HEALTH UP-DATE

OSTEOPOROSIS:

DOES CALCIUM HELP?

If a woman lives to be 75 years old, she has a 30 percent chance of fracturing a hip; with a broken hip, statistics show that woman has a 25 percent chance of dying of associated complications such as a blood clot.

These grim figures, quoted by Dr. Richard Sachson, an endocrinologist who practices at Presbyterian and St. Paul hospitals, aren’t new. Osteoporosis, the condition that causes women to be especially susceptible to bone fractures, might be the most written about, most talked about women’s problem of the year. Calcium supplements-in tablet form, in milk and in a variety of other foods and drinks-is the most touted health kick to beat the big O. But who needs calcium supplements? Can too much calcium be more dangerous than too little?

Sachson is quick to put the problem in perspective: “Osteoporosis is basically a normal aging process. As both men and women grow older they lose bone density. White women have less bone tissue than black women and much less than men. They also tend to lose bone more quickly than these other groups and are therefore most susceptible to the problems associated with bone degeneration.” Doctors are seeing more osteoporosis and are spending more energy warning younger women to prevent the problem because the population is living longer and therefore experiencing more advanced stages of the normal problems associated with aging.

The use of calcium supplements in prevention of osteoporosis remains controversial. Sachson explains that women absorb less calcium as they age and usually take in fewer calcium rich foods for a variety of reasons. High calcium foods tend also to be high in calories and cholesterol and are avoided for those reasons. Many women also develop lactose intolerance as they grow older and choose to take in fewer dairy products because they upset their systems.

But lack of calcium, Sachson says, is not the major cause of osteoporosis. A sedentary lifestyle contributes to the problem. Bones constantly deteriorate, but development of new bone tissue is stimulated by physical stress and activity. Exercise, then, can help postpone the problem.

The greatest single contributor to bone deterioration is a lack of estrogen. The decline in the secretion of estrogen by the ovaries after menopause, especially if the ovaries are surgically removed, results in a more rapid loss in calcium from your bones. Literature given to clients of Las Colinas Preven-tative Medicine Center explains that “Bone loss can be prevented by the initiation of estrogen replacement therapy, especially if begun within the first year or two after menopause (when the rate of bone loss is greatest.) Beginning estrogen therapy in elderly women is lacking convincing evidence that it will be effective in preventing osteoporosis.”

The Preventative Medicine Center provides in their client health notebooks a list of risk factors that have been identified in regard to osteoporosis which include, in addition to those that Sachson mentioned, family history and frame size. Women with smaller bone mass to begin with suffer the effects of osteoporosis more quickly and women whose female relatives have had the disease are more likely to develop it than those without any history of it in the family. Smoking, alcohol and caffeine use, the literature says, also have been identified as factors associated with increased risk of osteoporosis.

It is at about age 40 or at menopause, if it occurs for some reason before that age, that calcium intake should be carefully watched and perhaps supplemented. As long as not more than 1500 milligrams of calcium is ingested daily, there is little danger of side effects other than possible development of kidney stones.

Sachson uses a machine called a bone densitometer to measure the thickness or density of the bones. If a woman has a bone fracture and her bone density is below a certain point, then osteoporosis can be named as the cause. At that point calcium supplements can keep the problem from growing worse, but nothing can reverse damage already done by osteoporosis. For that reason, prevention – exercise, proper diet and regular check-ups from age 40 – is a woman’s best bet against osteoporosis.

ALOE VERA EYE CARE

Aloe vera has long been credited with magical, healing powers. It’s in your makeup and shampoo and, according to a recent Health magazine report, it may find its way into eyedrops as well. Health quotes Neville Baron, MD. a New Jersey ophthalmologist, predicting aloe vera extract will be the “miracle eye drop of the twentieth century.”

