Death by falling over

"Gary,
I am very sad to say, my wifes dad passed away on sunday. He was 84, but as a young man was an excellent athlete, a natural swimmer, track athlete and even played rugby for XYZ Province while the allblacks were on tour (away) one time.
3 years ago he could give me a good game of tennis.
Less than a year ago, he was knocked over by a dog and his hip broke.
He seems to have fallen into the category of people dying after a hip breakage, he died in his sleep in a home in XYZ Town.
What is the link between breaking a hip and a rapid demise in health resulting in death?
Anon"
__________________________
Gary Moller comments:
First of all my condolences are extended to the family. Knowing Anon reasonably well, I strongly advise that he gets some tennis coaching right away.

Among older adults, falls are the leading cause of injury deaths and the most common cause of non-fatal injuries and and hospital admissions for trauma. The cause of death is usually a blood clot in the lungs or elsewhere interrupting critical circulation. This is due to the frail state of the person, the immediate tissue trauma of the injury and the formation of blood clots at the injury site and from the immobilisation. Even if they recover from the fracture and are discharged, their even frailer state and the disability from the injury may be so great that their health never recovers and decline can be rapid, usually from pre-existing comorbidities, such as dementia. Getting a dose of the flu may be all that it takes to kill the debilitated person. Anon's family tragedy is being repeated several times daily.

I gained some further details from Anon and learned that his father in law had been on some kind of anti-depressant for many years, as well as medication for blood pressure. It is significant that he had recently gone into a managed care facility. Prior to his fall he had had a number of "turns" which could have been mild strokes. This came as no surprise. Unfortunately, for him and his family, the causes for his demise may have been put in place many years ago when that first pill was prescribed. Here is my speculation about what could have been going on:

• One of the most accurate indicators of decline in health and independence is balance. Medications that are prescribed to alter mood and to control blood pressure may expedite the decline in balance and hasten dulling of the mental faculties. Refer to my article here that expands on this.
• I will add that blood pressure medication does not cure blood pressure problems; it merely hides or suppresses the condition - the wolf remains at the door and the problem becomes more and more difficult to manage as time passes. The same can be said in many cases of prescribing mood altering drugs.
• Blood pressure medication can cause "brain fog". I recall one insurance study several years ago that found that elderly drivers on blood pressure medication had a nine-fold increase in motor vehicle insurance claims as compared to their non-medicated peers.
• Many of these medications can affect nutrition by causing unpleasant side-effects like cotton mouth and poor digestion. Up to 90% of some groups of elderly may suffer malnutrition. Read Should they Eat Cake?. Weak muscles, dementia/brain fog, osteoporosis and poor balance are killers when combined.
• Medications that are being prescribed wholesale to osteoporotic patients nowadays may be causing disastrous problems down the line by hindering bone healing post fracture. Read this Blog
  
• The "turns" that Anon described might have been the inevitable result of progressive cardiovascular disease, including excessively high blood pressure as medication becomes increasingly ineffective. Balance is usually seriously affected by these mini-strokes.
• From personal observation, the very act of institutionalisation may bring about a rapid loss of independence and decline in health status. My article "Should they Eat Cake?" touches on this.
• The survival of the debilitated old person, as per above, is under serious threat from a fall and prospects of making a good recovery are not good.

What can be done to prevent this sort of tragedy happening? The good news is that much can be done, including:

• Blood pressure pills or not, implement agressive lifestyle and diet changes to address the underlying factors that cause blood pressure and otehr cardiovascular ailments. Go here for more information
  and go here
• For mood and behavioural problems, seek drugs-free treatments, including exercise, nutrition and counselling.
• If on medications, question the need and ask your Dr to help devise a plan to either reduce the dose, or preferably to get off them completely. Ask about drug-free alternatives and do not hesitate to seek second and third opinions.
• Exercise vigorously 3-4 times a week. This can be walking and doing resistance exercise like gardening. The Myotec Pocket Gym is designed for safe use by the elderly to keep muscles and bones strong.
• Get outdoors daily to get sunlight on the body. Vitamin D from sunlight + exercise + good nutrition = strong bones and many, many other health benefits.
• If the day is sunless, then get a little Vitamin D (sometimes called cholecalcitrol) from a supplement like cod liver oil or Nutrimon (a low cost chewable multivit for kids; but fine for adults)
• Get multivitamins, including the B Group and Vit C; multi minerals, especially calcium and magnesium; and omega3 oils into the daily diet right away and keep these in place during old age. I am running a special this month on the Red Seal Effergize multivitamin tablets.
• Practice balancing skills now and into old age. This can be as simple as practicing balancing on either foot each day. This is also a good test to see if a new medication is affecting balance. (If balance deteriorates, go back to your Dr immediately and ask for a review). If you get really good at balancing on one leg, then try doing it with your eyes closed.
• Keep agile: Take up tap dancing, martial arts and walk rutted and rooty trails at every opportunity. Ride a bike. Play tennis (get some professional coaching regardless of age and ability).
• Design your house to be "fall friendly". Live in a single level swelling with no hard wood, tile or concrete floors. Fit natural wool carpets with thick underlays. Use non slip surfaces in showers, on steps and paths and light them well. Fit hand rails in bathrooms. Have a proper step ladder for getting up to high cupboards and for changing light bulbs.

