Bone Density Test | DEXA Scan

Bone density tests, or DEXA scans, can tell if you are at a higher risk for breaking bones or if you have osteoporosis. This painless procedure is the only test patients can use to tell if they have weakened bones or osteoporosis. Contact your provider if you believe you could benefit from a bone density test.

What is a bone density test?

A bone density test measures the calcium in the tested area of the bone. This determines the strength and durability of the bones. Bone density tests can tell if a patient is at increased risk for breaking bones. They can also determine if osteoporosis medication is working. Bone density can be tested in a number of places:

• Spine
• Hip
• Wrists
• Fingers
• Leg
• Heel

Some patients can have low bone density but not yet have osteoporosis. Doctors will work with patients and consider the need for osteoporosis treatment based on the results of the tests.

Bone density test process

Patients must not take any minerals or vitamins the day of the exam. Barium and radioisotopes exposure can also affect test results. The bone density in the spine and hip are the most frequently tested.

Patients are be tested by using a DXA machine. DXA machines give off low doses of X-rays and show bone density. The test should take approximately 15 minutes and can be taken at most hospital radiology departments and medical practices. Follow-up tests should be taken every two years to measure improvements or decreases in density.

Do I need a bone density scan?

Women are at greater risk of getting osteoporosis than men. Bone density tests are recommended for:

• Women 65 and older
• Men 70 and older
• Smokers
• Women with early menopause
• People at risk for osteoporosis
• People whose X-rays show bone loss in their spine
• People who could have a break in their spine
• People who have lost ½ inch of height in one year
• People who have lost 1 ½ inches of height in total
• People with a family history of osteoporosis

Speak with your provider about bone density testing and how you can prevent broken bones.

Cognitive Impairment

Cognitive impairment affects memory, concentration, and decision-making. Mild cognitive impairment can be more than the normal decline that comes with aging, but it is not as serious as dementia. Talk to your provider if you, your family, or friends have noticed that your mental abilities are not what they used to be.

Do I have cognitive impairment?

Forgetfulness and memory lapses are a normal sign of aging. With mild cognitive impairment, the symptoms may be worse. Talk to your primary care provider about your concerns. Here are some symptoms to look out for:

• You are forgetting things more often than you used to.
• You forget what you were just talking about or lose your train of thought during a conversation.
• You have problems following directions.
• There is loss of judgment or increased impulsive behavior.
• Your mood fluctuates.
• You act out of character.
• You have difficulty holding a conversation.

What are the risk factors?

• Increased age
• Genetics
• Diabetes
• Depression
• Smoking
• Brain injury
• High blood pressure, cholesterol, or other chronic conditions

How is cognitive impairment diagnosed?

Doctors may check your mental functioning through dementia testing, knowledge assessments and more to assess cognitive impairment. In addition, the following tests and screenings may be recommended:

• Neurological tests of your reflexes, eye movement, and walking or balance 
• Blood tests for Vitamin B12 and thyroid function, which could point to causes of cognitive impairment 
• Mental status screening
• Brain imaging     

Is there treatment for cognitive impairment?

If doctors can determine what the cause is, they may be able to treat the underlying reason for the impairment. Vitamin B12 deficiency, abnormal thyroid function, and depression all can lead to cognitive impairment, but it can be alleviated with treatment.

Know the stages of cognitive impairment

There are multiple stages of cognitive impairment, ranging from mild to severe. Someone may start out in the early stages with mild cognitive impairment and advance to more severe stages, or they may continue experiencing mild symptoms for a long period of time.

• Mild cognitive impairment: This is when the symptoms listed above are not extreme. A person may have a few of the symptoms listed above, but it is still possible for them to lead a normal, safe life. 
• Advanced cognitive impairment (dementia): This is when a person needs help communicating (talking or writing). People with severe cognitive impairment have multiple symptoms that are dramatic; they may need constant help with memory or be unable to understand what things mean anymore (how to turn off a stove, or what time to go to bed). It is no longer safe for a person with this stage of cognitive impairment to live alone.

People may also experience complications from having cognitive impairment. Those complications can include:

• Depression
• Irritability
• Anxiety
• Apathy
• Dementia or Alzheimer's disease

Preventing cognitive impairment

There is not much known yet about preventing cognitive impairment; however, there are things you can do to decrease your chances of developing it.

