Knee - lubrication TWO

Gareth Phillips knees with band aids (plasters) over each injection.

Lubrication TWO happened Friday April 25. [Read about Lubrication ONE].

It didn't really hurt. After the first lubrication the knees felt good for several days and then on Thursday I started to limp. The promise is that this second lubrication will be better. I'm hoping.

The doctor (works for the surgical group Resurgens) .

I asked if lubrication worked for other joints and the answer was that technically yes but getting an insurance company to pay was difficult. The FDA has approved lubrication only for knees, so using lubrication for any other joint would be an "off label" application. Hence payment problems. He said that the treatment worked fine for ankles and knees. Hips were OK but very limited experience with lubricating hips.

Look at this MRI of a knee.
My MRI's and X-rays are just too dark to scan and upload.

Cartilage shows up as white on X-rays and bone as black. However bone with no protective cartilage, as behind my knee cap, is gray indicating a high water content. Bone with a high water content is soft i.e. the body is finding a way to compensate for no cartilage by creating a substitute of softer bone.

If you want to start understanding any knee problems you might have - start here with Knee Guru.

Are your bones hard enough ?

In his book Frameworks the orthopedic surgeon Dr. Nicholas A. DiNubile makes the intriguing statement that when he's operating on a young female athlete he often can drill into leg bone just with hand pressure because the bones are so soft. The doctor compares that to most men of similar age where he needs to use power tools plus all his strength.

DiNubile says he often orders DEXA bone density scans even for fit young female athletes with stress fractures.

Dr. Nic's risk factors for osteoporosis:

1. History of fractures as an adult
2. Family history of fractures or osteoporosis
3. cigarette smoking
4. slight build or underweight
5. white or Asian
6. Eating disorder
7. Early menopause or hysterectomy
8. Sedentary lifestyle
9. Alcohol abuse
10. Low-calcium diet
11. Vitamin D deficient - including inadequate sunlight exposure
12. High caffeine intake
13. Certain medical disorders e.g. thyroid dysfunction, or use of some medications e.g. prednisone, corticosteroids, dilantin.

Dr Nic also has a couple of other interesting thoughts:

• the body can only absorb 550 mg of calcium at one go - spread calcium intake across the day
• alcohol, caffeine and smoking can all reduce calcium being used by the body to keep bones strong.

Bone Stress-fractures - calcium and vitamin D really do help

Bone fractures, due to bones getting over stressed, is a big problem for the US Navy - particularly with female recruits. 21% of female recruits going through basic training suffered bone stress fractures. The nutrition trial was to find out if taking high doses of calcium and vitamin D would make a difference.

Taking 2,000 mg of calcium and 800 IU of vitamin D per day made a big difference with a 20% reduction in bone stress-fractures. These intakes are high compared to US guidelines but there is enough evidence to expect the guidelines to eventually change. For women aged 19 to 50 the US government guideline on calcium i s 1,000 mg per day and 400 IU's of vitamin D a day. The female navy recruits were taking in a lot of calcium and vitamin D by US standards but the higher doses seem to be essential to have an impact on bone health.

The research published on-line today in The Journal of Bone and Mineral Research was the result of research involving the Naval Institute for Dental and Biomedical Research at Great Lakes ,Illinois and Creighton University Osteoporosis Research Center, Omaha, Nebraska.

The Creighton University Osteoporosis Research Center has been running an osteoporosis study since 1967 amongst a group of nuns. At the start, the average age of the nuns was 40. Much research has been published from this study.

The outcomes from the nun study include:

• protein intake needs to be high to use and retain calcium
• body requirements for vitamin D have to be fully satisfied
• calcium intake needs to go up 50% at menopause
• this increase in calcium intake at menopause is difficult for many to manage
• high intake of calcium and vitamin D reduces bone fracture risk 40 to 55%
• osteoporosis is influenced by many factors with nutrition being just one but one that is under one's own control.

Stronger, Fitter Lungs

You might have trouble breathing. Your lungs just do not deliver enough oxygen. What to do ?

Try PowerBreathe.
Look at this TV interview - I know it's British and a little bit jokey (but none the worse for that). By the way

£90 is about $ 180 - maybe a tad more but in the USA you can purchase for $60 to $80.

Have a laugh at this refugee from the Hobits reviewing PowerBreathe.

Knees - getting mine lubricated

Friday 18th April I had both knees lubricated with Hyalgan (full name sodium hyaluronate). It's manufactured by Sanofi Aventis. I'm going to have 3 injections in each knee ( 6 syringes which in total will cost me $116 purchased via Medco). It would have been about 4 times more expensive via the Publix pharmacy.

