by Dr. C.V Ramana

What is osteoporosis?
It is the “weakening” or “softening” of bones.
Bone consists of a framework or matrix of collagen and other soft tissue elements. It is then “hardened” by deposition of calcium mineral into the matrix. We think of bone as being a “static” component of the body, but this is not true. Bone is constantly formed and broken down throughout our life as the result of a complex interplay of dueling hormones, health, diet, and activity. In childhood and young adulthood, bone growth is faster than breakdown. People generally reach peak bone mass in their late 20’s. After that, bone breakdown tends to be faster than new bone formation. When calcium is taken out of mature (or fully formed) bone and not replaced, the frame left behind is soft or weak, and easily susceptible to fracture.
Why is calcium needed in the body?
Calcium is an important mineral in the body – it is vital to the formation and strengthening of our bones, but also plays an important role in the function of muscles and nerves as well as innumerable biochemical reactions in the body. Calcium is transported throughout the body dissolved in blood, and so, available to all of our organs and tissues in carrying out their functions. The amount of calcium in the blood is tightly regulated by hormones released into the bloodstream from the thyroid and parathyroid glands (located below the Adam’s Apple), pituitary gland (in the brain), as well as the adrenal glands and kidneys.
Our bones serve as a massive reservoir of calcium that can be tapped when calcium levels in the blood are low due to inadequate dietary intake, inadequate levels of vitamin D in our bodies, or the wrong form of vitamin D due to inadequate exposure to sunlight, or as a result of some medications.
How to know if you have osteoporosis?
Unfortunately, this is a “silent disease” and does not become symptomatic until a bone is fractured, or the back becomes kyphotic (stooped) due to slow collapse of multiple vertebra in the upper spine.
How to find out if you have osteoporosis?
Sometimes the diagnosis may be suggested based on the appearance of bones on x-rays or CT scans that you may have for other reasons. The most reliable way, though, is through a test called DEXA which measures Bone Mineral Density (BMD) in various bones in the body.
Blood tests to determine the level of Calcium, Vitamin D, calcitonin and parathyroid hormone can also be helpful, especially in planning treatment.
Risk factors for developing osteoporosis
Factors that can be modified
* Lifestyle – inactive lifestyle or extended bedrest
* Smoking
* Alcohol consumption
* Inadequate dietary intake
* Sex hormones – abnormal absence of menstrual periods or menopause with low estrogen in women, and low testosterone in men
* Medications – long term use of steroids, some seizure medications
Factors that cannot be modified
* Sex – women are more prone to develop this than men
* Age – bone mass decreases in everyone after the late 20’s
* Body size – small boned women are more likely to develop osteoporosis]
Ethnicity – Caucasian and Asian women have a higher likelihood, though African American and Hispanic women are also at high risk.
* Heredity – people whose parents have osteoporosis have an increased likelihood
How can it be treated?
* Smoking cessation
* Decrease alcohol consumption
* Lifestyle modification – weight bearing exercises such as walking, jogging, hiking, climbing stairs, playing tennis and dancing are all good. Resistance exercises such as weight lifting or weight training machines are good
* Increase dietary intake of calcium and vitamin D
* Recommended levels – calcium – more than 1000 mg/day after the age of 30, and 1200 mg/day for women after the age of 50. Vitamin D – more than 600 IU/day for adults up to age 70, and 800 IU/day for men and women beyond the age of 70.
Medications
* Supplemental calcium and Vitamin D
* Prescription medications that work in a variety of ways to interfere with the rates of bone formation and breakdown balance
* Bisphosphonates (which bind to calcium for deposition in bone)
* Estrogen and estrogen analogues
* Estrogen receptor modifiers
* Calcitonin – hormone
* Parathyroid hormone blocker
Who can treat Osteoporosis?
A primary healthcare provider should be contacted for diagnosis and development of a treatment plan. In some cases, they may refer to a specialist for the treatment. Specialists can include endocrinologists, rheumatologists, and women’s health specialists such as an Ob/Gyn.
Dr. C.V Ramana is a vascular and interventional radiologist with more than 20 years of practice experience. He has expertise in all areas of vascular and interventional radiology. Dr. Ramana has a Ph. D from Yale University and MD from CWRU in Cleveland, Ohio where he subsequently completed his fellowship in Vascular and Interventional Radiology at the Cleveland Clinic. https://naadihealthcare.com/

