The maker of opioid painkiller Opana ER is pulling the drug off the market at the request of federal regulators because it’s being abused.
Endo International PLC said Thursday it will voluntarily stop selling the pills, approved for use in patients with severe, constant pain, after consulting with the U.S. Food and Drug Administration. It’s the first opioid drug that the FDA has sought to remove from the market due to abuse.
The drugmaker said in a statement that the extended-release opioid is safe and effective when used as intended, and that Endo still believes Opana ER’s benefits outweigh its risks.
But last month, the FDA said it had concluded the drug is too risky. The agency said it had seen a "significant shift" from people crushing and snorting the pill to get high to injecting it instead. Besides contributing to overdoses, abuse of Opana ER was blamed for a 2015 outbreak of HIV and hepatitis C in southern Indiana linked to sharing needles, according to the FDA.
Opana ER got U.S. approval in 2006. In 2012, Endo changed the drug’s formulation to try to make it harder to abuse. The FDA approved sales of the new version but refused to let Endo market it as abuse deterrent.
The agency asked the company to stop selling Opana ER after its advisers, reviewing its safety at a March hearing, voted 18-8 against keeping it on the market.
Dublin, Ireland-based Endo, which has U.S. headquarters in the Philadelphia suburb of Malvern, said it will work with the FDA to try to minimize disruption for patients, who will need to switch to alternative treatments.
Endo primarily makes generic medicines, as well as a number of brand-name specialty drugs. Endo reported that Opana ER last year posted net sales of $159 million. The company said it will take a pre-tax charge of about $20 million to write off the drug’s remaining value.
As of June, there were no generic versions of the reformulated Opana ER on the market, according to the FDA, but two generics of earlier versions are on sale, called oxymorphone.
The agency said it would also review other opioid painkillers and could take further action.
U.S.-traded shares of Endo fell 1.9 percent to $11.17 Thursday, more than twice the rate of decline on a down day for the broader markets. When the FDA urged Endo to pull Opana ER on June 8, company shares plunged 13.4 percent.
A 7-year-old German shepherd dog named Star has some new pep in her step. She lost part of her right hind leg at birth, leaving her unable to walk comfortably. Then two months ago she was fitted with a customized prosthetic leg. Star’s owner, Elaine Diasparra, says the difference has been drastic.
"She’s amazing and she can actually go for walks now," she said.
Star is one of a growing number of injured dogs whose owners are turning to human-like prosthetics and orthotics to improve their quality of life.
"In the last decade I would say there’s been an explosion, at least in my practice," said Dr. Leilani Alvarez, who specializes in sports medicine and rehabilitation at the Animal Medical Center. She fits at least one dog a month with assisted devices.
"[Previously] when there would be an injury like Star had, the knee-jerk reaction is ‘Let’s amputate,’ because they say ‘dogs do great on three legs,’ But that’s not really true," Dr. Alvarez said. "Dogs really struggle as they get older, particularly a German shepherd. So being able to retain a limb and allow them to walk on that limb can be the difference between them living through the end of their life expectancy to them having to be euthanized."
A lot of time and technology goes into making devices like Star’s. Hers was made by OrthoPets in Colorado, one of the biggest manufacturers of animal prostheses and orthotics in the country.
"We have about 20 different devices that we can fabricate," said OrthoPets founder Amy Kaufmann. The procedure is multi-step and involves advanced computer scanning and 3D printing.
"During that 3D carving machine we’re actually carving out an exact replica of the patient’s limb and then we go through the process of fabricating that custom-made device," Kaufmann said.
OrthoPets has worked on more than 13,000 animals from 35 different countries since 2003. And not just dogs; peacocks and llamas are among the animals they’ve built devices for.
"Anywhere from as small as a mouse up to a 2,000-pound horse," Kaufman said.
Their business goes beyond artificial limbs to high-tech orthotic braces.
The company created what is called a stifle brace for Fievel, a black Lab mix who suffers from a painful torn ACL. He’d been doing physical therapy at Water for Dogs in TriBeCa, where veterinary medical director Dr. Jonathan Block decided to fit him for the brace.
