hello i'm jeanette grandchild introducing dr richard vella on what's going on and this morning is very timely for me and  simple dietary he is board certified in pediatric surgery and a fellow in ambulatory foot surgery and medical specialty sports now in private practice and is at medford and he is going to be talking about give me a break observations on accidents of the elderly at home well unfortunately i am a demonstration i fell at home and had spent yesterday at the hospital having x rays of my back and my knee which had previous knee replacement surgery and they s get back to having it came with you and don't overdo tell you heal again so i think this is an amazing coincidence i'm going having my own private physician to explain all the thing how it could why it happens and how could be prevented and so forth so what alerted you to why elderly fall in the home and stop while working at the hospital so many patients came in in a wheelchair with a cane or crutches and i always say what happened to you they say i fell i said well it's rather obvious i can see by the cast but i'm where did you fall and why and they said well i  felt well and actually i felt at home and i said if you fell in your own home that's insane i know i had so many of my patients come and say yes i fell down my own stairs i fell on a particle that was on the stairway and so it eluded me that too many people were following at home and there are some bad reasons and obvious reasons and i came up with the idea that i said well if it's predictable it's preventable if it can possibly happen it's going to happen and many people even if you spill something in on your table you say i knew that was going to happen so it was predictable it's also preventable so from there on i launched into a new career of why the elderly fall at home and what can i do to prevent it now but we were talking earlier on before we started the first show form now you were telling me about some statistics about how many fall out and so forth yes it's really alarming when i say one hundred fifty thousand people fall in a year and die three million people three million people fall at home and end up in the car and what's more alarming fifty percent of people over eighty five fall at home and die fifty percent so one of the things i was thinking about is actually this lecture is to tell people how they can live longer that's actually what's going to happen many people die unnecessarily much too early in life because of an accident but an accident by definition is an unexpected event of course you didn't expect to fall how can i prevent the fall there are so many ways you can prevent the fall and i can go into that ok and what are the common reasons for falling you know there are so many common reasons when i talk to people say why did you fall well number one reason strangely enough is i was rushing to the telephone because somebody was calling me and i say so do you know if it was an important call an important call is a your children be maybe the president of the united states see another important call is telemarketing open have you sold your time share  broke your ankle only fractured your hip rushing to the phone for this you're going to be crushing in words that you never could imagine one of the reasons is that people fall also is because of clutter in the house  rugs articles left on a stairway in another cute thing is people fall downstairs well if you don't fall downstairs if you're holding on to a railing but you will fall down the stairs if you're carrying a package in front of your face and you can see where you're going you can also fall up stairs people are walking up stairs and they don't elevate their foot high enough over the rise and they trip on a step and fall for the good thing about that is going to fall on your face you won't but you don't have a weird looking nose i do anyway but go ahead and there are many other reasons that you cannot help and i break them down into intrinsic and extrinsic and extr out help if you get hit by a bus or a train car or a boy on a bicycle or roller skates that's extrinsic came from the outside you didn't see that but intrinsic you can help intrinsic action can happen by virtue of the fact you may already have a line fracture in your pelvis but you don't know it until you stand up and you turn your body in such a dimension that  a larger fracture and instead of a linear fracture becomes an open fracture and this causes you to fall down and you will collapse right on the floor you could also have severe arthritis or less you don't have control of your feet and your hands if you have brain stem injuries you can have neuropathy you can have any one of the diseases that affects the brain causes weakness you could have a problem with vision and you can see where you going you may be on medication the medication could make you dizzy or light headed if you find that you have any of these ailments carry a cane hold on to exactly try to think of things to build up your muscle tone put a grab bar in the bathroom the bathroom is the worst place to fall because everything you fall on is metal or iron or steel a stone that's a bad fall if you're going to fall fall in your bedroom on your bed you dear so what do you recommand besides you know get rid of the clutter and so forth and keep up your strength one of the first things i tell people is to carry a cane if you feel imbalance if you say i'm not steady on my feet