Saturday, August 8, 2009

Hip Pain

By Shawn Vuong

According to, osteoporosis is a condition where bones become weak and brittle due to low calcium levels. Osteomalacia on the other hand is a condition where the bones soften do to low Vitamin D. In children this condition is called rickets.

This week Dr. Holm give a very common medical story about the nice elderly lady who fell and broke a hip, due to these hiding conditions. But what does this have to do with us young people you may ask? Dr. Holm's story is more than just a description of a common clinical picture of osteoporosis or osteomalacia, it's about bone health. These days more and more people are sitting in front of the computer all day at the office, or maybe in the dorm room skipping class and playing WOW (World of Warcraft). We are not getting enough Vitamin D and we are not leading lives conducive to good bone health.

So some suggestions for those of us who do not want to break a hip include:

- 30 minutes a day of weight bearing exercise
- Drink more milk and get a little sun
- Take a multivitamin


By Richard P. Holm MD

Osteoporosis is a condition of thinning and porous bone, while osteomalacia is about soft protein-poor bone. To understand the difference, listen to this common and real story.

The eighty year-old woman arrives in the emergency room by ambulance with a new hip fracture. She would be writhing in pain, but if she moves it hurts even more, so she is lying perfectly still in pain.

After injecting pain reliever, the doctor notes the right leg is shortened, turned outward, and the X-Ray indicates a fracture of the hip. More specifically the break is in the neck between the ball and the body of the thighbone, also called the femur.

The doctor listens carefully to her story and discovers that she is a widow still living in her own home, still doing some gardening, still driving her friends around town to club meetings, still cooking and cleaning for herself. But all of that changed when she lost her balance on the back stoop, couldn’t find a rail to catch herself, and down she came striking hard on the cement sidewalk.

Her daughter-in-law says that it is a miracle she hadn’t tripped before what with the loose rugs scattered through the rooms, the electrical cords running everywhere, and the hand-knitted slippery foot warmers she wears after supper while shuffling around the darkened house.

The diagnosis of osteomalacia is suspected, as she describes generalized fatigue and aching over the last five years, and on exam she has a remarkable arching back and now this fractured hip. Later a very low Vitamin D level confirms the diagnosis, and the doctor suspects it’s been low the last half of her life, resulting from working inside the house most of the day, with little exposure to the sun. Vitamin D supplement becomes part of the patient’s treatment.

It is interesting to point out that there is no real clinical difference between osteoporosis and osteomalacia.

This was a story about home safety and prevention of falls, about bone building and bone maintenance, and how much more important vitamin D is than we used to think.

The Big Cover-Up

By Shawn Vuong

Erectile disfunction, as well as sexual problems in general are difficult for any man to talk about. Whether that be friends, family, or the physician sexual performance is still a secretive area of a person's life. Even in this day and age with all kinds of sexual and personal information and entertainment a click away, many people shy away from the subject of sex.

If you or someone you know is having sexual problems such as erectile disfunction, the "blue pill" may not be the right answer. It's important to go in and speak with a primary care professional about these subjects. Although you may be tempted to keep these problems under wraps and consult Dr. Google, these problems could signify significant medical problems. While google can be a good starting source for information, it shouldn't be your only one.

By Richard P. Holm MD

Just last week a ninety-two year old man asked me to renew his prescription for Viagra. I gleefully responded, but it made me think how complex and difficult this issue can be.

There is probably nothing so personal, and maybe so important to a guy growing up than his ability to perform sexually. I mean we’re talking that part of the sexual ego of every young man that wishes to be superb, something that women crave to have, and every other guy would envy.

It is all covered up, however. Knowing what a man is supposed to do in the bedroom, and what constitutes normal male sexual function is something that is all too clouded in secrecy. When I was 14, the major source of information about male performance came to me at the roller-skating rink, when camping out, or late in the night from reading questionable literature with a flashlight, and I don’t think this kind of education has improved much since.

And with all the overblown expectation, and not knowing what is normal, comes the self-consciousness and hesitation to ask when there might be a problem.

A recent study indicated loss of erectile function or so-called impotence occurs in more than 50% of 40-70 year old men, and increases with age. The problem is twice as bad for smokers than for non-smokers, three times as bad for diabetics, and four times as bad for people with heart disease. It also increases significantly with psychosocial problems associated with hostility, suppressed anger, and depression.

But that’s not all. Men in poor physical condition, or with thyroid disease, B12 deficiency, sleep apnea, and other medical conditions may also present with a loss of desire for sex, or an inability to have an erection.

Bottom line: the loss of erectile function might indicate something is medically wrong, and men should expect more from their doctor than a prescription for Viagra. This is a problem that shouldn’t be kept under the covers.