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Resistance Exercise for Knee OA

Resistance Exercise for Knee OA

Research indicates that knee pain occurring with movement due to osteoarthritis (OA) strongly predicts the need for functional assistance and is the second leading cause of disability in the United States. Muscle strengthening through resistance exercise is one of the treatment options for OA-induced pain. According to Kevin R. Vincent, MD, PhD, most patients with knee OA experience pain and therefore do not want to be active. “This causes the muscles around the joint to become weaker, making the joint less stable and ultimately causing patients to become less functional,” he says. “Self-efficacy often decreases when patients feel like they’re not as functional as they once were or as they lose confidence in their own capabilities.” Beyond the functional benefits of resistance exercise, there are other benefits of muscle strengthening to consider, such as psychosocial well-being, cognitive function, and self-esteem. “These factors can all improve with resistance exercise,” Dr. Vincent says. “There may also be decreases in anxiety, depression, and negative stress-related emotions.” Stronger muscles can also lower the blood pressure response to exertion and improve glycemic levels. Overall, patients who participate in resistance exercise programs tend to enjoy better outcomes with many of the other treatments used for knee OA. Getting Started Several factors must be taken into account before starting patients on resistance exercise programs. “The level of disease severity and the overall health of the patient should be considered,” says Dr. Vincent. “Physicians should understand the willingness and ability of patients to participate in these programs and then tailor them based on whether they’ll be exercising at home or in a fitness center.” The key to...

Anesthesia vs. Surgery: Can’t We All Just Get Along?

A surgeon did an operation under local anesthesia with sedation in a very anxious, elderly patient. Everyone was aware of the patient’s anxiety, and she was maintained on midazolam (Versed) by an anesthesiologist throughout the procedure, which went smoothly. When she returned a few weeks later for a similar procedure at another site, a different anesthesiologist was involved and refused to sedate the patient, who complained bitterly after the case. She said if she had known that sedation was not going to be given for the second procedure, she would not have undergone it. She filed a formal complaint with hospital administration as did the surgeon. The preoperative nurse told the surgeon that she had spoken with the second anesthesiologist and informed him that the patient was anxious and wanted a similar type of sedation for the second case, but he refused to give it. He accused the nurse of telling him how to do his job. For now, the anesthesiologist in question is no longer being assigned to the surgeon’s cases. What happens when anesthesia and surgery disagree? There is no simple answer to this issue. Anesthesia is one of the few specialties that you must consult and work with but have no control over who is assigned to your cases. You may have a couple of “go to” internists or cardiologists. You can ask your favorite radiologist to look at an x-ray for you. But anesthesiologists are assigned to you by the chief of anesthesia or the anesthesiologist-in-charge for the day. So no matter how incompetent or disagreeable a particular anesthesiologist is, you may have to work...
A Look at Female-to-Female HIV Transmission

A Look at Female-to-Female HIV Transmission

Few cases of HIV transmission between women who have sex with women (WSW) have been reported in the United States, but these cases still can and do occur. Studies have shown that HIV can be transmitted by female-to-female sexual contact with unprotected exposure to vaginal or other bodily fluids and to blood from menstruation. Historically, confirming HIV transmission during female-to-female sexual contact has been difficult because other risk factors are almost always present or cannot be ruled out. “It can be difficult to determine if HIV was transmitted by female-to-female sex or other more common modes of transmission, such as injection drug use and heterosexual sex,” says Amy Lansky, PhD, MPH. A Case Report According to a report published in the Morbidity & Mortality Weekly Report, the Houston Depart­ment of Health contacted the CDC in August 2012 regarding a rare transmission of HIV that likely resulted from sexual contact between HIV-discordant partners. The women involved reported having unprotected sex during a 6-month monog­amous relationship. The woman with newly acquired HIV did not report any other recognized risk factors for HIV infection. The other partner was previously diagnosed with HIV and had stopped receiving antiretroviral treatment in 2010. In this case, laboratory tests confirmed that the woman with newly diagnosed HIV had a virus that was virtually identical to that of her partner. “This case was unique because the CDC was able to use both phylogenetic and epidemiologic data in the investigation,” Dr. Lansky says. The viruses infecting the two women had a 98% or higher sequence identity in three genes. The couple had not received any preventive counseling before...
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