Aug
25
2018

The Downside Of Living To 100

A review article has examined longevity and reviewed the downside of living to 100. In their 80’s about 10% of the population live in nursing homes, but among centenarians 55% are residing in nursing homes. They are often very lonely, as their social circles have shrunk as they aged.

Common diseases of older people

Osteoarthritis makes it difficult for people to get around, it causes chronic pain and it can also be the reason for falls. In 1990 there were 213.4 cases of osteoarthritis per 100,000. 26 years later, in 2016 there were 232.1 cases of osteoarthritis per 100,000 people.

Chronic obstructive pulmonary disease (COPD) has been falling, because less people smoke cigarettes now. Statistics show 1667 cases of COPD per 100,000 in 1990, but only 945 cases of COPD per 100,000 in 2016.

Diarrhea and common infections have dropped sharply from 8951 per 100,000 in 1990 to 3276 per 100,000 in 2016.

What other common diseases do older people get?

There are a number of common diseases that affect the elderly.

Osteoarthritis

Osteoarthritis of the hips and the knees are common, but it can affect every joint in the body. In the end stage knee replacements or hip replacements may be necessary. But before a total knee replacement or total hip replacement can even come into consideration, the person’s heart needs a thorough checkup to ensure that it is safe for the patient to undergo surgery under a general anesthetic.

Heart disease

Older people often have heart disease.

When coronary arteries are narrowed, heart attacks occur. Cardiologists can place stents, so that previously narrowed coronary arteries receive normal blood flow. Following such a procedure the patient may live for another 10 to 15 years.

There are also heart valve calcifications. The aortic valve is particularly endangered. A heart surgeon may be able to replace a diseased aortic valve by a porcine valve.

The nervous system of the heart transmits electrical signals from the sinus node to the muscle fibers, which can get diseased. Heart rhythm problems may necessitate the insertion of a pacemaker.

Finally, the heart may enlarge, but pump less blood than before. This condition is congestive heart failure. The 5-year survival for this condition is only 50.4%. Unfortunately there is very little the doctor can do for patients like this.

Cancer

The older we get, the more DNA mutations we accumulate. At one point cancer develops. If the diagnosis happens at an early stage there is a good chance that surgery can remove a cancerous growth, and the patient survives. But there are cancers that are notoriously difficult to recognize in the early stages. These are: cancer of the pancreas, kidney cancer, stomach cancer and certain types of leukemias.

Respiratory diseases

Those who smoked earlier in life may develop chronic obstructive pulmonary disease (COPD). It is a chronically disabling lung disorder. Often these individuals have to carry an oxygen tank with them wherever they go. The 5-year survival rate for people with COPD is 40 to 70%.

Osteoporosis

Osteoporosis is a disease where the bone is brittle. Spontaneous bone fractures can occur at the wrists, the upper thigh bone (femoral fractures) or in the vertebral bones. Women in menopause are hormone deficient and this contributes to calcium depletion of the bones. Lately research has shown that vitamin K2 and vitamin D3 are necessary for a normal calcium metabolism. Briefly, 200 micrograms of vitamin K2 and 5000 IU of vitamin D3 every day are the necessary dosage that the body can absorb calcium from the gut, eliminate it from the blood vessels and deposit it into the bone. Calcium is present in milk products and milk. If a person does not consume enough milk products a supplement of 1000 mg of calcium daily does make sense.

Alzheimer’s

The older we get, the more likely it is an onset of Alzheimer’s or dementia. Between the ages of 90 to 94 there is a yearly increase of Alzheimer’s of 12.7% per year. The group from age 95 to 99 years has a yearly increase of Alzheimer’s of 21.2% per year. Persons aged 100 years and older have an increase of Alzheimer’s by 40.7% per year. What this means is that essentially there is a doubling of Alzheimer’s every 5.5 years. We do not have all of the answers why this is happening and why Alzheimer’s develops. But we do know that diabetics are more likely to develop Alzheimer’s. High blood sugar levels and high insulin levels seem to lead to the precipitation of the tau protein in the brain, which causes Alzheimer’s.