In the image: A is the knee cap (patella); B is the shin bone (tibiae); C is the meniscus lateralis; D is the thigh bone (femur); The white stripes between the femur and the patella is cartilage and in my case this had been totally worn away after 40 years of running. In the spaces and invisible is synovial fluid which the injections will cause to become more effective as a lubricant.



The lubrication injections are, hopefully, close to the end of a year long attempt to get back to reasonably serious running. My knees have hurt after running for a long time but about a year ago they became just too painful. I tried physical therapy and while this was good to start with I ended up in more pain than I started with.

The next step was an anti-inflammatory: firstly, dichlofenac; then later, piroxicam. Dichlorfenac didn't seem to have much effect but piroxicam did. However my 'normal' doctor seemed to worry about prescribing piroxicam because people have ended up in the emergency room because of it. This didn't happen to me but I'm pleased to be able to stop taking it.

My knees also have osteoarthritis. The New York Times carried this nastily detailed report on what can happen to knees.

Hyalgan is made from the rooster combs on chickens. Luckily I have no chicken allergy. However nothing is without some side affects and I did suffer headaches after the lubrication injections - as about a third of people do.

Another 2 weeks to end of injections, then maybe a couple of months to full effectiveness.

I might just, be able to run the Peachtree 10K in Atlanta on July 4th.

Bone Health - Know if you are Vitamin D deficient

Bones get weaker as we age - particularly in women. This is the pattern: bone strength increases through childhood and the teen years; in our twenties and thirties bone strength high; then declines late thirties into the forties ; and declines even more around menopause.  

Are all bones affected by osteoporosis or just a few bones ?  This is the pattern: wrist; back in the chest area; top of the thigh; they all could get weaker. Weaker means that they might fracture or break.

So what might you do ? There are many drugs aimed at helping osteoporosis. 

Look at this list.

Exercise can definitely help and I'll get into details in the next post but trying to combat osteoporosis with exercise alone is probably not the best way to go.You need expert medical advice. 

However you should not forget some simple additional approaches: get enough sun; enough calcium; reduce your salt intake. Sunshine on our skins causes Vitamin D to be made in the skin. If you live in a northern climate and have darker skin then it is likely that your body does not get enough intensity of sunshine to make enough Vitamin D. It is thought that more than half of Americans are Vitamin D deficient. 

You can test yourself for your Vitamin D level by buying (a somewhat expensive) kit from Virginia Hopkins.

Getting your salt (sodium) intake down sharply is also a good idea because high salt intake negates the good impact of a high calcium intake.

If you want to consider exercise before I write a blog specifically on exercise and osteoporosis then get yourself this video from the National Osteoporosis Foundation.

Personal Trainers - CBS Early Show carries an injury story

The CBS Early Show had a segment about the problems that a Personal Trainer can cause !
The show aired on April 3rd, 2008 at 7.30am. I'm hard at work at that time so I've only just caught up to this news item.

One of the stories was about a middle-age woman who wanted to lose some weight; hired a personal trainer; had two work-outs and subsequently suffered kidney failure. This she attributed to being worked out too hard by the trainer. Doubtless we'll hear more about this story as times goes by.

After clicking on the link problems that a Personal Trainer can cause , you might need to click on the play arrow in the video controls. CBS will show you an advert (30 seconds) before the news item starts to play. Be patient.

How much do Triathletes know about Female Athlete Triad

The Medical College of Wisconsin had the clever idea to investigate how much, if anything, Triathletes know about the Female Athlete Triad. The research cohort was tiny - 15 female athletes - but the results amaze in that half the athletes did not know what exactly Female Athlete Triad is !

Nearly half of the women had problems with their periods - amenorrhea. If you read yesterday's post you'll see that missing periods or not having periods at all is a major factor in reduced bone density- leading over the years to osteoporea.

More than half the female athletes were not taking in enough calories to support their activity level. This lack of enough calories leads to amenorrhea.

The results were written up - look at the abstract - you'll need a subscription to get the full report.

Just to state the obvious, Female Athlete Triad is NOT just confined to Triathletes, it can strike any hard exercising women - whatever the sport or activity.

Osteopenia - weak bones. Female Athlete Triad

Osteopenia is the condition which lets you know that you are going to have to change your ways if you want to avoid osteoporosis. Osteopenia means that your bones do not have as much mineral, mainly calcium, built in as they should have. This means that the bones are not as strong as they should be.