"He [now] goes on hikes, he doesn’t experience any more pain, he doesn’t come back limping from playing in the park, and we’ve avoided surgery," Dr. Block said.
But the devices aren’t cheap, starting at around $1,500, and that doesn’t include the cost of vet care and rehabilitation.
"There is an expense associated with it and there’s a lot of rehabilitation involved," Dr. Block said. "So it’s a process and takes patience."
But the pet owners say it is well worth it.
"This brace will be with him for his lifetime, for as long as he needs it," said Mei van der Schans, Fievel’s owner.
A happier dog makes a happier dog owner, who seems willing to go to ever-greater lengths for a pet.
Dr. Alvarez summed it up: "Clients are treating their pets as they would their child, and when they learn that they can do something to help their pet in the same way they would for their child, they choose to do it for their dog as well."
Taking a bike ride can offer various health benefits, but along with those pros come the cons: notably, the risk of being seriously hurt in an accident.
UC San Francisco researchers say such incidences have risen steadily for adults since the late 1990s, with more visits to the ER and hospital and more of the accompanying costs for medical care, per a new study in the Injury Prevention journal.
Between 1997 and 2013, there were about 3.8 million non-fatal bicycle injuries and nearly 10,000 deaths, with a press release noting that the total outlay for all associated medical costs until the end of the study hit $237 billion—a figure about twice that of the costs linked to all other occupational illnesses during the same time.
In 2013 alone, the costs for bike accidents hovered close to $24.5 billion. That’s also about a 137 percent spike over the course of the study for non-fatal accidents, and 23 percent for fatal ones.
Men seem to have the most trouble behind the handlebars, racking up 75 percent of the total costs, and riders 45 and over are also faltering: While they accounted for only about 26 percent of total costs in 1997, by 2013 that figure had jumped to 54 percent.
Crookston, Minn. – Parker Hanson’s success could be measured by his 90-mph fastball, his nasty slider or his leadership, which helped vault his college baseball team into the playoffs. Or it could be marked by what he’s missing.
Hanson was born without a left hand, but found a way to adapt at a young age so he could pitch, field, bat and play the game he loved. When University of Minnesota-Crookston coach Steve Gust went searching for recruits to help turn around one of the worst programs in NCAA Division II baseball, he found talent and toughness in Hanson.
“He’s an inspirational story for an inspirational team,” Gust said.
Hanson, 20, in his first year with the Golden Eagles, doesn’t run away from being different. He sees baseball as a platform to further his goal of becoming a motivational speaker, and enjoys the numerous texts, emails and social media posts from people who say he has helped change their lives. He likes talking about his disability.
“I guess when I was younger, I was kind of a little shy and scared to let people know I had one hand,” Hanson said. “As I got older, I felt there was no choice but to embrace it. You can either stay in a shell or act like you don’t have one hand and try to hide from other people, or you can go out there and show people you are like everyone else.”
A native of Hawley, in northwestern Minnesota, Hanson said he didn’t realize he was different until one day in elementary school when a presentation featured a standout archer paralyzed from the waist down. Hanson came home and asked his mom if she knew he was handicapped. Then he went outside and played more baseball.
It was in sixth grade when Hanson did a history project on major league pitcher Jim Abbott, who was born without a right hand. Hanson said he later studied Abbott’s mechanics, which has helped him throw, field and smoothly transfer his glove from his left arm to his right hand after a pitch. Hanson has not met Abbott, but got a Twitter message from him that read, “Find your dream and go after it with all you know.”
Hanson did the school project on Abbott the year after he was passed over for a travelling baseball team.
“He didn’t have to do his project on Jim Abbott. He could have done it on anybody just to blend in,” said Jennifer Tjaden, Hanson’s sixth-grade teacher. “By him finding somebody he could use as a role model, it was such a good fit. Parker always said he wanted to be a professional baseball player.”
Hanson said he received much of his competitive spirit from his mom, Barb, fueled by games of H-O-R-S-E in the driveway. Barb Hanson said her son started playing T-ball when he was 3 years old.
