Important Drug Warning (Osteoporosis) ….. again!
Every week or two I receive in the mail an envelope with a big red box on the front that says: IMPORTANT DRUG WARNING. The FDA forces the company making the medication to send a letter to every doctor when “post marketing experience” demonstrates some new usually fatal effect of the drug. It is quite common that medications harm patients in ways unknown because the first clinical trials include a few thousand people and it is when millions take the drug that more comes to light.
Last week’s warning was about Boniva, one of the medications used to treat osteoporosis in the elderly. The warning advised that Boniva can cause a fatal allergic reaction called Anaphylaxis especially if administered by injection. This new finding adds to the list of serious effects of this kind of medication that include: severe ulceration of the esophagus; severe and incapacitating bone, joint and muscle pain; necrosis of the jaw; unusual fractures of the hip and asthma; and less serious troubles with indigestion, diarrhea and headache.
Certainly it is true that the bone weakening illness of Osteoporosis is an important condition of the aging population. 35% of old women and 20% of old men have bones with low mineral content. And hip and spinal fractures occur more frequently in those who have Osteoporosis. In general of those who broke a hip only 15% will be able to walk across a room without assistance after 6 months. Hip fractures often dramatically change the person’s life and decreases longevity.
But the Bone Mineral Density (BMD) is only one factor that influences the likelihood of breaking a bone. Fewer than 45% of the women over the age of 55 who had a non-vertebral fracture were osteoporotic. Most had normal bones for their age.
Low mineral content of the bone is ONE risk factor, but not the only one, and not the most important in all cases. The other risk factors include: age above 85, low weight, Prednisone use, tranquilizer use, poor vision, smoking, cognitive impairment, excessive alcohol intake; poor diet for Vitamin D, Calcium and/or protein; lack of exercise, lack of attention to home safety and lack of urinary control.
Someone with poor vision and arthritis of the hands/fingers and lower extremities will have a harder time negotiating any physical space. Slippery floors, badly placed electrical cords, clutter on the floor, pets, unsecured throw rugs and poor lighting are common home hazards. The slippery surfaces of the bathroom are dangerous without proper grab bars and non-slip mats and shower/bath chairs. When mind numbing medicines like tranquilizers, narcotic pain medications or antidepressants are added to the mix falls are much more likely, especially at night.
Regular exercise is an important preventive measure. Not only are muscles and bones strengthened, but exercise improves equipoise which is ability to recover balance and equilibrium due to better reflexes and grace of movement.
Fractures of old age can be avoided by having good nutrition, by avoiding mind dulling and bone softening medications, by doing regular exercise that includes training in balance and by initiating a home safety program. Food can be supplemented with Vitamin D and with a particular calcium supplement that has been shown to increase bone mass in the elderly. Once all of these tools are in place the person can be accessed for the risks and benefits of medication like Boniva, Fosamax, Actonel, Atelvia, Binosto, Didronel and the like. Usually homeopathy is enough.
NOISE AND MY EARS
Every time I spend a day in the forest I am stunned by the quiet. Slowly I realize that I am listening intently. My auditory senses reach out to find sound. There is a rustle of the wind in the trees, then the buzz of a bee, a bird’s call or a crack of a branch as a deer jumps away from by presence. It is sweetly soothing to be in an environment so rich with life, so alive and simultaneously so still.
And when I return to the city, the concrete slab, I can hear the hum of its confused mechanics. There is no straining to hear something. Instead the city assaults my ears and brain with a barrage of noise. And if I add to the volume by listening to loud music, going to sporting events or some exercise classes or concerts that feature blaring noise, my ears can actually ring afterward from the damage.
Certainly loud noise is a common cause of early hearing loss and contributes to age related loss of hearing called Presbycusis. Loud noise fatigues the protective mechanisms of the middle ear and finally damages the delicate organ that receives the airwave sound pulses and translates them into nerve impulses. It is the damage to this transducer called the Cochlea that is the most common cause of deafness.
To see what my ears have to cope with every day I purchased a simple decibel meter at Radio Shack and carried it around for a week. My findings have to be compared to standard values known to be quiet, to be annoying, to be possibly damaging or to be seriously damaging.
50 Decibels is like a quiet suburb or conversation at home
60 Db. might be like an office or quiet restaurant
70 Db. is like being in a living room with music on. Upper 70s begin to be annoying.
80 Db. is twice as loud as 70, and like being near a diesel truck, garbage disposal or in an average factory
90 Db. is four times as loud as 70 and like being near a motorcycle, power mower or newspaper press
100 Db. is eight times as loud as 70 and will cause pain.
Exposure to 80 Db. for eight hours might cause damage, and 90 Db. will likely damage the ears.
MY DAY OF NOISE:
MUNI Bus = 82. BART 75-83 in the station and 90-100 while running (90-94 in the tube). City streets = 66 – 87 depending on trucks passing. Restaurant at noon = 70. My living room = 50. Bank = 62-68. Senior Lunch program 62-72. Walgreens = 62-64. My kitchen = 64. Café 70-74. Windy street = 72-90. Loud spin class at the Y = 92. Regular spin class = 76 Bar at noon = 74-81(for research only)
The damaging levels of noise in the 80-100 range were not completely avoidable. I will not do the spin class with the teacher who thinks we have to be pumped up with ear splitting noise, and don’t ride motorcycles. But I often ride BART and MUNI, or am out on city streets, or in a noisy restaurant or occasional bar.
Some years ago I started wearing ordinary compressible foam earplugs during airplane flights. It just helped me cope with the constant engine noise and focus on my own needs. Since then I carry earplugs in my briefcase, shoulder bas and coats. I put them in whenever I ride BART, am a t a loud concert or bar or am riding on MUNI. Some clubs even make them available to patrons at concerts. In this noisy industrial world in which we live a long time it makes sense to protect our ears. Eye doctors and eye wear marketers have made a big deal of wearing glasses that protect us from the sun’s glare and reflection off the many shiny surfaces in the modern urban landscape. It is probably more important to protect our ears against harmful noise that is ubiquitous in cities and in many workplaces.
I don't mind being the guy walking around with blue foam things in his ears, because I want to be the old guy who still enjoys music, has ease in conversations and is able to appreciate the nuiances of my clarinet playing.
The Concrete Slab
Returning, it’s ever on returning.
And only if coming back on the road.
The megalopolis, the concrete slab
gives forth its hum, its noisy code.
After three weeks at the forest or coast,
senses attune to a natural sound.
The wind in the trees, the patter of rain,
bird calls and critters make noise all around.
At first it seems quiet, no sound is heard.
So dull the ears on the slab have become.
The blare of the streets fade slowly away,
a shroud lifted to reveal where I’m from.
The whoosh in the trees and croak of the frog,
A crow’s caw, song bird’s tune, and a hawk’s screech,
To attract, defend and announce I’m here,
nature’s orchestra my numb ear does breech.
What joy there is in simple quietude.
A pleasure on which my soul thrives so well.
A bliss that lets thoughts bubble up from deep.
A touchstone from which some beauty can swell.
The hum of the road, the sound of return,
Is the first to break my sweet reverie.
Gasoline horses drag me up the hill.
The crest bares the city’s cacophony.
Horns blare, doors slam, steel clangs, electric hum,
together the volume becomes a drone.
Millions of fans whirl and more motors roar,
a city’s pulse, carbon, nuclear moan.
A week on the slab and I think again,
how I do crave the river’s slow sweet sound.
An owl’s hoot, rooster’s crow, squirrel’s foot step,
the redwoods, blue jays, noisy life abound.