1 NW 64th Street 73116 Oklahoma City, OK Phone: (405) 608-8884

Each year, across the country, thousands of educators, caregivers, health and aging professionals, and older adults focus their efforts on one goal: preventing falls. That’s why the Oklahoma State Department of Health (OSDH) is partnering with the National Council on Aging (NCOA) and the Falls Free® Coalition to celebrate Falls Prevention Awareness Day, Sept. 23. This year’s activities will focus on the teamwork needed to prevent falls effectively.
Every second of every day in the United States an older adult falls, making falls the number one cause of fatal and nonfatal injury among older Americans. Every week in Oklahoma, approximately 124 adults age 65 and older are hospitalized and 11 die from a fall. Acute care hospital charges alone total more than $250 million a year.
Falls are not a normal part of aging, and an individual has the power to prevent them. The OSDH offers the following tips on simple tips to prevent falls:
Exercise regularly. Exercises that improve strength, balance, and coordination are the most helpful in lowering the risk of fall-related injuries.
*Speak up. Talk to your doctor about fall risks and prevention. *Ask a doctor or pharmacist to review both prescription and over-the-counter medications for side effects and interactions. The way medications work in the body can change with age. Some medications or combinations of medications can contribute to drowsiness or dizziness, which increases the risk of falling. *Have vision screenings at least once a year. The wrong prescription eyeglasses or health conditions, such as glaucoma or cataracts, limit vision and may increase the risk of falling. *Reduce hazards in the home that may lead to fall-related injuries. *Keep floors clean and clear of clutter where people walk.
*Maintain adequate lighting throughout the home, especially near stairways. *Remove throw rugs or use non-skid throw rugs in the home, and use non-slip mats in the bathtub or shower. *Install handrails on stairways and grab bars in bathrooms. *Keep regularly needed items in easy-to-reach places that don’t require the use of a step stool.
The Tai Chi: Moving for Better Balance program has been proven to reduce the risk of falls. Throughout Oklahoma, many individuals have been trained as Tai Chi instructors and teach Tai Chi: Moving for Better Balance classes to older adults. This exercise program focuses on improving functional abilities, such as balance and physical function, to reduce fall-related risks and frequency of falls. Oklahoma seniors are invited to join one of the more than 90 open Tai Chi: Moving for Better Balance classes across the state.
To receive more information on classes and how to prevent falls, contact the OSDH Injury Prevention Service at (405) 271-3430 or visit http://falls.health.ok.gov.

Gov. Kevin Stitt signed a bill on that enhances requirements for health care providers who perform mammograms to notify patients about their test results. The measure is part of Oklahoma’s ongoing efforts to fight breast cancer.
Known as Nancy’s Law, the legislation is named for Nancy Simpson of Edmond, who lost her life to breast cancer in 2018 at the age of 69. The law focuses on dense breast tissue, which can interfere with efforts to detect breast cancer.
“Mammograms are vital tools for detecting breast cancer,” said Sen. Adam Pugh (R), Edmond, who co-authored the bill. “But for some women, they may not tell the whole story. Nancy’s Law will equip those women with the knowledge they need to take charge of their health and, in some cases, save their lives.”
Dense breast tissue affects as many as half of all women and can obscure basic mammography scans, making cancer more difficult to detect. Under existing Oklahoma law, if a patient is found to have dense breast tissue, when she receives her mammography results, the health care facility that performed the mammogram must advise the patient of this fact and provide information on additional testing options.
The new legislation requires those mammography results and notification to be emailed to the patient if she so elects.
“Our wives, mothers, sisters and daughters depend on breast screening to detect cancer,” said the bill’s co-author Rep. Lewis Moore (R), Arcadia. “This new measure will give more Oklahoma women the chance to live their lives cancer-free.”
Simpson worked for 30 years as a laboratory technician at the Oklahoma Medical Research Foundation, searching for effective ways to control fats that play a major role in heart disease and stroke.
Although she underwent yearly mammograms, Simpson’s dense breast tissue hid her cancer until doctors discovered it at stage 4, when it was too advanced to respond to treatment. At the end of her life, she wrote a letter to Pugh and Moore that served as the catalyst for the new legislation.
“Nancy dedicated her career to helping make discoveries to benefit people she would never know,” said OMRF President Stephen Prescott, M.D. “Even in the fight for her own life, she did what she could to ensure that future generations of women could take control of their own breast health and live longer.”
“We are so grateful to Sen. Pugh and his staff for what they’ve done in Nancy’s memory,” said John Simpson. “Nancy was a caring, empathetic person. She would love knowing that Nancy’s Law will save lives.”
“This law is a major step for women’s health in Oklahoma,” said Stitt. “It ensures that all women can take advantage of advances in breast cancer detection and treatment that can spell the difference between life and death.”
Nancy’s Law will take effect Nov. 1.

