Feb
01
2020

About the Opioid Epidemic

Dr. Anna Lembke gave a talk about the opioid epidemic on Dec. 13, 2019. This was at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019. The full title of her presentation was “From Freud to Fentanyl: Update on the Opioid Epidemic.” Dr. Lembke is an associate professor at the Stanford University School of Medicine. From 1999 to 2010 opioid sales went up 6-fold. Opioid treatment admissions and opioid deaths have risen 5-fold in the same time period. Physicians prescribe too many opioid pills. One slide summarized how patients got opioid pills. 53% had pain pills given by friends for free or bought opioids from them. 37.5% received pain pills from a doctor by prescription. 6% bought pain pills from a drug dealer or a stranger. In about 3.4% it was not traceable how the persons using drugs obtained them.

Compassionate doctor and drug-seeking patient

The doctor went through medical school wanting to care about patients. Compassion to help is a powerful motivating force. On the other hand, most patients are glad that the physician wants to help and they do their part to contribute to healing. Except, there is a small percentage of patients who take advantage of a soft-hearted physician. They will demand prescriptions, even if they are not in pain. They may do this to sell the drugs to get some extra income. Others take more pills than what the doctor  prescribed, because they want to get high on the drugs. Patients who have an addiction to pain pills, have a process in their brain, called neuroadaptation. Whenever the dosage in the blood goes down, they are now adapted to taking more pills.

About the opioid epidemic and the role of Big Pharma

Pharmaceutical marketing spent more than 26 billion USD in 2012. This consisted of drug representatives visiting doctor’s offices and giving hand-outs of free samples to physicians. There were promotional mailings, advertisements, direct-to-consumer advertising and educational and promotional meetings. In addition, pharmaceutical marketing included sponsoring clinical trials. In 1980 there was still an opinion that pain drugs would be harmless and in the majority of cases would not be the cause for abuse.

Purdue Pharma, the producer of the pain pill OxyContin, was caught in secretly pushing the sales of OxyContin in order to sell more of their drug suboxone, which helps with drug withdrawal.

A law suit against Purdue Pharma brought the  “project Tango” to light.

Three myths about drug addiction

Myth #1: Opioids work for chronic pain

The pain pill producers have been pushing for the concept that pain pills would work for chronic pain. However, clinical studies showed that pain pills will only work for acute pain and when it becomes chronic pain, pills against pain become less reliable. People who take pain pills for chronic pain enter into a vicious cycle. They need to take more pain pills to experience relief from pain. But they often do not realize that the drug withdrawal pain is what gets them into seeking more drugs.

Purdue stated this:“We now know that many patients with chronic, non-malignant pain respond very well to opioids. The barriers to vastly improved treatment for hundreds of thousands of people in pain, are simply the misinformation and prejudice of doctors, pharmacists and regulatory bodies.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Myth #2: When it comes to opioids, no dose is too high and no duration is too long

This reflects what Purdue says to increase its pain medication sales.“Opioids are effective, easily titrated, and have a favorable benefit-to-risk ratio. Large doses of opioids may be necessary to control pain if it is severe, and extended courses may be necessary if the pain is chronic.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Evidence from unbiased researchers show that opioids taken in high doses and taken over long periods of time harm patients.

Patients develop cardiac arrhythmias, depression and may commit suicide. Other symptoms are  constipation, addiction, cognitive impairment, hormonal imbalances and  death. In addition, opioids can cause an annoying skin hypersensitivity.

Research further showed that gradual opioid withdrawal improves chronic pain (2017 study by Frank et al.)

Myth # 3: Less than 1% will get addicted to pain pills

Purdue stated:
“Contrary to our teaching, addiction is very rare and possibly nonexistent as a result of treating such patients with opioids.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Here is the truth: A meta-analysis of 38 studies showed that people abused pain pills on average between 21 and 29%. Addiction rates were between 8% and 12%. These figures likely are under estimates. The authors said that the real figure of opioid abuse is likely about 40%.

Poor people treated differently

Poor people on Medicaid in the US receive twice the rate of opioids as do non-Medicaid patients. But Medicaid patients die at 6-times the rate from prescription overdoses. Often patients receive a prescription for pain pills and also a prescription for benzodiazepines. The doctor prescribes benzodiazepines for sleep problems or anxiety. Drug interactions of two potentially addicting drugs likely are more detrimental on the long-term.

Examples of a doctor’s visit (YouTube display)

Dr. Lembke played a YouTube video where she was role-playing her previous behavior as a supportive physician who prescribed opioids to patients (drug-seeking patient and supportive physician).

However, she said that she learnt from experience. In the meantime, when she finds out from a computer program that a patient is deceiving her, she behaves differently (doctor non-supportive towards a doctor-shopping drug addict).

