the downside of supplements

Tuesday, January 3, 2017

It’s a new year and people fill it with resolutions to eat better, work out a little more, get in shape and be healthy. As January 1st shows up in the rear view mirror, the best intentions fall nu the wayside and sometimes people turn to a pill or supplement as an opportunity to regain momentum or perhaps replace the time and effort that being healthy entails.

When an athlete fails a drug screen, the response and excuse often is that the pill/powder/liquid was adulterated. The athlete did not know what was in the supplement or medication and there was no intent to cheat or gain a competitive advantage. Aside from Lance Armstrong and the recent Russian sports machine drug abuse indictment, most athletes have their transgressions and suspensions forgotten with time. Sammy Sosa, Barry Bonds and Roger Clemens are on the ballot for Cooperstown. But the reality is that role models do affect public behavior and the New Year has a few stories that are reminders that performance enhancement opportunities are wide spread and can be dangerous.

Caffeine jump starts the world in coffee, soda and also in energy drinks. That is not necessarily a good thing, because the concept of “everything in moderation” can be overwhelmed by “if a little is good, a lot must be great.”  Research from the US military has found that energy drink abuse leads to sleep pattern disturbances and is associated with service members falling asleep on duty. The conclusion of a Walter Reed study of more than 1, 000 soldiers found that energy drinks are “unregulated and can have negative side effects…those who had three or more drinks per day were more likely to fall asleep during briefings or on guard duty.” The authors of the report also concluded that the long term effects of larger doses of the ingredients in energy drinks is not known. Imagine if the FDA released the same statement for a prescription drug.

The Armed Forces report deals with adults but what about supplements that are being advertised and supplied to kids? The American Academy of Pediatrics has a policy position recommending against the use of creatine and testosterone products in the pediatric (under 18) population. But what stops a middle or high school athlete from walking into a health food store and buying products that have not been found safe for their use…it seems absolutely nothing. Research to be published in the Journal of Pediatrics found that health food sales people had no trouble recommending creatine and testosterone boosters to researchers posing as a 15 year old high school athlete. There are no laws that prevent such recommendations or sales. Trusting the recommendation of a supplement shop sales clerk is not the same as a discussion with a pharmacist.

 So who cares? The supplement manufacturers should maintain strict standards as to what is in their product and the consumer should be reassured that the product label accurately lists what is contained in a pill or powder. If only the consumer could be that certain. It remains a buyer beware marketplace. In 2015, the New Your Attorney General’s office found that Walgreens’ Walmart, Target and GNC all had supplements on their shelves that did not contain the ingredients that were documented on the label. Almost 80% of the supplements did not contain the medicines they were supposed to, but instead included “cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies.” The story made headlines for a day or two as the stores agreed to reach out to their suppliers. After another New Year has passed, how that story has played out is uncertain.

 For all the criticism leveled at the Federal Drug Administration, at least the US public can be reassured that the medications prescribed by a physician and dispensed by a pharmacist, will have the ingredient in the pill that is labelled on the bottle. The same holds true for hundreds of over the counter medications like aspirin or Tylenol and their generics. While we might not like the ads or commercials of some drugs, at least we know that their labs and production facilities are regulated to a high standard. When it comes to herbal supplements…not so much. It’s very much a buyer beware marketplace.

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fractured, broken, or cracked

Sunday, December 25, 2016


Adam Schefter ‏‪@AdamSchefter

Fractured fibula for Marcus Mariota.

Broken fibula for Derek Carr.



Words matter when it comes to medicine. Patients and their families potentially can get confused when different terms are used to describe the same situation. This is especially true when reporters, people who write for a living, use interchangeable words and readers might presume one injury is worse than another. With the above tweet, ESPN’s Mr. Schefter sows those seeds of confusion.

Fracture, broken and cracked all mean the same thing…the integrity of a bone has been disrupted. One term does not imply a more serious injury. You can’t be a little bit broken, fractured or cracked. However, fractures may be more or less serious than others. Some need surgery while some, with time can heal on their own.


It is important to know that the fibula is a strut bone in the shin that runs from the knee to the ankle. While it is an important structure, it is not part of the bones that make up the knee joint (femur and tibia) or the two that make up the ankle joint (tibia and talus).Fibula fractrues are often associated with tibia fractures but isolated injuries to the fibula do occur. When they do, the fractures are not all treated the same. For the isolated fibula injury, it’s like real estate; it’s all about location.

fibula head

Fibular head fractures usually occur because of a direct blow or a twisting injury and non-displaced fractures are often treated with supportive care: weight bearing as tolerated, ice and pain medications. Fractures that are displaced, meaning that the two ends don’t align well, may need an orthopedic specialist to consider surgery. The big deal with this injury is the peroneal nerve. It wraps around the fibular head and if it is damaged, the muscles it controls can stop working, leading to foot drop.

midshaft fibula

Mid-shaft fibular fractures are relatively uncommon, but are usually due to a direct blow. Unless the bone is shattered or significantly displaced (not aligned), the treatment is time.

distal fibula

The distal fibula has a bony protuberance or bulge that is called the lateral malleolus. Ligaments that attach to it help stabilize the ankle. Fractures of the lateral malleolus or the distal part of the fibula may need surgery to maintain ankle stability.

The big thing to remember about fibula fractures has to do with anatomy. The tibia, fibula, knee and ankle form a ring. If there is a twisting injury, there are usually two injuries to be found because it’s hard to twist a ring and break it in only one place. Think of twisting a pretzel and snapping only one curve. For the certified athletic trainer on the field or the doctor in the ER or office, finding an isolated fibula fracture leads to looking for another injury before accepting “just” one injury. And that second injury may be torn a ligament in the knee or ankle that may be more important than the obvious broken bone.

Based on news releases, Derek Carr’s broken fibula may be distal and it required surgery. The location of Marcus Mariota’s fracture hasn’t been released just yet. It’s a reminder that the word broken did not determine injury severity or the need for surgery. It was just a word.

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