Monday, June 18, 2007

Joint Health and General Physical Wellness

I think I've mentioned my musculoskeletal wellness dream world before, right? It is a land where health insurance covers the following:
  • Dental health (dentist) check up every 6 months
  • Nutrition/diet health (dietician) check up every 6 months
  • Musculoskeletal health (physical therapist) check up every 6 months
Teach and remind people how to floss, what good food choices are, how to move well with exercise, etc. and they can hopefully keep their bodies as healthy as possible.

I did a little check up on my 75 y.o. mother-in-law this week. She walks and swims for her exercise, but her L hip has been a bit painful, especially early in the morning, when she walks with my father-in-law. Ended up doing a few gentle distractions and posterior glides; taught her a pretty nice little home exercise program (HEP) that included supine and standing hip mobility work, sit-to-stand, single leg stance, yellow band side steps/monster walks and side step ups. We also did some fun balance work with the agility ladder, and experimented with the weighted vest. I think we'll get her a 15 lb. vest and see if we can't get her off the Fosomax she's been on over 5 years for low-grade osteopenia.

The next morning, after a fabulous evening of dinner and drinks celebrating their 56th wedding anniversary, she reported a significant decrease in her hip discomfort (from 8/10 to 1/10) with the morning walk. And I'm pretty sure the numbing effects of the wine and gourmet hot chocolate with Bailey's from the night before had worn off.

This morning she's still very happy, without any joint discomfort. Now, you can all imagine what happens with most 75 y.o. women who go to their general MD with hip discomfort; they get x-rays, some meds and are sent to an orthopedic surgeon who then may or may not suggest a hip replacement if the problem is severe enough. These are the people who usually only get to see a physical therapist AFTER a hip replacement, not before. They are not usually sent to a person who can do a thorough (or even basic) musculoskeletal evaluation and instruct them in a weight-bearing exercise program that addresses balance, bone/joint health, stability and safety.

Unfortunately, most people in her situation get trapped in the merry-go-round of doctor visits, tests, meds, doctors visits, more meds, more tests, chronic pain, surgery, more meds, less function, more meds, less function, and so on and so on.

If only our health care system really valued education and practitioner-patient interaction that didn't involve fancy, expensive technology. And state laws allowed, physicians supported and insurance companies paid for direct access to physical therapists for physical wellness.


Anonymous said...

Way to go T! Sounds like a good program. But........let me tell you about them ther bis phosphenates!!!! They aren't all they are cracked up to be. They might be doing more harm than good! Turns out they decrease bone turnover in general.....The latest and greatest is the idea that they may even prevent healing if a fracture does occur because of the need for osteoclast participation in remodeling after fracture... Might be a good idea to do away with the Fosomax anyway.

The Iron Maven said...

Hey S,

That's what I'm thinkin' too, but takin' baby steps so as not to do too many things at once. I told her of the new info.

I'd like to throw that crap away today. It's $80/month and their insurance doesn't pay; so they get it across the border in Mexcio. What healthcare system we have, eh?

When I talk to her next, I'll gently make the suggestion.


Suma said...

Its very informative...but Fosomax will work? I don't actual know how is it a good idea..

suma valluru