About the Opioid Epidemic

About the Opioid Epidemic

Conclusion about the opioid epidemic 

The topic of opioid addiction is multifaceted. I summarized a lecture presented at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019 by Dr. Lembke. She talked about the opioid epidemic and the difficulties keeping the science of opioids separated from the marketing by Big Pharma. Three myths of Big Pharma were analyzed and on every occasion the truth was the opposite of the myth. Chronic pain does not respond to opioids, yet many physicians keep on prescribing these drugs. Medicaid does not help poor patients. They get twice the opioid prescriptions as non-Medicaid patients get. But Medicaid patients die at 6-times the rate from prescription overdoses. There are many unanswered questions regarding opioids. Hopefully, more judicious prescribing by physicians and alternative ways of treating pain by chiropractors, physiotherapist and acupuncturists will gradually improve the situation.

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.

Mar
17
2018

Benefits Of Hot Baths And Saunas

Don Benedict hurt his lower back and tells about benefits of hot baths and saunas to relieve his chronic pain. He is a 70-year old former handball player. He played competitive handball for 30 years in the Pacific Northwest. His story is reviewed here. In order to stay in shape, he ran 5 miles every other day. But at the age of 57 he ruptured a disc in his back. In the following years he ruptured several more discs and had three back surgeries for that. Eventually scar formation set in and no more surgery was possible. This left him with a chronic pain syndrome, for which he received prescriptions for strong pain medications. OxyContin, Tramadol and anti-anxiety pills were on his prescription list. He needed to take 14 doses of pills per day to control his chronic back pain.

Benefits of hot baths and saunas for chronic pain

Finally he remembered that as a younger man he was a summer river guide on Idaho’s Salmon River. When he and his wife had sore muscles they would relax in the hot baths of natural hot springs. Other people who visited these hot springs told him how having hot baths helped them for their aches and pains. For the past four years Don and his wife have been visiting the hot springs in Idaho City three times per week. This has decreased Don’s back pain significantly. He could reduce more than half of his pain medications and reduce the potency of the pain pills as well. The water temperature in the hot springs hovers between 97 and 99 degrees Fahrenheit (36 to 37 degrees Celsius). His wife, who has an asthmatic condition, reported that the hot soaks helped her muscle spasms around the throat.

Other treatment modalities to prevent chronic pain

13 years ago, when Don ruptured his first disc stem, cell treatments were not readily available. But if the same would happen today an unconventional stem cell therapy could be a treatment modality, and chronic pain could be avoided. I am mentioning this here, because Don’s suffering from chronic back pain was causing him a lot of unnecessary suffering. Discectomy surgery, which destabilizes the back and causes scarring, is not the first choice of treatment today.

Stem cell therapy

Instead stem cells are taken from the patient’s fatty tissue (liposuction) and from the bone marrow. A stem cell mix between bone marrow stem cells and mesenchymal stem cells (from fatty tissue) is made. Platelet rich plasma is added to this as an activator. The mix is injected into the disc space of the ruptured disc. Now the stem cells do their magic healing. The beauty of this medical procedure is that healing takes place without any scarring. The stem cells mend all of the damage. They do so by transforming themselves into identical body cells that overbridge broken tissues.

Benefits of hot baths and saunas for heart

  1. 2016 study published in the Journal of Physiology describes a study that included adults in their low twenties. Their arms were intermittently exposed to 40.5°C (105°F) water temperature for 60 minutes over a period of 8 weeks. This lowered their blood pressure and caused the arteries in the treatment group to be more flexible.
  2. Scientists in Finland have focused on the benefits of saunas, which is a Scandinavian tradition. Their study in the American Journal of Hypertension followed more than 1,600 middle-age men for almost 25 years. The results showed that the more the men visited saunas, the less they were suffering from high blood pressure. These were the statistics:
  • Visited sauna 2 to 3 times per week: 24% less likely to develop high blood pressure compared to those who had a sauna only once or not at all.
  • Visited sauna 4 to 7 times per week: 46% reduction of blood pressure.

Benefits of hot baths and saunas regarding dementia prevention

2016 study out of Finland found that frequent exposures to saunas could reduce the risk of developing dementia.

Compared to having a sauna only once per week (no reduction of dementia) these were some observations:

  • Visiting the sauna 2-3 times per week: 22% reduction of dementia.
  • Visiting the sauna 4-7 times per week: 66% reduction of dementia.

With regard to Alzheimer’s disease the corresponding figures were a 20% reduction and a 65% reduction.

Benefits of hot baths and saunas for brain injuries

Dr. Burke from the Emory University Rehabilitative Hospital is investigating the benefits of hot baths and saunas regarding brain-injured patients.

He recommends 4 saunas per week for brain-injured patients. Dr. Burke said: “This is one thing that’s passive and easier to do, especially in people who have injured joints who need to keep their brains and hearts in good condition, but can’t physically do some of the exercises.“

Caution regarding benefits of hot baths and saunas

Within 48 hours of a new injury, Dr. Burke says, it is best to use ice packs in order to reduce the swelling of the tissues. But subsequently he switches the patients to heat in form of saunas. Some patients have low blood pressure to start with. They may not be good candidates for hot baths as they may pass out when their already low blood pressure gets a further reduction. Always check with your own doctor before doing hot baths or saunas.

Europe’s history of hot baths and saunas

Saunas have a long history in Finland and in the rest of Europe.

Hot baths have a century-old history in Europe and Japan.