Diabetes

When diabetes is not well controlled, there is accelerated hardening of the arteries. This can cause heart attacks and strokes. Longstanding diabetes can affect the kidneys (diabetic nephropathy, kidney damage) and can lead to hardening of the leg arteries. Often the only treatment left is a below knee amputation. Blindness from uncontrolled diabetes is common and pain from diabetic neuropathy as well.

Diabetics have an average life expectancy of 77 to 81 years. However, if they pay attention to their blood sugars and manage their diabetes closely they can live past the age of 85.

Falls and balance problems

As people age, their balance organ is not functioning as well. Also, people with high blood pressure medication may have postural hypotensive episodes that can lead to falls.

There may be a lack of cognitive functioning and misjudging of steps, ledges and irregularities in the floor. When a person has brittle bones from osteoporosis and they fall, a hip fracture is very common. At a higher age surgery for a hip fracture is dangerous. It can have a mortality of 50%.

Obesity

A person with obesity has a life expectancy that is 10 years less than a person without obesity. The reason for this is that with obesity This is so, because the risk of heart attacks, strokes, cancer, arthritis and diabetes is increased.

Depression

Older people often get depressed. It even has its own name: involutional depression. People can get into a state of mind, where they think negatively. Depressed people feel that they have nothing to live for. They lost friends; they are shut in because they can’t drive a car any more. This type of depression needs treatment by a psychologist or psychiatrist. The danger of leaving depression untreated is that the person may get suicidal. In older people depression is often precipitated by physical health problems.

Oral health

When teeth are not looked after, gingivitis and periodontitis can develop. Infected gums can shed bacteria into the blood and this can affect the heart valves. Endocarditis, the infection of heart valves, is a cardiological emergency. Prolonged antibiotic therapy is necessary to overcome this condition.

Poverty

Poverty has real consequences. The aging person may not have access to the optimal medical care facility because of a lack of funds. But even at a younger age there is evidence that people are healthier when they are wealthier.

Shingles

Older people often get shingles, even if they had chickenpox or shingles as a child. This is evidence that the immune system is getting weaker. Shingles in an older person should alarm the treating physician that there could be an underlying cancer. Due to that knowledge a cancer-screening tests should be part of the medical exam. In addition, a varicella vaccine should be offered to the patient to build up immunity.

The Downside Of Living To 100

The Downside Of Living To 100

Conclusion

Living to 100 is often glorified in the press. Maybe you have seen a 90-year old jogger completing a marathon, or you saw an 85-year old couple ballroom dancing. But what they don’t show you is what I summarized here, the less glamorous things about living to 100. You may get a heart attack or a stroke. Osteoarthritis may affect you how you walk. Congestive heart failure may make you get short of breath when you walk upstairs. Then there are various cancer types that are difficult to diagnose early.

If you have smoked in the past, you may suffer from chronic obstructive pulmonary disease (COPD), which leaves you breathless.

Other illnesses

Osteoporosis can lead to spontaneous fractures. Because the bone has a lack of calcium, this is difficult to treat and takes a long time to heal.

Alzheimer’s is ever so much more common when you approach the year 100. There are other medical conditions you can get: obesity, diabetes and depression. When you get shingles for the second time, it may mean that your immune system is getting weak and a cancer-screening test should be done.

There are some downsides when you approach the age of 100.

Know your risks and be vigilant

You may keep your physician busy checking out various age-related illnesses, but more importantly, get regular check-ups and tests. Any condition is easier to treat with an earlier diagnosis! The message for anybody reading this is very simple. Prevention through healthy living is something you can actively pursue. Keep your body and your mind busy. Enjoy time with friends and family instead of living a solitary existence. See the glass that is half full instead of viewing it as half empty. Stick to a healthy diet. Knowing all the risks is not a scare but a call to being vigilant. Knowledge is powerful and will help you to enjoy your golden years feeling well and happy.

Jan
06
2018

Lyme Disease The Great Imitator

Dr. Pamela Smith talked about Lyme disease the great imitator when she gave a presentation. This was at the 25th Congress of the American Academy of Anti-Aging Medicine, Dec. 14-17, 2017, which I attended. Dr. Smith gave a talk about how to approach a complex patient when multiple systems are affected. Part of that talk dealt with Lyme disease, which I will review below in some detail.

