The Gift of Bone -Twice!

By Matt Arrasmith, tissue recipient

m-arrasmithLike most boys in middle school, sports were my passion.  I played baseball, basketball, football, ran cross-country and enjoyed pretty much anything where I was active.  When I was in the seventh grade, I began to experience knee pain – but as most teenage boys would be told, it was shrugged off as just growing pains. As the years passed, the pain continued to get worse and finally my parents took me to the doctor where they did an x-ray of my knee.  At first it appeared that nothing was wrong, but thankfully my doctor delved deeper. Little did I know, my world would be turned upside down.

I had just turned 15-years-old, in March of 1996, when I was diagnosed with bone cancer in my leg.  My parents and I were told the particular type of cancer I had, chondrosarcoma, does not respond to chemotherapy and the most common treatment is amputation. This was devastating news. To say that we were matt-grad2stunned was an understatement. This would have meant as a 15-year-old athletic young man, my left leg would have been amputated at the hip.  My life would never be the same.  It is pretty rare that this cancer is contained within the femur but I was told that my tumor was contained. Because of that silver lining, my doctors recommended a brand new procedure.

They suggested that the six-inch portion of my femur containing the tumor be taken out and replaced with donor bone. I underwent three surgeries, including a 12-hour procedure, and then spent about a year on crutches. Today, after a total of six surgeries on my leg, including one in 2011 where I received a second amazing gift of donor bone, I am still walking and enjoying life. And, unfortunately while playing certain sports is no longer an option, I still have my leg!

m-arrasmith-dartsI took part in the 2016 Transplant Games of America, playing Texas Hold ‘em poker, bowling and golf, thanks to the generosity of my donor. It was an awesome experience, meeting people from across the country who have been touched by organ, eye and tissue donation.

I am thankful to all of the doctors that helped drastically change my life. But I am most thankful to my two bone donors – I was incredibly lucky to have had the option of using donor bone to save my leg – and my life as I know it. Won’t you say “yes” to organ, eye and tissue donation?

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Custom-Fitted Spine Implants

Personalized rods may improve outcomes, cut surgery time

spine_colman_storyCustom fit is the key when it comes to spinal implant rods, which an estimated 38,000 people need each year. This need is especially great for people who have a spinal deformity such as scoliosis, which causes the spine to twist and turn into complex and sometimes dangerous positions. In 2010 and 2011, an estimated 1.6 million people received treatment for scoliosis according to the Bone and Joint Initiative, a consortium of professional medical societies.

Correcting this deformity involves moving a distorted spine into a different position, which is no simple task. To accomplish it, surgeons attach metal rods to the bones surrounding the spinal column in order to support and straighten the spine.

To perform this demanding procedure, surgeons previously needed to be as much a sculptor as a physician. Over the years, they have mastered the art of cutting, bending and twisting metal rods to fit each patient.

Often, however, this manipulation may create weak spots in the rod where it can break in the future. In addition, the manipulation of the rods traditionally has been done in the operating room during surgery, adding to the time a patient spends in surgery under anesthesia.

Now, however, advances in medical imaging and implant manufacturing are making it possible to tailor an implant to the patient receiving it.

Matthew Colman, MD, has begun using patient-specific rods in reconstructive surgery — giving patients with spinal deformities implants designed to fit their anatomy perfectly. An assistant professor of orthopedic surgery at Rush University Medical Center, Colman is one of few spinal surgeons in the world who also specializes in spine cancer treatment and was one of the first doctors in Chicago to use these patient specific rods.

The customization is done in advance of the operation in cooperation with an implant manufacturer. To create the rods, Colman uploads the patient’s calibrated X-rays to a computer. Then he uses a sophisticated software program to plan the reconstructive surgical procedure.

The software allows him to simulate deformity correction and other surgical maneuvers in order to map out and determine the exact length and shape of the rod. The specifications are sent to the manufacturer, and the finished rod is delivered to Rush.

Because so much of the planning is done before surgery, less time is needed during the operation itself. “When we reduce time operating room we help to decrease the chances for infection and blood loss during surgery — and we decrease potential mistakes with the measurements,” Colman says. “In addition, manipulating the rod by hand-bending them may cause them to break more easily, which is theoretically avoided with the custom manufacturing process.”

