A Path to Wellness NYC

22Mar 2017

osteoporosis2“Osteoporosis is my passion. It is important to know the facts about this common disease, which can affect the quality of life for so many individuals, particularly post-menopausal females.”
– Magdalena Cadet, M.D. – Rheumatologist

Osteoporosis, is defined as a disorder of low bone mass causing bones to become thin, weak and brittle. This condition is not acutely life threatening, but can lead to debilitating fractures of the hip, spine and wrist along with various complications. Some of these fractures result from low trauma such as coughing, sneezing or tripping after losing balance. Complications from an osteoporotic fracture may significantly impact a person’s daily activities and quality of life.

Some of the risk factors for osteoporosis include age, family history, history of previous fracture, race, vitamin D deficiency, low body mass index, excessive alcohol intake and smoking history, certain medications like steroids and specific diseases such as rheumatoid arthritis. Males are also at risk as well as some younger individuals who may have medical conditions such as lupus, seizures, inflammatory bowel disease or thyroid disorder, and are taking treatment that may affect bone quality.

ostoeporosisAt the American Society for Bone and Mineral Research Annual Meeting in 2016, there was a discussion focusing on the “call to action” by numerous bone health-related organizations to increase the screening, diagnosis and treatment of individuals who are at high risk for fractures. The annual meeting emphasized the need to adequately treat osteoporosis around the country and the world. Dr. Kenneth Saag, the president of the National Osteoporosis Foundation spoke about the upward projection of increases in hip fracture in men and women by 2050 as compared to the past. This increase will be likely due to a significant decline in the rate of bone density (DXA) testing therefore resulting in the decline in diagnosis and treatment of high risk patients. Dr. Saag also pointed out that 2016 data surprisingly showed half as many patients were placed on an osteoporosis regimen compared to the mid-2000s.

As a rheumatologist, it is imperative to assess an individual’s risk for osteoporosis and fracture. This is done by:
• Obtaining a thorough clinical personal and family history
• Performing bone density testing (DEXA)
• Obtaining blood work to check for calcium, vitamin D, parathyroid and thyroid levels
• Using an online tool called FRAX to quantify an UNTREATED individual’s ten-year probability of a hip or major osteoporotic fracture.

Once this assessment is completed, physicians should discuss lifestyle changes to help prevent this bone disorder. A few of these tips include:

• Stop smoking today! Get on some type of nicotine replacement with the advice of your doctor as soon as you can. It is no surprise that nicotine consumption can generate free radicals that destroy bone cells and increase cortisol levels that accelerate bone deterioration.
• Limit the excessive (more than 2-3 ounces a day) alcohol intake. Alcohol interacts with bone forming cells and can affect the liver and pancreas which play a role in calcium and vitamin D absorption.
• Engage in balance and flexibility training and strengthening (weight bearing) exercises to stimulate estrogen production and bone formation. Swimming, walking, yoga and Tai Chiu are encouraged.
• Get some adequate calcium and vitamin D into the diet. Good sources of calcium can be found in milk, yogurt, nuts (almonds), cheese, dark green vegetables, orange juice, sardines and soy milk. Vitamin D sources may include cod liver oil, fish oil, eggs, fortified dairy products and over the counter supplements.

Sometimes women and men may develop worsening bone density despite their participation in good lifestyle modifications, and may require medications to increase their bone density and strength. Some of these medications aim to help build bone mass and increase bone strength, and other medications aim to prevent further bone loss. Other drugs affect the interaction of the different cells involved in the bone remodeling process. Estrogen has also been used to help protect the skeleton by promoting calcium absorption and preventing the death of bone forming cells. Every person is different and must discuss the options with his or her physician and evaluate the comfort level with the drug side effect profile before making a final decision. Keep in mind that not treating osteoporosis is risky and may lead to disability. No therapy is permanent.

“I hope that with more education about this public health concern, people will empower themselves to take measures to improve their bone health!” – Magdalena Cadet, M.D. – Rheumatologist

For more info on Dr. Cadet and the Bone & Joint Health and Osteoporosis Center of The Spine & Pain Institute of New York, please visit: www.OsteoCenterNY.com

www.nof.org (National osteoporosis Foundation)
www.rheumatology.org (American College of Rheumatology)
Highlights from American Society for Bone and Mineral Research Annual Meeting September 16-19; Atlanta

17Mar 2017

shutterstock_107831294Nurse Practitioners and Physician Assistants: Who are they and what do they do?

With the increasing demands on healthcare services and Physicians in particular, healthcare roles such as a Physician Assistant (PA) and Nurse Practitioner (NP) have evolved and developed over recent years. In the past, these roles were known as “mid-level” healthcare providers; however this term can portray these highly qualified and skilled healthcare professionals to only provide an average or mediocre service to patients which is far from the truth! In fact, NP’s and PA’s undergo extensive and rigorous education and clinical training followed by robust state examinations before attaining a license to practice and treat patientsa,1.