• Exercise at least 3-5 times per week for 30-60 minutes.
• Maintain a healthy diet.
• Avoid smoking and heavy alcohol use.
• Avoid activities that may cause a concussion or head injury.
• Maintain healthy blood sugar levels.
• Maintain healthy cholesterol.
• Keep your brain active: do puzzles, play games, and engage with family, friends, and your community—whatever challenges your brain!

Geriatric Medicine

Geriatric medicine at ZMC focuses on the unique needs of older people while also giving families resources and education to help care for their loved one. 

What is Geriatric Medicine?

Geriatric medicine is geared toward preventative care for seniors. Their needs and concerns are handled by doctors with specialized training in caring for the elderly. These providers focus on the importance of older people managing their health care and maintaining their independence.

Older people do not need to see a geriatric doctor to have specialized care. Your provider can perform a geriatric assessment that looks at physical health, cognition, and your environment. A geriatric assessment is more than a physical exam. It looks at functional capabilities and quality of life. Talk to your primary care provider about a geriatric assessment.

Focus on the Unique Needs of Older Adults

Geriatric medicine considers the unique healthcare needs of older adults. Older patients, for example, may be on multiple medications and have a range of health problems to manage.

Geriatric medicine focuses on health promotion and disease prevention.

Higher Risk Factors for Older People

Seniors are at a higher risk of developing illnesses or diseases. Health conditions that affect older adults in higher numbers include:

• Diabetes 
• Arthritis
• Cognitive Heart Failure
• Dementia 
• Muscle weakness
• Osteoporosis
• COPD
• Sleep Apnea
• Vision and hearing problems
• 
  

Medicare has a benefit called the Annual Wellness Visit that will help you make a plan with your healthcare team for how to stay healthy. This is a free, yearly visit where you will talk with your healthcare provider about your medical history, risk for certain diseases, the current state of your health, and create a personalized prevention plan. 

• Review your Health Risk Assessment, which you may complete before or during your visit. (See a sample Health Risk Assessment.)
• Make a list of providers involved in your health care and a list of medications, including vitamins.
• Take your medical and family history.
• Measure your height, weight and blood pressure.
• Review risk factors for depression.
• Screen for cognitive impairment.
• Review your functional ability and level of safety.
• Create a written screening schedule or checklist for the next 5 - 10 years.

Your healthcare provider might refer you for screenings or services outside of the appointment.

This is not the same as a yearly physical exam. Your healthcare provider will not listen to your heart and lungs or check other parts of your body. You will probably not have blood tests during this visit.

You can get your first Annual Wellness Visit after you have been enrolled in Medicare for 12 months. After your first Wellness Visit, you can get a follow up Wellness Visit every 12 months.

• Medicare will pay for the Annual Wellness Visit. 
• Medicare will pay for most screening services you need.
• You might have to pay a copayment for some screening services and follow up visits.

When you call your doctor’s office, tell them that you would like to schedule your Annual Wellness Visit. They will help you to plan for the visit. They may send you a form about your health to fill out and bring to your appointment.

• A list of your healthcare providers.
• The names of your medical equipment supply companies.
• A list of all of your medicines and dosages, including over-the-counter drugs, vitamins and herbals.
• The names of the pharmacies you use

Neurological Rehabilitation

ZMC provides therapy and refer you to  rehabilitation medicine services close to home for patients with neurological disorders, including stroke and brain injuries. There are different types of therapy based on patient need, including physical therapy (PT), occupational therapy (OT) and speech therapy (ST). 

Care may be hospital-based or in an outpatient setting. We provide contacts of skilled rehabilitation services for adults and children.

What is neurological rehabilitation?

Neurological rehabilitation also is called neuro rehabilitation. It is a doctor-ordered program for people who have disorders, diseases, and injuries of the brain, spinal cord and nervous system.

Neuro rehab often helps symptoms and improves function. Talk to your primary care doctor, family healthcare provider or specialist about getting a referral for neuro rehabilitation and therapy.

Stroke and neurological rehabilitation services

Our therapy programs for neuro rehabilitation help people improve function, including language, social skills and daily living tasks. Our rehabilitation therapists provide individualized treatment plans and compassionate care.

Depending on individual need and diagnosis, therapy services may include:

• Aquatic therapy
• Cognitive rehabilitation
• Occupational therapy
• Physical therapy
• Post-concussion care
• Speech therapy
• Vestibular rehab (balance and falls program)

Nutrition Services

What are nutrition services?

Nutrition services provide patients with education and counseling on their diet.

Nutrition services may focus on overall health and well-being or may be a part of treatment for specific diseases.

