Health Features

Health Matters

Your health affects every aspect of your life, from how you feel to how you function. And while some diagnoses and issues are out of our control, many can be prevented or at least dealt with early enough to allow for a promising recovery. Here, we take a look at three main concerns: hip replacement, breast cancer and migraines.

hip replacement
You’ve got to give the baby boomers credit. They’re living longer than previous generations and want to keep the pedal to the metal—even after parts of their bodies’ original equipment have worn out. That never-give-up spirit and the advanced state of joint implants is creating what some medical journals are calling a flood of patients known as ‘bionic boomers.’

“Our baby boomer population is reaching the age where their joints are starting to wear out,” says Dr. Robert Sciortino, an orthopedic surgeon at STL Orthopedics. Hip replacement has become so successful and the materials so much better, people aren’t willing to wait. When I was a resident, we rarely did a hip replacement on someone who wasn’t 65 and retired. Now, people in their 50s don’t want to wait while the prime years of their life are limited by a bad hip.”

Sciortino has replaced 750 hips through a procedure called SuperPath, which minimizes incisions and recovery time. “In a traditional replacement, the hip is dislocated,” he says. “The only way to do that is to cut the ligaments, muscles and tendons that hold the hip together. With SuperPath, we work inside the hip joint and don’t have to cut ligaments. Recovery is a lot faster, and people don’t need to follow the same precautions.”

Most of his patients are between 55 and 65 years old, and the average length of hospital stay following a SuperPath surgery is around one and a half days, Sciortino says. About 100 of his patients went home the day of surgery. “Once they are recovered, they can do almost all normal activity,” he says. “They can do light sports, but probably not contact sports. A little bit of running here and there is OK, and I have patients continue with weight training, skiing, tennis, golf, swimming and bicycle racing.”

the facts
» Hip replacements in the U.S. more than doubled from 2000 to 2014, reaching 371,605 annually, according to federal data.
» The American Academy of Orthopaedic Surgeons tracks replacements handled by 4,755 surgeons at 654 institutions. It reports that hip replacements have a success rate of more than 95 percent, and joints can be expected to last more than 20 years.
» Nationally, a hip replacement costs an average of $40,000.

hip fractures in women
Hip fractures are an unfortunate fact of life in the later years. More than 265,000 older adults fracture a hip each year in the United States. About 25 percent of them die within a year, and most survivors never recover previous functionality. Researchers at Washington University School of Medicine are launching a national study to determine whether women who have broken a hip can benefit from testosterone therapy and exercise. The five-year study will be funded with a $15.6 million grant from the National Institute on Aging of the National Institutes of Health. For the study, 300 women 65 and older who have suffered a broken hip will be treated at one of six medical centers across the country.

“After a woman sustains a hip fracture, standard physical therapy often is completed within a few weeks, but many patients still have significant problems with mobility and their ability to perform daily activities,” says Dr. Ellen Binder, the study’s principal investigator and a professor of medicine at Washington University. “Previously, we demonstrated that continuing physical therapy and exercise for six months—especially with the addition of weightlifting exercises—significantly improves strength and the ability to walk and live. In this study, we want to learn whether testosterone supplementation can improve things even more.”

For more information or to volunteer for the study, contact Kelly Monroe at 314.273.1160 or monroek@wustl.edu.

breast health
More than 316,000 women were diagnosed with breast cancer in the U.S. last year. While breast cancer mortality has decreased dramatically in recent decades, it is not clear whether diagnoses have stabilized or continue to increase. The number of breast cancers diagnosed in women younger than 50 actually has increased about 0.2 percent annually over the past two decades, according to the U.S. Centers for Disease Control. Several factors confound the statistical analysis: More sophisticated mammogram technology is increasing detection rates; greater awareness of family risks is leading many women to begin mammography at younger ages; and rising obesity rates may be increasing the occurrence of breast cancer.

“The rates of breast cancer in women younger than 45 have been steady over the last 30 years,” says Dr. Julie Margenthaler, a surgeon at Siteman Cancer Center. “There has been a lot of controversy around the appropriate age for starting mammography, and that has caused confusion about screening practices and rates of breast cancer.”