In addition to custom-made spinal rods, Colman has also been involved in the design of patient-specific 3-D printed vertebral cages, which are used to provide anterior (frontal) support for spinal reconstructions when the area in front of the spine has been MOR300x250destroyed or removed due to infection, a tumor or trauma. The cages are in the process of receiving U.S. Food and Drug Administration approval for use in the United States.

“The future of implants is in customization,” Colman says. “New technology is streamlining the process, making surgery more efficient and effective by employing faster and better working methods.”

New study suggests strategies for keeping off pounds

You’ve succeeded in losing weight. Now, what can you do to keep the pounds off? Most people seem to struggle with long-term weight loss. By some estimates, only about 20% of overweight individuals are successful in keeping off at least 10% of their initial body weight for a year or longer. A new study, however, suggests that using specific strategies — such as weighing yourself regularly and planning for situations in which you might backslide — could modestly slow the rate of weight regain in obese adults who have lost weight.

In the study, employing such strategies in a maintenance program increased theHow to really lose weight proportion of adults who stayed at or lowered their weight, after initial weight loss, by 13.9 percentage points, said Corrine Voils, research career scientist at William S. Middleton Veterans Memorial Hospital in Madison, Wisconsin and lead author of the study. However, more research is needed to determine which specific strategies offered the most benefit and which may have not had much of an impact. The study, which involved mostly men of various races and involved self-reports, was published in the journal Annals of Internal Medicine on Monday.

“We went into this study unsure what to expect,” said Voils, who is also a professor of surgery at the University of Wisconsin-Madison. “We knew that maintaining weight loss is hard and that previous maintenance studies have tended to focus on middle-aged white females. We were unsure if a mainly telephone-based program would work in a population that is primarily men and of mixed race,” she said. “We were happy to see that our strategies reduced the rate of weight regain.”

More than one-third of American adults are considered to be obese, meaning their body mass index is 30 or higher, according to the Centers for Disease Control and Prevention. Obesity has been linked to numerous health problems, including heart disease, stroke, type 2 diabetes and several types of cancer.

Obesity is now recognized as a chronic disease

The new study involved 222 obese patients, of whom only 34 were women. All of the patients had lost at least 8.8 pounds in a 16-week weight loss program. They were randomly assigned to participate in either an intervention group that provided weight maintenance strategies for an additional 42 weeks or a group that received usual medical care, with no emphasis on weight maintenance.

Those in the intervention group participated in three in-person group meetings and eight individual telephone calls, in which they were given a maintenance calorie budget and strategies on how to exercise, get support from their family and friends, and monitor their weight. The phone calls also involved the patients reflecting on how their lives have improved as a result of weight loss, making a plan for situations when they might feel tempted to go back to old habits, and specifying how frequently they weigh themselves and revisit weight loss efforts if they have gained weight.

All participants, in both groups, were scheduled for assessment appointments at the beginning of the study and then after 14, 26, 42 and 56 weeks. After 56 weeks, Voils said, 58.6% of patients in the intervention group either regained some weight or saw no change in weight, while 72.5% of patients in the other group regained or saw no change, a difference of 13.9 percentage points.

The average weight regain in the intervention group was only about 1.6 pounds, compared with about 5.2 pounds in the other group, the researchers found. “Although this may not seem like a lot of weight, given the low program costs and the high benefit of carrying less weight over the longer term, this is an important finding that adds to our understanding about how best to help patients with obesity,” said Dr. Jennifer Kraschnewski, associate professor at the Penn State College of Medicine, who was not involved in the new study.

What might help weight control the most?


It remains unclear in the study whether regular weighing, planning for high-risk situations or obtaining outside support was most effective in weight loss management, Voils said. “Our study design did not allow us to say which component of our intervention was most effective,” Voils said. “There is evidence that self-weighing and relapse prevention help people maintain weight loss. Our intervention incorporates those skills and adds having patients reflect on the benefits they experienced with weight loss and talking with a support person about what they can do to support weight maintenance efforts,” she said.