Father Sebastian Kneipp invented hydrotherapy, where cold and hot water baths are applied sequentially. The present resurgence of interest in the benefits of hot baths and saunas for healing purposes is nothing new. What may be new is that the medical profession at large is finally paying attention to the research of Father Sebastian Kneipp. He knew that there were benefits of hot baths and saunas.

Benefits Of Hot Baths And Saunas

Benefits Of Hot Baths And Saunas

Conclusion

There are benefits of hot baths and saunas. This is what was spelled out in the studies cited in this review. The fact that heat can heal was something that Father Sebastian Kneipp knew long time ago. Medical facts have a way to recirculate. But now we know that it can lower blood pressure and can improve the flexibility of arteries. It can help with tissue perfusion and reduce chronic pain. But it also prevents dementia and Alzheimer’s disease. In addition it helps patients with brain injuries to recover faster than without hot baths and saunas.

Advantage of heat treatments

The advantage of heat treatments is the fact that no side effects occur like with the use of drugs. Heat treatments are natural, but drug treatments are artificial. Hot baths and saunas can easily be part of one’s lifestyle. If you feel you need more of it, you can go ahead and do it, but if you feel you don’t need as much, use less. Make it fit into your lifestyle. It is also obvious that too much of a good thing is no longer a good approach to wellness. Limit the temperature in hot baths and don’t exaggerate the time you spend in a hot sauna.

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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!

Sep
10
2016

Crazy Food Trends

CNN wrote about strange, crazy food trends that seem to receive a following. I thought it would be interesting to analyze them medically and point out to the reader what’s right and what’s wrong.

Crazy food trend one: Ashwagandha

In India this herb, also known as Indian ginseng has been used as part of the Ayurvedic medicine for centuries.

At the 22nd Annual Anti-Aging (A4M) Las Vegas Conference in mid December 2014 Pamela Smith gave a presentation entitled ”How To Maintain Memory At Any Age”. She gave a comprehensive overview of what you can do to prevent Alzheimer’s disease.

Dr. Smith recommended many other supplements, which I will not explain in detail here: B vitamins, vitamin E and C, carnosine, acetyl-L-carnitine, boron, ginger, coenzyme Q-10 (or CoQ-10), curcumin, vinpocetine, zinc, grape seed extract, blueberry extract, Ashwagandha, glyceryl-phosphoryl-choline, SAMe, huperzine A and DMAE and others. She specifically pointed out that she felt Ashwagandha was very powerful. It helps people preserve their memory, more so than regular drugs that doctors prescribe.

When the benefits of taking CoQ-10 were discussed, Dr. Smith reminded the audience “whatever is good for the heart, is good for the brain”. She recommended reading Dr. Perlmutter’s book from which this phrase was borrowed (Ref. 1).

Ashwagandha is an herb with multifaceted effects. Here is a review by a doctor about the various effects of Ashwagandha.

It does not belong into foods; it should only be in use as a supplement, if your doctor agrees with it.

Crazy food trend two: astrologically farmed eggs

Picture biodynamic farming of eggs with the guidance of the moon. Now you are producing astrologically farmed eggs. The Hemsley sisters insist you should eat these astrologically farmed eggs for breakfast. I don’t buy into this. This is hokey! It smells like somebody is trying to lure money out of your pocket by trying to convince you that there is health benefit to “astrologically farmed eggs”. There isn’t.

What does make sense is to buy eggs that do not have antibiotic residue in them and that came from free-range hens. Yes, I buy organic eggs that are somewhat more expensive. If you like to buy organic omega-3 eggs, this would also be scientifically superior to ordinary hen eggs. There is also the difference of “free run” and “free range” hens. “Free run” does not give you any guarantee for a healthy product, as the birds live in crowded barns and are likely receiving medications to combat diseases. “Free range” birds are hens that have access to the outdoors, and there is less of the overcrowding that is common in a barn.

Crazy food trend three: Cordyceps

There are about 400 subspecies to these sac fungi. Cordyceps has been used in Chinese medicines to help as an aphrodisiac, help improve kidney function in the elderly and also with regard to some anticancer activity. There are very few clinical review papers to substantiate any of these claims; yet traditional medicine insists on using Cordyceps for these purposes. If you want to see a traditional Chinese doctor, do so on your own. But don’t consume food that is prepared with Cordyceps.

Gwyneth Paltrow’s morning smoothie cost more than 200$, so if anything, I would be more concerned about bankruptcy than real nutrition with this type of breakfast drink.

I have my doubts that Cordyceps that kill ants to sprout their spores in their corpses (see Wiki link above) could be of any objective benefit to humans.

Crazy food trend four: blue majik

Blue Majik is just another name for a common antioxidant, phycocyanin. It derives from algae, Arthrospira platensis.It has some similarity with the green spirulina. But just because it seems fashionable right now, does not mean that it is superior to vitamin C as a cheap antioxidant or vitamin E. The creators of blue majik are cashing in on color effects and selling false hopes of better health. You can live very well without it.

