Prioritizing Spinal Health in Healthcare 💪

Following World Spine Day: Prioritizing Spinal Health in Healthcare 💪

Last week’s World Spine Day was a great reminder of how crucial spinal health is, especially for healthcare workers who face daily physical strain. At Ergotrics, we’re committed to making patient handling safer and more ergonomic for caregivers.

QUADRIPLEGIA

That’s why we developed the Ergotrics Inflatable Board and Inflatable Prone Support (IPS)—innovative solutions designed to protect the spine while improving patient care.

💡 The Inflatable Board ensures safe, effortless patient transfers, reducing the risk of back injuries for caregivers.

💡 The IPS optimizes patient positioning, particularly in prone procedures, offering both comfort and spinal protection.

Let’s continue to put spinal health at the forefront of healthcare practices. Discover how our products can help safeguard your team and improve patient care today!

DOWNLOAD THE GUIDE TO SPINAL INJURY

Integrating AI-driven technologies like Ray-Ban Smart Glasses and Apple AirPods Pro is a game-changer for accessibility

Even. though I have been a techie and nerd, some of the advancements using AI and other smart devices are mind-boggling

When it comes to medicine and healthcare AI is a game-changer and will enable patients with challenges to lead near-normal lives.

Fascinating! Integrating AI-driven technologies like Ray-Ban Smart Glasses and Apple AirPods Pro is a game-changer for accessibility. Imagine further enhancing this with AI-powered health monitoring wearables that track vital signs in real time, alerting users and physicians to any anomalies instantly. Combining these with AI-driven telemedicine platforms could provide seamless, real-time consultations, making healthcare more proactive and personalized. The potential for improving patient outcomes and quality of life is immense. Exciting times ahead for both patients and healthcare providers!

Apple Air Pods Pro

Rayban Smart Glasses

The combination of easily wearable, artificial intelligence and earpads allows for visual recognition of objects, and text yields an audible result describing the image and its instructions. The smart glasses can recognize a visual space and tell the wearer where the wearer is located. If you do not have AirPods, no matter what, the Rayban Smartglasses have built-in speakers

Additional uses include music and phone calls.

Both of these products can be found on Amazon. The consumer reviews rave about this product.

Cardiovascular Damage Resulting from Chronic Excessive Endurance Exercise

How Much is Too Much?

Cardiovascular Damage Resulting from Chronic Excessive Endurance Exercise - PMC

A daily routine of physical activity is highly beneficial in the prevention and treatment of many prevalent chronic diseases, especially of the cardiovascular (CV) system. However, chronic, excessive sustained endurance exercise may cause adverse structural remodeling of the heart and large arteries. An evolving body of data indicates that chronically training for and participating in extreme endurance competitions such as marathons, ultra-marathons, Iron-man distance triathlons, very long distance bicycle racing, etc., can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which generally return to normal within seven to ten days. In veteran extreme endurance athletes, this recurrent myocardial injury and repair may eventually result in patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, potentially creating a substrate for atrial and ventricular arrhythmias. Furthermore, chronic, excessive, sustained, high-intensity endurance exercise may be associated with diastolic dysfunction, large-artery wall stiffening, and coronary artery calcification. Not all veteran extreme endurance athletes develop pathological remodeling, and indeed lifelong exercisers generally have low mortality rates and excellent functional capacity. The aim of this review is to discuss the emerging understanding of the cardiac pathophysiology of extreme endurance exercise and make suggestions about healthier fitness patterns for promoting optimal CV health and longevity.

Dose of physical activity and all-cause mortality reduction. The mortality benefits of exercise appear with even small amounts of daily exercise and peak at 50 minutes of vigorous exercise.