Aloe vera absorbs damaging ultraviolet rays, says Baron, and could well act as “liquid sunglasses.” Certain types of UV light have been linked to cataracts, degeneration of the retina and abnormalities of the lens, and there is evidence that its effects are cumulative. Aloe vera extract would not only be useful in protecting the extra-sensitive eyes of people with these problems, but it might also help shield normal eyes from damaging rays, the Health article said.



CHICKEN POX VACCINE

BEING READIED

A vaccine for the most common remaining childhood disease, chicken pox, may be in use within two years. The vaccine, which may be added to the commonly administered mumps, measles and rubella innoculation, is especially exciting to physicians, says Dr. James Luby, professor of internal medicine at Southwestern Medical School, because varicella, as chicken pox is also called, is a herpes-type virus and a vaccine has never existed for a herpes-related disease.

Since chicken pox and shingles or herpes zoster are caused by the same virus, and apparently shingles appears only in individuals who’ve suffered chicken pox, the vaccine could have a positive effect on controlling shingles as well.

Merck, Sharp and Dome is the drug company researching the vaccine. They have applied to the Food and Drug Association for manufacturing licenses and the vaccine is already being tested among immuno-suppressed children, who are most susceptible to the disease.



CONSUMER HEALTH SERVICES: MEDICAL REFERRALS BY PHONE

When you need a doctor-when your temperature is spiking or your head is so full of ragweed you feel like the Goodyear blimp -is the time you, are least able to conduct a careful; search. Newcomers to Dallas and Fort-Worth complain about the overwhelm-ing Yellow Page lists of specialists and subspecialists and the dirth of un-: biased advice on choosing a physician.

For that reason, Consumer Health Services, an independent medical referral service based in Denver with offices in Washington, D.C., and Houston, has come to town. The phone counseling service seeks to match callers with doctors who fit their needs, something any number of referral services already do. The difference here is the absence of vest-pocket interests. To be listed in CHS’s computer, a doctor completes more than 25 pages of questions. A CHS caller is asked of their needs, likes and dislikes in regard to a physician. The company’s computer, in turn, produces the name of an appropriate doctor and the counselor makes a conference call to the doctor’s office and sets up an appointment. After the patient sees the doctor, that physician pays CHS a one-time fee.

The typical referral service is sponsored by a hospital and the only physicians on the service’s list are those affiliated with the sponsoring hospital. They are usually referred to callers on a rotating basis. When someone calls needing a doctor, they are simply referred to whomever is next on the list. Consumer Health Services represents more than a dozen area hospitals and it is the caller who makes the final choice based on the information given to him about several doctors by the service.



A NEW WAY TO TAKE

MEDICATION:

THROUGH THE SKIN

There’s good news on the horizon for those who’d just as soon take their medicine without needles, I.V. tubes and quarter-sized horse pills. A new way of delivering drugs enlists our body’s largest and perhaps least appreciated organ-the skin.

This system of drug delivery, which uses a small adhesive bandage containing the drug and special mechanisms for controlling its release into the body, has been popular in the control of motion sickness for several years under the name of Transderm Scop. Now physicians are employing this method to administer nitroglycerin for preventing and treating angina. Estro-derm, the Transderm delivery of estrogen for treatment of symptoms of menopause, has recently been approved by the FDA.

The advantages of drug delivery through the skin over drugs that enter the body through the gastrointestinal tract and intravenous or intramuscular drugs are great, according to CIBA Pharmaceutical, developers of the system. One advantage of this system is speed; drugs are absorbed directly through the skin in consistent amounts and travel directly into the bloodstream. Orally administered drugs, on the other hand, enter the blood stream unevenly, with varying concentrations.

The transderm patch in use for motion sickness is a dime-sized patch to reservoir containing the drug; a micro-porous membrane that controls the rate at which the drug is released; and an adhesive layer that keeps the unit on the skin.

Researchers are working now on developing transdermal applications of a number of other drugs including de-congestants, contraceptives and central nervous system drugs.



