. Estrogen therapy is effective in preventing osteoporosis, but other medications have become more important in recent years. (See On Line Orthopaedics Library articles on Osteoporosis.) So what are we to do?

Exercise. Even simple moderate activity like walking is associated with a significant health benefit.

A recent editorial in the Journal of the American Medical Association pointed out that even frail adults living at home who participate in a moderate activity program will experience distinct benefits in their physical and mental function and capacity.

In studies that evaluate approaches to reduce the functional decline in human aging, the findings repeatedly favor the positive effects of continued physical and mental activity, particularly physical activity.

Unfortunately the message seems largely unheard by both the United States population and health care providers. Exercise, unlike pharmaceuticals does not bring huge profits to any industrial sector. Sadly, patients look to medication rather than behavioral change to improve their health. We are a society driven to find an easy way out, that is for a medicine or pill to take to solve a problem.

Trying to get our patients into physical activity programs and to exercise is enormously difficult. The many conveniences that do our work and our increasingly sedentary lifestyle contribute significantly to the aging process. Unfortunately, it starts early in life.

Unfortunately, physicians and their style of practice sharply focused on medical technology and pharmaceuticals do not help this problem. It would be unfair to blame this entirely on our patients and not lay some of the blame at the feet of our physicians.

Very often our complementary and alternative medicine colleagues have done a much better job in bringing to the attention of patients the need for behavioral modification.

It is horribly simplistic to reduce treatment of the aging process to one word, but here goes.

EXERCISE. Simple isn't it? But how do you get people to do it? People simply don't want to take the time to do it. They have other things to do that seem more interesting to them and more beneficial. For treatment of the aging process, NOTHING IS MORE BENEFICIAL.

Walking. Riding a bike. Treadmill. Working outdoors on a regular basis. Swimming. The list goes on and on.

I think people have heard this so often that they just tune it out.

We are not trying to make people immortal. We are trying to keep people independent and active and as healthy as possible.

There are additional benefits to exercise in that balance and strength, by being improved in the elderly, has been shown to substantially decrease the incidence of falls.

Aging seems to degrade the ability to recover and keep a slip from turning into a fall.

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8.

Addendum to Tennis Elbow article -

It should be pointed out that cases of tennis elbow (lateral epicondylitis) may take many months for the condition to resolve whether the treatment is non-surgical or surgical. If the condition has resulted from activities in the patient's work place, ergonomic evaluation is essential to assist the worker. Avoidance of activity patterns that require overhand gripping and pulling can decrease the incidence of this injury significantly.

There have been several operations that have been done to try to relieve the pain of tennis elbow, but perhaps the most common is a procedure in which the attachment of the extensor tendons to the lateral aspect of the elbow or lateral epicondyle is released and a small portion of the bone underneath is removed.

The upper extremity needs to be immobilized in a long arm splint for at least two to four weeks and then gentle range of motion exercise is begun. Surgery is usually done as an outpatient and general anesthesia would be a common form of anesthesia for this condition.

While it can take an extended period of time for the elbow to heal, it usually will heal and symptoms will markedly diminish. I have very rarely seen the recurrence of tennis elbow following surgery if the patient has initially gotten a good result.

The discomfort that the patient does have in the early months following surgery often can be related more to the deconditioned extensor muscles in the forearm.

Perhaps the very low rate of recurrence is due to the combination of successful therapy following surgery and ergonomic changes in the work place or at home.

It has been noted that some of the most successful surgical results are in patients who have initially responded to a cortisone-like injection in the elbow, but then had a recurrence of symptoms at some point following the injection.

Tennis elbow or lateral epicondylitis is the most common affliction of the elbow that we treat. It's cousin, medial epicondylitis, which has occasionally been referred to as golfer's elbow is very similar to its lateral counterpart, but is much less common and non-surgical treatment is almost always effective.

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