Hello all and welcome to Week 6!
I was on site for a full 3 days this week, and saw such a variety of patients and cases. Although we saw so many, I’ll be focusing on 2 visits in this post: one for diagnosis and treatment of osteoporosis and a well woman exam.
\Osteoporosis is screened for in a bone density test, which is basically a series of detailed x-rays taken of the wrist, femoral head, pelvis, and spine. These tests are compared to bone strength at the epitome of density: age 30 (a different strength is used for each gender). The patient is given T scores, with -1 being one standard deviation less dense than the average density at age 30, -2 being two standard deviations less dense, and so on. Patients with a T score of -1 or less are healthy, a T score of -1.1 to -2.4 are osteopenic (a milder, pre-osteoporotic condition), and a T score of -2.5 or less are osteoporotic.
Once a patient is diagnosed with osteoporosis, there are three main courses of action to be taken: Vitamin D and calcium supplements, prescriptions (such as Prolia or Fosamax that stimulate osteocyte growth), and weight-bearing exercise. Each of these strengthen bones back to a healthy density, so that in case of a fall, bones are not broken so easily! We treat lots of osteoporotic patients, and help move them back to healthy densities, through combinations of these aforementioned treatments.
The other major visit we had this week was well woman exams-- a visit I had not seen yet. This is a comprehensive wellness visit focused around women’s health, much like those at a gynecologist. Not all primary care offices offer visits like these, but it’s just another speciality Dr. Barker has tucked under her belt.
In these visits, we covered preventative home care such as self-breast exams, as well as running in office screenings like pelvic exams and pap smears (which I mentioned in the last post!). I also got to watch an IUD insertion, another experience I honestly never would have had without this internship. Opening my eyes to another field of medicine, these visits were beyond interesting.
So that’s this week’s update! Additionally, I know some of my peers have been taking spring breaks; my week off will be the first week of April! A little while longer. Thanks for reading, and see you next week!
Hey Julia! This is post was so wonderful, and I am so happy to hear that you are learning so much more than you had anticipated. Dr. Barker sounds like an amazing woman and mentor :D Quick question, for the bone density test, is there a particular reason they look only at the wrist, femoral head, pelvis, and spine? Thank you so much, and I can't wait for your next post!
ReplyDeleteHi Saleena! She's absolutely amazing to work with, and I am learning so much! We look at these areas because they are the most likely to break during a fall. If elderly patients were to trip and try to catch themselves with their wrist, or fall down completely, these areas would be the first to fracture. Thanks for reading!
DeleteHi Julia! I hope you had a great Saint Patrick's day, every time I read your blog I learn something new about the medical field, I had no idea that there was a scale system to determine if a patient has osteoporosis, I had always thought it was a more of a case-by-case basis, but I guess it makes sense to put a level of objectivity on it. Until next week, good luck!
ReplyDeleteHi Connor! I hope you did too. Yes-- the concrete system for diagnoses helps treatment be easier and more efficient. Thanks for reading!
DeleteHey Julia!
ReplyDeleteI am so glad you got to mentor Dr. Baker more this week. I was wondering, how does one know to see a doctor about whether they have osteoporosis or not? Do they feel discomfort in their bones before coming to see their doctor? I can't wait to hear more!
Shivalee Nigam
Hi! Osteoporosis is checked for after the age of 50 with bone density tests every two years. There are no symptoms until it's too late, meaning you cannot tell you have it without screenings until you slip and a minor slip severely fractures a bone. Thanks for reading!
DeleteHey Julia!
ReplyDeleteI'm sure it was so cool to see different fields of study, some that you may even take part in. Dr. Barker sounds like a great mentor to learn so much from! I was wondering, do people feel weaknesses in their bones before seeing a doctor? Additionally, are size and weight incorporated into the compared density, or is it just based on age? I can't wait to hear more next week!
Julie Loison
Hi Julie! They do not! Osteoporosis has no symptoms other than after a fall. They can, but much more important factors are age and diet. The more calcium and Vitamin D someone gets through their diet, the stronger their bones! Also, younger people have healthier bones (as you probably guessed). Thanks for reading!