HOW TO HANDLE AN

EMERGENCY: STAY CALM

AND DIAL 744-4444

Successful handling of an emergency depends more than anything on maintaining a level head full of common sense. Keeping your calm is a hard skill to practice in advance of a life and death situation, but a review of the information you’ll need to know in an emergency can prove priceless even if it seems mundane at present.

Chief Ronnie James and William Jer-nigan of the Dallas Fire Department agreed to provide us with a review of the questions their emergency dispatchers ask callers and a brief description of how the City of Dallas hanreservoir containing the drug; a micro-porous membrane that controls the rate at which the drug is released; and an adhesive layer that keeps the unit on the skin.

Researchers are working now on developing transdermal applications of a number of other drugs including de-congestants, contraceptives and central nervous system drugs.



HOW TO HANDLE AN

EMERGENCY: STAY CALM

AND DIAL 744-4444

Successful handling of an emergency depends more than anything on maintaining a level head full of common sense. Keeping your calm is a hard skill to practice in advance of a life and death situation, but a review of the information you’ll need to know in an emergency can prove priceless even if it seems mundane at present.

Chief Ronnie James and William Jer-nigan of the Dallas Fire Department agreed to provide us with a review of the questions their emergency dispatchers ask callers and a brief description of how the City of Dallas handles emergencies. Some of what they told us was news; other information should be common knowledge in the community.

Contrary to what we might be accustomed to seeing on the silver screen, it is never a good idea to dial “O” in an emergency and demand, “Operator, get me the police.” While dramatic, a call placed to an operator only stows down help in an emergency. The operator you contact, says James, still must dial 744-4444, the number you should know and use in all emergencies until the day, possibly in the spring of 1988, when Dallas gets a 911 system.

Until Dallas can institute 911, a computerized system which will automatically provide dispatchers with the location of the caller, dialing 744-4444 is your first job in obtaining medical help or police or firefighting assistance. When your call is answered you will immediately be asked the nature of your problem, “How can we help you?” At that point your call will be switched to the police department or to the fire department. The fire department handles medical emergencies and gathers information and sends a computer printout to the police department if both emergency medical help and police involvement is necessary.

The next question a caller will be asked is if people are trapped at the scene and the address where help is needed. Jernigan says a clear and complete address, including words such as avenue, drive, east or west if they are part of the street name, is essential. Be prepared to spell the street name and, in order to avoid any possible confusion, give the nearest cross street and the phone number from which you are calling. Jernigan says that the team of dispatchers has some Spanish speaking ability, but he can’t promise there will be a bilingual dispatcher on every shift,

A dispatcher’s goal is to obtain, in the shortest possible period of time, specific, accurate information in order to have emergency service under way within 30 to 45 seconds. The dispatcher uses the information received essentially to fill in the blanks in a computer display. Even though the situation is undoubtably stressful, it’s important to speak as calmly and clearly as possible in responding to dispatcher’s questions and to answer questions in the sequence they are asked. It’s also a good idea to send someone out to the street if the emergency has taken place inside, especially in an apartment complex, so that they can watch for the emergency vehicle and direct help quickly to the emergency.

The greatest problem dispatchers and emergency personnel encounter is people lying intentionally about their medical problems in hopes of getting a “taxi” to the hospital. Jernigan says mistaking a non-emergency for an emergency is not the same as a false alarm, a call made maliciously or in a situation that is obviously not an emergency. If you question whether or not emergency assistance is necessary, Jernigan says, don’t hesitate to call for help. In 1985 Dallas paramedics made about 67,000 runs and transported individuals to hospitals on only about 48 percent of those runs. A charge is incurred only when transportation occurs.

The average response time in an emergency, Jernigan says, is 4.1 minutes for a fire engine and 5.1 minutes for a mobile intensive care unit, the ambulances operated by the Dallas Fire Department. The personnel who operate the MICUs are firefighters with 860 hours of paramedic training. Depending on the injuries involved and the number of demands for ambulances at the time, you will be given a choice of hospitals.