“I don’t want to say I gave him any special encouragement to do baseball,” Barb Hanson said. “I would never discourage him from doing anything. It was whatever his heart desired.”
Gust, the Golden Eagles coach, landed Hanson after he played one year at Dakota County Technical College, a stint in which he started losing interest in the game. Gust, in his previous college coaching job, had passed on recruiting Hanson in high school, calling him “a little bit better than average.” Last year, he saw a player who was still maturing and could help a team that just made the conference playoffs after winning three games combined the previous two seasons.
“He’s a guy with a big heart who competes. And now he’s got good stuff,” Gust said. “I never look at him as having a disability. I look at him as one of the top pitchers on our squad and one of the top pitchers in our league.”
Despite a nagging wrist injury late in the season, Hanson (4-3, 4.93 ERA) has been one of the most reliable starting pitchers for the Golden Eagles and near the top in most statistical categories. A day before they needed a win in their final regular-season game to advance to the conference playoffs, Gust didn’t think Hanson’s wrist was strong enough for him to start.
Hanson strongly suggested he get the ball.
“Right before the game, there’s no way we were going to lose,” Gust said. “I thought, wow, he’s ready to go, but is he too ready? Is he thinking with his heart and not his brain? He assured me there were no issues with his arm.”
Gust thought he would be lucky to get three or four innings and 60 pitches out of Hanson. He went six innings and threw nearly 90 pitches, and Crookston beat Southwest Minnesota State 6-3 to advance to this week’s Northern Sun Interscholastic Conference tourney.
“Parker kind of just did it all,” teammate Matthew Dallas said.
Zach Frazier, Hanson’s catcher, said he wouldn’t label Hanson as cocky, but said he has “that little arrogance that all pitchers should have.”
No team scares him, Frazier said.
“It’s fun to catch him, it’s fun to work with him, it’s fun to have him on our team,” Frazier said. “But mainly he’s the guy we want in a must-win game. When Parker’s on the mound, you like your chances.”
A model demonstrates the Welwalk WW-1000, a wearable robotic leg brace designed to help partially paralyzed people walk at the main system with treadmill and monitor, at Toyota Motor Corp.’s head office in Tokyo, Wednesday, April 12, 2017.
(AP)
TOKYO – Toyota is introducing a wearable robotic leg brace designed to help partially paralyzed people walk.
The Welwalk WW-1000 system is made up of a motorized mechanical frame that fits on a person’s leg from the knee down. The patients can practice walking wearing the robotic device on a special treadmill that can support their weight.
Toyota Motor Corp. demonstrated the equipment for reporters at its Tokyo headquarters on Wednesday.
One hundred such systems will be rented to medical facilities in Japan later this year, Toyota said. The service entails a one-time initial charge of $9,000 and a $3,200 monthly fee.
The gadget is designed to be worn on one leg at a time for patients severely paralyzed on one side of the body due to a stroke or other ailments, Eiichi Saito, a medical doctor and executive vice president at Fujita Health University, explained.
The university joined with Toyota in developing the device.
A person demonstrating it strapped the brace to her thigh, knee, ankle and foot and then showed how it is used to practice walking on the treadmill. Her body was supported from above by a harness and the motor helped to bend and straighten her knee. Sensors in the device can monitor the walking and adjust quickly to help out. Medical staff control the system through a touch panel screen.
Japanese automakers have been developing robotics both for manufacturing and other uses. Honda Motor Co.’s Asimo humanoid can run and dance, pour a drink and carry on simple conversations, while WelWalk is more of a system that uses robotics than a stand-alone robot.
Given how common paralysis due to strokes is in fast-aging Japan, Toyota’s device could be very helpful, Saito said. He said patients using it can recover more quickly as the sensitive robotic sensor in Welwalk fine-tunes the level of support better than a human therapist can.
"This helps just barely enough," said Saito, explaining that helping too much can slow progress in rehabilitation.
