Symptomatic knee osteoarthritis (OA) increased during the past 20 years but radiographic OA did not

A recent surge in knee replacements is assumed to be due to aging and increased obesity of the U.S. population.

This cross-sectional study used data from 6 NHANES (National Health and Nutrition Examination Survey) surveys between 1971 and 2004 and from 3 examination periods in the FOA (Framingham Osteoarthritis) Study between 1983 through 2005 of the U.S. population.

Prevalence of knee pain increased by 65% in NHANES from 1974 to 1994.

In the FOA Study, prevalence of knee pain and symptomatic knee osteoarthritis doubled in women and tripled in men over 20 years.

However, no such trend was observed in the prevalence of radiographic knee osteoarthritis.

Prevalence of knee pain has increased substantially over 20 years. Obesity accounted for only part of this increase.

Symptomatic knee osteoarthritis increased but radiographic knee osteoarthritis did not. Why the patients are more symptomatic now than 20 years ago?

What is Boomeritis?

In 2006, the NYTimes described the health problems of aging baby boomers who continue to exercise: osteoarthritis which needs "knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures." Some doctors call this phenomenon "boomeritis" or "Generation Ouch."

References:

Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis: Survey and Cohort Data. ANN INTERN MED, December 6, 2011, vol. 155 no. 11 725-732.

What is Boomeritis?

Image source: OpenClipart.org, public domain.

Boxing and brain disease - Cleveland Clinic video

Boxing and Brain Health - a video from the Cleveland Clinic YouTube channel.

Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

First snowmobile front flip landed and winter sport trauma (video)

Heath Frisby lands the first snowmobile front flip in competition:



This is what happens when the things don't go as planned: Colten Moore flies 120 feet into the air and then hits the snow hard in Snowmobile Freestyle Finals... (video below). He not only survived but went on to win Winter X Games Gold later.



Not all extreme winter sport champions are so lucky though, and some of them have barely escaped death, with life-altering injuries: Kevin Pearce reflects on Sarah Burke's death (USA Today).

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Acute altitude illnesses

This summary is based on a recent BMJ review:

Acute altitude illnesses include:

- high altitude headache
- acute mountain sickness
- high altitude cerebral edema
- high altitude pulmonary edema

Typical scenarios in which such illness occurs include:

- a family trek to Everest base camp in Nepal (5,360 m)
- a fund raising climb of Mount Kilimanjaro (5,895 m), shown in the map below
- a tourist visit to Machu Picchu (2,430 m)


View Larger Map

High altitude headache and acute mountain sickness often occur a few hours after arrival at altitudes over 3,000 meters.

Occurrence of acute mountain sickness is reduced by slow ascent. Severity can be modified by prophylactic acetazolamide.

Mild to moderate acute mountain sickness usually resolves with:

- rest
- hydration
- halting ascent
- analgesics

Occasionally people with acute mountain sickness develop high altitude cerebral oedema with confusion, ataxia, persistent headache, and vomiting.

Severe acute mountain sickness and high altitude cerebral edema require urgent treatment with:

- oxygen if available
- dexamethasone
- possibly acetazolamide
- rapid descent

High altitude pulmonary edema is a rare but potentially life threatening condition that occurs 1-4 days after arrival at altitudes above 2,500 meters. Treatment includes oxygen if available, nifedipine, and rapid descent to lower altitude.

What do extreme athletes who can summit the peaks of Mt. Everest have in common with people with heart failure? This Mayo Clinic video explains it:



References:

Clinical Review: Acute altitude illnesses. BMJ 2011; 343:d4943 doi: 10.1136/bmj.d4943

Restraint technique could be fatal: Forcing a detainee to bend over while seated can lead to death

Researchers found that the hold, forcing a detainee to bend over while seated, can massively cut lung capacity.

They placed 40 volunteers in chairs and then leaned them forward, bringing their face close to the lap. They used arm holds and applied a small amount of force to prevent the volunteer from attempting to return to a normal sitting position. In the worst cases, the lungs' capacity was almost halved.

