Against All Odds: How Twenty Courageous People Overcame Debilitating Illness, Disease, and Other Physical Challenges

Against All Odds: How Our Bodies Make a Way in Overcoming Illness, Disease, and Other Physical Challenges

Donnie’s Story: Osteoporosis

“The problem in your mom’s case is that treatment was started 15-20 years too late.” Hearing my mom’s (Donnie’s) doctor state so directly what I already knew in my heart, hit me harder than I expected. Immediately, self-recriminating thoughts ran through my mind because I remembered many years earlier being asked by my mom if I thought she should begin hormone replacement therapy (HRT) after having just gone through an early menopause. I told her no. Unequivocally no. And I hadn’t thought twice about it. Given the state of her bones today, I’m not so sure I was right, I was simply trusting what I’d been reading about the dangers of hormone replacement therapy and its link to various cancers in women.

Even though my mom has a strong family history of breast cancer and her gynecologist at the time was aware of this risk, he still believed she would be better off on HRT for her long-term bone health. My mother though, who had watched her various family members painfully linger and then die of cancer, wasn’t so sure. Like me, she was torn between trusting her physician and trusting her instincts because of the contradictory medical studies released at the time. Ironically, the only thing that wasn’t in doubt was that these two voices of authority conflicted with each other.

So today, some 30 years later, at age 71, my mom’s bones are beginning to break and all our earlier confidence about the decision to forgo HRT because of its cancer risk is crumbling too. While there is no easy answer and my mom very well might fall into “what if” types of doubtful thinking, she understands it wouldn’t do her any good. Donnie is fully aware of her current risks and yet she’s at peace because she realizes that while the medical world will constantly be changing its stance on everything pertaining to “what’s good for us,” Donnie’s trust remains stalwart in Christ. She knows whatever future health challenges lie ahead; she puts her absolute trust in God’s daily provision for strength. Her life motto very well could be one often quoted from Oswald Chambers, “Trust God and do the next thing, ” because that is precisely what she’s done. Day after day, Donnie gets up and takes the next step.

Donnie’s Story

About two years ago, our family had planned a lovely day of escape for my mom, my three young adult daughters and myself. Each of us had been under tremendous stress and we were still mourning the loss of several immediate family members who had died one after the other all within the previous six months. So we women decided that a day of shopping, eating out, and just relaxing together, minus the emotional strain of the past spring and summer, would be exactly what the doctor ordered. A perfect plan, or so we thought.

Working at my computer two days before we were to leave, I received a frantic call from my oldest daughter informing me that my mother had just fallen outside her home. Within an hour, my mom was being treated at a local emergency room for a broken tibia (this being the second break in the same leg in five short months, as she had broken a bone in her foot in early spring). The ER doctor placed a soft cast on her leg and she was then treated by her orthopedic surgeon during the following weeks. A few non-eventful months passed and her bones seemed to be on the mend, so my parents happily left for their annual winter-long retreat to Arizona.

Within days of getting settled in Scottsdale, my mother noticed bruising and swelling on the top of her foot so more x-rays and an MRI were ordered. The tests revealed she now had three pre-stress fractures developing on the same foot (the first break had apparently never healed completely). Another walking cast, more therapy, and additional anxiety ensued as the injury/treatment/healing cycle repeated itself yet again. Would this year’s pattern of bone injuries be indicative of my mom’s future? We certainly hoped not. Still, three breaks in nine months was nothing to lightly dismiss.

Mulling over my mom’s current health, we tried to figure out what could be done. This “figuring out” meant taking a look back, years back, to my mom’s late thirties when early menopause took her by surprise. Piecing her personal health composite together, we now understand that she lost excessive amounts of estrogen early on which contributed to her rapidly debilitating osteoporosis issues of today. So we questioned and considered her past, present and future health outlook with that specific information in mind.

It seemed so unlikely that a single choice, one made many years ago,
could so affect her overall health, and yet it had. Questions like, “Did we miss something?” and “What could we have done to prevent this?” started to revisit our thoughts with greater frequency. Looking back at my mom’s personal health history, we realized she still would have made the same choice over again because of her family history of breast cancer. Right or wrong, today is all she has to combat the affects of osteoporosis.

