woman falling

First off, I am getting crazy over apps Instagram, FB and YouTube because of videos, reels and what-have-you features, which for a social media-latecomer like me is a wonderful learning experience but time consuming. One of the established health recommendations is - physical and mental exercise go hand in hand in living a good quality life. A lot of seniors abandon their mental sharpness because they feel like they have done all the heavy mental lifting already. That is a misconception. As long as we are alive, the brain needs to sharpen its neurons, make new axonal connections and form new patterns of neuronal networks to prevent it from deteriorating. An idle brain is susceptible to dementia which progresses to Alzheimer's. A lot of dementia is obviously genetic, just like every other disease, but it still pays to minimize and delay its progression.

Now ack to my current topic. 

Imagine yourself having had a fracture, say of a hip or a knee or pelvis. You went through surgery. ‘Ok’, the surgeon says after the successful operation, ‘you can get out of bed, but your leg should be non-weight bearing.’ So, you get up with the PT. He brings in a walker for your use. He tells you to sit on the edge of bed. You feel all the unimaginable pain bearing down on you. You realize it is hard to move the operated/fractured leg. You summon all your body strength - both arms and core and the normal leg to help you move on bed. It helps that the PT holds your operated leg as he maneuvers it to the edge of bed and 1-2-3 up, you finally get yourself sitting on the edge of bed. 

But that is only the first step. Besides the pain you feel slightly dizzy. You also want to use the bathroom. How?

The PT hands you the walker. Again, he reminds you of the non-weight bearing precaution of the operated leg. The walker helps. But the degree of your ability to use only one leg and both arms to help you stand and walk poses an existential crisis.

In my experience with patients, there is usually a big advantage for one who is more active, strong, and at normal weight when it comes to recovering from injuries (and surgeries) like leg or back fractures. And fractures are easy to get. It takes only one or two seconds to fracture a bone leading to months of painful recovery.

I have seen it all - a frail woman walking her dog with a leash as it leaps towards another dog across the street dragging the poor woman until she falls breaking her hip. A man trying to change a light bulb while standing on a stool and, losing balance, he falls and breaks his knee. These are risky but with advanced medical management, easy to recover from. The worst kinds are the life-threatening falls that hit the head, whether it is the sink or the bathtub or the floor which can lead to brain trauma that range from subarachnoid bleed to subdural hematoma if not treated immediately. And then there are spinal fractures that can require surgery or months of bracing or worse, paralysis depending on the extent of trauma.

As I am turning into a senior citizen myself, I often find myself wondering about what I could do if I were one of these fractured patients. Can I stand on one leg without falling? Can I hold my injured leg up for at least walking around the house? 

Can I avoid these falls and strengthen my bones to reduce the intensity of the injury?  Yes, there are steps to do that proactively but still, there are a few things in the Laws of Nature that are immutably designed by our Creator. Everything deteriorates, declines, weakens, becomes chaotic because of the Second Law of thermodynamics otherwise known as entropy. Humans, in the course of time, were able to delay this human entropy by adding more years to life. In ancient times, people were considered old in their twenties, dead before 40. Today, we are full of baby boomers on their way to century old years.  There is a difference between adding mere years versus having quality life through those years. Unless you have lived under a rock in the last 100 years, you and everyone else know these life-prolonging measures that will give us long and good quality lives:  exercise, diet, minimal stress, vice-free lifestyle and more recently, protecting oneself from infections such as during pandemics.

I am limiting this blog to exercise right now. That includes mobility and strength as the necessary components of independent functions. What are the potential health problems that can affect these?

Osteoporosis is the weakening of bones through the erosion of its main building blocks that include protein, calcium and Vitamin D. The main component of bone is collagen which is cemented by calcium. And for the body to absorb calcium it needs Vitamin D. A good source of vitamin D is the sun. Diet is important for bones. So is gravity. 

Osteoporosis is caused by a decrease in bone density, which makes bones more fragile and easier to break. There are many causes of osteoporosis, including aging, estrogen or androgen hormone deficiency, medications (especially corticosteroids), an overactive thyroid gland or excessive thyroid medication, cancer, a sedentary lifestyle, poor nutrition, low calcium consumption or poor calcium absorption. Other risk factors for osteoporosis include being a postmenopausal female, low body weight or having a chronic inflammatory condition (such as rheumatoid arthritis or Crohn’s disease). Smoking or drinking excessive alcohol are also potential contributors to osteoporosis. (from google)

Simply put, the older we get, both men and women are susceptible to decalcification, demineralization, and erosion of bones (due to medical conditions) that render us all susceptible to osteoporosis. Although most of us are educated about osteoporosis and how to manage it, it is worth reviewing what are evidence-based solutions:

  1. Proper nutrition, remember proteins and calcium. And vitamin D (Spending time in sunlight because the sun is one of the best sources of Vitamin D, consuming fatty fish and seafood, eating mushrooms rich in minerals, having egg yolks, fortified foods and supplements etc. )
  2. Weight bearing, such as walking, triggers the formation of new bone cells. This has been established among the astronauts who lingered in space. Although negligible, their bone densities were reduced upon return to earth. They were back to normal once ‘earthly’ mobility resumed.
  3. Strength training improves the bone-forming cells through nudging and pushing (similar to other weight bearing exercises).
  4. Obviously, you can have diseases that may reduce bone density, so it is important to work with your physician on proper medications and supplements to minimize their impact on bone strength.
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