Health related information and news from around the world.

After she fought so hard against breast cancer, Rosemary wasn’t about to just sign up for HRT as she went into menopause. She simply tolerated the menopausal symptoms she had as best she could, until they subsided after a couple years and she figured her hormonal troubles were over.

But when I sent her for a bone scan when she was in her mid-SOs, it showed she had osteoporosis. Fortunately, her NTX was 37, within the normal range, so her fracture risk was still manageably low. I prescribed Miacalcin and she started taking nutritional supplements, including calcium. After a year, however, her NTX levels were up to 57, putting her at higher risk for fracture and indicating an increasing rate of progression of bone loss. For Rosemary, Miacalcin wasn’t doing enough.

I had her hormone levels analyzed, and found her estrogen levels were very low. Because of her fear of a breast cancer relapse, Rosemary decided to add the estriol and ipriflavone to the Miacalcin. She felt comfortable with the natural estrogen since it does not increase the risk of breast cancer while still providing some of the benefits of synthetic estrogen. Since estriol has been less studied than other forms of estrogen, and it remains unproven that the bone benefits equal those of synthetic estrogen, Rosemary uses the ipriflavone—with its proven bone benefits—to ensure her bones are covered.

Rosemary pays attention to her diet, and is generally active. She considers herself a spiritual person, and copes with the many stresses in her life with regular meditation. But with her hormones finally in balance, she feels better than she has in a long time, and she now encourages her friends facing menopause to look carefully into alternatives for HRT. If a breast cancer survivor could find a regimen that suited her, she figures, anybody can.

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Surgery

Kneecap alignment problems can be diagnosed by X ray, which will clearly show a patella that is off track. Depending on the cause of the problem, the following types of surgery may be performed.

Lateral Release. In some cases, the patella is being pulled off track by tight lateral bands, or retinaculum, which the physician can feel when she palpates the area. In a lateral release, which is done arthroscopically, the surgeon simply cuts the lateral bands, reducing the lateral pull on the patella, thus the patella moves back into place.

As with any arthroscopic procedure, possible risks include a small chance of developing an infection (under 1 percent), nerve damage, skin numbness, and other problems that are described on your patient consent form, which all patients should read carefully.

Patellar Realignment. There are two types of surgical procedures for patellar realignment: proximal realignment or distal realignment.

In a proximal realignment, an open-knee procedure, the surgeon must first perform a lateral release. After the lateral release, he cuts a piece of the quadriceps tendon (all the way down around the medial side of the patella to the medial border of the patellar tendon) and resutures the quadriceps tendon to a more medial position.

In a distal realignment (which may also include a proximal realignment), the surgeon moves the patellar tendon insertion at the tibia tubercle over to a more medial position and sometimes distal and elevated.

Exercise

Rehabilitation is crucial after patellar surgery. Keep in mind that surgery is not a cure-all. Even after surgery, it is imperative that you continue with a good strengthening program tailored your particular problem.

Bracing

Some people may find that a functional brace worn during activity may offer some relief for patellar problems. Frankly, there is no specific evidence that it does; however, it may have a subtle effect on the tracking of the kneecap, which could relieve discomfort. A patellar femoral workout brace is primarily a sleeve made of cloth or neoprene (rubber). This brace has a hole or pad around the kneecap to stress-relieve the area. A different variety of the patella brace has single straps around the distal (lower) part of the extensor mechanism around the patellar tendon. Either brace is fine if it works for you. Avoid braces that are too tight around the kneecap or an Ace bandage that compresses the knee too tightly—both can cause further discomfort. Braces can be purchased at surgical supply stores and some sporting good stores.

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