The field of robotic aids for walking and rehabilitation is growing quickly. A battery-powered wearable exoskeleton made by Israeli manufacturer ReWalk Robotics enables people relying on a wheelchair to stand upright and walk.
Such systems also can aid therapists in monitoring a patient’s progress, Luke Hares, chief technology officer at Cambridge Medical Robotics in Britain, said in a phone interview.
"They can be so much more precise," he said.
Previously, Toyota has shown robots that play the violin and trumpet. It plans to start sales in Japan of a tiny boy-like robot for conversational companionship. It is also investing in artificial intelligence and developing self-driving vehicles.
Toshiyuki Isobe, Toyota’s chief officer for research, said Welwalk reflects the company’s desire to apply robotics in medicine and other social welfare areas, not just entertainment. The company also has an R2-D2-like machine, called the Human Support Robot, whose mechanical arm can help bed-ridden people pick things up.
"Our vision is about trying to deliver mobility for everybody," said Isobe. "We have been developing industrial robotics for auto manufacturing, and we are trying to figure out how we can use that technology to fill social needs and help people more."
More than 20,000 people living in U.S. nursing homes experienced serious injuries to the face last year, mainly from falling and hitting hard surfaces or while getting in and out of bed, a recent study suggests.
With the population aging and about 1.4 million Americans already in nursing homes, programs focused on fall prevention should concentrate more on averting these injuries that can cause considerable pain and disability, the research team writes in Otolaryngology – Head and Neck Surgery.
"Families move their loved ones into facilities to keep them safe. Since this can already be a difficult process, we feel an obligation to identify preventable injuries in our continuing efforts to improve patient safety," Dr. Peter Svider, one of the study authors, said by email.
Face injuries can be particularly serious for elderly people because they can affect vital functions like speech, swallowing, sight, and even breathing, said Svider, a researcher at Wayne State University School of Medicine in Detroit, Michigan.
To estimate the number and causes of face injuries in elderly nursing home residents, the research team analyzed nationwide data from emergency departments.
Between 2011 and 2015, they found that 109,795 people over age 60 and living in nursing homes required emergency room care for face injuries. Half of the patients were over age 84 and 65 percent were women.
For each incident, the study team noted where on the face patients were hurt and how they sustained the injury.
The most common wounds were deep cuts or skin tears, which made up over 44 percent of all injuries. A similar proportion of patients experienced other soft-tissue injuries, including bruises on the skin or in deep tissues and the tearing off of patches of skin including eyelids or ears.
Bone fractures accounted for nearly 13 percent of injuries. More than two thirds of these breaks were to the nose, and the next most common fracture site was the eye socket.
The injuries were most often the result of falling and hitting structures like the floor, countertops, doors or cabinets, representing 57 percent of injuries.
Getting in and out of bed was the second most common source of injury, accounting for 23 percent.
"Falls are a tremendous source of disability in older adults," said Hilaire Thompson, a professor at the University of Washington School of Nursing in Seattle.
"Older trauma patients are more likely to experience a longer hospital stay, increased number of complications, higher costs of care and a higher likelihood of dying for any specific injury than younger adults," Thompson, who was not involved in the study, said by email.
"Facial injuries are underappreciated," Thompson added, "as they may accompany other sometimes more severe injuries and are therefore overlooked."
Thompson said patients can reduce their risk of falling by doing exercise or physical therapy and getting their vision checked, while nursing homes can pay greater attention to fall risks during their patient assessments.
"We encourage families moving their loved ones into a skilled nursing facility to inquire about the level of supervision provided, particularly with regards to transfer to and from bed as well as assistance using the bathroom," Svider said.
The option may work best for patients who have tried several other traditional treatments.
(iStock)
An alternative medicine approach to joint pain that typically uses injections of sugar or sodium may be worth trying for knee osteoarthritis after traditional approaches fail, a recent review suggests.
Knee osteoarthritis, a leading cause of pain and disability in older adults, occurs when flexible tissue at the ends of bones wears down. While it can’t be cured, physical therapy or anti-inflammatory medications are often prescribed to relieve pain and improve mobility.