Mortality and Running Speed

The graph indicates an optimal running speed of 7 mph

Risk Stratification of Endurance Athletes

Currently, we have no proven screening methods for detecting the CV pathology associated with EEE. A logical strategy for now would deploy post-competition cardiac biomarkers, echocardiography, and/or advanced imaging such as CMR to identify individuals at risk for and with subclinical adverse structural remodeling and the substrate for arrhythmias.61 For any individual who is considering EEE efforts such as marathons or day-long aerobic races for any other activity that elevates cardiac output for a sustained period (continuously over several hours), it may be reasonable to obtain a maximal treadmill exercise test to screen for ischemia and/or exercise-induced arrhythmias and Heart CT for CAC scoring, particularly for those who are over age 50 and who have been chronically training for and competing in EEE events. Aortic pulse wave velocity could give an inference into the development of vascular stiffness that may not be readily appreciated by cuff blood pressure measurement.

Avoiding Exercise-Induced CV Damage

Suggestions for an exercise routine that will optimize heath, fitness and longevity without causing adverse cardiovascular structural and electrical remodeling:

Avoid a daily routine of exhaustive strenuous exercise training for periods greater than one hour continuously. An ideal target might be not more than seven hours weekly of cumulative strenuous endurance ET.1,2,9,51

When doing exhaustive aerobic ET, take intermittent rest periods (even for a few minutes at an easier pace, such as slowing down to walk in the middle of a run). This allows the cardiac output to normalize temporarily, providing a ‘cardiac rest period’ when the chamber dimensions, blood pressure, and pulse come down closer to baseline resting parameters before resuming strenuous exercise again.2

Accumulate a large amount of daily light-to-moderate physical activity, such as walking, gardening, housekeeping, etc. Avoid prolonged sitting. Walk intermittently throughout the day. Look for opportunities to take the stairs. 1, 2 Buy a pedometer and gradually try to build up to 10,000 steps per day.

Once or twice weekly, perform high-intensity interval exercise training to improve or maintain peak aerobic fitness. This is more effective in improving overall fitness and peak aerobic capacity than is continuous aerobic exercise training, despite a much shorter total accumulated exercise time spent doing the interval workout.65, 66

Incorporate cross-training using stretching, for example, yoga, and strength training into the weekly exercise routine. This confers multi-faceted fitness and reduces the burden of cardiac work compared to a routine of daily long-distance endurance exercise training. 1, 2

Avoid chronically competing in very long-distance races, such as marathons, ultra-marathons, Iron-man distance triathlons, 100-mile bicycle races, etc., especially after age 45 or 50.

Individuals over 45 or 50 years of age should reduce the intensity and duration of endurance exercise training sessions, and allow more recovery time.

Cascade of Dependency (AKA HOSPITAL ACQUIRED FRAILTY)

So just how fast does the Cascade of Dependency (AKA HOSPITAL ACQUIRED FRAILTY) happen?

Changes begin virtually overnight, and the stampede of systemic attacks on our bodies quickens.

Physical therapy is not just for post-operative care for, joint surgery, such as hip or knee replacement. It is a vital component for recovery from heart surgery, neurosurgery, or chronic medical conditions requiring hospitalization for several days.

UTIs, cognitive decline (no this isn't dementia), muscle wasting, pulmonary challenges, BP changes, etc., etc.

We've all seen this happen with older patients. Sometimes, they hit home a lot harder.

Here is a tragic story.

A grandmother who was VERY clearly mobile healthy, and smart as a whip 2 weeks before her hospitalization.

In 2024, we realize how detrimental bed immobility is.

For the first week in the hospital following a fall and surgery, she was to get PT 2x per day. 14 treatments ordered.

How many did she actually get? 2 times...TOTAL.

Never out of bed, never sitting up at bedside, she just laid in bed while her whole body shut down.

But she was seen by a number of 'specialists' as multiple systems were failing. Awesome, but they missed the root cause.

The family requested repeatedly therapy and even nursing help to get her out of bed. Didn't happen.

Can we at least get her sitting up for meals? Didn't happen.

I should have flown out there to help. I didn't. I trusted the hospital would keep its promises to finally start getting her up. And then it was too late.