Transmission of Lyme disease

Lyme disease is one of the fastest growing infectious diseases in the US. As a result about 200,000 new cases of Lyme disease occur in the US every year.

The transmission occurs through ticks that that carry a spirochete, called Borrelia burgdorferi.

This bacterium, much as syphilis, which also is caused by a spirochete, produces imitator disease patterns. Clinically it can be a challenge to diagnose Lyme disease.

The common way of transmission to humans is by infected ticks that bite the skin. But Dr. Smith said that transmission of the spirochete can also occur by breastfeeding, blood transfusions, in vitro fertilization and finally by sex. Although originally Lyme disease infected ticks were found on deer, other species can also be carriers. Ticks from mice, foxes, raccoons, songbirds, chipmunks, and squirrels can also transmit Lyme disease.

Clinical presentation of Lyme disease

Only 30 – 40% of adults with Lyme disease have the characteristic rash of the “bull’s-eye lesion” (erythema migrans). With children this presentation is even less common (only 10% have erythema migrans). If there is a bull’s-eye lesion, this will last from one week to several months. A laboratory test using an enzyme-linked immunosorbent assay (ELISA test) can confirm the diagnosis of the disease.

Disseminated early or late Lyme disease

Fatigue, headaches and weakness can be non-specific symptoms of Lyme disease. Furthermore, other non-specific symptoms like back pain, muscle and joint pains as well as chills can detract the physician from diagnosing Lyme disease. In addition irregular heartbeats, nausea, vomiting, swollen lymph glands, memory loss, gait problems, bladder and kidney problems are other symptoms. Finally, liver problems, sore throat, fever, seizures, depression, dementia, hallucinations, mood swings and arthritis can be other symptoms.Even eating disorders, verbal aggression, schizophrenia and suicide can be symptoms of Lyme disease.

Common symptoms that have a link to Lyme disease

Common symptoms of Lyme disease include headaches, fatigue, joint pain and swelling of joints, stiffness of the neck or back. There can be difficulties with concentration, speech or writing. Further symptoms are sleep disturbances, numbness or tingling of arms or feet and forgetfulness. 

Lyme disease development

Borrelia burgdorferi can be found inside body cells and outside of cells as biofilms. This form makes them resistant as it allows Borrelia burgdorferi to exchange DNA and makes them resistant to antibiotics. There are also two major forms of Borrelia burgdorferi, namely cell-wall forms and cystic forms. Once the patient has been bitten by the infected tick Borrelia can quickly change shape into the more difficult to treat cystic form. Within 24 hours Lyme disease can spread to other parts of the body. Common such areas are the eyes, brain tissue and glial cells, heart, collagen, synovial fluid of joints and skeletal muscle fibers.

Lyme disease can also complicate many other diseases. These are ALS, Alzheimer’s disease, fibromyalgia, MS, bipolar disorder, neurological disease, heart disease (Lyme carditis) and autism.

Treatment of Lyme disease

  1. Dr. Smith said that Lyme disease is often complicated by dysfunctional gut flora. She prefers to start patients on a sugar-free and gluten-free diet. The patient also has to take probiotics.
  2. 75% of Lyme disease patients show a cure after three weeks of Doxycycline 100 mg twice per day. Alternatively cefuroxime 500 mg twice per day is a medication of choice.
  3. Cefuroxime only treats the cell‐wall forms. Doxycycline treats the intracellular forms. Metronidazole or tinidazole will help to eradicate the cystic forms of Lyme disease.
  4. Grapefruit seed extract is another treatment modality if the patient is allergic to Metronidazole. It eradicates the cystic form of Lyme disease.
  5. Serrapeptase from whole leaf stevia extract will also help to eradicate Borrelia biofilms and persisters.
  6. Monolaurin, a coconut oil extract is effective in treating all three morphological forms of Borrelia burgdorferi.

Patients with neurological symptoms

Patients with neck stiffness, headaches or neuropathy need treatment for a longer period of time. These patients also need monitoring for recurrent Lyme disease at the end of the treatment.

Case presentation of a patient with Lyme disease

Dr. Smith presented one of her patients with Lyme disease in detail. She was a 45-year old executive. She suffered from extreme fatigue. It took quite a few tests to find out that her antibody titers against Lyme disease were very high.

