Archive for the ‘Healthy bones Osteoporosis Rheumatic’ Category

DRUG THERAPIES FOR HEALTHY BONES: RALOXIFENE (EVISTA)

The newest pharmaceutical option for protecting bone density is raloxifene (brand name Evista). Raloxifene is a selective estrogen receptor modulator (SERM), which, simply stated, means it has a chemical structure similar to estrogen and attaches itself to molecules in the body where estrogen would otherwise attach. It prevents bone loss by reducing breakdown of bone much the way estrogen replacement therapy does. Postmenopausal women can expect about a 3 percent increase in bone density in the first year of taking raloxifene and 1 to 2 percent per year after that. This brings a 40 to 50 percent reduction of risk of fracture in the spine. Less than 60 percent of women will see increases in bone density with raloxifene, a markedly lower response rate than with the options described earlier, including estrogen. Raloxifene is sometimes given with a progesterone, which might improve your chances of benefiting, as well as the magnitude of your results, though there is no hard evidence of that yet.
Since raloxifene blocks estrogen, it is the best choice for postmenopausal women who can’t take estrogen, especially those fearing an increase in breast cancer risk. It is not an option for men. Although it isn’t quite as effective as other prescription options in protecting bone at the hip, and is only about half as effective in the spine, it doesn’t increase the risk of uterine cancer (as estrogen does) and may actually protect against breast cancer. (Raloxifene is very similar to tamoxifen, which has gotten a lot of press as preventing breast cancer.) It doesn’t cause breast soreness or uterine bleeding, as estrogen can.
If you can take estrogen but are hesitant to, and are wondering if this is a better alternative, note that raloxifene does not offer some of the benefits that estrogen does. Raloxifene’s effect on the heart is still unclear. Though it appears to lower cholesterol levels, it is unknown as yet whether that translates into protection against heart disease and heart attacks equivalent to estrogen’s. Raloxifene does not relieve menopausal symptoms, and can even cause or increase hot flashes. No studies have yet been completed on raloxifene’s effect on colon cancer or Alzheimer’s disease, but estrogen is known to offer protection against both. Finally, raloxifene has one of the same potential side effects as estrogen: dangerous blood clots.
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SPINAL CORD INJURY: PHYSICAL CHANGES AND LIMITATIONS

At this stage in your recovery, awareness of physical changes and limitations is a primary concern. You may not be able to walk to the bathroom, tie your shoes, or eat your food without assistance from another person. Like Jim, you may not be able to walk at all. If your cervical spine is damaged, your arms and hands may be weak or paralyzed. You may not be able to turn over in bed, feed yourself, or hug your child.
For many people with spinal cord injury, being unable to walk is the most frustrating part of their disability. Persons with paraplegia can sometimes learn to walk with crutches and metal braces, but this is not for everyone. “Brace-walking” may require weeks and weeks of intensive physical therapy, because it is quite different from “normal” walking. It requires a whole gamut of new physical skills, and it can be slow and extremely strenuous. Even with sophisticated braces, lightweight crutches, and extensive physical therapy, some individuals with paraplegia find that walking with crutches and braces is simply too difficult, too strenuous, and too slow for use in the real world.
Individuals with injury at a very high level of the spinal cord may need to use a mechanical ventilator (respirator), because the muscles that control breathing are partially paralyzed. Some need special help to cough or clear fluids from the throat and chest. Some people have difficulty communicating because the ventilator and tracheostomy tube interfere with speech, and paralysis of the arms prevents them from writing. Weeks of speech therapy and specialized tubing and air valves may be needed to learn to talk again.
Depending on the type of spinal cord damage, you may have mild or profound changes in sensation. If you are quadriplegic, you may be unable to regulate your body temperature, perhaps experiencing fluctuations from hot to cold (even developing a fever in hot weather) and having to rely more on air conditioners, heaters, blankets, and so forth. You may experience bowel or bladder incontinence, inability to empty your bowel or bladder spontaneously, or a combination of these, requiring bladder catheterization or a bowel program to maintain healthy elimination. And your sexual function and sensation may be affected. Men may have changes in their ability to have an erection, experience sexual pleasure, or ejaculate. Women’s menstrual cycles may be temporarily interrupted, although menses and fertility generally return after some months, and they may have changes in genital sensation and the ability to lubricate or have an orgasm.
Rehabilitation is the period in which you confront and come to understand the full range of your limitations, disabilities, and complications. This is one of the most physically difficult tasks a person can undertake. It is also emotionally disruptive, intellectually demanding, and a challenge to your personality, social skills, and spiritual beliefs. One of the keys to success is being able to cope with a variety of emotional responses while simultaneously focusing your energy on physical recovery.
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