Though it remains difficult to establish which part of the intervention had the most impact on patients, having constant interaction with a supportive coach probably played a significant role in weight maintenance, said Dr. Samuel Grief, associate professor of clinical family medicine at the University of Illinois College of Medicine at Chicago, who was not involved in the study.

“Group dynamics tend to be more helpful, or a team-based approach using care coordination,” Grief said. “That would be my answer. Because strategies like food journaling or diaries or writing out what activities you do every day or emotions that you’re feeling, all that is relevant, but there’s not a lot of science behind those causing weight loss or mitigation of weight regain. Otherwise, everybody would do it,” he said. “Also, it would have been helpful to gauge their self-efficacy.”

Studies suggest that having self-efficacy, or believing that you will be successful in losing weight, has been linked to greater success in weight management, Grief said.
Additionally, the researchers were unable to assess longer-term weight maintenance and relied on self-reports about dietary intake and physical activity. “Our population was primarily middle-aged men who were white or African-American, and results may not generalize to other populations,” Voils said.

Tips for keeping the weight off

The National Weight Control Registry, which has tracked more than 10,000 individuals who have maintained significant weight losses, offers some recommendations on how to maintain weight control.

Rena Wing, a professor at Brown University’s Warren Alpert Medical School, and James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center, established the registry in 1994. “To maintain weight loss, there must be continued adherence to a low-calorie diet and high physical activity,” Wing said. She said the registry suggests that the following strategies may help someone who is trying to maintain their weight loss:

>Maintain high levels of physical activity, in which the recommended goal is 250 minutes per week of moderate-intensity activity, such as brisk walking.
>Monitor your weight by weighing yourself frequently.
>Monitor and keep track of your diet and activity.
>Take immediate action in the face of small weight regains.

By Jacqueline Howard, CNN

Out of Despair, the Gift of Life

After losing her sister, one writer discovers a sense of peace.

1216 diary essay organ donation plnmph

Karen Abercrombie recently shared insight into her experience with donation after her sister, Julie, passed away. Karen describes how the compassion of the donation community helped her heal and her amazement when she learned about the impact of Julie’s tissue donation. Read more>>

“I was astounded to learn that upward of 80 people’s lives were either saved or enriched by Julie’s donations, including, of course, Carson Palmer’s.”

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How Exercise Shapes You, Far Beyond the Gym

By

When I first started training for marathons a little over ten years ago, my coach told me something I’ve never forgotten: that I would need to learn how to be comfortable with being uncomfortable. I didn’t know it at the time, but that skill, cultivated through running, would help me as much, if not more, off the road as it would on it.

It’s not just me, and it’s not just running. Ask anyone whose day regularly includes a hard bike ride, sprints in the pool, a complex problem on the climbing wall, or a progressive powerlifting circuit, and they’ll likely tell you the same: A difficult conversation just doesn’t seem so difficult anymore. A tight deadline not so intimidating. Relationship problems not so problematic.

Maybe it’s that if you’re regularly working out, you’re simply too tired to care. But that’s probably not the case. Research shows that, if anything, physical activity boosts short-term brain function and heightens awareness. And even on days they don’t train — which rules out fatigue as a factor — those who habitually push their bodies tend to confront daily stressors with a stoic demeanor. While the traditional benefits of vigorous exercise — like prevention and treatment of diabetes, heart disease, stroke, hypertension, and osteoporosis — are well known and often reported, the most powerful benefit might be the lesson that my coach imparted to me: In a world where comfort is king, arduous physical activity provides a rare opportunity to practice suffering.

Few hone this skill better than professional endurance and adventure athletes, who make a living withstanding conditions others cannot. For my column with Outside Magazine, I’ve had the privilege of interviewing the world’s top endurance and adventure athletes on the practices underlying their success. Regardless of sport, the most resounding theme, by far, is that they’ve all learned how to embrace uncomfortable situations:

• Olympic marathoner Des Linden told me that at mile 20 of 26.2, when the inevitable suffering kicks in, through years of practice she’s learned to stay relaxed and in the moment. She repeats the mantra: “calm, calm, calm; relax, relax, relax.”