Here is her long list of symptoms: hair loss, four urinary tract infections in quick succession, brain fog, extreme fatigue, systemic pain, musculoskeletal pain, anxiety and depression, eczema, psoriasis, itching, stomach ache, trouble eating, weight loss of 12 pounds, flu, strep presented like meningitis.

Comprehensive treatment of patient with Lyme disease

Dr. Pamela Smith instituted a comprehensive treatment protocol. It turned out that she had developed gastritis, which was the reason for her weight loss. This needed conventional treatment. After the treatment with antibiotics, her energy picked up, and her appetite came back. She also engaged in yoga and other self-awareness programs. She deliberately slowed down her lifestyle activities. Her symptoms were mostly gone or significantly diminished. She was able to function. She experienced energy, joy, and could focus again. The only symptoms left were some mild pain, some bladder problems, some limitations with her diet and mild brain fog.

Husband had Lyme disease

Part of the work-up was to test her husband for Lyme disease. He tested positive. He was also treated although he was entirely asymptomatic. When his treatment was finished, the doctor tested him for a specific antibody and this came back as negative. This meant that he now was free of Borrelia burgdorferi and would no longer be able to infect her. The doctor thought that it was most likely through sex that she had contracted Lyme disease. The problem is that some people are completely asymptomatic, but nevertheless they can be carriers of Lyme disease.

Lyme Disease The Great Imitator

Lyme Disease The Great Imitator

Conclusion

Lyme disease, the great imitator, has become a more common disease in the US and around the world. Years back Lyme disease was often overlooked. But lately physicians have diagnosed Lyme disease earlier as diagnostic tests have improved. With earlier treatment a lot of suffering of the patient can be prevented. But in many cases symptoms are confusing as Lyme disease involves several organ systems. This makes the diagnosis more difficult. By diagnosing Lyme disease earlier, treatment can start at an earlier stage, and the patient will soon return to a state of wellness.

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Apr
01
2017

When Food Causes Inflammation

Dr. Hal Blatman gave a talk about when food causes inflammation. He gave his talk on Dec. 9 at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “Food, Pain and Dietary Effects of Inflammation”.

Dr. Blatman is the medical director of Blatman Health and Wellness Center, Cincinnati and Batman Medical Services, Manhattan.

General remarks about nutrition

Dr. Blatman pointed out that mistakes of nutrition are often behind chronic diseases and illnesses. The physician’s task is to explain to patients how they can change their food intake to improve inflammation in the body and to allow the body to heal itself.

Hippocrates said 400 BC “Let food be thy medicine and medicine be thy food”.

In this context Dr. Blatman stated that nutrition could exacerbate symptoms or relieve symptoms and there must be rules for good nutrition. If we do not take care of our nutrition, the gut flora composition changes and causes leaky gut syndrome. But if we consume healthy foods all of this improves.

Mathematical formula for when food causes inflammation

To make it easier to understand the impact of food on our health the speaker offered this formula: G-B+R=P

G = stands for good, beneficial things you can put into your body.

B = bad, toxic things that affect your body negatively.

R = reserves that your body has since birth (minus the amounts you have used up)

P = pain and problems you are going to experience

It is P (pain and other medical problems) what brings the patient to see the doctor. G and B is what the patient can change. When done right, the P value in the formula reduces and the pain or medical problems go away.

Nutritional rules

Dr. Blatman said there are three rules about nutrition.

Rule #1 is to not eat fake or toxic foods

He listed NutraSweet, Splenda, Saccharin, margarine and olestra.

Aspartame

Aspartame experiments on rats showed that it can cause cancer: Dr. Blatman said that aspartame causes multiple myeloma and Hodgkin’s lymphoma in man. Aspartame worsens depression, 10% is metabolized in the liver into methanol, a nerve poison.

Splenda

Splenda (sucralose) originates from sugar. However, several chlorine atoms were inserted into the sugar molecule. It reduces beneficial microflora in the gut. It also interacts with liver enzymes, which interfere with the bioavailability of oral drugs.

Saccharin

Saccharin alters gut bacteria and increases glucose tolerance.