Crazy food trend five: cannabis

When I heard that people are starting to mix cannabis into foods, it reminded me about a story I heard from one of my patients in the mid 1980’s who worked in the shipyards of North Vancouver. One day he saw some cookies on a tray in the lunchroom. A co-worker offered some to him and he ate it. After 5 minutes his head started pounding with an excruciating headache and he became nauseous. Shortly after he vomited and started getting a rapid heartbeat. His co-workers laughed and told him that these were very special cookies that they treated with marijuana.

I suspect that whoever baked these cookies used a higher dose of marijuana and my patient experienced a marijuana overdose.

This example illustrates that cannabis has special properties that affect the body.

In the brain it binds to cannabinoid receptors. These are not only present in brain tissue, but also in lungs, liver and kidneys. Even the immune cells have cannabinoid receptors.

There may be a place for chronic pain patients under the guidance of a physician to get medical marijuana. But keep cannabis away from your food. Don’t consume it! You have no idea what you are doing to your body that is full of receptors for cannabis. Cannabis requires treatment like a drug. This means a doctor should prescribe marijuana and the patient s should take it according to doctor’s orders. Like with any drug there will be effects and also side effects.

Crazy Food Trends

Crazy Food Trends

Conclusion

Out of five crazy foods reviewed there are only 2 that merit consideration, but not mixed into food. These are Ashwagandha as a supplement (part of memory loss prevention and others) and cannabis for chronic pain. A physician should supervise both. The remainders are fashion crazes. Unfortunately many people will fall for these fashion trends and lose a lot of money. This will make someone who peddles these items very rich. Is this what you want to do: throw your money out and toss it right into the pocket a huckster? Rethink what you want to do. You may just want to buy organic eggs from chickens that happily scratch away in a farmyard. This is very much down to earth, and nothing “astronomically farmed” is needed.

References

Ref 1: David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

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Aug
06
2016

Pain Treatment

General practitioners see a lot of patients with various pain symptoms for which they seek pain treatment. The underlying conditions might be from an arthritic problem that suddenly becomes symptomatic, or an acute back injury may send pain from the lower back into one of the legs. Others may experience excruciating headaches like migraines or tension type headaches. Often these painful conditions require some immediate pain relievers to treat the pain, but this can turn into a nightmare of drug dependency and may even lead to the development of chronic pain. Here I like to review an article that I found in the June edition of ConsumersReports.org.  In my review I included most of the content, but added a few newer pain treatment modalities.

Acute pain

Here I’m discussing back pain as an example. When a disc bursts in the lower back because the person was lifting an object too heavy to lift, acute pain develops in the lower back. This is often located at the lower lumbar spine level (L5/S1) causing radiating pain into one of the legs.

In a case like this it will often take several weeks before the body can heal this condition.

Chronic pain

It can happen in many cases that the pain will still be there 3 to 6 months down the road. If a disc fragment pushes on the nerve root in the nearby canal through which the nerve root travels, this will cause the muscles supplied by the nerve root to melt away in the leg of the affected side. If nothing is done about this, the acute pain turns into chronic pain, which is much more difficult to resolve. The initial physician may refer the patient to a neurosurgeon who will review the case together with the help of an MRI scan that shows the underlying pathology. The neurosurgeon may determine that a mini discectomy will reduce the pressure onto the nerve root.

Relief of pressure on nerve root from mini discectomy

This surgery may be able to prevent chronic pain from setting in. Once the pressure is relieved, the nerve can start the healing process. It is critical to not miss the point where acute pain crosses over into chronic pain. This happens at around 2 to 3 months into the pain condition. Chronic pain is much more difficult to treat as some of the neurological pain pathways that form after such injuries can persist within the spinal cord or even within the central nervous system, even after successful disc surgery that is done too late. With respect to the example given above, if the patient is operated on too late (1 to 2 years after the injury), the procedure may not be effective in relieving the pain. A chronic pain syndrome has started.

How pain treatment is done

  1. Avoid bed rest

In the past (up to the late 1970’s to mid 1980’s bed rest was the accepted initial mode of treatment. Even though patients often felt some relief of pain initially, this led to muscle atrophy (literally a melting away of muscles) in the muscles that are supporting the spine. These structural changes destabilized the spine and often made the pain more chronic until physiotherapy treatments and active exercises rebuilt the supporting muscles again.

  1. See a physiotherapist

Physiotherapists can use different treatment modalities like traction, a TENS machine, active exercises that all can help to alleviate back pain due to muscle spasm. If there is only a strain, this will often help to resolve your back pain within 4 weeks. But if there is an underlying disc herniation as previously explained, you need to be assessed by a physician in an urgent care center, primary care setting or by an emergency physician in the emergency department of a hospital. When the examination confirms an abnormal reflex from a nerve root compression, a referral to a neurosurgeon or orthopedic surgeon is usually made as previously explained.

  1. Chiropractic treatment

Some people have their backs treated periodically to prevent back troubles. When they get an acute back pain they likely will see the chiropractor again. In cases of a back strain, where one or more muscles are pulled, this approach will be helpful together with some home exercises and swimming to build up muscle strength along the spine. However, in the case of a herniated disc chiropractic adjustments should not be done (physicians say they are “contra-indicated”). Instead the patient should be referred to either a neurosurgeon or an orthopedic surgeon.

