Osteoporosis is a disease that causes your skeleton to weaken and bones to break. A milder form of this condition is referred to as osteopenia. Your physician has recently identified you as having this condition based on a recent bone density test known as a DXA scan.
There are several steps that you can take to help treat and prevent further weakening of your bones. No single step is enough to help, but all in concert may help prevent further bone loss.
Be sure that you are ingesting the recommended daily amounts of calcium and vitamin D.
Calcium plays an important role in maintaining bone. Calcium alone cannot prevent or cure osteoporosis but is an important part of our overall treatment program. Men over the age of 50 should consume 1,200 mg of calcium per day. You may be able to consume enough calcium through your diet, and you can specifically measure your calcium intake based on the table on page 3 which specifically delineates calcium content in many common foods. However, it is not uncommon for you to need a calcium supplement. There are several different types of calcium available. We would recommend Citracal. Of note, Citracal contains both calcium and vitamin D. Other supplements are available and you may discuss this further with your physician.
Vitamin D also plays a major role in calcium absorption. It is imperative that you consume both adequate amounts of vitamin D and calcium. The recommended daily intake of vitamin D should be between 400 and 800 iu. Major sources of vitamin D in your diet include vitamin D fortified dairy products, egg yolks, fish and liver. Most calcium supplements do include vitamin D as well. Do not take more than 800 iu, in that massive doses of vitamin D may be harmful. In addition, vitamin D is manufactured in the skin and usually 10-15 minutes of sun exposure on the hands, arms, and face 2-3 times a week is enough to satisfy the body's vitamin D requirement. The use of sunscreen, however, will markedly diminish the manufacturing of vitamin D in the skin.
Many multiple vitamins include vitamin D as well as calcium so you need to include these in your daily intake measurements.
Engage in regular weight bearing exercise.
Exercise is important to bone health. The best exercise for your bones is weight bearing exercise such as walking, dancing, jogging, stair climbing and racquet sports. You may need to check with you physician if you have had a sedentary lifestyle before you begin any vigorous exercise program.
Avoid smoking as well as excessive alcohol. Both are noted to be associated with decreasing bone density.
You may need to take medication recommended by your physician.
Bisphosphonates such as Fosamax, Actonel, and Boniva, are the most common medications your physician may prescribe. These involve tablets that are taken at weekly or monthly intervals. In addition there are more potent bisphosphonates available in an intravenous form which are given every three months. Your physician will decide which type of medication would be best for your particular condition. Ongoing research suggests there may be new medications in the future which hold even more promise; however, at this time these are the current drugs that are most commonly used.
Your First Visit
Your first visit with our Nurse Practitioner will take approximately one hour. At your visit the Nurse Practitioner will take a health history and perform an examination to evaluate the cause for your bladder problem. If you have not recently had a urine test performed, you should come expecting to give a specimen. You may also have a "bladder scan" of your bladder to ensure you are emptying completely. This will take place in the exam room and is not a specialized x-ray procedure. A small amount of ultrasound jelly is placed over the abdomen and a sensor is then placed on the belly. The machine gives a reading of how much urine is left in the bladder.
An abdominal and pelvic examination is then performed on female patients to ensure there is no secondary cause for the bladder problem. Male patients may have a prostate exam to ensure there are no other abnormalities.
Following the examination, muscle testing of the pelvic floor muscle will be performed. The procedure is not uncomfortable.
In females this is done one of two ways: (1) A small sensor is placed in the rectal opening and you will be asked to tighten the rectal muscle as if you were holding back gas. The reasons for these instructions is all the pelvic floor muscles attach into the rectum. Therefore, it is easier to contract the larger muscle of the rectum and it automatically tightens the rest of the muscles which control bladder leaking or urinary frequency and urgency. (2) A small sensor like a tampon is placed in the vagina and the same instructions are given as above.
In males a small sensor is placed in the rectal opening and you will be asked to tighten the rectal muscle as if you were holding back gas. The reason for these instructions is all the pelvic floor muscles attach into the rectum. Therefore, it is easier to contract the larger muscle of the rectum and it automatically tightens the rest of the muscles which control bladder leaking or urinary frequency and urgency.
The muscle testing is important because no two people are exactly alike. The level of exercises we recommend will be based on the muscle testing. If too many exercises are performed, it may actually fatigue the muscle. If not enough are performed, the muscle will not improve.