Hydrogenated fat and margarine

Insects don’t eat margarine, mold will not grow on it, and it will not support life. Merchants like it because food does not turn stale on shelves. Hydrogenated fats like margarine are like poisons. They raise the bad LDL cholesterol levels and reduce beneficial HDL cholesterol levels. The prostaglandin balance changes so that inflammation occurs. There is increased evidence of diabetes and the cell membrane composition changes. Proinflammatory cytokines can cause pain in the dorsal root ganglions. It follows from all of this that it is best to cut out all hydrogenated fat and margarines.

Partially hydrogenated vegetable oil

The cell membrane consists of two lipid layers at a specific ratio of omega-6 essential fatty acids and omega-3 essential fatty acids. It also contains triglycerides, phospholipids and protein. Cell membrane absorb nutrients to move into the cell and eliminate waste out of it. The cell membrane needs to remain flexible and within neurons needs to transmit electrical information. The membrane composition is critical for the cell membranes to perform optimally. It is here that the physician has to explain this to the patient. All the fats we eat are the raw material, which will make up our cell membranes. So what fat we eat that day travels into the cell wall that becomes part of it that day. The same process occurs with cell wall repair. If we eat hydrogenated fat that day, it travels into the cell wall.  A membrane with hydrogenated fat will:

  • Not transmit nutrients inside the cell
  • Will not transmit waste out
  • Causes the membrane to lose flexibility
  • In a nerve cell there will be abnormal neuron transmission

If we eat hydrogenated fat, we become like a “genuine GM truck fixed with inferior parts”, so Dr. Blatman. The interesting observation is that it takes 4 months after eliminating hydrogenated oil from the diet to get it out from red blood cells. Be aware that French fries increase pain for 4 months, so why eat them?

Olestra

Olestra, an artificial fat: This fat, Olestra has been developed as an artificial fat and is used in chips. It can cause diarrhea, abdominal cramps and weight gain with long-term use. Olestra belongs into the group of fake/toxic foods. Don’t eat Pringles or chips that are made with this.

Healthy oils

There are two types of essential fatty acids, omega-6 fatty acids and omega-3 fatty acids. Many processed foods contain only omega-6 fatty acids, because this is the cheapest way to produce them (they are based on vegetable oils). Instead you want to eat healthy fats like omega-3 fatty acids contained in nuts and fish. You can also add molecularly distilled, high potency omega-3 fatty acids (purified fish oil) as a supplement to help restore the balance between omega-6 and omega-3 in your food intake. Avoid omega-6 fatty acids from corn oil, safflower oil, grape seed oil, soybean oil, cottonseed oil, canola oil and peanut oil.

Metabolism of omega-6 fatty acids versus omega-3 fatty acids

Compare the metabolism of omega-6 fatty acids with that of omega-3 fatty acids.

The linoleic acid of omega-6 fatty acids gets metabolized into arachidonic acid, which causes pro-inflammatory mediators, PGE2 and LTB4. On the other hand with omega-3 fatty acids alpha-linolenic acid (ALA) is metabolized into EPA, DHA and the anti-inflammatory mediators PGE3 and LTB5.

It is easily understandable why a surplus of omega-6 fatty acids from processed foods will disbalance the omega-6 to omega-3 ratio. This ratio should be 1:1 to 3:1, but many Americans’ omega-6 to omega-3 ratio is 6:1 to 18:1. Omega-6-fatty acids cause arthritis, heart disease and strokes. Be particularly careful in avoiding soybean oil, which is the most popular oil in the last few decades to foul up the omega-6 to omega-3 ratio through processed foods.

Balance of omega-3 and omega-6 fatty acids

When it comes to balancing omega-3 and omega-6 fatty acids in your diet, be aware that nutritional balancing can help you restore the ideal omega-6 to omega-3 ratio of 1:1 to 3:1. An easy way is to cut out processed foods as much as possible. Supplement with molecularly distilled fish oil capsules to add more omega-3 fatty acids into your food intake. Dr. Blatman gave the example of rheumatoid arthritis patients that were put on omega-3 supplements. After 24 weeks their joint swelling and tenderness went down.