  1. Medication for pain

Often physicians prescribe Tylenol with codeine, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) or morphine for pain relief. All narcotic medication have side-effects; they can cause constipation, can cause vomiting, make you feel dizzy and can lead to falls, particularly in elderly patients. These falls can cause hip fractures and other fractures that complicate the recovery from the original pain. Never exceed the dosage of pain medicine prescribed on the label, and if it does not relieve the pain, see your physician again for a reassessment to rule out any complications.

Depression with back pain

Often people with back pain also have depression. To address this issue your physician may prescribe an antidepressant like duloxetine (Cymbalta), which has been approved by the FDA for treatment of lower back pain. But there are two rare, but important side effects to know about. Cymbalta can cause lowering of blood pressure, which leads to dizziness. This can cause serious falls with the danger of fractures. The other complication is the risk of liver failure.

Side effects of pain treatment

Pain pills can be addicting

While there seems to be an urgency to treat a patient who is in pain with pain medication, the treating physician must not forget that pain medication is potentially addicting and patients often use higher doses than advisable. However, pain medication has a narrow therapeutic window meaning that the toxic levels are not much higher than the drug levels necessary to relieve pain.

Some medications are only marginally effective

There are medications that are only marginally effective, if at all. Glucosamine and chondroitin are used for relief of arthritic pain in osteoarthritis sufferers. They are eliminated by a liver enzyme system that also eliminates blood thinners. If a patient is on blood thinners, the addition of glucosamine and chondroitin can lead to dangerous bleeding. Instead of using glucosamine and chondroitin when you experience pain and inflammation in joints, reduce your activities, but stay as active as you can to avoid your symptoms from getting worse.

Tests for severe migraines

When a patient has a severe migraine headache it is tempting to want to rule out a brain tumor. But a CT scan exposes the patient to dangerously high radiation doses that over time could cause brain cancer or leukemia. There are physical examination methods to rule out a brain tumor. If the findings are positive, an MRI scan can be used to get much more detail of the brain than a CT study would reveal. MRI scans do not have undesirable side effects.

Use gentle movement to remobilize the painful joints

Before you rush into using anti-inflammatory drugs, use gentle movement to remobilize the painful joint, back or limb. Activities like swimming, walking or yoga can reduce pain and allow you to recover from a painful condition according to a Cochrane Library analysis of 61 studies.

Non steroidal anti inflammatory drugs (NSADs)

For more pain relief NSAID (non steroidal anti inflammatory drugs) pain relievers like ibuprofen (Advil) or naproxen (Aleve) for a brief period will also help. The problem with long-term use of NSAIDs is that it can cause kidney damage. With longer use of NSAIDs there is also a danger of stomach bleeding, heart attacks and strokes.

Toxicity with Tylenol

The pain drug acetaminophen (Tylenol) has a narrow therapeutic window and is less effective in pain relief than the NSAIDs. The FDA has recommended as the highest daily dose 4000 mg of acetaminophen. But if you are a heavy drinker or you have liver disease, your daily dose of acetaminophen should not exceed 3250 mg to avoid liver toxicity. Long-term use of acetaminophen can also damage your kidneys, therefore the recommendation to use acetaminophen only for a short period of time (a few days).

Side effects of triptan drugs for migraines

Migraine headache drugs: The newer migraine drugs, called triptans temporarily narrow widened blood vessels. This relieves severe migraines within about 2 hours. However, these medications are not recommended for those with high blood pressure, chest pain, heart disease or circulation problems in the legs, as blood vessel constriction could bring on heart attacks or worsen circulation problems.

Common sense approach to pain treatment

The key for any pain condition is to treat the pain right away to minimize the impact that pain has on you and to prevent developing chronic pain, which is more difficult to treat.

Here are some examples.

Migraine headaches

If you have a migraine headache, use an over-the-counter pain reliever like naproxen or ibuprofen to treat the migraine pain very early. A combination of acetaminophen, aspirin and caffeine (like Excedrin Migraine or a generic copy) will also do. This will stop the release of prostaglandins, which would send pain signals to the brain. Heat packs or cold packs on your head can also help in the treatment of a headache. A 2013 study from Germany has shown that migraine sufferers can get rid of their migraine headaches in 60% by having sex. It sounds like a nice idea, but what they have not considered may be the fact that somebody who has a splitting headache is not feeling like sex at all!

Triptan pills for migraines

If your home remedies did not help, see your physician for one of the triptan pills. Sumatriptan or a similar drug constricts blood vessels to the brain. The doctor will also look for common triggering factors that can bring on a migraine. Weak neck and shoulder muscles may respond to physiotherapy strengthening. In women a condition called estrogen dominance is associated with migraines and can be treated with bioidentical progesterone to balance estrogen and progesterone in the body by elevating progesterone concentration.

Acute lower back pain 

Acute lower back pain usually follows an event where the person lifted something too heavy or injured the back from a fall. The important part is to rule out a fracture. Most of the time there is no underlying fracture, just a muscle strain. A muscle strain usually sorts itself out in time. Stay active as much as possible. But if the back pain does not resolve within a few days, see your physician for more tests. X-rays can delineate structural changes like a fracture. As explained earlier, an MRI scan can rule out a disc herniation. Instead of neurosurgery, further options nowadays are prolotherapy, stem cell therapy or a combination prolotherapy/stem cell therapy. This type of therapy will also work for knee injuries (meniscal or ligamentous tears).