Researchers examined data from 10 previous studies of what’s known as prolotherapy, which is often used for chronic back pain. Prolotherapy involves injecting a solution of natural irritants like sugar or sodium next to the site where soft tissue like ligaments, tendons or muscle were injured or tore away from the bone.
Results from these studies, which had a total of 529 patients, suggest that prolotherapy may be a safe way to help ease pain from knee osteoarthritis. But the evidence on the effectiveness of prolotherapy isn’t strong enough to recommend it until after other treatments fail, said senior study author Dr. Nicola Maffulli of the University of Salerno in Italy.
"There is no evidence that prolotherapy should be tried as a first line therapy," Maffulli said by email. "It should always be part of a holistic management plan, with weight reduction, activity changes, and physiotherapy."
Ideal patients for prolotherapy might include people with mild to moderate knee osteoarthritis who don’t get relief from medication or physical therapy, Maffulli added.
Across all of the studies that Maffulli and colleagues reviewed, most tested injections containing dextrose (a sugar), and two combined dextrose and sodium. A few tested dextrose solutions that also contained anesthetics like lidocaine or ropivacaine.
Participants reported improvements in pain, function and range of motion with prolotherapy and also reported high levels of satisfaction with the treatment.
But these small studies had such different designs and patient populations that it wasn’t possible to do a pooled analysis of all data from all the studies to determine if there was a meaningful benefit in a larger group of people, researchers report in the British Medical Bulletin.
Eight of the 10 studies were of poor quality, researchers concluded. Most studies didn’t report what’s known as an effect size, or how much more pain relief people got from prolotherapy than from no treatment or from other interventions.
None of the studies reported dangerous side effects from prolotherapy, and the researchers note that the solutions injected may not cost much or be difficult to administer.
The trouble with knee osteoarthritis is that evidence is mixed for other options, too, said Dr. Regina Sit, a researcher at the Chinese University of Hong Kong who wasn’t involved in the study.
"Conservative therapies such exercises, physical therapy, oral analgesic medications and complementary therapies such as acupuncture and herbal treatment have marginal effectiveness," Sit said by email.
Joint injections are a common approach for this type of pain, Sit added. Clinicians might inject corticosteroids or hyaluronic acid, which is similar to a lubricant found naturally in joints.
While it’s possible prolotherapy may be safe and effective, research to date doesn’t offer a clear picture of how this option stacks up against other types of injections for knee osteoarthritis, Sit said.
"Studies are needed to conclude which injection therapy should be given higher priority in routine clinical care," Sit added.
Twenty years ago, Chris Kaag was a 21-year-old U.S. Marine completing a second tour in Aviano, Italy, when he noticed his legs were dragging on a run. After nine weeks of testing at Walter Reed National Military Medical Center in Bethesda, he was diagnosed with adrenomyeloneuropathy (AMN), a genetic degenerative neurological condition that he had never heard of before.
Later, his family realized that his mother’s brother had AMN, and his two younger brothers also tested positive for it. Symptoms of AMN may include progressive stiffness of the legs, speech difficulties, adrenal insufficiency, bladder control issues and sexual dysfunction. According to the National Institutes of Health, some patients may experience behavior abnormalities, vision loss, hearing issues and/or seizures.
After his diagnosis, he medically retired from the Marines holding the rank of Sergeant. He was then transferred to a specialist in Baltimore who was based at Kennedy Krieger Institute, a research and treatment center for children with disabilities.
“Every time I went down there — I was still walking at the time — and you would see kids on feeding tubes and breathing tubes, and confined to wheelchairs and confined to beds,” Kaag, now 40, told Fox News. “It hit me a lot.”
The specialist told Kaag he would either live a relatively normal life or be confined to a wheelchair within five years. While his brothers’ symptoms have progressed at a slower pace, Kaag said a concussion he sustained while playing rugby for the Marines may have contributed to his early onset AMN, and he now relies on a wheelchair.