Rebalancing the omega-6 to omega-3 ratio was able to treat depression as this research showed. This makes you wonder how much depression may be caused by overconsumption of processed food.

Suggested doses of omega-3 fatty acid supplementation

Dr. Blatman suggested the following doses of omega-3 supplementation for various purposes:

  • 1 gram/day as supplementation for healthy adults with a good diet
  • 1-3 grams/day for people with cardiovascular disease
  • 5-10 grams/day for patients with an autoimmune disease, with chronic pain or with neuropsychiatric conditions

He mentioned that these doses are empirical, but in his opinion definitely help. Due to quality differences he suggested that you buy fish oil capsules in a health food store where the quality is best. Stay away from discount stores (the quality is the worst) and drug stores.

Other healthy oils are olive oil and coconut oil. They are also useful for cooking.

Rule #2 is not to eat inflammatory foods

Our body functions like a luxury car; it needs pure food to function. Anything less leads to inflammation, particularly when you eat sugar and processed foods.

Inflammatory foods are sugar, white flour, fruit juice and white/red potatoes. A medium potato=1/2 cup of sugar! Other problematic foods are wheat grain contained in breads, pasta, cereal and thickeners in soups and sauces.

What is the problem with these foods? They break down the zonulin proteins that are a bridge between the lining cells of the gut.

This leads to an increase of intestinal permeability, and leaky gut syndrome can develop. Inflammatory cytokines from visceral fat add to the gut inflammation, and cardiovascular disease and high blood pressure can develop.

Fried potatoes, in particular the consumption of French fries, have been identified as the cause of inflammatory bowel disorder (IBD). Countries with the highest consumption of French fries have the highest incidence of IBD.

A Mediterranean diet and the DASH diet are anti-inflammatory diets.

Rule #3 is to not disturb the bowel flora

A healthy bowel flora is symbiotic with the body. You achieve this by eating green leafy vegetables. A toxic flora from dysbiotic microbes comes from eating white flour, white sugar and red meat. Red meat leaves residues on which dysbiotic bacteria thrive.

Symbiotic gut bacteria produce vitamin K, cobalamin, pyridoxine, biotin, riboflavin, pantothenic acid and short fatty acids. They also degrade metabolic toxins, prevent pathogens from colonization and they stimulate the immune system to mature.

Dysbiosis occurs when the wrong diet consisting of sodas, white flour, sugar and red meat is over consumed. There are toxins that are produced by the dysbiotic microbes. These injure the bowel wall and make the immune system work harder. Immune system dysfunction, fatigue and fibromyalgia can follow.

Dr. Blatman stated that gut dysbiosis that causes leaky gut syndrome could also cause ulcer disease, diabetes, heart disease, fibromyalgia, chronic fatigue syndrome, chronic pain and even cancer.

When Food Causes Inflammation

When Food Causes Inflammation

Conclusion

This was a whirlwind tour through a talk given by Dr. Blatman during the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. What food we eat determines what gut bacteria we harbor, symbiotic ones or toxic ones. This in turn determines which way our health develops. But the content of what we eat is also important. If we consume processed foods we end up consuming way too many omega-6 fatty acids, which cause inflammation, arthritis and heart disease. This is happening in front of our eyes, if we start seeing things the way they are. I was aware of this since the mid 1990’s. In a lecture I attended at a continuing education conference a cardiologist pointed out that inflammation was the determining factor of whether or not our patients would get a heart attack.

Cholesterol concept being replaced by inflammation concept

The lecturer mentioned then that the older cholesterol concept would be replaced by the newer inflammation concept. He was right, but it goes even further! There is the important omega-6 to omega-3 ratio, and fish oil supplementation helps. At the same time it is necessary cutting out processed foods. But there is the newer insight that our bowel flora and red meat consumption can culture toxic bacteria in our own gut. It is in our power to start eating more vegetables and cut out sugar and starchy food. It is time to see chips and French fries not as a “convenience” but a hazard to your health. Food does not have to cause inflammation; right food choices will help us to stay well and live longer.