Let’s look at the table below, which outlines the similarities and differences between their extensive training and their roles as healthcare professionals in patient care.

Screen Shot 2017-03-17 at 10.46.46 AM

Although their training is different, both NP’s and PA’s can work in private practice, hospitals, ambulatory centers and can specialize within a particular field of medicine or population1,3. NP’s blend clinical expertise in their assessment, diagnosis and treatment of health conditions with disease prevention and health education resulting in a comprehensive health care plan1. PA’s assess, diagnose and treat health conditions focusing on their clinical and scientific expertise and experience3. A point that is often forgotten but fundamental to quality healthcare is the time spent with patients. NP’s and PA’s often have more time with patients – thus increasing the value and quality of the care patients receive. Casey Grillo, one of our NP’s sums it up with a simple but fitting thought: “Nurse Practitioners… The heart of healthcare.” Here at The Spine & Pain Institute of New York, our highly qualified and skilled NP’s and PA’s work alongside our attending Physicians as a team; assessing and treating each patient based on their individual needs. Each patient case is discussed in detail using the best available evidence. Combining these backgrounds provides a platform for our patients to receive the highest quality of care. So… whether you are seen by our NP’s, PA’s or attending Physicians during your visits with us, rest assured you will receive the most advanced, beneficial and appropriate treatment and care available!

References

  1. aanp.org (American Association of Nurse Practitioner’s)
  2. Criteria for Evaluation of Nurse Practitioner programs, 2012, 4th
  3. aapa.org (American Association of Physician Assistant’s)
09Mar 2017

headshot8Since my childhood, I have always been fascinated by the power of musculoskeletal system and the amazing things it can do.  As a current long distance runner and former competitive figure skater and dancer, I have become fascinated by the interplay of bones and joints with ligaments and tendons.

I had a few other poignant experiences during my medical journey, which led me to the field of rheumatology.  During my second year of medical school, I met a girl who had complained of several months of joint pain and swelling, fatigue, weight loss, hair loss, and a rash. She came to me one day and told me that she had been diagnosed with lupus (SLE). At that point in medical school, I had never heard of this disease and I believed that arthritis only affected older patients and only involved the joints. I later learned that this was a myth. She never fully understood the extent of her disease. She was not aware of the co-morbidities, such as early heart disease, lung disease, or kidney damage, that can occur with SLE and other rheumatologic conditions if early and aggressive treatment is not taken to control the disease activity. Several months after her diagnosis, I received the sad news that she had passed away from complications of her disease.

I also watched my best friend’s father who is a physician battle with moderate to severe psoriatic arthritis. He had to temporarily walk away from his medical practice for several years until his joint pain, stiffness and physical function improved after receiving treatment. During my years as a rheumatologist, I’ve seen many more patients who have touched my heart and left the same imprint on my mind. I see some patients struggle with daily common activities like brushing their teeth, combing their hair, or walking a block due to their arthritis.  Arthritis and other musculoskeletal and autoimmune diseases can affect one’s physical and emotional functioning.  My goal is to encourage individuals to take an active role in their disease management by first educating themselves about their condition. I also encourage all individuals living with arthritis or autoimmune diseases to engage in a healthy lifestyle such as exercising, watching their caloric intake and being aggressive about their treatment plan and follow up care.

If you are interested in learning more about Dr. Cadet, please feel free to email or call one of our offices for a consultation. She would be more than happy to discuss your condition and treatment options for an individualized treatment plan. www.OsteoCenterNY.com

01Mar 2017

SCS-implantA spinal cord stimulator, also known as SCS, is a surgical implantable device that sends electrical pulses to the spinal cord nerves for the management and relief of chronic pain.

SCS is an alternative therapy typically recommended for patients who have been unresponsive or failed conventional therapies. Such therapies include but are not limited to, oral medication and steroid injections. SCS can also benefit patients who have underwent and failed more aggressive procedures such as back surgery, patients who suffer from residual pain after surgery, patients who suffer from chronic peripheral neuropathy or plexopathy, and patients who have been diagnosed with illnesses like Multiple Sclerosis, just to name a few.

SCS is an innovative technology that targets some of the most difficult pain problems a person can be challenged with. This technology has given patients a second chance to experience a normal pain free life, resuming everyday activities, without many restrictions or pain related worry. It has allowed patients to regain control of their lives.

“For the appropriate patient, the application of spinal cord stimulation can dramatically decrease pain and restore quality of life” says Dr. Kiran V. Patel, Pain Management Specialist at The Spine & Pain Institute of New York.

If you are interested in learning more about SCS for your chronic pain, please feel free to email or call one of our offices for a consultation. Our award winning physicians at The Spine and Pain Institute of New York would be more than happy to discuss your condition and treatment options for an individualized treatment plan.

(Anthony H Wheeler, MD;  Kim J Burchiel, MD  2015)
http://emedicine.medscape.com/article/1980819-overview

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