Hip or knee pain

Conventional medicine usually treats osteoarthritis with NSAIDs, but may not warn you about the possibility of gastric erosions that can lead to massive stomach bleeding, heart attacks or strokes when using NSAIDs. It also can lead to kidney damage that can cause sudden kidney failure. The key is to use anti-inflammatory medication only for a few weeks. If arthritis persists, it is wiser to seek the advice of a naturopathic physician for prolotherapy treatment. One or two treatments of prolotherapy can give relief of pain. If prolotherapy does not succeed, it is best to move on to mixed stem cell therapy with bone marrow and mesenchymal stem cells (from fat cells) as well as PRP (platelet rich plasma). This usually leads to complete healing of osteoarthritis and eliminates the need of total knee or total hip replacement.

Neck and shoulder pain

This often develops because of poor posture, shoulder tendinitis or neck muscle spasm. Physiotherapy is often successful treating this. If not the physiotherapist can use intramuscular stimulation (IMS) with acupuncture needles. This may be more successful in interrupting the abnormal neuropathic pain pathways. Alternatively electro acupuncture with a TENS-like device can also be successful. The newest treatment modality is the Weber medical system using a low-dose laser applicator. Prolotherapy can also be used for shoulder and neck problems, if the ligaments are lax. It requires a lot of experience on behalf of the health professional to choose the right treatment protocol for the condition.

Tension headaches

Anxiety, stress and fatigue can all lead to tension headaches. Initially you may want to drink liquids, as dehydration is related to tension headaches. If your headache is still present after one hour, use naproxen or acetaminophen. Take a warm or cold shower and lie down with a cool cloth on your forehead. If you still have a headache, check with your doctor whether it is indeed a tension headache or a migraine. You may have jaw clenching or teeth grinding during your sleep. If your bite seems off, see a dentist. For stress control use relaxation techniques.

Other ways to treat tension headaches

Some suggestions sound mundane enough, but they can be effective: Get enough sleep, get enough exercise, and work on improving your posture. A physician trained in trigger point injections with local anesthetics (often anesthetists or general practitioners) can freeze your suboccipital and supraorbital nerves with lidocaine, which I have seen to work in 60% to 70% of cases in my former practice.

Pain Treatment

Pain Treatment

Conclusion

Pain treatment can be confusing as pain itself can be very multifaceted. The key is to search for the cause of the pain. Then treat pain very quickly. This way it has time within 2 to 3 months to turn into a chronic pain condition. Chronic pain is much more difficult to treat. The physician should treat acute pain successfully. Conventional medicine has to yet learn from naturopathic medicine and alternative medicine practitioners. They use prolotherapy, stem cell therapy, IMS and trigger point injections with local anesthetics.  In addition low-dose laser therapy (Weber medical system) are valuable alternative methods to treat pain. These methods can successfully treat pain conditions. The physician can incorporate them into general medical practice.

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Jan
18
2014

The Super Powers Of Vitamin D

Originally, when vitamin D was found to be the missing ingredient in preventing rickets in growing children the recommended daily allowance (RDA) to prevent rickets was found to be 400 IU of vitamin D. The active metabolite has been identified as vitamin D3 for which the body has receptors on all vital organs (heart, brain, bones, kidneys, liver). In recent years new insights have been gained as it turns out that the RDA’s were set much too low for many diseases that can develop when vitamin D intake is too low, particularly in the aging population. Higher doses of vitamin D3 in the range of 800 to 1000 IU per day have been shown to prevent osteoporosis, falls and fractures in older adults and in nursing home populations. But the immune system of everybody is dependent on higher doses of vitamin D3. Recently (Dec. 12 to 15, 2013) I attended a lecture at the A4M conference in Las Vegas where Dr. Eisenstein reviewed the latest on vitamin D3. It is now known that 2/3 of the US population is deficient for vitamin D as measured by blood tests (less than 25 ng/ml).  The standard test is the 25-hydroxy-vitamin D level (abbreviated as 25(OH)D level). It is now known that you require at least a level of more than 40 to 60 ng/ml of 25(OH)D as measured in the US, which translates to more than 100 to 150 nmol/L measured in metric units in other countries, to prevent cancer.