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Nov
26
2016

Chronic Shoulder Pain Treatment

This overview is about chronic shoulder pain treatment. A 71- year old health conscious patient was exercising in a gym. When he used the shoulder machine, he suddenly experienced a stinging pain in his left shoulder. The location of the pain seemed to be in the upper (superior) portion of the trapezius muscle. With this he also felt pain in his left neck.

This was fitness gone wrong! It can happen, that overdoing exercise or lack of judgment can lead to injury. Trainers caution us, when we embark on exercise programs, and yet, it happens! Often the road to recovery is a bumpy stretch, and if the problem persists, it can lead to chronic pain. With this knowledge the patient sought help. The first approach was visiting a

Chiropractor

He sought the help of a chiropractor and had 6 manipulations in the neck and thoracic spine. The spine had good range of motion, but the left shoulder pain in the trapezius muscle stayed.

He found that heat application to the trapezius muscle helped. So he bought an electric heating pad that he applied once or twice a day for pain relief. He also sought the input of his G.P. The doctor offered him a prescription for pain pills.

Pain pills

This was the predictable regimen, but the patient was concerned about the side effects of pain pills, and he declined. He had heard of a supplement, called Lipo (from Trophic). It contains 300 mg of choline bitartrate, 300mg of inositol and 300 mg of methionine in one tablet. At a medical conference he learnt that two Lipos were as effective in relieving the pain as one Motrin. He took two of these pain relievers from the health food store a couple of times per day. He alternated this with the heating pad to control his pain.

Since the condition improved only marginally, he looked at the option of

Prolotherapy

After 5 treatments the chiropractor mentioned  that he likely could not help the patient. The patient decided to try prolotherapy. He had heard that this would be good for chronic musculoskeletal pain. The naturopath whom he saw examined thoroughly and determined that the patient would be a good candidate for 2 to 4 prolotherapy treatments. After one treatment on the left side along the cervical spine and the left trapezius area the pain was reduced by 30% of what it was before. The second prolotherapy treatment was given again to the left side and also to the right side to keep it symmetrical. The naturopathic physician told the patient that he would see him for follow-up in 4 weeks.

Treatment of left should did not improve things

The treatment of the right asymptomatic side did not cause any pain, but the left side started flaring up after the second treatment, causing pain that was almost as bad as the original pain. When the patient returned to the naturopath and told him about the flare-up of pain in his left shoulder, he was told that this is what sometimes happens when treatments are not spaced far enough apart. He felt that this should be observed now and reassessed in 6 months in case there was no progress. It was time to look at other options.

IMS treatments

The chiropractor indicated that he could likely could not remove the pain. Instead he suggested that maybe a physiotherapist trained in intramuscular stimulation treatment (IMS), also known as dry needling could be of help. The patient was waiting for the appointment with the naturopath for prolotherapy when he saw the physiotherapist for IMS treatments. He examined the patient and noticed a persistent trigger point in the upper trapezius muscle, which he thought was causing the chronic pain.

Partial success of intramuscular stimulation treatment (IMS)

Two IMS treatments relieved the pain by about 50%. But about two or three days later the pain came back to about 75% of the original pain after the gym injury. The appointment for the prolotherapy by the naturopath had taken two months to wait for, so he had already had 3 IMS treatments just before the prolotherapy to get some pain relief. The IMS trained physiotherapist thought that perhaps a few more treatments, up to five or six might be able to take the pain away. So the patient continued treatments on a weekly basis.

Ultimate failure of IMS

Unfortunately the hope for pain relief did not materialize. The pain improved to about 30 to 40% of the original pain, but it always came back just 2 or 3 days later. Fortunately for him he could apply the heating pad and the pain would stay away for 3 to 5 hours. It also responded to taking two tablets of the choline bitartrate/inositol/methionine combination that took the residual pain away for several hours. Self-massaging the trigger point also gave some relief.

Recurrence of pain

But occasionally the pain came back with a vengeance and felt like a charley horse. This could suddenly occur in his left shoulder making it difficult to move his left arm. It as particularly bad when he needed an outstretched arm for ballroom dancing. Also, lifting of heavy objects or working out in the gym were difficult to do. Even just holding on to the rails of the treadmill when doing a fast walk on the treadmill for half an hour could lead to a flare up of the left shoulder pain. It is frustrating, when there is only temporary relief, but no real cure, but giving up is no option. Often we find more information on the Internet. What came up was low-dose laser therapy.

