Monthly Archives: February 2017

Know More About Fractured Bone

Any crack or break in a bone is considered to be a fractured bone. Although auto accidents are a common cause of fractured bones, most fractures actually occur inside the home.

The most common fractured bone in children is an arm bone, because kids hold out their arms when they fall. For people over age 65 who fall, the most common fractures are hip, spine, arm, and leg fractures.

Fractured bone symptoms depend on what bone is fractured and the type of break you experience, from a stress fracture in the shin or a compression fracture in the spine. The shin bone is the most commonly broken long bone in the body, but fractured leg symptoms from the shin bone can range from mild swelling to a bone actually sticking out through the skin.

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Symptoms that may occur with most fractured bones include:

  • A misshapen or deformed bone or joint
  • Bruising and swelling around the fracture
  • Severe pain that is worse with movement
  • Broken skin with visible bone showing
  • Loss of sensation or a tingling
  • Limited or complete loss of movement

Types of Bone Fractures

A bone fracture can range from a tiny crack in one spot to multiple complete breaks. Doctors use different terms to describe these types of fractured bones:

  • Greenstick. A greenstick fracture is a crack on one side of a bone that does not go all the way through.
  • Complete. A complete fracture is one that goes all the way through the bone.
  • Stress. A stress fracture is a hairline crack that occurs from overuse. Minor leg fracture symptoms often occur from stress fractures.
  • Compression. A compression fracture is when a bone collapses. This type of fracture usually occurs in the bones of the spine.
  • Open. An open fracture is a fracture that has broken the skin. These are also called compound fractures.
  • Comminuted. A comminuted fracture means that the bone is broken in more than one place.

Who Is at Risk for Fractures?

You are at greatest risk for a fractured bone when you are under age 20 or over age 65. After middle age, women are at greater risk for fractured bones than men because of osteoporosis. Loss of estrogen after menopause can cause low levels of calcium, which can make a woman’s bones weaker and easier to fracture.

Other risk factors include:

  • Participating in sports, especially contact sports
  • Weak muscles and bones from not getting enough exercise
  • Having a bone tumor
  • Having a disease that weakens bones

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What to Do for a Fractured Bone

If you or a loved one might have a fractured bone, the first thing to do is stay calm and get help. Movement of a fractured bone can make things worse. Lower leg fracture symptoms or suspected fracture of a hand or arm may require a call to the doctor. More severe fractures may require first aid and emergency treatment. Here are some basic first-aid rules for fractures:

  • Never move a broken bone if it is unstable or if it involves the head, neck, spine, or hip. If a person needs to be moved to safety, he should be grabbed by his clothing (the top of the shirt, belt, or pant legs) and dragged gently.
  • Apply ice packs to reduce swelling.
  • Avoid shock by keeping the person flat and warm with a blanket. The feet can be elevated 12 inches above the head. Do not move a person to get him flat or raise his legs if a head, neck, or back injury is suspected.
  • For an open fracture, rinse the wound to remove dirt and cover it with a clean dressing. Control bleeding with gentle pressure.

Not all fractured bones are medical emergencies, but all fractured bone symptoms need to be checked by a doctor. Call 911 for fractured bone emergencies such as open fractures; severe bleeding; cold, clammy, or blue skin; and possible fractures of the head, neck, back, hip, or upper leg.

The Important of Health Emergency Fund

Even with good health insurance, a health emergency or a prolonged illness can be a financial disaster. Health insurance deductibles, co-payments, emergency room costs, and other costs of illness can add up in a hurry.

A health savings account (HSA) is one way you can put aside tax-free money for a health emergency. HSAs were established in 2003. If you are covered by a type of insurance known as a high-deductible insurance plan, you can make tax-deductible contributions to an HSA. Your employer may also make tax-deductible contributions.

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“An HSA account is very different from having a general emergency fund account,” says Joseph J. Porco, managing member of the Financial Security Group, LLC, in Newtown, Conn. “An emergency fund is about more than just out-of-pocket medical expenses. If possible, it’s a good idea to have both.”

How Much of an Emergency Fund Do You Need?

For an older adult, a health emergency might result in the need for long-term care, possibly for the rest of the senior’s life. For a young adult supporting a family, a medical emergency might be much more than just the cost of illness. Your health emergency could cause a disability that results in loss of income over an extended period. That means you should save enough to cover all your expenses.

“Most advisers would say you should have enough emergency funds saved to cover your family expenses for three to six months. I would recommend trying to put enough aside to cover all your expenses, not just health expenses, for 6 to 12 months,” says Porco.

How much you need for a health emergency and how much you can actually put into an emergency fund will depend on your family size, your income, your health status, and your age. But your first step is to understand your health insurance situation.