Nutrition services dietitians

Nutrition services are provided by registered dietitians. A registered dietitian specializes in food and nutrition. ZMC requires that registered dietitians be licensed by the Board of Dietetic Practice as licensed dietitians.

Registered dietitians provide reliable nutrition information and use evidence-based practice that is specific to patients’ nutritional goals.

Nutrition plays an important role in many conditions and diseases, including diabetes, obesity, heart disease, and gastrointestinal problems.

At ZMC your provider can refer you to a registered dietitians who are there to help you achieve better health.

Who needs nutrition services?

ZMC providers can provide nutrition education and counseling on many aspects of health, including:

• Low blood sugar
• High blood sugar
• High cholesterol
• High blood pressure
• Acid reflux disease
• Kidney disease
• Weight management for children and adults
• Eating disorders
• Food allergies

Dietitian services

Nutrition services can be individualized to help you achieve a specific goal. Dietitians provide services that include:

• Weekly visits
• Individual counseling
• Support groups
• Informational/educational sessions
• Metabolism testing
• Individualized food plans to help reach a specific goal
• Food preparation tips

Talk to your provider about a referral to receive nutrition services.

Many health conditions can cause balance problems, such as feeling dizzy or feeling unsteady on your feet. We have doctors skilled in evaluating balance problems and coming up with a treatment plan that is unique to your needs.

There are many systems in your body that must work together to help you keep your balance such as your eyes, your muscles and joints, your blood vessels and your nerves. One of the most important body parts in keeping your balance is a special organ in your inner ear that makes up your vestibular system. Balance problems can cause you to feel:

• Dizzy
• Like you are going to fall over
• Unsteady on your feet
• Faint or lightheaded  

If you are having balance problems, your doctor will do a complete physical exam. He or she may also do a neurological exam, or an exam of how your brain is working. Some of the tests your doctor may order at a local hospital are:

• Hearing tests
• Vision tests
• Balance tests
• Special pictures of your brain called an MRI and a CT scan
• Blood pressure tests

An electronystagmogram, or ENG test, may be done to find the problem causing you to lose your balance, feel dizzy or experience vertigo. ENG testing is done to find the location of the problem – the inner ear, the brain or the nerves connecting them. The test can be done at your doctor’s office or at a hospital. The test is painless and is done in a darkened room. First electrodes are attached to the face using a paste that easily is wiped off afterward.

You will be asked to follow a moving point of light with your eyes. You also will be asked to look straight ahead and side to side without turning your head. Your eye movements are measured and recorded. The test may take an hour or 90 minutes. The test will show how well your eyes, inner ears, brain and nerves help you keep your balance. Your provider may advise you not to take some medications for up to five days prior to the test to ensure the best results.

How your balance problem is treated will depend on the cause. If it is caused by an infection, you may need to just give it time and continue to allow your body to rest and heal. Other treatments may include:

• Physical therapy, including exercises to maintain your balance, strengthen your body, and prevent falls
• Medicines
• Lifestyle changes like watching the food you eat or using aids to help you keep your balance
• Surgery

Provider at ZMC evaluate and treat problems with balance and dizziness, also called vestibular disorders. People who have trouble standing or moving without losing their balance are able to build strength and flexibility. They gain confidence and have more independence.

Vestibular rehabilitation therapy (VRT) is evaluation, training and education for people with balance problems or vestibular disorders. A referral from your healthcare provider is needed. VRT first identifies what is causing the problem. Balance is affected by different body systems, including the inner ear, vision, and your musculoskeletal system. People who receive VRT often have:

• Dizziness
• Benign Paroxysmal Positional Vertigo (BPPV)
• Trouble with balance
• Meniere’s syndrome
• Neck-related dizziness
• Migraine headaches

Patients receive an evaluation. With vestibular rehabilitation therapy At a local hospital where patients learn exercise they also can do at home. They also learn about behavior changes that can reduce symptoms of dizziness. Therapists also help patients deal with the fear and worry that comes with dizziness and fear of falling. The therapy helps to improve symptoms that include:

• Dizziness
• Blurry vision
• Trouble keeping your balance
• Headaches
• Falling down a lot
• Wooziness
• Vertigo / spinning

Wound Care | Ostomy Care

At ZMC our providers offer the highest level of medical services for hard-to-heal wounds as well as ostomy care, including colostomy, ileostomy, urostomy, fistulas and leaking tube/drain sites. Our wound care providers are experienced in wound management and ostomy care. They will work with you, your primary care provider and other specialists to develop an individualized plan to manage your wound and ostomy care. The following are wound and ostomy care services:

Diabetes Wound Care

Patients with diabetes are at risk of complications, including slow wound healing. Talk to your doctor if you have signs or symptoms of diabetic wounds. Wounds need to be treated as soon as possible to avoid serious health problems.