Dr. Christina Min, medical oncologist at Mercy Clinic Oncology and Hematology at the David C. Pratt Cancer Center, says while breast cancer is being diagnosed at younger ages, the majority of the patient population is still older.

mammograms
“If you are what we call an average-risk woman, meaning you don’t have any significant family history of breast cancer, the general recommendation is to start yearly mammograms at age 40,” Margenthaler says. “If you do have a family history, the recommendation is to undergo a risk assessment evaluation. We determine how high the risk is and whether we should start watching earlier. The general rule of thumb is to start 10 years earlier than the relative’s age at diagnosis.”

Three-dimensional mammography scanners have contributed to improved survival rates. Margenthaler explains that with the previous two-dimensional technology, the breast was condensed as a single image on an X-ray. “With the 3-D mammogram, the breast is still compressed, but the machine generates slices that the radiologist can scroll through at different depths,” she says.

prevention
Women can reduce their risk of breast cancer, Min says, but they have to take care of themselves in general.
» Keep a healthy weight. When you are overweight, fatty cells produce estrogen, which can increase your risk.
» The American Cancer Society advises limiting yourself to one alcoholic drink a night.
» If you are taking any kind of hormone replacement, be aware of the risks of increased hormone exposure.
» If you have family history of breast or ovarian cancer, it should be addressed through screening. Genetic assays can be very helpful.

migraines
Medical science continues to seek better answers to the essential question about migraine headaches: Why me? While much remains to be learned, a new class of medications is promising to bring historic levels of relief. “The cause of migraines is not well understood,” says Dr. Aninda Acharya, a SLUCare neurologist. “They do run in families, which suggests a genetic basis.”

triggers and medication
Migraines have long been linked to wine, still considered one of the significant contributors. “Generally there is a trigger, although it’s not always identified,” Acharya says. “This leads to a cascade of events in the brain, including the release of inflammatory factors. It also is thought that people with migraines have an abnormality in the function of the trigeminal nerve, which is in the pain-sensing structures of the brain.” The cascade of events remains mysterious, but there are proven means of minimizing one’s risks.

“The first intervention is trying to identify triggers,” Acharya says. “Common ones include stress, certain foods, lack of sleep and hunger. I encourage patients to keep a headache diary to record the occurrence of their migraines and possible triggers. If the triggers can be avoided, the patient may not need medication.”

Acharya says three categories of medications have been found helpful in preventing migraines: antidepressants, anti-seizure medications and blood pressure medications. “Some studies suggest magnesium and riboflavin can help prevent migraine attacks,” he notes. “If patients continue to have migraines despite preventive measures, there are medications that can help stop an attack. The first line includes over-the-counter medications such as ibuprofen, naproxen and acetaminophen. Next are prescription triptans. Generally, narcotic medications are avoided because of the side effects, such as the potential for addiction and lack of long-term efficacy.”

If standard treatments do not bring relief, further testing may be recommended, Acharya says. “Occasionally we order an MRI of the brain if something suggests a more serious condition is present.”

a new drug
Earlier this year, the U.S. Food and Drug Administration approved the first preventive migraine treatment in a new class of drugs that block the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks. This molecule is one of the known keys to migraines, Acharya says. “These molecules irritate pain-sensitive structures in the brain, resulting in a severe headache,” he notes.

The new drug, Aimovig, is a monthly self-injection that binds and blocks the CGRP receptor. “Clinical trials have shown a marked reduction of migraines in patients who took this medication when compared to a placebo,” Acharya says. “Three other drugs are in the late stages of development and may be on the market in the coming years.”

the facts
» About 12 percent of Americans (39 million people) suffer from migraines.
» Women are three times more likely to suffer from them than men.
» Migraines are characterized by throbbing head pain associated with nausea, vomiting, and light and noise sensitivity.
» Preceding the headaches, about 20 percent of patients have an aura, which usually consists of flashing lights or zig-zag lines that distort vision.
» Nine out of 10 people with migraines report they cannot function normally with them.
» Nearly three out of 10 require bed rest during an attack.
» A ’complicated migraine’ can include numbness, tingling, dizziness and confusion.

Recommended