If an elderly person is injured from a fall:

• Insist on getting the best treatment by experienced doctors and do not tolerate any delays.
• Make sure hospitalised person has a Guardian Angel appointed to look over them (more about this in a later article).
• Insist on minimal medication and take the opportunity of hospital monitoring to safely get off any unnecessary drugs that were prescribed in the past.
• Insist on high standards of personal hygiene by everyone, including the cleaning of Dr's stethoscopes between patients. Refer to my article about hospital infections.
• Get them onto a Super Smoothie and extra vitamins and minerals as well as Omega3 oil like flaxseed oil quickly. (Discuss the Omega3 oil with the Drs first if the patient is on anticoagulants, because these oils have similar properties and the medication might need to be adjusted). You can either make up the Smoothie at home and bring into hospital, or make it by the bedside with a small blender. The fresher the better. The hospital food will only serve to add to an already malnourished state and healing will be seriously compromised.

Finally, ACC have a number of excellent injury prevention resources to prevent falls. Go here for them.

Essential reading: Imaging X-rays Cause Cancer

Imaging X-rays Cause Cancer

"Let's play a new game: Its called Fry Teddy"

Go here for a PDF summary of the BEIR VII report on this most important subject.

http://fermat.nap.edu/execsumm_pdf/11340.pdf
The report was issued by the National Academy of Sciences in the fall of 2005. The National Academy of Sciences is the largest scientific body in the world. The focus of their report was the part that ionizing radiation plays in the development of cancer. The benchmark that they came up with is that an x-ray exposure of 10 mSieverts (mSv; units that radiation dose is measured in), which is roughly equivalent to the radiation a patient is exposed to with a CT study of the chest or a CT study of the abdomen, produces cancer in 1 per 1000 patients.

Read the following quotation by imaging expert Dr Richard C. Semelka, MD:

“The indisputable fact, and in my opinion rendered truly indisputable by the BEIR VII report, is that medical x-rays cause cancer. BEIR VII also emphasizes that there may be no safe lower limit.^[1] This statement taken as said has the potential to cause considerable alarm, so my intuitive modification is that perhaps below the dose of a standard body CT, which is approximately 10 mSieverts (mSv; units that radiation dose is measured in), there is likely negligible if any risk for an individual test.
However, even 1 body CT scan (1 CT scan of only 1 of the following regions: the chest region, the abdominal region, or the pelvic region) carries with it some element of risk. The risk that BEIR VII reports is 1 in 1000 chance of developing cancer from a 10 mSv radiation dose. In my prior report, I described what is written on the US Food and Drug Administration Web site, which is a 1 chance in 2000 of developing cancer from a dose of 10 mSv. The BEIR VII report doubles that risk. The risk in children is even higher, with a reported chance of 1 in 550 of developing cancer.”

Read this extract carefully about what the Dr Semelka says about medical x-rays:

“In general, BEIR VII supports previously reported risk estimates for cancer and leukaemia, but the availability of new and more extensive data have strengthened confidence in these estimates. A comprehensive review of available biological and biophysical data supports a "linear-no-threshold" (LNT) risk model that the risk of cancer proceeds in a linear fashion at lower doses without a threshold and that the smallest dose has the potential to cause a small increase in risk to humans.”

Note that there is no safe lower threshold – cancer risk is linear.

The following is a table of the standard reported dose of radiation for various common imaging procedures:

Table: Average Radiation Doses Associated With Common Imaging Studies

Diagnostic Examination	Effective Dose (mSv)
X-rays
Chest (PA film)	0.02
Head	0.07
Cervical spine	0.3
Thoracic spine	1.4
Lumbar spine	1.8
Abdomen	0.53
Pelvis/hip	0.83
Limbs/joints	0.06
Upper GI	3.6
Lower GI	6.4
Screening mammogram	0.13
CT
Head	2.0
Abdomen	10.0
Chest	20-40
Pulmonary angiography	20-40
PET - CT	25

You can see from this table that many people are easily getting far too much radiation; especially from CT scans and when one takes account the number of x-ray studies that one may receive throughout a lifetime, including dental x-rays.

There is too much damaging radiation in my opinion and the experts now agree.

Patients who are receiving multiple CT scans and more x-rays from other sources are getting dosages that far exceed what would appear reasonable risk.

It is the patients and their families who end up carrying the can for the consequences. By the time any cancers rear their ugly heads, the institutions and the individuals who first ordered the radiation will probably be long gone. Who pays? Ultimately, it is the patient and their families.

Here is what Dr Semelka recommends to patients”

“I believe it is your right to know that radiation exposure from medical x-rays, in particular procedures utilizing high x-ray doses (eg, CT, PET, PET-CT), may result in cancer, and it is your right to request an alternative procedure when that alternative procedure generates comparable diagnostic information. Providers should know which alternative imaging modalities provide comparable information for the medical indication that you have. It is your right, based on the Hippocratic oath that all physicians have taken, that you undergo the safest test that has sufficient diagnostic accuracy to evaluate your condition. I recommend that you refer your provider to the BEIR VII report regarding radiation hazards, and Abdominal Pelvic MRI regarding how to perform and interpret MRI studies -- if the capabilities of MRI are questioned. Liver exams are one study in particular that should almost always be done with MRI.”

Concluding advice:
Always question the need for imaging x-rays, no matter the reason and to avoid CT scans altogether – be the imaging for a dental exam, a suspected fractured foot or to find the source of abdominal pain. In most cases, there is a good alternative. Where there is not, insist on the lowest possible exposure in order to get the job done and always insist on a protective lead shield to protect the rest of your body from radiation scatter.

Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII-Phase 2. 2005. Available at: http://books.nap.edu/catalog/11340.html