For the past week, I have been scouring drug stores searching, without success, for a greeting card I plan to mail to Erramatti Mangayamma and her husband, E. Raja Rao.
The card I’m looking for would say, “Congratulations! What the hell were you thinking?”
On Sept. 5, Mangayamma gave birth to twin girls. This event alone may not be card-worthy, as women give birth every day. But not all of them are 73 years old.
With an 80-year-old husband.
Mangayamma, who is from Andhra Pradesh, India, is believed to be the oldest woman ever to give birth. Unable to conceive since they were married in 1962, the couple approached Dr. Sanakayyala Umashankar, who reportedly agreed to administer one round of in vitro fertilization to Mangayamma.
As someone whose second child was conceived via IVF, I know the risks involved with implanting multiple eggs into a woman’s body. Before doing so, our fertility doctor wanted us to be aware we could end up with not one child, but an entire litter, and were we OK with that?
We ended up with one but, with an infant and a kindergartner to care for, we were routinely exhausted by midday. At the time, my wife was 36. I was 39. Roughly half the ages of Mangayamma and Rao.
Don’t get me wrong, having a baby is a joyous occasion. But do new parents who are well into their years of Social Security eligibility, IRA withdrawals and entry into retirement communities REALLY know what they are getting themselves into? Mrs. Mangayamma, you do know that you can’t go to bed until your new girls have drifted off, right? I’m 56 and my bedtime is approximately 9:30 p.m.
Your infants’ bedtimes should be approximately, oh wait, infants don’t have set bedtimes. Never mind.
Mr. Rao let’s discuss your duties as a first-time dad. Are you OK with assembling two cribs, two strollers and, nightly, bathing two slippery babies? The latter requires very steady hands. I’m not making any assumptions about your manual dexterity but just yesterday, my fingers unexplainably twitched, causing me to drop a full glass of water. Just saying.
Now, new parents, let’s flash forward a few years. I’m not sure how popular youth sports programs are in India, but my girls started playing soccer and softball when they were 6. Mr. Rao, how are your coaching skills? At 86, will you be up to teaching a team of giggly first-graders how to execute a corner kick? Will you be able to frantically wave your arm in a circular motion, signaling your lead runner should round third base and head for home? Are you confident you can perform both those feats without crumbling to the ground, having pulled something?
Also, be ready to argue with opposing coaches who may have different views about athletic development. Sports have changed considerably since you grew up in the good old 1950s.
Finally, let’s not forget that you sired two girls. It’s worth noting that, sometime around 2030, both will be entering those hormonally charged years that, for parents, are about as pleasant as repeatedly biting your tongue in the exact same spot. Mrs. Mangayamma, you’ll be 84 while your husband will be 91. Better pray you both suffer from hearing loss by then; it’s the only way you’ll be immune from the sounds of slamming bedroom doors, screaming arguments about who-took-whose pair of Justice shorts and shouting matches involving bathroom time.
Also, both likely will have radically different dietary restrictions by then. The only thing they will have in common is their disdain for your dinner of choice: Jell-O and soup.
Well, I’ve probably given too many opinions. I’m sure that, after more than 50 years of yearning for children, you two will make amazing parents. Enjoy the experience because it goes so fast. In the blink of an eye, they’ll be out of college and on their own.
And, at 94 and 101, you’ll be empty-nesters.

My favorites are the foliage colors and of course the temperature and the weather.

Rosa Knight

I can work in my garden again and there’s no mosquitoes.

Melanie Wright

The coolness and the Oklahoma State Fair.

June Cavendish

OU football and tailgating.

Vicki Bailey

About one in five licensed drivers in the United States is over the age of 65. Driving is one of the last points of independence some seniors have to give up. This makes it difficult when a family has to have the conversation with an elderly loved one about whether or not it is safe for them to continue driving.
“It is a major life change,” said Faye Beam, coordinator for the Retired and Senior Volunteer Program (RSVP) of Central Oklahoma’s Provide A Ride (PAR) program.
Provide-A-Ride is a free medical transportation program for seniors who are no longer able to drive to doctor’s appointments. Volunteers pick up seniors, take them to their appointments, wait with them, and return them home. Currently, volunteers take PAR clients to more than 300 physicians in the Oklahoma City metro area.
“I receive calls often from children concerned about their elderly parents driving,” Beam said. “All families face similar scenarios. Children become caregivers for their parents, and they worry about their well-being and safety.”
Some of the red flags Beam hears from family members about their elderly parents and driving include: parents getting lost, vision problems at night, easily distracted while driving, developing fear related to driving, or unable to keep up with the expenses of owning a vehicle.
Beam wants families to know that PAR can be a reliable, safe alternative form of transportation for their loved one and encourages family members to have their loved one call and talk with her about the program.
“I always try to make clients feel at ease and comfortable and in charge of scheduling their transportation to medical appointments,” she said.
As with new things, the PAR clients get used to their new form of transportation and most make friends with the volunteer drivers, Beam said.
“They have interesting conversations, and many look forward to the time spent with their Provide-A-Ride drivers,” Beam said.
Beam suggests taking gentle baby steps with elderly parents about the subject of driving.
“Give mom and dad time to think about giving up their vehicle,” she said.
Currently, the PAR program has 683 active clients and 55 volunteer drivers. Volunteer drivers choose their schedules and receive free supplemental liability insurance coverage and mileage reimbursement. If you would like more information for a loved one who can no longer drive or if you would like to sign up to be a volunteer driver, contact Faye Beam at 405.605.3110 or email her at faye.beam@rsvpokc.org.