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

90% of the vitamin D3 that we need comes from exposure to sunlight, which transforms a cholesterol metabolite (7-dehydrocholesterol) into the vitamin D precursor (vitamin D3 or cholecalciferol). This is what we absorb from naturally occurring fish oil and oily fish, but otherwise this does not naturally occur in foodstuffs (Ref. 1). Dr. Eisenstein pointed out that it is well known that people living north of the 37th degree latitude lack vitamin D3 because of a lack of sun exposure, particularly in the winter season. People south of the 37th degree latitude have enough sun exposure, but wherever you live, it is advisable to have your vitamin D3 level measured (as 25(OH)D level). If you do not eat enough fish or fish oil, the levels likely are too low as is the case for 2/3 of the US population. Vitamin D3 supplements will have to be taken by those whose levels are too low. Vitamin D3 is further metabolized by the liver and then by the kidneys into the active vitamin D compound, called 1,25(OH)2D3 (which is called “calcitriol”). The main effect of calcitriol is to absorb calcium and phosphate from the intestine into the blood stream. Together with vitamin K2 as explained in a prior blog these minerals are then taken up by the bone to prevent osteoporosis or rickets in the growing child. What has not been known for a long time is that vitamin D3 is also necessary for normal cell metabolism by most of your body cells, but particularly by the vital organs like the brain, the heart, the kidneys, the liver, the immune system and the bone. However, doses of 5000 IU to 10,000 IU of vitamin D3 capsules per day are required for optimal vitamin D3 health. This will lead to levels of below 200 ng/ml of 25(OH)D levels, which have been proven to be safe. According to Dr. Eisenstein no toxicity has been found below 30,000 IU of vitamin D3 per day, but based on other authors a dose of 10,000IU should be adequate for most people. Strangely enough colored people also have to take vitamin D3 supplements as their the higher melanin pigment in the skin filters out UV light so effectively that their 25(OH)D level can be low. Always err on the cautious side and have your vitamin D3 blood level taken.

Vitamin D3 has a characteristic stereotactic configuration (cis-triene structure), which allows it to bind free radicals and function as an antioxidant (Ref.2).

What are some of the clinical effects of vitamin D3?

1. Vitamin D3 has diverse effects on organs systems as Dr. Eisenstein summarized: vitamin D3 lifts depression and has been found to be of particular value for drug resistant depression. Take 5000 to 10,000 IU of vitamin D3 per day.

2. Muscle power increases with vitamin D3, particularly in those who work out regularly.

3. Many fertility clinics pay attention to vitamin D3 levels, as the higher the blood levels of vitamin D3 in a man, the faster this sperms move! And the more vitamin D3 she has on board, the better she ovulates. The end result is a higher pregnancy success rate when both partners take 5000 to 10,000 IU of vitamin D3 per day

4. Also, if a woman takes vitamin D3 during her pregnancy, the first set of teeth in the offspring will have fewer cavities.

5. Brain development in autistic children is much improved with vitamin D3 in higher doses. This needs to be combined with detoxification methods and supervised by one of the DAN physicians.

6.Chronic pain typically improves when vitamin D3 deficiency, which almost always is present in patients with chronic pain, is treated with vitamin D3 supplementation.

7. To prevent flus and colds and other infectious diseases, take higher doses of vitamin D3. When you come down with a flu, it is safe to increase your daily vitamin D3 intake to 30,000 IU of vitamin D3 for a few days until your symptoms improve, then resume your maintenance dose of 5000 IU to 10,000 IU per day.  This year’s dominant flu is the type A, subtype H1N1 – also known as the swine flu. Children should get 50% of the dose regimen detailed for adults when they develop a flu (for children: 15,000IU for three to five days , with tapering to a maintenance dose of 2500 to 5000 IU until blood levels of 25(OH)D are available). Here is a website of Dr. Cannell where he discusses dosages as well.

8. Asthmatic patients do better with vitamin D3 supplements requiring less maintenance anti-asthmatic medicine to keep them balanced with regard to their airways.

9. Chronic low vitamin D3 levels cause brain damage including Alzheimer’s disease. In this context it is important to know that the enzymatic conversion in the liver and kidneys slow down as we age requiring higher doses in older patients. This may have been the reason for the confusion about relatively low doses of 400 IU of vitamin D3 preventing rickets in children versus the need of vitamin D3 in middle aged and older patients where much higher doses are required as already explained.

10. High blood pressure is linked to vitamin D3 deficiency and it is better manageable with medication when vitamin D3 levels are normalized.

11. Live longer with vitamin D3. How is this possible, you might ask: the answer has been found in the telomeres, the shoelace like structures at the end of the DNA strand of each cell. Vitamin D3 lengthens the telomeres and promotes telomere repair; this is associated with a longer life span. Centenarians have longer telomeres. You can measure telomere length, but it is a pricey test, which is not for everyone, contrary to supplementation with vitamin D3 that should be taken by everyone!

12. As already indicated, vitamin D3 strengthens the immune system, but it also modulates the inflammatory response from muscle damage, so athletes can perform better. Patients with multiple sclerosis will improve as it slows down the inflammatory process. But other inflammatory diseases like arthritis, inflammatory bowel disease and even cancer will respond favorably to higher doses of vitamin D3 (20,000 to 30,000 IU of vitamin D3 in these cases). This is information that has not yet percolated into mainstream medicine, but will do so in the next few years (or decades?).

13. Higher percentages of cardiovascular disease are found in patients who have lower than 15 ng/ml  25-Hydroxy- vitamin D3 levels in their blood meaning that vitamin D3 supplementation prevents heart disease (Ref.3).

What are toxic vitamin D levels?

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25(OH)D blood levels taken from time to time. If any of these levels exceed 200 ng/ml it would be prudent to reduce the vitamin D dose or stop supplementation for a while. Otherwise it has been difficult to establish a toxic range.