"Imagine that from the perspective of the security staff. They feel you struggle and they will feel that you are getting angry. They will apply more force to manage your resistance. It becomes a vicious circle."

References:

Restraint technique could be fatal, research suggests. BBC.

Pets Cause Many ER Visits For Owners Due to Accidental Falls

From Cleveland Clinic YouTube channel: Accidental falls are the leading cause of non fatal injuries in the United States according to the American Association of Neurological Surgeons, and a new study finds more than 86,000 of those falls are caused by cats and dogs.

AMA Guide to Assessing and Counseling Older Drivers

Motor vehicle injuries are a leading cause of injury-related deaths in the older population (persons 65 years and older). Per mile driven, the fatality rate for drivers 85 years and older is 9 times higher than the rate for drivers 25 to 69 years old.

Physicians play an important role in the safe mobility of their older patients. The AMA encourages physicians to make driver safety a routine part of their geriatric medical services and the guide is freely available as PDF documents here:

AMA Physician's Guide to Assessing and Counseling Older Drivers

For example, dementia is just one of the risks that older drivers face:



Evaluation of driving risk in dementia (click to enlarge the image).

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

References:

AMA Physician's Guide to Assessing and Counseling Older Drivers

Evaluation of driving risk in dementia - practice parameter update

How much heat you can take? 232 years ago, three British gentlemen found out

Have you ever wondered how much heat you can take? 232 years ago, three British gentlemen decided to find out: 260 degrees Fahrenheit (126.6 degrees Celsius).

From NPR:



Be sure to check the cartoon slideshow too.

First Gunshot Victim in the New World - National Geographic Video

Archaeologists in Peru have discovered the 500-year-old skeleton of a man who died from a gunshot wound. Experts believe he's the first shooting victim in the New World.

Cyclist who survived: Use your head. Use your helmet

James Cracknell, OBE (born 5 May 1972) is a British rowing champion and double Olympic gold medalist.

From Official JCracknell: On 20th July it's exactly one year since James Cracknell was seriously injured in a cycling accident in America. His helmet saved him. James has made a short film to encourage others to wear cycle helmets. To show your support, pass the film to your friends and most importantly, when you're out cycling, use your head. Use your helmet.

More about the cycling Accident from Wikipedia:

On 20 July 2010, Cracknell was hit from behind by a truck whilst attempting to cycle, row, run and swim from Los Angeles to New York within 16 days. The accident happened at around 5.30 am on a quiet stretch of road outside Winslow, Arizona. It has been reported that his bicycle helmet saved his life but he suffered a contre-coup injury to the frontal lobes of his brain. He is now back at home with his family, although recovery is expected to be still some time away.

Related reading:

How Dangerous is Cycling? Cycling Accidents Facts and Figures - INFOGRAPHIC

Professor Tracks Clusters of Terrible Sport Injuries in Hope of Prevention

From the NYTimes:

Prof. Mueller almost immediately noticed a previously hidden cluster in, of all things, pole-vaulting. Several high school and college athletes each year were killed or paralyzed simply by missing the pit with the pole, falling on their heads off the landing pad, or sliding down the pole and hitting their heads on hard surfaces. Pits were soon expanded and surrounded with softer padding.

Mueller detected a strange number of paralytic accidents in organized swimming, all from relay-type dives into water that was too shallow — resulting in today’s minimum depths.


Concussion Recovery - Mayo Clinic Video

References:
Professor Tracks Ghastly Injuries in Hope of Prevention - NYTimes.com.

Video: Teens See Dangers of Texting While Driving

AssociatedPress — May 16, 2010 — Teenagers are driving through an obstacle course with their cell phones in hand to see why texting while driving is so dangerous.

Related:

Proposal: All cell phones sold in Chicago to allow parents to block their children from texting while driving. Chicago Tribune, 2011.

Effect of deployment on mental health of soldiers: common disorders and alcohol misuse more frequent than PTSD

This Lancet study examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009.