Additional treatments which may be incorporated are:
- Stimulation to the muscle. This is done with the vaginal sensor in women, which is inserted like a tampon. You will feel a gentle tapping sensation and feel the muscle contract. There is not uncomfortable for most people. This is the same type of therapy used for other muscles in the body to help them get stronger faster. It also helps those people who have difficulty with urgency and frequency by helping control the bladder.
- Dietary habits will be reviewed. We find some patients have bladders that are very sensitive to certain types of drinks or foods. Dietary changes may be recommended.
We find 75-80% of the patients we see will attain significant improvement or cure with this type of therapy alone. As with any form of treatment, there are some patients who do not benefit from non-surgical therapy. We recommend appointments every one to two weeks initially depending on your symptoms or progress. The average number of visits is six to eight. There are some people that require fewer visits and of course those who sometimes require more. Change in your symptoms should be noticed in three to four visits if non-surgical therapy is going to be successful for you. This does not mean that you will be cured in three to four visits, but you should notice gradual progress.
Remember loss of bladder control did not just occur overnight. We are working with the same muscles that have become weak so success does take some time, and most importantly it requires specific exercises and recommendations be followed. Occasionally we will also recommend medications if we feel they are warranted.
We encourage our patients to continue any vacation or travel you may have planned. Instructions may be given to keep your status of rehabilitation until you can return. Follow up visits usually take 30 minutes.
If you need to reschedule your appointment, we ask when possible to do so 24 hours in advance. We look forward to seeing you at your visit.
A flow study test is done to measure how fast the urine empties from your bladder. A flow study is done by asking you to void into a special toilet which records the volume of urine you have passed. (It is very important that you do not have a bowel movement into this special toilet during the flow study test.)
After you have emptied your bladder into this special toilet, the nurse will check your bladder to determine whether any urine has been left behind after you have finished urinating.
In order to be able to perform a flow test, you must have a strong urge to void. We realize that traveling quite a distance in the car when you have a fairly full bladder can be difficult. If you do not believe you can travel that distance with a full bladder, then we would ask that you come to our office early and be prepared to drink some fluids to allow your bladder to fill.
There are no other special preparations, fluid restrictions, or food restrictions for this test. If you wear incontinence pads or an external catheter, you may wish to bring extra supplies for replacement after the test.
- An antibiotic will be given to prevent infections just as you used prior to your prostate biopsy. Typically you will receive Cipro 500 mg, and you should begin this medication in the morning the day prior to your procedure and continue to take twice daily including the morning of your surgery. Take all pills until they are gone.
- An alpha-blocker, such as Uroxatral or Flomax, will be given to help the symptoms you will get from the implant. These symptoms typically include a slower or weak stream, burning with urination, urgency or frequency. This should be started the evening prior to surgery and typically taken for several months. If you are already taking this medication prior to your implant, you should just continue on the normal dose of medication.
- Take two Dulcolax laxative pills after supper the evening before the brachytherapy procedure and use a Fleet's enema the morning of the brachytherapy procedure. Both of these can be purchased at the pharmacy over the counter.
- Constipation needs to be avoided in the first two months after your procedure. Colace, also known as docusate, an over-the-counter (OTC) medication should be started twice per day. This should be initiated on the day after your implant. If you experience additional signs and symptoms of constipation in spite of this, we recommend senna compound or Senokot which is also an OTC medication, one to two per day. If you notice significant problems with rectal irritation, you should contact our office for a prescription for Anusol HC suppositories which will sooth this particular problem. This is not usually required, however.
- If you note ongoing burning with urination after your procedure, you should start Uristat or Azo-Standard which can be helpful. These are OTC medications which are available at the drugstore without a prescription. If your symptoms become more severe, you should contact our office to be evaluated further.
- Continue your routine pre-implant medications unless you have been specifically instructed differently.
- Pain is not typical after an implant, but if you have some minor discomfort we recommend an anti-inflammatory such as ibuprofen (Motrin) or naproxen (Aleve). The second medication, Aleve, is somewhat more convenient to use in that it is given twice daily, and we would recommend two tablets every 12 hours for discomfort, or you may use ibuprofen but this dose would be three tablets three times daily. These medications are both available at your drugstore without a prescription.
- You should avoid any activity which will bruise your perineal area where the seeds have been implanted. This would preclude you from riding an exercise bike or a motorcycle, or horseback riding in the first three to four weeks after your procedure.
- If you experience excessive urinary frequency or a feeling of inability to empty your bladder, you should contact our office to be evaluated for the possibility of urinary retention. This is an unusual complication that occurs after seed implantation, but needs to be evaluated in our office by checking a postvoid residual, which is a measurement of how much urine is retained in your bladder.