To her credit, she continues to take the best care of her body she can. She faithfully exercises daily, takes calcium/Vitamin D supplements, goes to her annual checkups, and has yearly DEXA scans. Once she started losing bone mass, her gynecologist placed her on Evista, a selective estrogen receptor modulator (SERM). Over time, her bone mass increased and stabilized for a few years, then she began losing ground again and now is breaking bones at an alarming rate. Even under the careful monitoring of her physicians, she is still facing old age with deteriorating bones…so for her, there’s no missing piece of information, no neglected treatment option or lapse of medical care to blame. My mother deliberately weighed her options and still believes made the best choice given her family history of breast cancer. The hard truth is that we realized there isn’t always a best solution here…all women have to weigh the risks and decide which course to follow as it pertains to them individually.

The more we researched and studied the possible risks for developing (and preventing) diseases such as cancer or osteoporosis later on in life, the more we recognized women must often choose between two prevention plans and their accompanying risks (and HRT does pose known health risks). As women take into account their family’s health history as well as their own lifestyle, women must be forward-thinking to gain the best information and treatment (preventative and palliative) plan for their lives.

While specialists treating osteoporosis provide treatment guidelines to both primary care physicians and their patients, these doctors necessarily rely on each individual patient to follow through on their own. Being proactive isn’t an option women can selectively decide to act upon or not. It is every woman’s responsibility and choice to see to it she takes advantage of all medicine has to offer as she works hard to maintain her own healthy lifestyle

The good news is that today’s woman not only has more information than my mom’s generation did, they have more choices, more treatment options…and more effective tests to predict, detect, and prevent diseases like osteoporosis. Given all the “more” women have to choose from…there just isn’t any reason for not being informed and taking an active role in one’s own healthcare and future well being. Donnie knows that no matter how proactive she is today, there aren’t any guarantees tomorrow, which is why she does the hard work of daily exercise, takes her supplements, and medications as directed…and in equal measure (as directed) she places herself body and soul into God’s hands.

As Dr. Christopher A. Foetisch, orthopedic surgeon specializing in sports medicine, Toledo Clinic, Toledo, Ohio, states, “The late thirties, early forties is when patients need to be proactive and insist on evaluation and treatment. Osteoporosis is a silent disease that often is not thought about until the fractures start to occur and at that point we have missed our prime prevention/treatment opportunities.”

An Expert Comments

“Osteoporosis complications (pelvic, hip and spine fractures) often have morbidities and mortality that are right up there with cancer and heart disease,” notes Dr. Foetisch. “This (osteoporosis) is just like cancer. It’s usually not diagnosed until it’s too late. Once the osteoporosis is advanced there is no going back to good, strong bone. I tell my patients the best offense is a good defense. Don’t let it happen in the first place.” Dr. Foetisch continues, “When a 50-year-old female goes to see her PCP the very last thing on her mind is osteoporosis treatment. But that is when she needs to begin being tested for the disease.”

For my mom, we can’t turn back the clock. So she does all she can today to treat and prevent further breaks. And she’s not alone. Osteoporosis leads to 1.5 million fractures, or breaks, each year. This silent disease threatens 25 million mainly female Americans, though it affects older men as well. Knowing osteoporosis is a preventable disease makes is especially difficult for today’s doctors as they treat an ever-increasing aging population. Dr. Foetisch believes osteoporosis is the most under treated problem in female health and tells all his female patients over the age of 50 to make sure their family doctor orders a bone density scan (DEXA) every 3-5 years. He also recommends they start on Calcium/Vitamin D supplements and encourages daily exercise to strengthen both body and bones. Dr. Foetisch offers women the below guidelines as RX for strengthening weak bones and fortifying already healthy ones. Though the damage can be devastating, it is vital to note that even the weakest bones will work to rebuild when given the right tools, for women with osteoporosis, the best tools are proactive in nature. We must do our part, our bodies will do theirs, and then as Donnie states, “We trust God for the results.”

· Initiate dialogue with your primary care physician on bone related preventative self-care during late thirties/early forties.
· Insist on baseline tests and treatment as warranted, especially if you have a related family history of the disease.
· Step up daily intake of supplements to 1500mg Calcium and 800mg Vitamin D.
· Engage in thirty minutes daily exercise such as walking, swimming, or biking.
· Begin DEXA Scans by age 50 and continue every 3-5 years thereafter depending upon findings.