Initially, he participated in triathlons and raised funds for research, but he didn’t like the idea of not knowing where he was sending the money to. In 2007, he started the IM Able Foundation, a nonprofit dedicated to helping build and support active lifestyles for individuals with physical and cognitive disabilities. Through the foundation, donors have the ability to see the equipment being purchased with their funds and the children they are helping.
Since then, he’s worked to grow the foundation’s overall goal through his Corps Fitness gym as well as through local programs around Pennsylvania, reaching upwards of 150 children. He partnered with a field coordinator at Alvernia University and established a program with the school’s occupational therapy students who can complete their field work by participating in the classes.
“They see a different side of that profession and how awesome it could be,” Kaag said.
While many inclusive fitness classes feature calisthenics born from Kaag’s days with the Marines, some are tailored to children’s specific needs and are easy to adjust. At Hogan Learning Academy, Kaag has instituted seven 30-minute classes for children on various levels of the autism spectrum.
“It’s about the camaraderie and being together,” Kaag said. “Some people get it, some people don’t, but it’s about having them move around. If they have sensory issues, we don’t have music up loud, I don’t whistle, it just depends on the class.”
Kaag said he measures the program’s success in the improvements he sees among his students. For instance, there was one student who wasn’t counting along with the group during exercises and had a stoic look on his face, but now, he said, the same student joins the circle and enthusiastically counts along with others.
Next on his agenda is building an adaptive playground for kids, for which he has partnered with the Fightin Phils, the minor league organization of the Philadelphia Phillies. To help raise money for the playground, as well as adaptive equipment for fitness classes, IM Able hostedits fourth annual Bash last week and is gearing up for its 14th annual Got the Nerve Triathlon.
Kaag, who is married to wife Gretchen and has a 4-year-old son, said he knows he’s fortunate to have looked at his prognosis in a positive light rather than focus on the negative. In doing so, he said he’s been able to help others feel empowered by leading an active lifestyle.
“I was a 21-year-old cocky, young guy,” Kaag said. “I thought I had the whole world figured out. [AMN] really changed my perception of everything and how I saw things.”
The bond between Devon Gales, a paralyzed former football player, and the opposing player involved in the collision that left him permanently injured is so tight, that Gales and his mother attended the former kicker’s wedding on Saturday.
Gales was playing wide receiver for the Southern University Jaguars during a September 2015 matchup against the University of Georgia Bulldogs when he collided with the team’s kicker, Marshall Morgan. The hit left Gales with a fractured C6 vertebrae and paralyzed from the waist down, WSB-TV reported.
“When I hit him my arms locked,” Gales told DawgNation during his recovery. “I wanted to roll over and lift my head. All I could remember is lifting my head trying to get up but I couldn’t get up.”
Morgan visited Gales in the hospital the Monday after his surgery, with Gales’ mother recalling an emotional moment between the two, DawgNation had reported. At the time they had spoken about having a connection, and over the weekend a series of photos appeared to show it still held strong.
Gales and his mother, Tanisha Deans-Gales were on hand to watch Morgan marry his fiancée, Madison Giddens, and stopped to pose for a few photos with the couple.
“What a true blessing to be in the mist of such wonderful people!” Deans-Gales posted along with the photos on Saturday. “Although tragedy brought us together, love has kept us together and we have been tragically blessed to be a part of this family!”
“Today two best friends made the commitment to love each other for life and I am so glad that they saw fit to have us share this precious moment with them! Congrats again Marshall and Maddie!” she posted.
In February, the University of Georgia announced a fund to help Gales build a new home, WSB-TV reported.
Women with osteoporosis who take drugs to help avoid fractures still need to have their bone density monitored, a Canadian study suggests.
Researchers who studied more than 6,600 women taking osteoporosis drugs found that for nearly one in five, bone mineral density at the hip actually decreased after the women started taking the medication.
The hip "is an excellent site for monitoring bone mineral density because it predicts fractures, can be measured with great reliability making it easier to detect small changes, and is not affected by age-related problems like spinal arthritis," said lead study author Dr. William Leslie, a radiology researcher at the University of Manitoba.