• World-champion big-wave surfer Nic Lamb says being uncomfortable, and even afraid, is a prerequisite to riding four-story waves. But he also knows it’s “the path to personal development.” He’s learned that while you can pull back, you can almost always push through. “Pushing through is courage. Pulling back is regret,” he says.

• Free-soloist Alex Honnold explains that, “The only way to deal with [pain] is practice. [I] get used to it during training so that when it happens on big climbs, it feels normal.”

• Evelyn Stevens, the women’s record holder for most miles cycled in an hour (29.81 – yes, that’s nuts), says that during her hardest training intervals, “instead of thinking I want these to be over, I try to feel and sit with the pain. Heck, I even try to embrace it.”

• Big-mountain climber Jimmy Chin, the first American to climb up — and then ski down — Mt. Everest’s South Pillar Route, told me an element of fear is there in everything he does, but he’s learned how to manage it: “It’s about sorting out perceived risk from real risk, and then being as rational as possible with what’s left.”

But you don’t need to scale massive vertical pitches or run five-minute miles to reap the benefits. Simply training for your first half marathon or CrossFit competition can also yield huge dividends that carry over into other areas of life. In the words of Kelly Starrett, one of the founding fathers of the CrossFit movement, “Anyone can benefit from cultivating a physical practice.” Science backs him up.

A study published in the British Journal of Health Psychology found that college students who went from not exercising at all to even a modest program (just two to three gym visits per week) reported a decrease in stress, smoking, alcohol and caffeine consumption, an increase in healthy eating and maintenance of household chores, and better spending and study habits. In addition to these real-life improvements, after two months of regular exercise, the students also performed better on laboratory tests of self-control. This led the researchers to speculate that exercise had a powerful impact on the students’ “capacity for self-regulation.” In laypeople’s terms, pushing through the discomfort associated with exercise — saying “yes” when their bodies and minds were telling them to say “no” — taught the students to stay cool, calm, and collected in the face of difficulty, whether that meant better managing stress, drinking less, or studying more.

For this reason, the author Charles Duhigg, in his 2012 bestseller The Power of Habit, calls exercise a “keystone habit,” or a change in one area life that brings about positive effects in other areas. Duhigg says keystone habits are powerful because “they change our sense of self and our sense of what is possible.” This explains why the charity Back on My Feet uses running to help individuals who are experiencing homelessness improve their situations. Since launching in 2009, Back on My Feet has had over 5,500 runners, 40 percent of whom have gained employment after starting to run with the group and 25 percent of whom have found permanent housing. This is also likely why it’s so common to hear about people who started training for a marathon to help them get over a divorce or even the death of a loved one.

Another study, this one published in the European Journal of Applied Physiology, evaluated how exercise changes our physiological response to stress. Researchers at the Karlsruhe Institute of Technology, in Germany, divided students into two groups at the beginning of the semester and instructed half to run twice a week for 20 weeks. At the end of the 20 weeks, which coincided with a particularly stressful time for the students — exams — the researchers had the students wear heart-rate monitors to measure their heart-rate variability, which is a common indicator of physiological stress (the more variability, the less stress). As you might guess by now, the students who were enrolled in the running program showed significantly greater heart-rate variability. Their bodies literally were not as stressed during exams: They were more comfortable during a generally uncomfortable time.

What’s remarkable and encouraging about these studies is that the subjects weren’t exercising at heroic intensities or volumes. They were simply doing something that was physically challenging for them – going from no exercise to some exercise; one need not be an elite athlete or fitness nerd to reap the bulletproofing benefits of exercise.

Why does any of this matter? For one, articles that claim prioritizing big fitness goals is a waste of time (exhibit A: “Don’t Run a Marathon) are downright wrong. But far more important than internet banter, perhaps a broader reframing of exercise is in order. Exercise isn’t just about helping out your health down the road, and it’s certainly not just about vanity. What you do in the gym (or on the roads, in the ocean, etc.) makes you a better, higher-performing person outside of it. The truth, cliché as it may sound, is this: When you develop physical fitness, you’re developing life fitness, too.

Brad Stulberg is a columnist for Outside Magazine, where he writes about health and the science of human performance. Follow him on Twitter @Bstulberg.