Monday 23 April 2018

Dear Dr Nina: Is there anything I can do to help improve my posture?

'Maintain a healthy weight, stop smoking and keep alcohol within healthy limits'
'Maintain a healthy weight, stop smoking and keep alcohol within healthy limits'

Nina Byrnes

I am a man in his late forties. As a child I had bad asthma which I grew out of in my late teens. However, this affected my posture badly. My shoulders now curve forward and there is a slight curve to my spine around the neck. I often get back pain. A friend of mine has recommended that I go to a Rolfer to have my posture corrected. Is this a good idea? If not, is there any solution open to me to retrain my bones and my posture or is it too late at my stage in life?

Dr Nina replies: I would think that if you had bad asthma there is a good chance that you had to take steroids many times when you were younger. Increased lifetime exposure to steroids is one risk for osteoporosis, a condition that can damage the vertebrae and lead to reduced height and postural change. 

A curve of the upper spine may occur which at it's worst becomes what is referred to as a dowagers hump. I'm not familiar with the process of Rolfing but research of evidence would suggest that although anecdotal benefits are reported there is no medical evidence it is of any benefit. I would however suggest you see your GP and be referred for a Dexa scan to check your bone density, to see if you are at risk of or have developed osteoporosis.

If this is the case, a medical treatment programme could be devised for you. It is estimated that our entire skeleton is remodelled every ten years between the ages of two and 30. Peak bone strength is reached in our 20s and stabilises until our mid-30s. From the age of 35 onwards we lose bone density and strength. Maintaining good bone health starts in childhood and continues life-long.

Calcium and vitamin D are the two main minerals involved in bone health. Unfortunately, a large percentage of people don't meet their adequate daily intake. Nearly 40pc of children and 75pc of adolescents don't have enough calcium in their diet. Vitamin D deficiency is also common with about eight in 10 adults and primary school children having less than 50pc of recommended vitamin D levels. The best source of calcium is from dairy products although other sources include green vegetables, pulses, and breads.

Poorly nourished bones become brittle and weak, leading firstly to osteopenia then to osteoporosis (brittle bone disease). Osteoporosis affects one in two women and one in five men. It can also affect children.

If bones are weak they can break easily often with little or no trauma. Osteoporotic fractures are serious especially in those over 60. Only 30pc of those over 60 who break a hip will regain full independence, and 20pc will die within 6-12 months due to secondary complications. A staggering 50pc will no longer be able to dress, wash or walk unassisted.

Women over 50 lose bone density rapidly at menopause but the rate in men also eventually catches up. The risk of earlier or more serious mineral loss is higher in those who are hormone deficient (menopause and testosterone), those with thyroid disease, a history of bone fractures, and a family history of osteoporosis. Taking steroids for a prolonged period is an important and serious risk. Lifestyle also plays a role. Smoking, excessive use of alcohol, and having a low Body Mass Index or frequent dieting all increase the risk.

There are things you can do to strengthen your bones. Take part in regular weight bearing exercise. Ensure you get five portions of dairy daily. Vitamin D is important and hard to maintain if you don't get enough sun. Look for fortified cereals, yogurts and milk or consider taking a supplement. Maintain a healthy weight, stop smoking and keep alcohol within healthy limits. Those with osteoporosis need other prescribed medication.

Q. My newborn wheezes a lot. Could she have asthma?

Dr Nina replies: Wheeze in a newborn can be due to a number of causes but assuming there is no physical problem with your child’s airway the most common cause would be bronchiolitis. Asthma is not usually diagnosed in children under the age of two. Bronchiolitis is a respiratory condition that causes inflammation in the bronchioles, or smaller airways, of the lung. Mucus is also created causing a cough and difficulty breathing in those affected. It occurs most commonly in children aged three to six months.

Bronchiolitis is most commonly cause by a virus. Respiratory syncytial virus (RSV) is the cause in 50 to 90pc of cases. The majority of cases of bronchiolitis occur in the winter months between November and March, as this is also the peak season for RSV virus, however it can occur at any time of the year.

There are number factors that put babies at risk.

Household smoke exposure is a well-known risk – especially maternal smoking – so it’s important not to smoke at home and not to allow anyone else to either. Breast-feeding reduces the risk for RSV as the mother’s immunity may pass across. Living in a crowded environment, having an older sibling or attending childcare facilities also increases the risk.

Bronchiolitis may cause a runny nose, cough and fever. The fever of bronchiolitis is usually less than 39 degrees. The symptoms of bronchiolitis can be frightening for parents as the wheezing and coughing can be quite pronounced.

The good news is that most cases can be treated at home. The majority of children with bronchiolitis recover fully but they may be more at risk of wheezing in the first few years of life.

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