Expert Credentials

Dr. Foetisch is an orthopedic surgeon who specializes in sports medicine with a practice emphasis involving the shoulder and knee. He is Board Certified through the American Board of Orthopedic Surgery and holds professional memberships through the American Academy of Orthopaedic Surgeons, the American Medical Association, the American Orthopedic Society for Sports Medicine, the Arthroscopy Association of North America, the Ohio State Medical Association, and the Toledo Academy of Medicine

A Weighty Issue — Too Many Pounds Make Surgery a More Risky Proposition

Monroe Evening News, The (MI)

A Weighty Issue
Too many pounds make surgery a more risky proposition

By Michele Howe Special to The Evening News

Published: September 13, 2010

Imagine yourself lying on a bed in the hospital’s pre-op area waiting to go into the operating room. Those final few minutes generally are filled with minor chitchat and maybe hugs from loved ones before you’re ushered into the OR. You might be a little anxious, but overall, you’re simply ready to get fixed and on your way to feeling better, healthier. Then, instead of a nurse arriving to escort you into the operating room, the anesthesiologist comes in to tell you that your surgery has been canceled. You’re shocked and you wonder what the snag could be. Is there a problem with the surgeon? The attending staff? Equipment failure? An emergency that’s taken priority over your procedure?

Truth is, it’s none of the above. The unhappy expression found on the faces of your doctor, his surgical team and the surrounding hospital staff, aren’t due to anything within the realm of their control. Rather, yours. It’s your weight.

What was once an isolated event has grown into a burgeoning problem in hospitals and medical clinics across the country. A patient’s excessive weight is causing more surgeries to be canceled at the last minute because of the potential — and frequently life-threatening — risk.

It used to be that when a patient heard that he’d need to undergo a surgical procedure, he’d consider the who, what, where, when and how, Today it’s becoming more common to consider how much.

More Americans overweight

For a growing number of patients, the most problematic obstacle to getting better rests solely with their excess weight. Statistics show that two-thirds of Americans are either overweight, defined as a body-mass index (BMI) of 25 or higher, or obese, a 30-plus BMI.

However, many people think their excessive weight doesn’t hurt them. They think they can be overweight and healthy at the same time. Doctors say, though, that if sudden urgent medical care is required, the obese are not on a level playing field concerning surgical risks as their normal-weighted counterparts.

The fact is, none of us can anticipate when a medical emergency requiring immediate surgery will occur. Nobody plans on getting into an auto accident or injured on the job, but it happens every day.

And in comparatively similar fashion, a frightening number of patient casualties occur when medical professionals are forced to refuse treatment to people because the risk is simply too great pre-operatively, during surgery and post-operatively.

That’s why more doctors and patients are having conversations about weight before scheduling surgery of any kind. The patient should listen closely to what the surgeon is telling him as well as what he isn’t.

He’ll explain that because of excess weight, the patient is at an increased risk for anesthesia complications, blood clots and wound problems and the rehabilitation experience probably will be more difficult and longer in duration than normal-weight people. Those having joint replacements can almost count on the appliance wearing out prematurely, leading to another surgery down the road.

What the patient can’t hear, however, are the thoughts in the doctor’s mind. What he may not say out loud because it’s so discouraging to him as the medical professional whose job it is to heal is what he’s seen transpire in case after case in previous obese patients under his care.

As he’s speaking to a patient, he’s also running a mental dialogue though his mind of how the surgery (on an obese patient) will differ from a normal-weighted patient.

From a surgeon’s perspective, he has no choice but to accept the additional risks and challenges of operating on someone whose weight makes it exponentially harder to perform his job (fixing the patient) from a purely technical standpoint.

Doctors report that frequently morbidly obese people tell them that they (the patients,) are willing to accept the increased risk for complications without a thought for the difficulty that their surgeons will encounter during the procedure as well as what this increased risk for complications means to the physician as the responsible party. There appears to be a mistaken assumption that their weight is not a factor that might affect their surgeon’s ability to perform the intricacies required during any medical procedure.

Similarly, some other patients falsely believe that their surgery can be executed with the same ease as a patient of normal weight.