What are diabetic wounds?

Diabetes affects the way the body processes glucose. Abnormally high blood glucose levels are associated with serious complications, including diabetic wounds. Diabetic wounds can be caused by:

• Nerve damage (neuropathy)
• Weakened immune system
• Narrow arteries

Diabetic wound signs and symptoms

People with diabetic wounds may have the following signs or symptoms:

• Chronic pain or no pain at all
• Inflammation and redness
• Pus drainage (weeping wound)
• Bad odor coming from the wound
• Dead tissue around the wound
• Numbness and dullness
• Fever and/or chills

Talk to your doctor if you are experiencing signs and/or symptoms associated with diabetic wounds.

Wounds need to be treated as soon as possible to avoid serious health problems. Some complications include:

• Foot injury
• Infections
• Ulcers
• Damage to nerves and bone
• Poor blood flow

Wounds that become serious may cause so much damage to tissue and bone that amputation is necessary. It is important to care for a wound immediately before amputation becomes the only option.

Research shows that ulcers often appear as the wound becomes very serious, requiring a lower limb amputation. Talk to your doctor if you are experiencing problems with your diabetic wounds not healing.

Diabetes wound treatment

The best treatment is prevention, since medical treatment for diabetic wounds provides limited help.

To prevent diabetic wounds you should:

• Keep your diabetes well controlled with diet, exercise, and medications
• Inspect the skin every day to look for developing wounds (or have a family member do it)
• Wear well fitting shoes that do not cause “pressure points”; do not wear shoes or socks that are too tight
• Avoid walking barefoot
• Keep nails carefully trimmed
• Keep the skin clean and dry
• Regularly see a podiatrist or have your primary doctor do a regular foot exam
•  Get early medical care for any injuries that do not seem to be healing as they should

If a wound occurs, treatment can include:

• Keeping all wounds clean and properly dressed
• Antibiotics 
• Surgical debridement (removal) of dead or infected tissue 
• Referral to a podiatrist or a wound care center
• Surgery for limb amputation when there is a serious infection
  

Pressure ulcers are painful skin injuries due to long periods of pressure on the affected area. At zmc, our expert team works to provide quality treatment for patients with pressure ulcers.

A pressure ulcer is a skin injury that often happens to people who are in a chair or in bed for long periods without changing positions. They can develop quickly and are commonly found on skin that covers bony areas of the body.  

Pressure ulcers often are called bed sores, because they may develop in people confined to their bed for long periods of time.

Pressure ulcers commonly are found on the heels, lower back, ankles or elbows. They can be hard to treat and may lead to serious infections if not treated correctly. 

Talk with your doctor, nurse or therapists if you have pressure ulcers or if you are at risk for developing them due to being immobile for a period of time.  They can help you find ways to prevent or lessen them.

Treating pressure ulcers can be difficult. The most important step in healing is to make sure the sore does not get worse. 

Here are some things your healthcare provider might suggest that can help with healing:

• Take the pressure off the affected area. 
• Use special padding under the area that is affected
• Change position often.
• Eat a healthy diet with plenty of protein.
• Cover the sore with a clean bandage. Your doctor will tell you what type you will need.
• Keep the healthy area around the sore clean.
• Your doctor might tell you take antibiotic medicine.
• See a doctor or nurse about removing dead tissue around the wound.

Some people are at higher risk of getting a pressure ulcer. Here are risk factors for getting pressure ulcers:

• Age: As part of the natural aging process, your skin gets thinner and weaker.  This makes it more easily injured. People who are 70 and older are more likely to get pressure ulcers.
• Lack of movement: Staying in one position for a long period of time puts pressure on your skin that can result in a sore. People who are not mobile are more likely to get pressure ulcers, including people confined to beds or wheelchairs.
• Poor diet: Not eating enough protein can lead to slower healing times and unhealthy skin.
• Another health condition: Having a health issue that affects healing, like diabetes, may make you more prone to having pressure ulcers. 
• Smoking reduces blood flow to the skin and causes dryness which can make people more susceptible to pressure ulcers.