DEM BONES, DEM BONES, a classic spiritual written by African-American author and composer, James Weldon Johnson believed to have been written sometime around 1928 is actually a retelling of a passage in the Old Testament. Who knew we could get an anatomy lesson from The Book of Ezekiel chapter 37, verses 1-14? Often subtitled the valley of the bones, it tells of the visit of the prophet Ezekiel to the Valley of Dry Bones in which he tells of the many dry skeletons and disconnected bones lying about which would one day be made whole, covered with flesh rise up at the command of the Lord, or God almighty. It appeared to be a perfect Halloween setting the way he described those bones walking around.
I don’t mean for this to turn into a dissertation on the Old Testament but instead a compliment to the tone of that fine old song. It is one of the best accounts ever written of not only the hope for believers in the future, but a wonderful accounting of the bones and their locations in the human body. The song actually was recorded through the years by a multitude of singers, groups both gospel and popular into this current day. It’s often used around Halloween in a spooky yet comical way to sing for and by children due to its catchy cadence. I did notice many of the lyrics have morphed over the years by various vocalists and teachers for their own purposes.
Take a guess what all of this is leading up to if you will? How about we talk about osteoporosis today? I just had to “go there” with this wonderful old song. I’ve always loved it and could have been politically correct and said, “Them bones” but that just didn’t feel right. That would be like belting out my favorite old spiritual when I am feeling depressed and changing “the trouble I seen”, to “the troubles I’ve seen.” As a writer, I believe in leaving the original the way it was written and not altering or messing with it. That’s called history and I believe in leaving it alone. If this offends anyone, well, I guess they can go online and learn a bit about osteoporosis from some other writer. I’ll include all the lyrics to the bones song at the conclusion of this blog so you can go around singing it all day like I have for the last week. It’s wonderful.
So many of us who suffer from various forms of arthritis whether brought on by unfortunate DNA from relatives or from an injury, know what it is to have a fractured bone or two. Prevention is, of course, the wisest path to follow but for many or maybe, most of us our preventive measures were half-hearted or came too late. This whole subject is far too complex and boring to go into in one blog but we do have time and space to cover the hot topics and important points to keep our bones as safe as they can be. I would also like to share a few personal experiences to make a somewhat “dry bones” subject a bit more interesting.
We see ads in all the magazines and TV for various forms of calcium supplements. We read about the frightening side effects of the many drugs we take for our diseases and sometimes, putting it all together is just too much. When you already feel rotten, keeping up and educating yourself is that last brick that makes you drop the load. Let’s just consider a few of the facts.
First of all, what is osteoporosis and why should it matter to me and to you? It is the loss of bone mass and occurs when demineralization causes us to lose bone. A severe osteoporotic bone looks like a dry sponge or a hunk of swiss cheese. It isn’t solid anymore and becomes brittle instead of strong increasing the chances of fractures.
Before the age of thirty, our bones are laying down layer upon layer with the aid of a good varied diet and average daily activity. Your Mom was right. You should have eaten those green vegetables and drank all your milk. You don’t have to get your spinach out of a can any longer. Popeye is long gone. This is the age of fresh and healthy and as a result, tastier. After the age of thirty, both men and women begin to lose bone mass. Men do have an advantage in that their loss is slower than that for us women. For women, it’s important to have the interaction of estrogen produced by the ovaries in adequate supply to help with the adult bone. I have a close relative who had severely shrunken ovaries, had no way of knowing it and years later, after a hysterectomy was told by the surgeon the ovaries they excised were barely there, hardly viable. She had already begun to develop severe osteoporosis resulting in curvature of the spine and spontaneous fractures of the vertebrae. She was also a smoker which didn’t help the situation at all. Anecdotally, she also never drank milk as a child. She hated it.
What causes osteoporosis? Many factors are involved but basically, they are heredity, poor diet, poor lifestyle choices with bad habits, diseases and the medications used for them as well as inactivity.
Heredity comes into play because many physicians have conducted studies which prove more Asian women and women of European descent, especially from the northern regions, have more problems with bone loss. Mothers and daughters can also share the problem, but if they both are aware of it, it can be prevented in most cases.
As adults, far too many of us skip meals, diet, don’t think about what we’re eating because we’re in a rush or a hundred and fifteen other reasons. Today’s world is a fast-paced one as we all know and for each of us, we get stuck in a rut of what we eat. We need a diet rich in calcium, magnesium, Vitamin D3 and selenium. All of these can be obtained from a diet rich in dairy or soy but if you don’t eat either of these sources, many companies are adding calcium to their juices and foods. Just look for it on the labels. So many health foods are available in the markets today as we consumers become more educated on the subject. Other sources for those minerals are green leafy vegetables raw or cooked, vegie juice mixes, fish like sardines or most fresh fish or canned varieties like tuna. Fortified cereals and whole wheat breads supply most of these. For Vitamin D, sunshine is the best source but for many of us who live in the north, like me, we do not get enough of it. I have a problem and get a rash from the sun as part of my rheumatoid disease and always cover up with long sleeves and a hat so I take 2000 iu’s of it each day and give my husband the same. Yes, I fill up his vitamins for the week because if I left it to him, he wouldn’t bother. I do have an unfortunate sharing about something he did like and that was the candied forms of calcium, chocolate or fruit flavored. When he passed the bottle, he would pop one in his mouth and developed the first kidney stone of his life as a result. Poor guy. That was a miserable experience. Watch how many of those you eat.