“The best way to start is to sit down with a financial adviser and figure out what your insurance actually covers and what it doesn’t cover. What are your insurance limits? What kind of medical bills might arise that you would be responsible for? Get some expert advice on how best to cover your actual needs,” advises Porco.

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What Insurance May Not Cover

How much insurance companies actually pay for accidents, cancer treatment, or surgery depends on what kind of insurance you have, but there are usually limits. Here are some facts to consider:

  • Cost of illness. Most insurance companies have a cap on how much they will pay for a long-term illness. A recent survey found that 10 percent of people with cancer have hit their lifetime cap and are no longer covered by insurance. Looking forward, however, the new health care reform law will eliminate caps on lifetime insurance by 2014.
  • Emergency room cost. If you have an accident that requires emergency treatment and you end up in an emergency room outside your insurance network, you may not be covered. One study found that HMOs in California denied one out of every six claims for emergency room costs.
  • Surgical coverage. You may be surprised at what your insurance company considers non-covered surgery. There can be a big gray area between covered “reconstructive” surgery and uncovered “cosmetic” surgery. Even when surgery is covered, your deductible may be $500 or more, and you may still be responsible for up to 25 percent or more of surgical costs, depending on the specifics of your plan.

How to Save for a Health Emergency

Once you know what your insurance actually covers and how much you need to put away for an emergency, the next question is where to put it. “Money that you put aside for a health emergency needs to be liquid and secure,” says Porco. “That means you need to be able to get it when you need it.”

And your money needs to remain liquid. “Those who fail to set up an emergency fund may find themselves running up credit card debts to cover their expenses. The last thing you need is to be paying interest on your emergency,” warns Porco.

Examples of places to put your emergency fund include an interest-bearing checking or savings account, money market fund, or bond fund. Don’t tie your money up in anything that would penalize you for early withdrawals or any investment or account that has the potential for loss.

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Practical Ways to Save

There are many different ways to approach starting — and adding to — your health emergency savings. “You can take advantage of a health savings account if this is offered at your job, but start a general emergency fund also,” suggests Porco.

Here are more health savings tips:

  • Put any money you get from a tax refund or earned income credit into your health savings fund.
  • Ask your bank or credit union to automatically transfer funds into your emergency account.
  • Explain the importance of an emergency fund to your family and get everyone involved in cutting back on unnecessary expenditures.

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Remember, while HSA accounts are useful, a general emergency fund is equally important. Whether it is a health emergency that involves an uncovered emergency room cost or a prolonged illness like cancer, the actual cost of illness may end up being much more than your out-of-pocket health costs if you’re unable to work. Sit down with a financial adviser and find out what you can do to better insulate yourself from a health emergency.

Know More About Chronic Fatigue Syndrome

Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling— improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.

Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.

Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.

In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.

In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”

“The number of serious adverse events was miniscule,” she added.

Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.

“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.

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However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.

“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.

In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”

The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.

“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.

“We know that cognitive behavioral therapy and gentle physical conditioning help people cope with any chronic disease — even congestive heart failure and multiple sclerosis,” Natelson said in an interview with MedPage Today.

Chronic fatigue syndrome is characterized by persisting or relapsing fatigue for at least six months that cannot be explained by any other physical or psychiatric disorder.

The fatigue is debilitating, and often is accompanied by joint and muscle pain, headaches, and tenderness of the lymph nodes.

In an editorial published with the study, Dr. Gijs Bleijenberg, and Dr. Hans Knoop, of Radboud University in Nijmegen, the Netherlands, explained the differences in these types of treatment for chronic fatigue.

“Both graded exercise therapy and cognitive behavior therapy assume that recovery from chronic fatigue syndrome is possible and convey this hope more or less explicitly to patients. Adaptive pacing therapy emphasizes that chronic fatigue syndrome is a chronic condition, to which the patient has to adapt,” Bleijenberg and Knoop wrote.

Graded exercise therapy and cognitive behavioral therapy have both been recommended by the U.K. National Institute for Health and Clinical Excellence, although evidence supporting these approaches remains sparse.

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Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.

These groups advocate exercise pacing and specialist medical care, according to the investigators.

To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.

Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.

More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.

At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:

  • Cognitive behavioral therapy, 59 percent
  • Graded exercise therapy, 61 percent
  • Adaptive pacing therapy, 42 percent
  • Specialist medical care, 45 percent

The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:

  • Cognitive behavioral therapy, 30 percent
  • Graded exercise therapy, 28 percent
  • Adaptive pacing therapy, 16 percent
  • Specialist medical care, 15 percent

Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.

Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.

White’s group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.

They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.