March 2009 Mayo Clinic Health Letter Highlights Knee Repair Surgery, Anxiety Disorder and Preventing Blood Clots
Active at 50? Still Prime for Knee Repair Surgery
A torn anterior cruciate ligament (ACL), a type of knee injury, doesn’t have to permanently sideline active adults age 50 and older, according to the March issue of Mayo Clinic Health Letter.
The ACL is a key ligament that stabilizes and supports the knee joint. It connects the thigh bone (femur) to the shinbone (tibia) and controls movement of the lower leg. The ACL is an important knee stabilizer when twisting, pivoting or jumping.
On the tennis court or during other high-intensity activities, a loud “pop” emitted from the knee and severe pain are the first signs of a torn ACL. A partial or complete tear can result from a hard twist on the joint, a sudden stop while running, a jump landing, or a direct blow to the knee.
Until recently, ACL tears occurring after age 50, and even after age 40, were typically managed with nonsurgical care that included modified activity levels and physical therapy. The treatment led to recovery but not the same level of stability as surgical repair.
More people 50 and older are leading active lives, which makes them good candidates for surgical reconstruction of the ACL. The ligament is reconstructed with a piece of tendon from the leg or with a tendon from a donor cadaver. With successful surgery, active adults can return to the same activities they participated in prior to the injury.
Effective Treatments Available for Anxiety Disorder
With generalized anxiety disorder, shedding worries is difficult, even when the worry is seemingly out of proportion to the concern. (“I can’t face my book club tonight.” “I wish I didn’t have to leave the house and deal with anyone.” “I hope I don’t feel sick again today. What if I am?”)
Other symptoms include startling easily, trouble falling or staying asleep, difficulty concentrating, fatigue, muscle tension, restlessness, feeling out of breath, nausea, diarrhea, headaches and excessive irritability.
Signs and symptoms appear gradually over time. Some who have GAD cannot recall the last time they felt at ease. Often the disorder begins between childhood and middle age, but it can occur anytime.
GAD is one of several types of anxiety disorders. Others include phobia, obsessive-compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Anxiety disorders can occur on their own, independent of other health concerns. Or anxiety can be a symptom of several health conditions, such as heart or lung disease, thyroid problems — even dietary problems. Treating the underlying condition can help reduce or manage the anxiety.
When anxiety is the primary concern, psychotherapy and medications can help worries become manageable.
Psychotherapy involves working with a therapist to identify unhealthy, negative beliefs and behaviors that contribute to anxiety and, then, learning how to replace them with healthy, positive beliefs.
Medications, both antidepressants and anti-anxiety drugs, also can help.
Among antidepressants, the first choice often is a selective serotonin reuptake inhibitor (SSRI). This category includes fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa). Other antidepressants that may be considered include duloxetine (Cymbalta) and venlafaxine (Effexor). These drugs can be highly effective, but may take several weeks to months before the full effects are evident. And, treatment may require trying more than one drug to determine what works best for an individual.
For acute anxiety and short-term help, your physician may recommend a benzodiazepine, which generally eases anxiety within 30 to 90 minutes. Drugs in this category include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan). Long-term use of these medications is a concern because they can be habit-forming and cause unsteadiness or balance problems, drowsiness and reduce muscle coordination. Buspirone (BuSpar) is another medication prescribed for anxiety. It doesn’t pose a risk of dependence but takes several weeks of regular doses to be effective.
Preventing Blood Clots: Risks from Long Flights and More
The March issue of Mayo Clinic Health Letter covers risk factors for deep vein thrombosis, as well as prevention, symptoms and treatment.
For most healthy adults, deep vein thrombosis is extremely rare. Every year, about 350,000 Americans are affected by DVT or a pulmonary embolism, where a clot breaks away and blocks the lung artery — often a fatal condition.
DVT develops in the larger, “deep” veins that are the final conduits funneling blood back to the heart. The condition occurs usually in the largest veins of the legs and pelvis. Many factors increase risk, including certain cancers, advanced age, living in a nursing home, use of hormone replacement therapy, pregnancy, recent childbirth, a family history of DVT, and obesity.
Any of several situations can trigger deep vein thrombosis. Airplane rides lasting six hours or more and long periods of sitting for any reason pose risks. That’s why travelers are urged to stretch or walk every hour and stay well hydrated during long flights. Hospitalization for a sudden medical problem also creates risks. Trauma or a fracture in the leg area or pelvis puts patients at especially high risk. Major surgery is in the same category, especially surgery that involves hip and knee replacement or is in the pelvic area.
Many DVTs can develop and grow quite large before symptoms appear. Eventually, in most cases, symptoms are present and can include:
- Swelling in the ankle area of the affected leg. Typically only one leg is affected.
- Leg pain that often starts in the calf and can feel like a cramp.
- Redness or warmth over the affected area and fever.
These symptoms should prompt a visit with a physician. Ultrasound and other imaging technology are used to diagnose DVT. Treatment for deep vein thrombosis seeks to prevent the clot from becoming bigger and to reduce the risk of pulmonary embolism. Most people with DVT are prescribed anticoagulant medications to take for a minimum of three months.
Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com.
SOURCE Mayo Clinic