When you look into the foods that are recommended for a diet rich in calcium, many of them are not popular choices. Let me share one list I came across with you and see what your reaction is, here it is: raw milk, yogurt or kefir, cooked kale, cooked broccoli, cheese, okra, almonds, bok choy, watercress and almonds. There you have them. The best recommendations. How many of those have you had today? Can you say YUM? I like yogurt and would eat fried okra if I could get any. Broccoli is only occasionally on my plate, kale I’m trying to adopt but with some stomach issues, raw milk, no thanks because I have read too many stories about problems with bacteria. Kefir is tolerable and bok choy is used in this household only when I cook stir-fry. Maybe I need to throw in some almonds and watercress, top it with kale and that would be it OR I could take my calcium supplement and eat those items which I know will agree with my body, my gut and my appetite. I’m just trying to be realistic. The choices for all of these minerals is so much greater than many of these web sites are pushing on us. In real life, many of us have irritable bowel syndrome or other digestive problems. We have to do what is best for each of us.
We have to look at the big picture when it comes to diet and read labels, eat a lot of what we know we like that is also good for us and take a supplement at the end of the day if we have any doubts. These are some of my personal favorites, but they don’t have to be yours. I like a cold bottle of Ensure in the morning to cover the bases, a small carton of lemon or cherry yogurt during the day, a glass of milk with lunch or dinner and right there, I have almost met my quota of 1200 mg of calcium for the day. I keep the refrigerator full of fresh vegies, cheese of all varieties, cottage cheese, buttermilk, etc. Read those labels, stock your shelves with what you like because if you don’t like it you’re not going to eat it. If you’re lactose intolerant but want to eat dairy products, buy a bottle of Lactaid. I drink the lactaid milk all the time and find it delicious. There are also many cheese made from other sources than dairy. Look, learn and eat.
Poor lifestyle choices can rob the body of all the minerals needed to build strong bones. Smoking has been proven to rob the body of bone mass but when you stop you can rejuvenate the bone loss. Drinking too much alcohol can also cause problems. Part of the problem is that alcohol is a diuretic and makes you urinate excessively, pulling vital minerals out of the body. Folks who imbibe to excess also have a problem with fractures due not only to the bone loss but the recklessness of being drunk. As an RN I’ve seen the results of many drunk driving accidents and the drunk individual will often survive while others are injured or die. Often, the inebriant is so relaxed he “rolls with the punches” and that saves his life. Remember, alcohol in excess robs the body of calcium, Vitamin D and magnesium. In moderation, this is not much of a problem.
I know you don’t want to hear it but according to Dr. Andrew Weil, coffee in excess of 2 cups per day rob the body of calcium. The fact my husband and youngest granddaughter don’t want to hear is that excessive sodium intake can also rob the bones of their strength. You and I all know those folks who salt their food before they have even tasted it. As a cook, that drives me crazy, how about you?
Well folks, that leaves the last big culprit which causes problems for each of us when it comes to “dem bones” and that’s diseases and the medications many of us have to take in order to make it through life. We don’t have time nor space to go into all the culprits but the worst offender is without a doubt steroids used to treat pain, progress of the various rheumatoid diseases among others. Many folks take steroids for various respiratory diseases, CHF, COPD, etc. Many years ago, after prednisone was introduced to the medical world it was the “magic bullet.” It was given far too generously and many dangerous side effects were unearthed the hard way; when people died.
My own dear Dad had a rheumatoid condition called giant cell arteritis as well as polymyalgia rheumatica. He had inflamed arteries and muscle tissue which was so painful he cried out each time he moved. It was a sudden onset occurrence and he had a very difficult time being diagnosed. The doctors at our local hospital said it was sudden onset dementia and arthritis. We couldn’t accept that and got the assistance of one of the local internist to help us find the answers at a large university hospital several hours away. They began to give Dad massive doses of steroids and he reacted miraculously and his symptoms were 90% resolved. We were thrilled by his progress until his bones began to break. He broke a rib leaning on a counter at the bank. He fractured vertebra after vertebra by simply moving to put on a shoe or reach for something. He had personality changes and other problems as well.