OGE Energy Corp. will join forces with United Way of Central Oklahoma during its annual fundraising campaign to double new, first-time company contributions.
“United Way agencies provide such valuable services to our communities, and we’re only as strong as the communities we serve,” said Sean Trauschke, chairman, President and CEO of OGE Energy Corp. “We identified this as a way to help support and grow the missions of these agencies where we live and work.”
This opportunity comes at a critical time as United Way of Central Oklahoma begins fundraising efforts for 57 local nonprofits, serving hundreds of thousands of clients each year who need us more than ever. The gift will help Partner Agencies serve more central Oklahomans by providing life-saving services to those in need.
“OGE Energy Corp. is known for giving back in big ways, and we are truly grateful that they thought of United Way – that says a lot about the caring nature of their organization,” said Debby Hampton, United Way of Central Oklahoma president and CEO. “It takes all of us to make this a more compassionate community, and OGE’s support is one of the big puzzle pieces that makes that possible throughout central Oklahoma.”
Donations may be made online at unitedwayokc.org or by giving through your workplace campaign.
About United Way of Central Oklahoma
United Way of Central Oklahoma researches human needs within the communities of central Oklahoma and directs resources to accountable health and human services agencies to meet those needs by improving the health, safety, education and economic well-being of its most vulnerable citizens. For more information about United Way of Central Oklahoma, please visit unitedwayokc.org or call (405) 236-8441.

by Susan Price – www.NursingHomeAbuseCenter.org

Individuals who have limited mobility or who are confined to a bed or wheelchair are at a high risk of developing bedsores. What starts as inflammation can quickly turn into a painful wound that is difficult to treat. What’s more, once bedsores are established, the patient is at risk for infection, sepsis, gangrene, and amputation. These complications can be fatal.
Bedsores most commonly develop on bony prominences, or parts of the body that come into the most contact with a bed, chair, or other surface. Common places bedsores develop include the heels, elbows, tailbone, and shoulder blades.
Fortunately, bedsores are preventable. Caregivers who follow the standards of care for repositioning, skin care, diet, and exercise can help prevent bedsores among patients.
Exercise to Prevent Bedsores
Exercise is a great way to help prevent bedsores. Exercise increases blood flow throughout the body, including to the skin. This helps prevent bedsores by keeping skin and underlying tissue healthy and well oxygenated. Exercises don’t have to be strenuous in order to be effective. Here are some examples of the type of exercises that can help prevent bedsores. · Ankle Stretches – Ankle stretches are a great way to improve circulation and range of motion. Caregivers assist with ankle stretches by holding the heel and ankle, and slowing bending and moving the foot around. · Arm Lifts – Arm lifts can be done with assistance, or solo. Raise the arm as high as possible (and comfortable), and hold it for ten seconds. Arm lifts can be easily customized depending on the patient’s needs. · Leg Lifts – Leg lifts are a great way to improve circulation and encourage flexibility and range of motion. These exercises can be done with the patient on their back or side, depending on what is most suitable. The leg is slowly raised even with the hip, and is held there for 10-20 seconds as is comfortable and appropriate. · Palm Stretches – Palm stretches are a simple way to improve circulation in the lower arm and hand. With this exercise, the patient opens his or her hand as wide as possible extending the fingers. Then, the patient touches each finger to their thumb slowly before extending the finger again.
Doing these exercises a few times each day, or even once a day, can reduce the risk of a patient developing bedsores.
Exercise as Part of a Healthcare Plan
Exercise is most effective at preventing bedsores when it is part of a comprehensive healthcare plan.
Caregivers can also help prevent bedsores by making sure patients have adequate food and hydration, access to medical care, and assistance with hygiene.
Bedsores often develop on parts of the body that are covered with clothing or linens. Caregivers should perform routine skin checks to look for signs of a developing bedsore. Once a developing bedsore is stageable, it is dangerous and needs immediate medical attention.
Of course, you should never start an exercise regimen for yourself, or for someone you are caring for, without talking to a doctor first. Exercise should be performed with the guidance of a doctor who knows about the overall health of the patient.
Sources: www.nursinghomeabusecenter.org/bedsores/
www.accessrehabequip.com.au/blog/post/21-how-to-prevent-bedsores%3A-exercises-for-pressure-care-patients/
https://advancedtissue.com/2015/06/4-effective-exercises-for-bedridden-patients/
https://www.nursinghomeabusecenter.org/stages-of-bedsores/