It’s helpful to know or have available in your purse or wallet your medical history and information about any medications you may be taking regularly.

CONTROLLING YOUR

HEALTHCARE COSTS BY ASKING

THE RIGHT QUESTIONS

Consumers interested in controlling their own healthcare costs might profit by carefully considering the issue of generic drugs. Dr. William Pettinger, professor of internal medicine and pharmacology at Southwestern Medical School, says generic drugs aren’t always money savers.

A drug becomes generic when a specific time interval, 15 to 17 years, has passed since its patent was issued. At that point, companies other than the one that developed the drug can sell it as long as they don’t use the trade name. The trouble for the pharmaceutical companies is that there is a lag between the time of the patent issue and the time when product testing and clinical trials are complete and marketing of the drug can begin. Because of this lag time, a drug company may not have enough time to recoup their developing costs before losing exclusive rights to their drug. This problem raises an argument among drug companies over whether the interval of exclusivity should begin at the time the patent is issued or from the time marketing is begun.

Because of this fierce competition between the drug companies and the relative newness of the drugs now available with generic labels, generic drugs may not be much cheaper than name brands although the pharmacy might pay one-third the cost of what they’d pay for a name brand.

The generic drugs that offer the most savings are those that have been on the market many years, such as aspirin. Pettinger says every aspirin on the market is equivalent to Bayer.

Pettinger says savings on drugs are available if a patient is willing to do some legwork. He has these suggestions for getting the best deal on medication:



● Ask your physician if less expensive equivalents are available for thedrugs he prescribes.



● Call a number of pharmacies andget at least three different bids on yourprescription.



● If you know you’ll be on a certainmedication for an extended period andthat you won’t have a bad reaction to adrug, ask your pharmacist to try to obtain a cheaper bulk rate from the drugcompany.



DALLAS TO HAVE ITS OWN TEACHING HOSPITAL

From Dallas’s medical centers have arisen more than a handful of modern-day heroes, men and women who’ve won this city international acclaim for their accomplishments in medical research and treatment. Like last year’s Nobel Prize winners, Dr. Michael Brown and Dr. Joseph Goldstein, most of these local stars would credit their successes to an environment in Dallas that promotes research and encourages creative approaches to medical issues. But that environment has lacked one component that every other major American city and maior medical school in the country can claim: its own private teaching facility.

University Medical Center, a proposed referred-patient teaching hospital that will be affiliated with Southwestern Medical School, is scheduled to be completed in early 1989 and will fill the bid in Dallas for a private teaching facility to complement a medical school that ranks among the top 15 in the country. Currently Parkland Memorial Hospital serves as the primary teaching hospital for Southwestern, but teaching has by necessity ranked behind that hospital’s most important role, serving the citizens of Dallas County, especially the indigent population. Beds available at Parkland for referred patients have been scarce.

The new 159-bed center should broaden the resources now available to Parkland patients by attracting top medical researchers and physicians to the area. Referral patients who suffer from complex diseases or injuries will have better opportunities for specialized treatment and diagnosis, and faculty and medical students will have increased access to study of those special cases.

University Medical Center is to be built east of Parkland Memorial Hospital on land to be leased from the Dallas County Hospital District. Although the center is being built under the auspices of the University of Texas Health Science Center, the University of Texas board of regents precludes university support for its construction. Bruce Lip-shy, President of Zale Corporation, is vice chairman of the center and has spearheaded fundraising efforts.

The new medical center is meant to complement existing Dallas hospitals rather than detract from them. The influx of patients should stimulate the entire medical community as well as the city’s economy. Houston, home to teaching referral hospital M.D. Anderson, earns approximately $715 million a year from referred patients outside the city who use that area’s hospitals. In comparison, Dallas gains only $267 million from patients outside the area.

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