Weight can affect tests

Patients also must understand that weight-related health risks exist even before an individual enters the operating room. Extra fat can render some clinical tests ineffective at detecting potential and existing health problems.

Amy Parham, weight-loss participant on NBC’s “The Bigger Loser” in summer, 2008, remembers her wake-up call after viewing her bone density test results for the first time. She recognized at that moment how her extra pounds were punishing her organs and lungs hour by hour, day after day.

“It was eye opening to see that the fat was not something that was not only keeping me from buttoning my smaller pants, but it was also shoving my organs around and prohibiting them from working properly. Even my lungs were so compressed I couldn’t breathe well,” she said.

Mrs. Parham realized that as much as she hated how fat looks on the outside, “It is the fat that we don’t see, (on the inside) that is killing us.”

Beyond the risk complications already cited, a doctor knows that a surgical outcome may not be what the patient’s expecting because even with the most skilled surgeon working on his behalf, excess weight will continue to hinder mobility and range of motion post-operatively.

Both doctor and patient enter surgery at a disadvantage because both are fighting to overcome weighty odds of the most costly kind. Doctors warn that obesity is a life-and-death risk, a risk Mrs. Parham came to understand.

“I believe that many times vanity is the motivation for wanting to lose weight, but people need to wake up and realize that they are playing Russian roulette with their lives by the choices they make. I was slowly killing myself and didn’t even know it.”

Michele Howe is a LaSalle resident and author of “Burdens Do a Body Good.”

The Toledo Blade’s article by Dr. Christopher Foetisch on “Rotator Cuff Symptoms and Surgical Treatment”

Rotator cuff symptoms and surgical treatment

By CHRIS FOETISCH, M.D.
SPECIAL TO THE BLADE

My co-author, of Burdens Do a Body Good, Dr. Christopher Foetisch, offers some excellent insight on common shoulder problems, symptoms, and the associated medical solutions. I’m so happy to share his work with my readers!

This is one of a series of columns about health issues written about staff members of ProMedica, Mercy Health Partners, and the Toledo Clinic.

Pain, loss of motion, and weakness may occur when one of the rotator cuff tendons tear.

The pain can range from mildly annoying to severe, affecting sleep and normal activities. People usually will complain of pain over the top of the shoulder and arm.

In some patients, the pain can descend down the outside of the arm all the way to the elbow. The other common symptom of a rotator cuff tear is weakness of the shoulder.

Weakness causes difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects.

Most rotator cuff tears occur through normal wear and tear. Some occur as result of an injury such as a fall. Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age. The highest incidence occurs in individuals who are older than 60 years.

What is the rotator cuff?
The rotator cuff is a group of four muscles that surround the ball of the shoulder joint.

The muscles function to provide rotation, elevate the arm, and give stability to the shoulder joint.

The supraspinatus most frequently is involved in degenerative tears of the rotator cuff. More than one tendon can be involved if the tear has been present for a long time or after a severe injury.

There is a bursa (sac) between the rotator cuff and acromion that allows the muscles to glide freely when moving. When rotator cuff tendons are injured or damaged, this bursa often becomes inflamed and painful.

What is the treatment?
Nonsurgical treatment typically involves avoidance of activities that cause symptoms. Physical therapy and injections also can be helpful. Nonsurgical management of a rotator cuff tear can provide relief in approximately 50 percent of individuals.

Surgical management is indicated for a rotator cuff tear that does not respond to nonoperative management and is associated with weakness, loss of function, and significant pain.

The main reason to consider rotator cuff surgery is for pain relief.

Surgical treatment of a torn rotator cuff is designed to repair the tendon back to the ball of the shoulder joint from where it is torn. The surgery can be performed as an open repair through an incision or athroscopically through several small holes.

Less invasive
Surgical techniques for rotator cuff repair have progressed to more minimally invasive procedures.

The most recent development is the all-arthroscopic technique. Each step toward less invasive surgery has benefited the patient by decreasing pain from surgery, decreasing postoperative stiffness, decreasing surgical blood loss, and decreasing the length of stay in the hospital. Most arthroscopic rotator cuff repairs are done as an outpatient. Additionally, athroscopic surgery has the benefit of finding and fixing other problems that cannot be identified through an open repair.