I have already lost two sisters to rheumatoid diseases and both took far too many steroids. One of them took it to alleviate the hellish pain she lived with everyday due to psoriatic arthritis, losing all of her cervical bones and finally living with a neck of nuts, bolts and wires holding up her head. She had multiple joints replaced, with a hip replacement which kept popping out of place and a knee which finally had been replaced so often the bones eroded due to osteomyelitis. She died with a stiff leg without a knee. She was a sweet, beautiful woman with four children who didn’t know you could not take steroids at random and took them like aspirins. She got the drug from various doctors or told them she dropped them down the sink, lost them, etc. One other sister had relapsing polychondritis, as I do, was also an RN and knew the dangers of this drug but was in constant pain and took more than she should because it was all her doctors could come up with and they kept prescribing them. It is my opinion she needed better doctors but she was with a large health organization and had “faith” in them. She was the mother of five wonderful adults.
I have also been on steroids over the years but not in the amount my Dad was put on those many years ago. I am on the lowest dose possible for me to limit the side effects and still keep down the anti-inflammatory effects of two rheumatoid diseases. I take 5 mg. per day. They had Dad on 40 mg twice daily but originally on more than that. It’s a fine line many of us have to walk. Do I have osteoporosis? Yes, I do. I was on several of the bisphosphonate drugs but was taken off of them when my primary care doctor was concerned about my developing some of the many dangerous side effects of these drugs. Within a year I had my first vertebral fracture from riding in my husband’s beautiful new Camaro. We were going out to eat with friends and the guys sat in front while we gals jumped into the back seat. That did it for me. My second fracture occurred a year later, ironically, on the day we had taken a trip into Portland, OR for me to get my first dose of an IV drug for bone density called Zometa. I reached over to the hump between the seats, (in my car, not the Camaro) to pick up our Yorkie, George and crushed another one. I went into the appointment and wondered why I was more uncomfortable than usual while sitting in the reclining chair for the IV. I went home, suffered for two days then ended with a trip to the hospital by ambulance where they tried to hospitalize me but I stubbornly refused because I knew I would be more comfortable at home. The ambulance ride was a horror. I can remember when ambulances were Cadillacs but now they appear to be more like buckboards. I rode home from the hospital after a CT scan which confirmed the crushing at L1, in my Ford Taurus with my husband driving, and basically went to bed for a month. I have now been on IV Zometa for three years with an infusion every three months. It is also treating my metastatic bone cancer. This month I will be switching to a different drug called Xgeva which is given as an injection. Like all of the drugs in this category, it carries risks from side effects. All of us who live with chronic disease know that side effects will always be with us and it is up to us and our physicians to determine if the risks are worth taking.
After all of this, you are probably thinking, “Well, what now?” The answer to that is first of all to find out if you have osteoporosis by talking to your doctor about getting a bone density test. This is usually a scan, often a DEXA (dual energy X-ray absorptiometry) which is a computerized exam of, most commonly, the hip or the spine or both. Routine X-rays do not reveal osteoporosis until it has already begun. Find out your results and go from there.
Be aware of what your results are and if they are good, keep them that way through daily exercise, a diet rich in all of the minerals we talked about and take a supplement just to be sure. I’m not going to get into the types of supplements but you can read labels, and chat with your doctor. I take calcium carbonate, in many forms. Sometimes it’s an antacid if my gut if behaving badly. Yes, they have calcium carbonate. Just try to reach your daily input of 1000-1500 mg. of calcium each day depending on your size and your sex. Ask your doctor. Many have other opinions. Get informed. For those of us who are ill, the exercise may have to be moderate but do not embrace invalidism…please. This is your life and mine we are chatting about and we have to keep moving these bodies which are held together by a frame of bones. Does it hurt to move? Do it anyway if you are not fractured or in danger of falling down. Care is the word but moving is the need. Movement of the muscles and other soft tissues keep the bones healthy.
I promised you a song to hum, whistle or sing as you go through your day and here it is. This is one of the earlier versions, recorded by the Delta Rhythm Boys.
THE DRY BONES SONG
Ezekiel connected dem dry bones,
Ezekiel connected dem dry bones,
Ezekiel in the Valley of Dry Bones,
Now hear the word of the Lord.
Toe bone connected to the foot bone,
Foot bone connected to the heel bone,
Heel bone connected to the ankle bone,
The ankle bone connected to the shin bone,
Shin bone connected to the knee bone,
Knee bone connected to the thigh bone,
Thigh bone connected to the hip bone,
Hip bone connected to the back bone,
Back bone connected to the shoulder bone,
Shoulder bone connected to the neck bone,
Neck bone connected to the head bone,
Now hear the word of the Lord.
Dem bones, dem bones gonna walk around,
Dem bones, dem bones gonna walk around,
Dem bones, dem bones gonna walk around,
Now hear the word of the Lord.
My dear friends and readers, please stay connected so you can walk around.