A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

Of course none of us really wants to be either of those things.  We want to be brilliant and stunningly beautiful.  And rich.  And happy.  And living on an island with a cabana boy named Juan who fulfills our every desire…

Maybe that part is just me.

We have all been lead to believe that we should want it all and that we can get it all and if we don’t want and have it all, there is something wrong with us.  However, I now have some scientific proof that the choice between brains and beauty is more real than you may have thought!

In late April, the Wall Street Journal published an article, entitled “A Case for those Extra 10 Pounds”, that said that, while the recommendations are to control calories and make healthy diet choices, it seems that there is actually some benefit that comes from being 10-15 pounds overweight.  A little extra weight can lead to a lower risk of osteoporosis and even make you look younger.

Bring on the ice cream!

Just as I was really settling into my celebration of the joys of science, a new study came out that says that extra fat is linked to smaller brain volume, and potentially linked to Alzheimer’s Disease.  Lucky for me and my desire to continue to eat ice cream, it is unclear whether smaller brains lead to extra fat or vice versa.  I am pulling for the first one.  The idea of fat causing my brain to shrink is disturbing in more ways than one.

So extra fat causes Alzheimer’s, and too little fat causes osteoporosis.  A little extra fat will keep my face unlined and youthfully full, but may cause me to eventually forget my name. Am I willing to give up the ice cream to reduce the risk of dementia?

Is it wrong that I am not sure which way to go on this?

Tylenol has a long history of bumps in the road, starting with drug-tampering problems back in 1982, which resulted in the brand being held up as an example of what to do when disaster strikes your product.  Take responsibility.  Take Action.  Don’t make excuses.

The public was reassured by how the Tylenol scare was handled and sales eventually returned to the brand.  Tylenol came to mean a trusted and safe product once again.  And in a market with unimaginable generic competition, that trust went a long way toward making consumers feel like the branded choice was the right choice.

More recent troubles, however, cannot be blamed on nameless and faceless culprits who are threatening the safety of the American public.  This time the responsibility for manufacturing irregularities fall solidly in the lap of McNeil.  There is no denying that they must take responsibility, there is nowhere else to put it.  But the public is not so quick to forgive this time.

Part of the difference is that this time McNeil is truly to blame for the issue.  And the other part of the difference comes from how the world has changed in those intervening 28 years.  In the world of 1982, the news of the recall and corrective action came through formal channels and gossip about the problem was contained within neighborhoods.  In the world of 2010, news of the recall hit Twitter and Facebook long before it made the front pages of the newspaper or local news broadcasts.  Along with the immediacy of informing the public, McNeil was unable to control the message, and unprepared to deal with the fallout.  Their customer service resources were inadequate, their recall website not up to date, their response times were not up to snuff.

So now, in addition to being worried about the threat that recalled medications might hold for their families, people are angry that McNeil isn’t managing the situation as well as they could.  The brand is breaking.

As the process of restocking medicine cabinets with generic versions of McNeil’s recalled drugs is documented in minute detail via social media networks, more and more people see that generics offer safe, cost-effective alternatives to the branded drugs.  The more social proof that consumers see that the generics are just as effective, the more likely they will be to continue to eschew the branded products.  There is no upside of going back to Tylenol or Benedryl.  Those names are tainted with both the manufacturing issues (real or imagined, it makes no difference) and the customer service disappointments.

The bar for what consumers expect from a generic drug is much lower.  Does it work?  Does it cost less than the branded product?  Is it safe?  Customer service and advertising and image don’t enter into the equation for these purposes.

By dropping the ball so many times, McNeil is training consumers to be satisfied with a less impressive package.  It will be interesting to see if they are able to resolve and recover from this current crisis situation.  As surprised as I am to say this, my bets in this case are against the brand.

A New York Times review of the new book The Secret Life of the Grown-Up Brain caught my eye a week or so ago, and the author, Barbara Straunch, had some interesting insights to share relative to what middle-aged brains are actually good at, and how to keep our brains functioning well into the future.

• Our brains are still growing and developing far into adulthood.  Although we do have some compromises in short term memory (Where are my keys anyway? And what is your name?), the middle-aged brain is actually better in many ways than at any other point in our lives.

• Logic, creativity and social skills are all at a high point during those middle years.  Although you might not remember the name of the person to whom you are speaking, you will be an excellent judge of his character.

• We do not, as previously thought, actually lose brain cells as we age.

• Exercise and diet recommendations that benefit your heart are also likely to benefit the health of your brain.  Exercise in particular can actually help strengthen and grow your brain.  So get out there and start moving!

• Although there are benefits to making your brain work hard, crossword puzzles and learning a foreign language hold no particular magic powers in terms of maintaining the health of your brain.  Partaking in vigorous debates on subjects of interest can be just as helpful, so unless you just love the Sunday Times crossword puzzle, you can stop doing it!

• Meeting and engaging with people is healthy for your brain, and your mood!

It is so refreshing to hear that middle age is not necessarily the beginning of a slow slide into senility.  Staying engaged and active in life, both in terms of intellectual pursuits and social involvement, seems to be key to keeping your gray matter from graying.

I am hopeful that by maintaining an active life filled with fulfilling relationships, creative pursuits and lively conversation, I can remain one less consumer of Long Term Care services in New York!

Although un-hip, I am quite interested in doing things to keep myself and my family healthy.  I try mightily to get my children to willingly eat vegetables. I don’t cook red meat. I choose fresh ingredients rather than food-in-a-box whenever possible.  I am embarking on an experiment to be a vegetarian, and I recently gave up caffeine for a month.  I am willing to try new things – within reason.