that's a warning from your body that says you're going to fall someday and you know when you're going to fall when people say and of all times to fall you know is there a good time to fall is a good time to have an accident people say well why did it happen now now now is when it's going to have a now is the time it's going to that's going to happen to you so think in terms of preventing the fall for the people who have been ill people who are frail and elderly being elderly doesn't mean you are frail the two difference items altogether there are many many elderly people who are not frail this sturdy and strong and still working case in point one right on i advice people to carry a cane and they say if i carry a cane i'm going to look old and i stick by a nice cane don't get a cane from the hospital that's going to look like a sick so carry your own personal cane here's another interesting point medicare the government sponsored agency which is so we talk about the government the government is here to help you right the government says if you commit a hospital with a fracture we'll give you a cane if you commit to the hospital you say i'm always  on my feet i should be evaluated for maybe do i need a cane they'll give you a cane the government will help you if you were a diabetic and you say i have no feeling in my feet i have neuropathy i don't know when my feet are down to the floor in fact i have irritations on my skin that i don't even feel until it becomes an ulcer and then infection the government says we will give you shoes free if you are diabetic and you can physician why is the government doing this because the shoes might cost one hundred in the quarter the came my cost six dollars but an operation for a repair of a hip could be thirty thousand dollars  medicare is going to pay or any smile in a fracture of a wrist or arm or dislocation of a shoulder is another twenty thousand dollars it's much cheaper to give you a cane for zero or even a pair of shoes i also advocate and so do all the physician that you should bone up on your vitamin d vitamin d ah yes two thousand units a day is recommended and that's not too much they've actually recommended fifty it three days two days two a day and but this is an exercise i'll give you a couple of exercises that you can do at home you can do in the street you can do while the waiting for a bus if i may absolutely looking absolutely belmont on the street pretty in a pothole we have a pothole in belmont just everything looks like it's been ridden yet the other exercise just sit on the chair while i'm doing this i'm exercising the muscles of my three cycle the quad the steps muscle these quads a very important for balance for standing for running for going upstairs these are the most important muslims that's an easy exercise you can do it at home sitting down the more difficult exercise but very important is to stand on one leg stand on one leg all right here we now the number one exercise in the world for the world is walking walking is the number one exercise that i recommend for everybody and walking is kind of interesting when i said there are books on walking oh yes i said i've been walking since i was fifteen months old or something but you don't walk the way you're supposed to walk one of the ways you have to walk is to avoid falling look where you're going number two people say well how far should i walk and how fast the exercise that i recommend is one hundred twenty steps a minute how you can do this easily if you have a second hand and you watch just walk carefully and constantly at a given pace of one hundred twenty steps per minute if you walk one hundred fifty one hundred sixty that's a very fast walk on even if you do less that's acceptable and they say how long should i walk walk through the point of relaxation and limitation which there was when you go for a walk it's not work it's supposed to be fun to walk at a pace that sleazy and casual at least twenty minutes preferably forty i tell people walking in the neighborhood and you can think that way look in people's houses he took a look at the garage you can look at their flowers and their gardens and you can see interesting people you might even meet somebody breathe deeply outside air it helps you because it activates your mind very few people walk with an empty mind everybody's working and while i'm walking i'm thinking about how many people who i have coming for dinner tonight which life sort of wish like a limit is my vacation time going to be this year there's always something with thinking about talking about why we're walking so your mind is active and the other wonderful thing that it does is it reduces stress and i like that yes i like that because you can get up for walk first and now if you're going to do is ice suggest you go to watch where you're walking you're going to be alert going to look at the people you're going to enjoy the scenery birds you going to take him take your mind off many many items that might be bothering you don't you think it's inspiring to be looking at the birds and everything and not just walk talking constantly into one of those things people hold i see them going up and down my street and they never speak to or look or anything they're just talking like this and that's right nor never was one of the dumbest things in the america is people walking with a cell phone one of the crossing the street and concentrating on what the person is saying as opposed