The findings suggest it may be time for some physicians to rethink their reluctance to get women bone mineral density tests after they start medication, Leslie said.
Whether to send women for these tests – also called DEXA scans, for dual-energy x-ray absorptiometry – once they start therapy "has been controversial," he added by email. "It is relatively inexpensive but adds to the cost of care while there has been little scientific data to answer the question of whether a change in bone mineral density while receiving treatment tells us anything about that person’s ongoing fracture risk."
During menopause and afterward, the body slows production of new bone tissue and women can face an increased risk of osteoporosis.
For the current study, researchers followed women for an average of 9.2 years starting when they were typically around 64 years old.
Most of the women were prescribed osteoporosis medicines known as bisphosphonates, which work by slowing down how fast the body removes old bone, allowing time to regrow bone and make fractures less likely. This family of drugs includes Fosamax (alendronate sodium), Actonel (risedronate sodium) and Boniva (ibandronate sodium).
Overall, 910 women, or about 14 percent, experienced fractures during the study period, including 198 with hip fractures, researchers report in the Annals of Internal Medicine.
Bone mineral density tests of the hip showed that about 30 percent of the women experienced an increase in density after they started taking drugs and another 19 percent of these women had decreases.
Compared to women with similar hip bone mineral density before and after starting osteoporosis drugs, the fracture risk for women with a decrease in total hip bone mineral density was 2.9 percent higher after five years and 5.5 percent higher after 10 years.
In contrast, the risk of fractures was 1.3 percent lower at five years and 2.6 percent lower at 10 years for women whose bone mineral density increased during the study.
One limitation of the study is that women didn’t all wait the same amount of time between their initial bone mineral density tests and follow-up scans, the authors note.
The researchers, therefore, can’t say what the best retesting regimen would be.
Because changes in bone mineral density occur fairly slowly in most women, "there is some controversy as to what time point following an initial baseline bone mineral density test should a repeat test be performed," said Dr. Matthew Drake, a researcher in radiology at the Mayo Clinic College of Medicine in Rochester, Minnesota.
If the test is repeated too quickly, it may be hard to tell if any measured change really represents bone loss, Drake, who wasn’t involved in the study, said by email. Waiting at least two to three years before a repeat test may be better for many patients, he said.
"There are several potential reasons why bone mineral density could decrease after osteoporosis therapy is started," Drake added. "These include failing to continue taking the medication as directed; a lack of adequate calcium and vitamin D intake," or a decrease in weight bearing activities.
A Salt Lake City, Utah, boy with autism has defied stereotypes and fulfilled his dream after winning a world championship in martial arts.
Fox13now.com reported that Ethan Fineshriber, 11, was diagnosed with the developmental disability at age 3. About two years later, his mom, Mara, encouraged him to start practicing a sport to make friends and get exercise. Ethan chose karate, and he fell in love with it.
He began doing taekwondo at ATA Taekwondo School and participated in competitions, the news station reported. Ethan had a knack for the martial art, and his coaches suggested he start competing at the national level.
After winning championships in the United States, Ethan set his sights on a world title. He began that mission three years ago, Fox13now.com reported.
In early July, Ethan competed at the ATA World Championship in Little Rock, Arkansas, and achieved his goal. Not even a teenager, Ethan has ample time to continue competing for more world titles, and that’s precisely what he plans to do.
Lounging by the pool or waking up in the middle of the night to use the bathroom aren’t what most able-bodied individuals would consider to be complicated tasks, but for bilateral amputees, the process of changing into their prostheses for these activities can be cumbersome. For injured soldiers— a record number reported major limb amputations in 2011— the transition back to civilian life also includes learning how to manage their new limbs.
Prior to the start of the conflict there wasn’t a large bilateral amputee population, and their level of care typically ended with an adaptable wheelchair, Dave Laufer, director of orthotic and prosthetic service at Walter Reed National Military Medical Center in Bethesda, Maryland, told FoxNews.com. But as more soldiers returned home with missing limbs, Laufer and his team were inundated with requests for something better than what was available.