9990 (56%) participants completed the study questionnaire (roughly 8000 regulars, 1700 reservists).

The prevalence was:

- 19·7% for symptoms of common mental disorders

- 13% for alcohol misuse

- 4% for post-traumatic stress disorder (PTSD)

Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22) and with post-traumatic stress disorder (PTSD) for reservists (2·83)

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of post-traumatic stress disorder (PTSD) was low.

References:

What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, Volume 375, Issue 9728, Pages 1783 - 1797, 22 May 2010.

What Happened to the Marlboro Marine?

Image source: The Los Angeles Times.

Decompression illness - Lancet review

Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression).

Types of decompression illness

The term decompression illness covers 2 entities:

- arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation

- decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas

Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression.

Risk of decompression illness is affected by immersion, exercise, and heat or cold.

Clinical features of decompression illness

Manifestations of this condition include a wide range of symptoms and signs:

- itching and minor pain

- neurological symptoms

- cardiac collapse

- death

Treatment of decompression illness

First-aid treatment is 100% oxygen. Definitive treatment is recompression to increased pressure, breathing 100% oxygen.

Adjunctive treatments include fluid administration and prophylaxis against venous thromboembolism in paralysed patients.

Prognosis of decompression illness

Treatment is effective in most cases although residual deficits can remain in serious cases, even after several recompressions.

References:
Decompression illness. The Lancet, Volume 377, Issue 9760, Pages 153 - 164, 8 January 2011.
Image source: OpenClipArt.org, public domain.

Headache? It could be that blade in skull (CNN video)

CNN: "I've got these stabbing pains" - Man complains about migraine, finds he has had a knife in his brain for 4 years.

Related reading:

Daily Mail

Sports Health With Cleveland Clinic (video)

There are a lot more sports health-related video from Cleveland Clinic on YouTube. I find many of these useful but they often don't get the numbers of views they deserve, for example the video embedded above was watched only 20 times as of 03/23/2011 (it was posted on 01/10/2011).

Protecting the brain from concussion: $20-helmet is a good way to protect $100,000 education

Neuropsychologist Kim Gorgens makes the case for better protecting our brains against the risk of concussion -- with a compelling pitch for putting helmets on kids: A $20-helmet is a good way to protect $100,000 education. "Mind your (brain) matter."

Just consider the following tragic story:

Former NFL payer shot himself in chest so that his brain could remain intact for examination for encephalopathy

Before he shot himself fatally in the chest Thursday, the former Chicago Bears defensive back Dave Duerson sent family members text messages requesting that his brain tissue be examined for the same damage recently found in other retired players.

As a longtime force in the N.F.L. players union, Duerson, 50, was keenly aware of chronic traumatic encephalopathy, the degenerative brain disease linked to depression, dementia and occasionally suicide among more than a dozen deceased players. He had expressed concern in recent months that he might have had the condition.

“This thing has the whole union community pretty shaken up.”

Related reading:

The protective effects of helmets in skiers and snowboarders - why 15% of neurosurgeons bought helmets right away. BMJ, 2011.

Before Shooting Himself, Duerson Asked That His Brain Be Studied, NYTimes, 2011.

Former NFL payer shot himself in chest so that his brain could remain intact for examination for encephalopathy, NYTimes, 2011.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Cars Decide If Driver Is Drunk - Video

Associated Press: An alcohol-detection prototype that uses automatic sensors to instantly gauge a driver's fitness has the potential to save thousands of lives, but could be a decade away from everyday use in cars.

Motorists under the influence of drugs are a growing threat on U.S. roads. If you think about driving on a Friday or Saturday evening about 16% of the vehicles - one in six of the cars - the driver will be under the influence of an illicit or licit drug.

"Drugged driving" hampers judgment, reaction time, driving skills and memory.

Related:
16% of motorists may be under the influence of drugs during weekends - one in six of the cars
Drunk Driving, Distracted Driving, Moralism, and Public Health - NEJM
30% of U.S. adults have been arrested by age 23: study. Reuters, 2011.