Had a 60 year old come in via stretcher holding her left wrist. Had a bag of ice over it but as I got the history, patient was skating at a roller rink and slipped and fell onto her butt, and outstretched left hand. Judging from the way the wrist now looked like a hockey stick, she was fractured, just had to see how bad on xrays. Went ahead and called the orthopedic surgeon on call and it happened to be the husband of an old residency partner from West Sub Hospital. He came in to try and reduce it with a local injection. (Sometimes we can inject the area of the break with the same numbing medicine used as the dentist-with these fractures, if we can pull the broken bones apart and cast the area-may be able to hold the two broken pieces in a straight line to heal faster)
The same hour, a 72 year old lady also came in holding her right wrist and stated she just came from a roller rink party and fell on her butt and outstretched left hand. Taking off the ice pack, wrist looked ok, mild redness to where the ice was but no swelling. Her xray showed a thin line of a fracture along the same bone as the first lady. I placed her into a splint and sling and told her to see the ortho in the am. Very little pain and very healthy lady.
Obviously, there are some variables that would change the fall in both ladies; angle of the fall, speed, exact position of the extremity in addition to the health of the patient. The only tangible thing I could deduce was health. The 60 year old didn't take supplements, drank coffee, and had cholesterol "issues" was still working fulltime and was not an "exerciser". The 72 year old exercised regularly, even pointed out with her daily walking, she would take a small handheld weight and rotate it one direction then the other for the entire 20-30 minute walk. She claimed her girlfreind she walks with keeps her laughing and claims she has no stress. She gets physicals regularly and had a recent bone scan that was normal.
It was amazing the 72 year old didn't break her hip and she only suffered a small stress fracture. Being a man that sees life with the "cup half full", I would believe her exercise and stress reduction played an important part in keeping her bones thick and strong. This just backs up the Saguil Approach in utilizing preventive medicine not only before the disease is found but even after the disease has been controlled with medicines or surgeries. I have always taken pride in the patients that would take my advise to control weight, exercise and change the way stress is dealt with. Many get a false sense of security when the "lab test result" is brought back to normal with a pill. Now a days, diabetics come to the er with 2-3 pills (on average) state the last blood tests looked great at the last quarterly visit, but yet they are overweight and don't follow their carbs or calories. I even remember a diabetic I was counseling about smoking, I told him the tobacco will kill him, he answered "I know I will die, my wife will die at some point and even you (pointing to me) will die sometime. At that point I knew he wasn't listening but if I only had enough time or another visit with him, I would find another way to approach this denial. Bottom line is I always believe, no matter how many pills, medical issues or lack of money, there is a particular way to get healthier for everyone before during and after a medical issue is discovered.