There was a recent article in the New York Times about the popularity of a fermented tea drink called kombucha.  Apparently this tea can do all kinds of magical things like re-growing hair, calming digestive issues and curing hangovers.  Those who drink it claim that it is quite delish.  Sounds good, right?  I’m in! I could be the first one in the suburbs to partake of this delightful elixir!  How do I get it?

This is where things get a little hairy for me.  Because kombucha is made by immersing a disk of bacteria into brewed tea and letting it sit, unrefrigerated, for up to two weeks.

A disk of bacteria.

In your tea.

On purpose.

I am so not down with that.

I understand the benefits of probiotics.  I eat yogurt (from the refrigerator, thank you very much).  But, I have to admit that I wouldn’t even drink the plain tea if it sat out for two weeks – and the introduction of the bacteria disk into the equation does nothing to improve the situation for me.

I suppose the nature of kombucha is essentially similar to beer.  Fermented substances in a drink are not that uncommon.  And yet, I can’t quite get my head around voluntarily introducing bacteria into a completely acceptable drink like tea.  I guess I don’t brew my own beer either, although I do enjoy drinking it.

There are packaged versions of kombucha available, including one made by Red Bull.  I am slightly more comfortable with the manufactured versions, mostly because I work under the assumption that beverage manufacturers are as terrified of being sued as I am of dying of kombucha poisoning.

I am a big sucker for slick marketing and putting anything, even something utterly disgusting, in a pretty bottle and giving it a fun name goes a long way to drawing my interest.  If I actually went out and purchased a Carpe Diem Kombucha, it would be an ultimate marking success for them.

Ooooo…pretty bottle….fancy name…who cares what’s in it?  I must have it!

I want to be cool and brave enough to jump on this bandwagon and give kombucha a try.  But the reality is that it’s probably beyond my capabilities to be that cool and brave.  And the Dunkin’ Donuts coffee is working just fine for me, thanks!

Dr. Berry’s findings, presented last week in San Francisco at the American Heart Association’s Annual Epidemiology and Prevention Conference, are based on an analysis of 1,765 men and women who had physical examinations performed during the 1970’s and 1980’s at the Cooper Institute, the Dallas-based birthplace of the aerobics movement. Put another way: If you’re not fit in your 50’s, your projected life span “is eight years shorter than if you are fit,” Dr. Berry says.

So regular exercise is the most cogent weapon we have to ward off illness and fight disease- as it results in lower blood pressure, healthier cholesterol, and lower blood sugar.

Rest assured… there is a silver lining to all this before you start jogging, digging ditches, or playing singles tennis:  Studies also indicate that exercise’s greatest impact occurs when individuals move from a sedentary lifestyle to embarking on regular moderate exercise regimens.

That’s encouraging. You go, Girl!

A recent report in the December Journals of Gerontology: Medical Sciences found that older women who volunteered for Experience Corps – tutoring elementary school children, had increased brain activity in regions important to cognitive function after a period of six months.

What was exciting about these results, is that it shows a direct correlation between community-based programs and improved cognitive functions. Until now, much study has been done on the brain-boosting power of cognitive, physical and social leisure activities, but little was known about the effectiveness of community-based service.

“This finding is best captured by a personal observation from one of the volunteers, who stated that ‘it [Experience Corps] removed the cobwebs from my brain.” wrote Michelle C. Carlson, of Johns Hopkins Bloomberg School of Public Health.

The seventeen women enrolled in this study were low-income African-Americans with little education, aged 65 and older, and deemed high-risk for cognitive declines, based on a mental state evaluation. Eight of the women actually participated in the tutoring program in Baltimore elementary schools, while the other nine served as the control.

Via functional magnetic resonance imaging, researchers assessed neural activity in the brain prior to the volunteering experience, and again after six months. Based on the fMRI assessment, the women who actively participated in Experience Corps saw improvements in mental function compared with those in the control group.

There you have it, doing your civic duty and assisting others is highly rewarding to all participants. These meaningful activities seem to be more enriching than highly stimulating activities performed alone

Utilizing MRI’s of the brain, they studied 20 healthy, thin people who went without breakfast that day. When those people were exposed to an array of food photos, both high and low fat, their brains become more active at the sight of the high-calorie options than when they saw low calorie foods. When this test was repeated on another day 90 minutes after they ate breakfast, there was no significant difference in their brain’s reaction to different caloric foods

Corresponding to the MRI findings, were ratings of appealing food pictures. After skipping breakfast, participants found calorie laden food choices to be much more tempting. After eating, however, the group did not show a strong preference for the high-calorie foods.

According to Tony Goldstone, MD, PhD, a consultant endocrinologist with the MRC Clinical Sciences Centre at Imperial College London, “Our results support the advice for eating a healthy breakfast as part of the dietary prevention and treatment of obesity, When people skip meals, especially breakfast, changes in brain activity in response to food may hinder weight loss and even promote weight gain.”

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

Will those stinging booster shots be a thing of the past, fading into oblivion together with walkmans, analog TV and Kodak film? With the advent of a new Band-aid-like painless patch lined with microneedles, our grandchildren may never know the ouch of a needle at an annual checkup.

Scientists have developed a patch that can simply be applied to a patient in place of using hypodermic needles, a big boon to diabetics and others suffering from diseases that require frequent pricks. This was presented at the 238th National Meeting of the American Chemical Society in Washington, D.C.

“If you can move to something that’s as easy to apply as a Band-Aid, you’ve now opened the door for people to self-administer their medicine without special training.” said Mark Prausnitz of Georgia Tech, one of the developers.

This development was enabled by advances in the electronics industry, which has microminimized all forms of technology – opening the door for the creation of needles that are only a few hundred microns long, about the width of a few strands of human hair.

Researchers are hopeful that the patch which will initially be used in a clinical setting could ultimately be self applied at home, replacing many other needle injections – even flu shots!