Osteoporosis possibly leads to bone breaks and fractures, you lose height and maybe start on round forward into a typical "old lady".

Consider this example, say you are late 20's to mid-30, run hard and long, maybe half or full marathons, good muscle definition, slim, body weight somewhat on the low side for your height. Sounds healthy ? What's the chance for osteoporosis in later life ?

The problem is that exercising really hard, not eating quite enough to support the energy expenditure, keeping your body weight low - so you look really cute - quite likely lead to loss of periods (or spotty periods). Amenorrhea in medical jargon which leads to loss of bone density. Your body does not pack enough mineral, particularly calcium, into the bones and maybe even leaches calcium out of healthy bones.

The jargon name is Female Athlete Triad with three components: not eating enough to support your exercise level; problems with periods; low bone density.

Is this a possibly serious issue for you personally?

Ask yourself these questions:

1. Does mother or grandmother have a stooped posture or has there been a loss in height over the years ?
YES and you definitely need to take this seriously as genetics is 60% to 80% of the issue.

2. What's your body weight.
A woman who weighs less than 127 pounds is 10 (TEN) times more likely to have osteopenia than a woman who weighs 150 pounds or more.

3. Periods.
Did you start periods late and/or did you enter menopause earlier.
Either indicates a possible problem.

4. Food.
Are you generally getting enough calories ?
Is there enough calcium in your diet ? Are you getting enough Vitamin D ?

5. Are you, or have you, taking corticosteroids e.g. prednisone, for things like asthma, psoriasis, rheumatoid arthritis ?
You have ?
Then you might have premature bone loss unless you've been taking additional drugs to stop bone loss.

6. Smoking ?
Bad news for bone health.


Want to know more ?

Try Reversing Osteopenia

Exercises for Osteoporosis

Asthma and COPD treated with Carbon Monoxide ?

Who would have thought that the killer gas carbon monoxide might be used to treat Asthma and Chronic Obstructive Lung Disease (COPD).

It turns out that carbon monoxide (CO) is produced naturally by the body in tiny quantities. The Swedish doctor Hulb Kerstjens tried giving 18 people a very low dose of carbon monoxide added to air for 4 consecutive days and found that inflammation had reduced by a third. Even more promising was that the lungs of the people involved also became more resistant to irritants in the air. Pollen, tiny particles from diesel fuel, molecules flying off furniture indoors and many other irritants set of an asthma reaction in many with this condition. Watch out later this year for news of a larger trial.

Breathing carbon monoxide (even in very low doses) needs to be made safer and more repeatable. Several companies are researching methods of delivering CO right to where it's needed on a molecule. The right molecule will unload exact quantities of CO right where needed. HemoCorm and Alfama are two such small bio research and development companies.

It's turning out that the application of CO could go much wider than asthma and COPD.

Ikaria of New Jersey (with R+D near Seattle, WA) is starting a clinical trial to find out if inhaled CO can help patients who have received kidney transplants.

It's possible that CO technology might find use in treating such diverse health issues as rheumatoid arthritis and acute liver failure.

Enjoy this article in AARP (American Association Of Retired Persons) and the photo on the right by Asger Carlsen/Getty Images.

Every day there seems to be more about over 60's, over 70's and no doubt very soon 100+ people showing phenomenal strength (strong for any age not just strong for their age).

I am just a little skeptical of this photo. It appears to show a guy of 122 pounds dead-lifting 495 pounds. To do the math, that is about 4 times body weight ! That is Olympic class at any age.

I'm a member of AARP. You can join from 50 onwards. Do not wait until you are retired to join.

As a Personal Trainer I offer a discount to AARP members.
Look for the white on gray box near the center of the BodyRestored.com home page or click here. Scroll down looking on the right for a box headed Find a TRAINER and enter my zip code of 30022.

Hard Core Body Building for everyone - including Seniors

Todays' New York Times had a great article about the over-60's developing really serious muscle. Look at this picture of Melvin Cooper, 64. The picture was taken by Kelly Shimoda for The New York Times.

Look at the full article to read about 60 and 70 year olds finding out that it's still possible to gain a body to envy with lots of muscle showing through virtually no sub-cutaneous fat.

All of them committed to 'natural' body building i.e. no use of Human Growth Hormone, Testosterone Therapy, steroids or the like. Equally they agree that you have to supplement seriously and that means creatine, glutamine, branched-chain amino acids, lots of vitamins and minerals plus eating 'clean'. That means getting the balance of protein, carbs and fat exactly right and moreover eating at the right times relative to exercise.

More pictures of amazing master going on senior fitness successes.