Expectations
Most people will be in a sling from two to six weeks depending on the size of the tear and difficulty of the repair. Typically, there is a course of physical therapy to help restore range of motion, function, and strength.

A complete recovery can take up to six months and larger tears may take longer. Most people are able to resume normal activities between three and four months. After rotator cuff repair, 80 percent to 95 percent of patients achieve a satisfactory result, defined as adequate pain relief, restoration or improvement of function, improvement in range of motion, and patient satisfaction with the procedure. Certain factors may decrease the likelihood of a satisfactory result such as poor tissue quality, large tears, poor compliance with postoperative rehabilitation and restrictions, and patient age older than 65 years.

Dr. Foetisch specializes in orthopedic surgery, with a practice emphasis involving the shoulder and knee.

Guest Post by Judy Roberts — Rest From Our Labor

I’m so pleased to offer a guest post by former newspaper journalist, now freelance writer, Judy Roberts, who brings her skillful knowledge of nature (floral and birding) together. On this holiday weekend when the country “rests” as a nation, take a few moments to quietly ponder Judy’s insightful thoughts on winding down from a hectic summer season by paying attention to the value of purposefully balancing rest and labor. Judy’s words make me want to grab a steaming hot cup of coffee and go sit outside and be still (and I think I will).

The earth is resting. It is early September and the late-summer sounds each morning are notably different from those in June or July when a multitude of bird songs reaches my ears on my daily walk. Now, I hear only subdued singing from the crickets and other insects of the field, a few bird chirps, and maybe a light whoosh of leaves from a scampering bunny. The frenzied activity and bursts of garden growth from July are long past and everything is catching its breath, except for the butterflies and hummingbirds that quietly flit about in their quest for nectar. Earlier in the season, the air was full of blackbird and wren chatter each morning and the garden seemed to explode with color as each day brought clusters of changes. Our avian friends were occupied building nests, then sitting on eggs, and finally feeding their young. A pair of Eastern Phoebes who spruced up last year’s nest and raised not one, but two broods in it, entertained us many an evening as they flew sorties between the garden and their nest, swooping down to catch insects and flying them back to the waiting mouths of their chicks. Busy, busy, busy. After the young had vacated the nest, I spied one of the pair bathing (the males and females are indistinguishable) and thought, “Ah, finally a nice bath without babies to tend!”

As late summer gives the earth and its occupants a breather, I’m trying to drink in this wondrous pause each day and learn from it. I know there is wisdom in stopping for a respite after a period of intensive work or play, or a major life event. It’s a message the Creator built into creation, yet I often ignore it to my detriment. Even when things seem not to be working very well, instead of heeding and pausing, I tend to follow our culture’s favorite mantra: “Keep going.”

Truth be told, like most people, I prefer being occupied and busy and sometimes, I just can’t bear to stop. Even if I feel the least bit tired, I reason that more activity will refresh me.

But this near stillness of late summer is beckoning. So I’m trying again to listen. Summer is ending, to be sure, concluding a period of intensive activity, whether it’s been working in the garden, going to the beach or pool, taking a vacation, having friends and family over for cook-outs or hosting traveling house guests. It’s time to pause, even if it feels uncomfortable, and submit to inactivity, resisting that impulse to do something, anything.

These mornings, I’m paying heed to the quiet and entering into it, letting the more subdued sights and sounds around me sink in, knowing that by doing so, I’m partaking of the rest that I, too, require.

A friend who recently retired from a demanding job did something like this on the first day she started to miss the busyness of her previous position. She likened the feeling to the beginning of a silent retreat, when her inner gears resist the onset of inactivity. Eventually, though, she grows to love this new pace so much that she almost hates to leave. Recalling this caused her to suspend her discomfort and to pray about her new life, asking God for discernment concerning the possibilities before her. She prayed that she would not accept any new activity simply out of a desire to be busy.

When God through his creation is reminding us to rest, it’s natural to resist. After all, we receive rewards for our activity – accolades from others, a sense of importance, and the satisfying rush of adrenalin. This is good. We were made for action. But our actions grow meaningless if they are not accompanied by periodic times of stillness. The same Creator whose hand is in the explosion of life we’ve just witnessed, summons us to steal away with him and rest as another season of growth winds down.