DeleteHi Julia!
ReplyDeleteIt's amazing how many different skills Dr. Barker has mastered! She certainly sounds like an inspiring mentor! What are the indicators of a low or "bad" bone density on an x-ray? Like what does Dr.Barker look for in an x-ray in order to determine if someone has osteoporosis? You said that you enjoyed opening your eyes to other fields of study, so would you consider gynecology as a future career option? Thank you! Hope you have another great week!
Bhumika K.
Hi! Different shades of coloring on the x-ray denote different densities. Thus a radiologist uses the shades to see how thin or thick the bones are while reading the scans. I would, but I definitely like the OB/GYN combination better, as it also incorporates babies! Thanks for reading!
DeleteHi Julia, Really well done blog. My question is what effect does the age of a person on the bones? is it just that they are getting weak or old or is there a scientific reason of why?
ReplyDeleteThank you in advance.
Hi! So over time bones do deteriorate naturally. Additionally though, estrogen protects bones and helps them grow stronger. When menopause hits women, their estrogen levels drop dramatically, so their bones are not as protected. Thus osteoporosis is more common in women, due to this change in hormones. Thanks for reading!
DeleteHi Julia! It's nice to hear about all the different areas of medicine you're able to observe and participate in! How exactly are osteoporosis patients diagnosed? I understand that patients have to take a bone density test, but what symptoms drive these patients to take the bone density test? I'm excited to hear about next week's adventures.
ReplyDeleteSophia Vaidya
Hi Sophia! Osteoporosis is asymptomatic; it is automatically screened for past a certain age. The tests are read by radiologists to check densities based on the coloring. Thanks for reading!
DeleteHi Julia!
ReplyDeleteThanks for your explanation on Osteoporosis. The way you explained the scale of bone density was very helpful to me. Additionally, do you think you are considering going into the OB/GYN field? You have seemed really excited about some aspects of this practice, so do you think it is something you would like to research more about?
Best,
Gabby W.
Hi Gabby! Glad I could help. I definitely am! As a woman, women's health in general is super interesting to me, as well as helping with the development and birth of babies.
DeleteIt is definitely something I will consider. Thanks!
Hi Julia!
ReplyDeleteThis week's blog post was really interesting and really easy for me to understand! I really love how you explain the different conditions, and then the various treatments for those conditions. I'm excited for next week's post!
Hi Kimmi! I'm so glad you enjoyed. Thanks for reading!
DeleteHi Julia! Fantastic Post! It's great that you got to see so many different cases. With Osteoporosis, it is interesting to see how they classify the bone strength. Is there a specific T-score that beyond that, they start to administer the vitamin supplements and prescriptions, like to prevent the T-score from going to be completely osteoporotic? Can't wait for next week's post!
ReplyDeleteHi Sri! Yes any score that is diagnosed as osteopenia, so a score of -1.0 to -2.4, or osteoporosis (as it can be reversed!) is recommended supplements to increase calcium and D levels. Only true osteoporosis cases receive prescriptions. Thanks!
DeleteHey Julia! Looks like you fixed your gif problem (which I guess is why all those gifs were happy and dancing), so yay! I love how I get to learn so much from your post, and it makes me so glad that I took anatomy last year or else I may be slightly completely lost. Just a quick question: why do you look at those specific areas (i.e. pelvis, wrist, etc) for the bone density test? Also, is there a reason why the epitome of bone strength is at age 30? Great post, and I can't wait for the next one!
ReplyDeleteHi Korina! I'm so glad you enjoy reading them! These are areas likely to be injured in a fall, either from direct impact or an attempt to catch oneself. And this age in general is usually a peak of health in lots of systems, as the tissues have developed and strengthened to this point and not began to truly age. Thanks for reading!
DeleteSounds like it has been a good week! I hope this week is even better.
ReplyDelete-Ms. Cooney
Thanks Ms. Cooney!!
Delete