We finally got her into skilled nursing with the help of the orthopedist. I called ahead to give them the details and to ensure they got her moving and kept an eye on her--with her cognition now she may be impulsive and try to get up.

She did try to get up (even in her state, she didn't want to be stuck in the bed) and fell all over again. Back to the hospital and back to being confined in bed.

My family lost her in 3 short weeks. Several months later the emotions for many of us are still raw.

For many older persons, hospitalization results in functional decline despite a cure or repair of the condition for which they were admitted. Hospitalization can result in complications unrelated to the problem that caused admission or to its specific treatment for reasons that are explainable and avoidable.

BOTTOM LINE

IF AT ALL POSSIBLE HAVE A FAMILY MEMBER OR CLOSE FRIEND VISIT YOUR RELATIVE TO HELP THEM SIT UP AND/OR GET OUT OF BED DAILY IF POSSIBLE.

I'm Dr. Gary Levin, a retired ophthalmologist who has dealt with many geriatric patients.

A Proactive Approach to Avoiding Seasonal Spike in Hospitalizations - Optimize Health

Brrr!

As colder temperatures approach, healthcare providers have an opportunity to practice preventative care for their at-risk patients. Colder temperatures have very real impacts on hospitalizations, especially for the elderly. One study demonstrated that for every 1 ⁰C decrease in temperature, hospital admissions increased 1.6% overall and 2.4% for the elderly (over 75). 

Seasonal Illnesses

Seasonal illnesses like the flu and Covid always spike in the winter and those with underlying chronic diseases are the most at risk for severe flu and Covid. Patients at high risk for severe flu or Covid during the winter can benefit tremendously from remote patient monitoring (RPM) and chronic care management (CCM). Now is the time to get patients onboarded and engaged with the process before the most serious winter risks set in.

Covid and the flu can cause significant spikes in blood sugar for diabetics. Patients with diabetes, even well-controlled diabetes, need to be checking their blood pressure more frequently when they are sick. A monitoring clinician with access to real-time data can help assess patients and determine if they need additional Similarly, these same illnesses can cause increases in blood pressure or fluid retention for patients with hypertension and heart failure. Using a remote blood pressure device and/or scale can catch spikes early, preventing hospitalizations or more adverse events.

Less Activity, More Eating 

According to a National Recreation and Park Association (NRPA) poll, 58% of U.S. adults are less active in the winter.  Less activity combined with a season full of sugary pumpkin spice, football parties, and holiday desserts isn’t great for anyone’s weight, blood pressure, or blood sugar. And it’s especially dangerous for those with diabetes and other chronic conditions. 

It’s easy to slide into less healthy habits in the winter and this can easily worsen health conditions. Remote patient monitoring is about more than just blood pressure or blood sugar readings. It’s about accountability and developing healthy habits with help from a monitoring clinician. 

Staying on track with lifestyle goals is more important than ever during the holidays when that last slice of pie or one more cookie is ever so tempting. Staying on track with lifestyle goals is more important than ever during the holidays when that last slice of pie or one more cookie is ever so tempting. And throughout the winter when staying on the couch is more appealing than working out. Patients who know someone is watching their vital signs are more likely to make smarter lifestyle choices.

Air Temperature and Heart Attacks

The American College of Cardiology has found that exposure to cold weather does increase hospital admissions for heart attacks.  Particularly, risks increase two to six days after cold spell exposure. The study found the risk decreases on day one of a cold spell likely because patients are staying indoors. This highlights the importance of proactive interventions to protect the most vulnerable patients from cold stress. 

When elderly or at-risk patients have an ongoing relationship with a monitoring clinician, that clinician can coach them to stay indoors and limit exposure during unsafe winter storms. At the same time, the clinician can encourage more frequent readings to check for trends in blood pressure that may require early intervention.

Air Temperature and Heart Attacks

The American College of Cardiology has found that exposure to cold weather does increase hospital admissions for heart attacks.  Particularly, risks increase two to six days after cold spell exposure. The study found the risk decreases on day one of a cold spell likely because patients are staying indoors. This highlights the importance of proactive interventions to protect the most vulnerable patients from cold stress. 