Low-dose laser therapy

The patient remembered having heard of low-dose laser therapy that might be useful in treating chronic pain. The physician treated the trigger point in his left shoulder with interstitial low-dose laser therapy. Dr. Weber who is the president of ISLA, the international society for laser applications, specializing in laser treatment, treated him with low-dose laser therapy.  This involved inserting a cannula into his left trapezius muscle close to the trigger point. He injected a small amount of procaine (local anesthetic), then 5 ml of normal saline. This was followed by three low-laser beam treatments for 10 minutes each, first blue, then green and finally yellow color. They were all given interstitially after which the cannula was removed.

Relief of pain with low-dose laser therapy

The surprise was that he felt relief almost instantly. There was still a bit of pain from the interstitial needle for about two days, but the trigger point in the trapezius muscle was no longer there. Finally after 6 months of intermittent pain there was relief of about 50% of the original pain. It was encouraging that this time the pain in that particular trigger point stayed away.

More laser treatment for other trigger points

But there were two other trigger points that were bothering him. After one month he received a second interstitial low dose laser treatment by the naturopath. He was the one who previously treated him with prolotherapy. 2 weeks later the naturopath administered the third laser treatment for yet another trigger point. This continued on for another few months. The pain disappeared, then it crept in slowly again, but at a lower level. It became a quest to eradicate the trigger points! Each time the same low-dose laser treatment targeted the remaining trigger points still palpable. It took a total of 9 interstitial treatments to finally reach the point where all of the pain was gone.

It felt strange: the chronic left shoulder pain had disappeared!

Chronic Shoulder Pain Treatment

Chronic Shoulder Pain Treatment

Conclusion

When pain lasts for more than 3 months, physicians refer to it as “chronic pain”. Often another name, neuropathic pain, is a substitute term that describes difficult to treat pain. By now you may have guessed that I was the patient in this blog.  It was in my interest to rid myself of this pain. I had previously described a similar pain in my lower back that was relieved with just one interstitial low-dose laser treatment at that time and my back has remained pain free since. Shortly after that successful treatment I developed the left shoulder pain from a soft tissue injury in the gym as mentioned. I was fortunate that Dr. Weber could treat me again, this time at his clinic in Lauenförde, Germany on occasion of a Germany trip that I had booked for holiday purposes.

Nine low-dose laser treatments for chronic shoulder pain

I was lucky that my lower back responded to this treatment in the past. The difference was that it took a total of nine low-dose laser treatments for my left shoulder to respond. Before the chronic pain came to a resolution I needed a total of 14 months of treatments!

It occurred to me that a successful outcome of treating pain requires collaboration between patient and therapist. Call it trial and error. In my case it was only the fourth treatment modality, the low-dose laser therapy that worked permanently.

I feel that the chiropractor did his best to ensure there was no nerve root irritation. He told me that his treatment had reached its limits.

IMS treatment and prolotherapy gave only limited relief

The IMS trained physiotherapist treated me before and after the prolotherapy. He told me after a total of 12 visits that he likely could not help me any more.

The naturopath who did the prolotherapy said that he had strengthened the ligaments along the spine on the left side. But he also stated that the trigger point from the gym injury showed no response to prolotherapy.

The final answer came from the treatment by Dr. Weber in Germany and the naturopath in Kelowna using the same Weber system machine with low-dose lasers. I think that this is an under-recognized treatment modality of musculoskeletal injuries, including sports injuries. You can find treatment providers for low-dose laser therapy throughout the US, Canada and Europe.

Persistence required on behalf of the patient, but also regarding the physician

Many physicians and naturopathic physicians use it as part of their pain management methods. The equipment has the FDA approval; Health Canada approved it also and the Medical Devices Directive in Europe approved it as well. Please note that this type of laser (low-dose laser) has nothing to do with laser treatment for cosmetic purposes.

It cannot emphasize enough that chronic pain treatment requires attention to detail. Feedback from the patient to the healthcare provider is necessary. Also, persistence on behalf of the patient is essential to follow through until the chronic pain recedes. It also shows that giving up is not an option!

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