“When you and I go home from work… you take your shoe off,” Dave Laufer, director of orthotic and prosthetic service at Walter Reed National Military Medical Center in Bethesda, Maryland, told FoxNews.com. “An amputee shoe is attached to his leg. When bilateral amputees take their shoes off they’re now sitting on a chair and they’re stuck.”
To stand upright for any task, amputees first have to roll a liner onto their residual limb, put on the prosthetic socket, then attach their prosthetic limb before standing up on both feet to ensure stability of the fit before walking again.
“It’s not a real comfortable process,” Laufer said.
Soldiers began turning to shorty feet, which were originally introduced to help amputees learn how to bear weight on their residual limbs. Shorty feet eilimate the need for liners and attachments, as they are specifically designed to fit the skin of the soldier’s remaining limbs. Seeing the success of others in physical therapy, Laufer began receiving requests for more pairs from soldiers looking for an easy way to hang around the house.
One of the early pairs is believed to have been ordered for a soldier who wanted to relax around the pool on his honeymoon without having to worry about getting his prosthetics wet. Others use them to play with their kids around the house or simply as a way to perform a task in the middle of the night without having to ask others for help.
To get an ideal prosthetic, Laufer and his team turned to another department at Walter Reed headed by Dr. Peter Liacouras, director of services in the 3-D Medical Applications Center. Liacouras received the order and after discussion with Laufer and other staff members, 3-D printed the shorty feet in titanium alloy.
“It’s titanium alloy,” Liacouras told Foxnews.com. “We have a printer here that will use an electron-B melting process to print layer by layer out of titanium powder," Liacouras told FoxNews.com. "We’ve done over 70 pairs of shorty feet.”
The shorty feet prototype design underwent several remodeling processes, including the addition of a padded bottom to act as a sole of the foot. A military insignia can also be etched onto the model to indicate which branch a soldier has served in.
A civilian prosthetic company saw the success of shorty feet and began manufacturing a version of them, which helps lighten the workload for Liacouras’ staff.
While shorty feet can provide the independence that some returning soldiers crave, they can also be a stepping stone for others on their path to recovery. Army Sgt. Adam Keys, 32, started walking on shorty feet before learning how to walk with another pair of prosthetic limbs.
On July 14, 2010, the vehicle Keys was traveling in through Kandahar, Afghanistan, hit an improvised explosive device (IED.) The blast cost Keys his left arm and both legs above the knee. He has since undergone more than 130 surgeries, meaning the shape, size and weight of his residual limbs have changed repeatedly, requiring numerous adjustments to his prosthetics.
Keys was first fitted with shorty feet in 2012 when he was learning to keep his balance and stand upright again. After spending nearly two years in a hospital bed and wheelchair, he was anxious to be upright but wanted to be taller. He’s now fitted with “sidekicks,” which he said helps him walk easier and provide him with the height he was looking for. Sidekicks differ from shorty feet in that they have an artificial knee joint and act more like a full leg.
“Although [shorty feet] are great and you keep your balance and everything, you have to swing your hip out to walk,” Keys told FoxNews.com. “With these sidekicks, you walk naturally instead of swing your hip out, you walk as if you have knees without knees so I love it.”
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Sgt. Adam Keys walks using his sidekicks.
(Sgt. Adam Keys – One Step Forward)
Keys and his mother, Julie, now travel the country as motivational speakers. Julie was his caregiver for more than five years during his recovery. During his “One Step Forward” talks, he tells audiences that, while he enlisted in the Army on Sept. 14, 2008, on the date of his injury, July 10, 2014, his mother unknowingly enlisted, as well.
“People look at me and say how did I do it and I say ‘Hey, there’s 100 people behind me and one of them was my mother of course,’” Keys said.
Keys plans to use the sidekicks and shorty feet four to five days per week at home to complete yardwork and on special occasions like nights out or weddings. Other days he relies on his wheelchair. He also plans to use the sidekicks for his speaking occasions.
“Having these shorty and sidekick feet, I’m going to use my feet at home a lot more for sure,” Keys said. “Being able to stand to do anything is always much better.”