When elderly or at-risk patients have an ongoing relationship with a monitoring clinician, that clinician can coach them to stay indoors and limit exposure during unsafe winter storms. At the same time, the clinician can encourage more frequent readings to check for trends in blood pressure that may require early intervention.

Seasonal Depression

Increased indoor time, decreased physical activity, and reduced sunlight can lead to seasonal affective disorder (SAD), a form of depression. This can exacerbate feelings of isolation and loneliness, which are already common among some elderly individuals. Anxiety and depression can have very real effects on blood pressure, weight, and other physical measures of health. Continuous engagement through remote patient monitoring and/or chronic care management can provide early warning signs of depression and worsening physical health due to anxiety and depression. Monitoring clinicians can watch for the physical signs of depression and also make referrals to help patients get the mental health help they may need.

A Holistic Approach to Health for Every Season

RPM and CCM provide a proactive, holistic approach to preventative health year-round. But with increased health risks – both physical and mental – during the colder seasons, having a monitoring clinician available for your most at-risk patients can save lives. 

And it doesn’t have to be taxing on your staff. Optimize Health can provide managed remote patient monitoring where our team of clinicians becomes an extension of your staff.  Contact us to learn more.

A Proactive Approach to Avoiding Seasonal Spike in Hospitalizations - Optimize Health

Cell and Gene Therapy (CGT) Access Model | CMS

Cell and Gene Therapy is a means for providing precision medical treatments.

The field is not without significant challenges.

Stem cell therapy is a promising field, but it also raises several controversies and ethical concerns. Here are some key issues:

Source of Stem Cells**

   Embryonic Stem Cells**: These are derived from human embryos, raising ethical concerns about the moral status of the embryos and issues related to consent and destruction.

   Adult Stem Cells**: While less controversial, they are often more limited in their ability to differentiate into various cell types.

Regulation and Oversight**

    There is ongoing debate about how stem cell therapies should be regulated. Some treatments are offered without sufficient scientific evidence of their safety and efficacy, leading to the potential exploitation of vulnerable patients.

Efficacy and Safety**

   Many stem cell therapies are still experimental, and their long-term effects are not fully understood. Cases of adverse effects, including tumor formation, have raised safety concerns.

Commercialization and Access**

    The commercialization of stem cell therapies can lead to disparities in access to treatment. High costs may limit availability to wealthier patients, raising questions about equity in healthcare.

Unproven Treatments**

    The emergence of clinics offering unverified stem cell treatments can mislead patients and divert them from proven therapies. This has led to calls for better education and regulation.

Informed Consent**

   - Obtaining informed consent can be complicated, especially if patients do not fully understand the experimental nature of the treatments or the risks involved.

Cloning and Genetic Modification**

   - The potential use of stem cells in cloning or genetic modification raises additional ethical concerns about "playing God" and the implications for human genetics.

The controversies surrounding stem cell therapy highlight the need for ongoing dialogue among scientists, ethicists, policymakers, and the public to navigate these complex issues responsibly.

Cell and gene therapy are innovative medical treatments that aim to address genetic disorders, cancers, and other diseases at the cellular and molecular levels.

### Cell Therapy

Cell therapy involves introducing, removing, or altering cells to treat a disease. This can include:

- **Stem Cell Therapy**: Using stem cells to regenerate damaged tissues or organs.

- **Immune Cell Therapy**: Modifying immune cells (like CAR-T cell therapy) to better recognize and attack cancer cells.

### Gene Therapy

Gene therapy focuses on correcting or replacing faulty genes responsible for disease development. This can involve:

- **Gene Replacement**: Introducing a healthy copy of a gene to compensate for a defective one.

- **Gene Editing**: Using techniques like CRISPR to directly alter genetic material within a patient's cells.

### Applications

- **Genetic Disorders**: Treating conditions like cystic fibrosis or hemophilia.

