Bone Basics for Baby Boomers

Bone Basics for Baby Boomers

There are presently millions of "baby boomers" in the United States. Baby boomers...that's the term we give to individuals in this country born between 1946 and 1964...a time in our culture when having babies was all the rage...very much in vogue. The boomers already make up a significant portion of the American population. As we age as a nation, and extend our longevity, too, the boomers will become more and more of a factor in the American healthcare delivery system.

Despite their advancing age, getting around and being mobile won't be any less important. After all, mobility is tantamount to freedom for many Americans. When we're confined, sick, and can't move around much at all or not as well as we used to, we feel frustrated, isolated, out of touch, and vulnerable. After all, so much of life in America centers around youth, vitality, and being constantly "on the go" and "on the move."

But it's perhaps inevitable that some of us -- the so-called baby boom generation and seniors too -- will develop problems with our bones, muscles, tendons, and ligaments as we age. Nothing quite slows a person down like a serious musculoskeletal problem. If you doubt that, go visit someone in a hospital or nursing home with a fractured hip. Or someone who has chronic neck or back pain...an unstable knee...or even a bad case of plantar fasciitis (heel pain). But are problems like this inevitable? What can we do now, if anything, to ward off problems later? To get straight answers to these questions and more, we asked Stuart C. Zeman, M.D., a nationally recognized orthopaedic surgeon and sports medicine authority, to fill us in on some bone basics for baby boomers. Here is our exclusive interview with Dr. Zeman.

Dr. Zeman, From a musculoskeletal standpoint, what happens when people age? Are the baby boomers in for some serious problems later on in life? If so what kinds of problems are most common?

Dr. Zeman: As we grow older, the musculoskeletal tissues in our bodies change. Generally, our bones become more brittle, our muscles get weaker, our joints get stiffer and we gain weight. Some of the more common problems encountered later in life include shoulder bursitis, neck and back strains, muscle pulls in the thigh and leg, and hip and knee arthritis.

What sets the stage for such problems?

Dr. Zeman: These changes are not only due to the aging process. When we're young, we have fewer commitments and athletic or exercise activities occur almost daily. Therefore, most young people are in relatively good shape and maintain a decent weight. As we grow older, our responsibilities and stress increase and we have less time to keep in shape. Finally, especially in women, hormonal changes can contribute to osteoporosis.

What, if anything, can people do in a preventive sense to decrease the probability of developing such problems as they start to age? What are the most important things to do right now, here, today?

Dr. Zeman: There are many things we can do to fight back, absolutely. We can eat more intelligently and keep in mind that the same three things have always worked to keep weight down: eat less, eat right, and exercise regularly. Cut down on fat intake, consider nutritional supplements, and exercise four to five times a week, preferably using circuit training type methods.

Dr. Zeman, is the healthcare system as it is developing in our country today (with its emphasis on increased enrollments in HMOs, capitated reimbursement systems, and an almost unending emphasis on cost containment) going to be equipped to handle the musculoskeletal problems of our aging baby boomers and senior citizens? Are there any deficiencies in the system that need to be rectified? Any suggestions for improvements that you'd like to see? Can society really care for the bone problems of its citizens with the way things are headed now?

Dr. Zeman: The health care system as it exists today is well-equipped technically to handle musculoskeletal problems but the environment is getting very frustrating for the average patient. Insurance companies are dictating the quality of care but they're forgetting the customer isn't stupid and knows best.

Are patients being referred appropriately to orthopaedic surgeons these days? What can patients, as smart healthcare consumers, do to ensure that they are receiving appropriate care in the orthopaedic area? Obviously, you don't want or need to go to an orthopaedic surgeon for problems that can be successfully treated in the primary care setting -- that's a given. But some physicians are expressing concern that maybe the proper referrals to sub-specialists such as orthopaedic surgeons are not being given, with the consequence that some people are being inaccurately diagnosed, not receiving proper treatment, or receiving necessary treatment too late. Is this a problem, in your opinion? What can healthcare consumers do to make sure they aren't slipping through the cracks in their respective healthcare/managed care systems? When should they insist on seeing an orthopaedist? Do they have any recourse if they feel they are being denied care that would be appropriate? Any guidelines you can give in this area?

Dr. Zeman: Unfortunately, many insurance companies and health plans are "encouraging" primary care physicians to take care of orthopedic problems and, in some cases, are "penalizing" these doctors for referring appropriate cases to specialists. The patient must stand his or her ground. As one of mine said last week, "My family doctor's secretary said to come in with my tennis elbow but I said 'no way, I'm going to my orthopedist.'" Remember, you're paying the insurance premium, even if you're getting it "through work."

Many family practitioners and pediatricians have a "comfort zone" with some specialties but orthopedic surgery is notoriously threatening for most of these physicians. Therefore, missed diagnosis and improper treatment are common. In the past two weeks, I've seen a missed anterior cruciate ligament tear in the knee by an emergency room doctor, a shoulder that had repeatedly been injected for "bursitis" when in reality there is a huge calcium deposit present (seen by a family doctor), and a very swollen ankle that was treated as a "bad sprain" with an ace bandage (by a pediatrician) when x-rays showed a fracture requiring surgery.

The good news is that a pediatrician down the street saw a child with a sore wrist (after falling off the monkey bars) and confessed, "I never treat orthopedic problems...they scare me." He sent the young lad over immediately to my office, a growth plate injury was seen on x-ray, and the patient was casted and out the door in fifteen minutes. The mother was noticeably delighted with the pediatrician's honesty, the child was treated quickly and appropriately, and the result will be good. This is the way it should be done.

Any final thoughts you'd care to leave our readers with, Dr. Zeman?

Dr. Zeman: Although the medical delivery system has gotten very frustrating, we still have the best care available. My advice to patients is purchase a plan that allows the freedom to go to the doctor and facility you want, without begging an administrative type (with ulterior motives) for permission. It may cost a few extra bucks, but it's well worth it. When you need competent medical help, you don't want to be hassled.

Thank you, Dr. Zeman, for an enlightening interview.

About the Doctor:

Dr. Zeman is a board certified orthopedic surgeon in private practice. A member of American Academy of Orthopedic Surgeons, American Board of Orthopedic Surgery, American College of Sports Medicine, and International College of Surgeons, he's had extensive experience in the professional sports arena and wrote the humorous and popular selling book, "So You Want To Be A Doctor".

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