Random Stuff: Lasers, Vitamins, and worthless PT

Zoledronic acid
A bisphosphonate used for hypercalcemia of malignancy.
NEJM recommends infusion to improve morbidity and mortality after hip fracture.
Has a well established safety profile.

Meta Analysis of Ca Vit D to prevent fractures and bone loss in age 50 and over:
"Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation).

"Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended."
Vitamin C reduces lipid peroxidation, scavenges hydroxyl radicals, protects the capillary endothelium, and inhibits vascular permeability. They assert that Complex regional pain syndrome type I or reflex sympathetic dystrophy which is treated symptomatically, and the clinical focus is on prevention. Major trauma can overwhelm homeostasis, lead to systemic inflammatory response syndrome and multiple-organ distress syndrome. This may parallel burn wounds and the development of CRPS because of the inflammatory reaction and the involved microangiopathy involving a cascade of deterioration and exaggeration of a similar process. High dose Vit C in early burn resuscitation has reportedly significantly reduced resuscitation fluid volume requirements, wound edema, severity of respiratory dysfunction, vascular permeability. This stuff reminds me of Jack's "molecular helmet."

Low level laser therapy for nonspecific low-back pain.6 reasonalbe quality RCTs showed some short-term and intermediate-term evidence of pain relief with LLLT, compared to sham therapy for subacute and chronic low-back pain. No difference disability and insufficient evidence for lumbar range of motion. Relapse rate was significantly lower than control.

Bracing after ACL reconstruction: "This study represents a systematic review of the Level I evidence (12 RCTs) to determine if appropriate evidence exists to support brace use. We found no evidence that pain, range of motion, graft stability, or protection from subsequent injury were affected by brace use..."

Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial: "As compared with no therapy, physiotherapy following first-time disc herniation operation is effective in the short-term. Because of the limited benefits of physiotherapy relative to "sham" therapy, it is open to question whether this treatment acts primarily physiologically in patients following first-time lumbar disc surgery, but psychological factors may contribute substantially to the benefits observed." This is quite a claim.