- **Cancer Treatment**: Engineering immune cells to target and destroy tumors.

- **Infectious Diseases**: Developing therapies to combat viral infections.

### Challenges

Both therapies face challenges, including ethical concerns, potential side effects, and the need for long-term studies to assess safety and efficacy.

Overall, cell and gene therapies represent a promising frontier in medicine, potentially providing durable solutions for previously untreatable conditions.

Cell and Gene Therapy (CGT) Access Model | CMS

                            

Social Determinants of Health (SDOH) could affect accessibility for this advanced and expensive treatment.  Fortunately, CMS is developing criteria for this treatment.

The Cell and Gene Therapy (CGT) Access Model aims to improve the lives of people with Medicaid living with rare and severe diseases by increasing access to potentially transformative treatments. Cell and gene therapies have high upfront costs but have the potential to reduce healthcare spending over time by addressing the underlying causes of disease, reducing the severity of illness, and reducing healthcare utilization. 

                               

Initially, the model will focus on access to gene therapy treatments for people living with sickle cell disease, a genetic blood disorder that disproportionately affects Black Americans.  

The average patient with sickle cell disease life span is 20 years shorter than normal.

Sickle Cell Treatment.  CASGEVY is a one-time* gene therapy that may help people 12 years and older with sickle cell disease (SCD) and frequent vaso-occlusive crises (VOCs) live severely VOC-free.†.   LYFGENIA is another gene modification technique.  

The CMS Access Model will serve as a guideline for many cell and gene treatments in the future.

Stem cell therapy has the potential to treat a variety of diseases and conditions. Some of the notable ones include:

1. **Hematological Disorders**:

   - Leukemia

   - Lymphoma

   - Aplastic anemia

2. **Neurological Conditions**:

   - Parkinson's disease

   - Multiple sclerosis

   - Spinal cord injuries

3. **Cardiovascular Diseases**:

   - Heart failure

   - Myocardial infarction (heart attack)

4. **Orthopedic Issues**:

   - Osteoarthritis

   - Bone fractures

5. **Autoimmune Diseases**:

   - Lupus

   - Rheumatoid arthritis

6. **Metabolic Disorders**:

   - Type 1 diabetes

   - Genetic metabolic diseases

7. **Eye Diseases**:

   - Age-related macular degeneration

   - Retinitis pigmentosa

8. **Skin Conditions**:

   - Burns

   - Chronic wounds

9. **Congenital Disorders**:

   - Certain inherited blood disorders

10. **Cancer Treatment**:

    - As part of bone marrow transplants for various cancers

While research is ongoing, the effectiveness and safety of stem cell therapy can vary depending on the condition and the type of stem cells used.

Gene therapy has the potential to treat a range of diseases, particularly those caused by genetic mutations. Some of the key conditions include:

Genetic Disorders**:

   - Cystic fibrosis

   - Duchenne muscular dystrophy

   - Hemophilia

   - Sickle cell disease

   - Tay-Sachs disease

Eye Disorders**:

   - Leber congenital amaurosis

   - Retinitis pigmentosa

Neurological Disorders**:

   - Spinal muscular atrophy (SMA)

   - Huntington's disease

Cancer**:

   - Certain types of leukemia and lymphoma

   - Solid tumors (using oncolytic viruses or CAR T-cell therapy)

Infectious Diseases**:

   - HIV/AIDS (experimental therapies)

Metabolic Disorders**:

   - Gaucher disease

   - Fabry disease

Cardiovascular Diseases**:

   - Genetic causes of heart disease, such as familial hypercholesterolemia

Immune Disorders**:

   - Severe combined immunodeficiency (SCID)

Some of these Gene therapies are still largely experimental, and ongoing research aims to improve their safety and efficacy for various conditions.

Next time you are thirsty, Drink Water, or Real Fruit Juice

These are some of the health reasons
that I remind myself of
to help me avoid drinking sodas
despite all the pleasure
it used to give me.