to a bus that is approaching quickly yes how do you miss a bus here while i was talkin a phone that's the ultimate stupidity in my book anyway so walking in it brought this your mind and it strengthens your muscle and bone one of the great ways to combat osteoporosis is not so much with medication but with strengthening of cortical the outside of the bone that strengthens the bone which is your basic means of support it's like the outside of a building it's a support it's the main support and you can strengthen bone tissue by walking even light jogging not swimming swimming is an exercise for breathing in for muscle development mostly the back and the legs of course but there's nothing like walking to strengthen the quadriceps and the circulation and we all need this and every doctor will tell you this is how you have to build up your strength is by walking you're not going to lose weight this is another strange thing if you don't lose weight walking you gain strength walking you lose weight by stop eating don't eat so much i don't know all of those i know we're all guilty of eating the wrong foods i had a cookie yesterday and my conscience is driving me crazy i have a guilt complex i had a cookie but you see you may feel a cramp you might feel tired you might run out of breath nowhere is it written you can't stop if you don't feel like walking stop and rest you can sit on a stone or a stone wall or on the grass you can wait not more than two minutes and you get up refreshing you see the pain is gone the more that cramp is gone in my leg and you can continue on however if you walk and within five minutes you have a severe crap in the cough of your leg that's very serious oh ah that's very serious and this is the first sign of a cheerio sclerosis that you'll be aware of you have pain in your lower leg in the cough and when you press it it's going to be painful to touch you say gee i only was walking i was only working for five minutes maybe six or seven and i can hardly walk down then you wait two or three minutes and seems to have gone and if you walk again and it comes back again you have to stop walking you go home and make an appointment to see a doctor about july sclerosis and some kind of new clues in or a blood if you have a blood clot that's very serious you can go to your brain and she'll lungs go see a brain you'll have a stroke go shell and you'll die so it's very serious when you consider everything all together however for the most part most people in generally good health can walk but don't think that you have to walk like a marathon runner you can just walk easy and relaxed the idea is that every time you put a foot down every time you put your foot down and it's a step you're putting pressure on the stronger that was so other things that i remember we talked about yeah what else did you want to talk it that's the most important thing thousands of diabetics a year i was trained under eliot joslin zero who was a famous johnson yes to johnson clinic and his son allan and it was the most fascinating time of my professional life because i learned about a disease that at that time was people just becoming aware of being a diabetic and they didn't have any idea that had any relationship to food or fat or exercise and d everybody aware of that and then i worked at the deaconess hospital at the at the diabetic clinic for quite a while and one of the things i learnt was diabetics have a disease that's nerves that you can touch something hot and you don't even know what's hot you don't feel anything as a case that was recorded actually was in the newspapers a diabetic lady fell asleep in her house while she had her knee resting against a hot radiator the radiator was very hot a steam radiator in her house and she fell asleep and her knee just relaxed and was leaning against the radiator she developed a severe burn she didn't feel it that's neuropathy that's how severe it can be you can get a burn and not if you can step on a needle and you don't know it you can get an irritation in your shoe you can have a pebble in your shoe and you won't even  this irritation can be so severe it can cause an opening in the skin and cause a ulceration which can take either months to heal all become infected and you can lose a limb so if nothing else be aware of the fact that the most important thing for diabetics that they can do to prevent problems before they go on you know if it's predictable it's preventable is to make sure your shoes fit reinforced areas where you will get the maximum irritation what a great idea so it's a little irritation under the heel the sock will absorb and if you have pressure on your toes there's a little reinforcement for the toes so you can walk around and feel some degree of protection oh that i've just got the little high side that were just about time to close and every would you believe i think where we covered the main things you hoped to cover  always cooked things that were good for ham how to make custard desserts without sugar and right and everything and he was into walking to every he worked in boston and every noon he would walk all around people would be interested in this have you ever given a talk at the senior center yes ok good well that's it for today on what's going on walk but walk carefully with good shoes and don't have something in front of you so that you can't see where you're walking and in the house you can't be a clutter bug and you've got to have the