This website claims that 40,000 IU of vitamin D3 or more would lead to toxic levels where the blood calcium levels would be increased, which can be measured as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU per day and that led to a blood level of 400 ng/ml of 25(OH)D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine). So, all of the papers that either indicated to the public that it would be unsafe or unnecessary to take vitamin D3 seem to have other agendas than communicating the truth. Had it been true that calcium would be released from the bones or calcium were absorbed too much from the gut, this would have caused calcification of the bones, soft tissues, heart and kidneys. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. Interesting that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

I talked to a participant of the conference (who has a fellowship degree of the A4M) about what is really known about vitamin D3 toxicity. He told me that there has been an unintentional overdose where a compounding pharmacy made a mistake, so that a patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months, before the mistake was uncovered. The patient felt sluggish, but did not have any other symptoms. He was told to stop the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. At this point no overdose of vitamin D3 has been established.

Conclusion

Vitamin D3 is a vital supplement that has been shown to prevent not only rickets in children, but also depression, MS, infections and even many cancers (Ref. 4). As usual there will be many critiques that doubt the validity of the above statements. But I have found that all of these effects described above were confirmed in several sources of various medical information. Keep in mind that negative rumours have a tendency to linger on for years.

More information on vitamin D3 for prevention of osteoporosis and hardening of arteries: https://www.askdrray.com/calcium-vitamin-d3-and-vitamin-k2-needed-for-bone-health/

Vitamin D3 deficiency can cause pancreatic cancer: http://nethealthbook.com/news/insufficient-vitamin-d3-linked-to-pancreatic-cancer/

References

1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed.,  © 2011 Saunders

2. Rheumatic Diseases Clinics of North America – Volume 38, Issue 1 (February 2012) , © 2012 W. B. Saunders Company

3. Wang TJ, Pencina MJ, Booth SL, et al:  Vitamin D deficiency and risk of  cardiovascular disease.   Circulation 117. (4): 503-511.2008.

4. “Recognition and Management of Vitamin D Deficiency”: American Family Physician – Volume 80, Issue 8 (October 2009),  © 2009 American Academy of Family Physicians

Last edited Nov. 7, 2014

Aug
03
2013

Treating Symptoms Not Effective, Find And Eradicate Causes

When you see a physician about a health problem, he or she general listens to your symptoms, examines you, comes to a diagnosis and then treats the symptoms. Medicine has been evolving since, anti-aging medicine has become more prominent and comprehensive medical practitioners have started to treat differently. The changing approach is best explained with some examples below. This is important as many general practitioners continue to treat symptoms and neglect to search for causes. Big Pharma is trying to keep the medical system in the “status quo” (the way it is), because they make big money by having general practitioners try out different ineffective medications (this way the profits keep on coming in.) One example is the cholesterol story. Only 50% of heart attacks are caused by high cholesterol, but physicians keep on prescribing statins whenever high cholesterol is found to prevent a heart attack. But the finding of high cholesterol could be caused by hypothyroidism (when the thyroid gland does not produce enough thyroid hormone). Diet can also play  a role, if the patient eats too many helpings of fatty meats and drinks alcohol regularly. Just prescribing statins to lower cholesterol is not the answer, treating the cause is!

I am going to describe 5 examples where usually symptoms are being treated instead of the causes. If you are in a hurry, just read example 3 below (gastritis and duodenal ulcer). After that you can skip forward and read the conclusion, where I will summarize what I think we should learn from this.

Treating Symptoms Not Effective, Find And Eradicate Causes

Treating Symptoms Not Effective, Find And Eradicate Causes

1)  Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where autoantibodies attack the joint surfaces. It is a multifaceted disease and typically requires a rheumatologist to get involved in the treatment. The standard treatment for RA is summarized in this link. Before engaging in these toxic treatments, it is very worthwhile to study this link and see, if any of your food components may have triggered your arthritis. Various agents in the food can contribute to the development of autoantibodies, such as wheat, soy, MSG, even salicylates. An elimination diet approach could pinpoint if there is any food component that may be the cause of your RA.

Dr.Lichten, in treating many RA cases has found (Ref.1, p. 85 and 86) that many patients had hormonal deficiencies, particularly a lack of DHEA when blood tests were done for this. DHEA is known to treat immune deficiencies and T cell responses were observed to raise 10-fold after DHEA supplementation; IGF-1 levels (an indirect measure of human growth hormone) increased and muscle mass improved when exercised as well along with DHEA replacement. RA patients responded well to relatively low doses of DHEA (25 mg daily for women and 50 mg daily for males). When other hormone tests are done to look for deficiencies, Dr. Lichten found sometimes thyroid deficiencies requiring hormone supplementation. Similarly when saliva tests are done to look for sex hormone deficiencies, there may be progesterone and/or estrogen deficiency in women and testosterone deficiency in males that needs to be replaced with bioidentical hormones. In RA patients there may be adrenal gland deficiency setting in, which can be diagnosed by a four-point saliva cortisol hormone test. Only these cases of true hormone deficiency will benefit from small doses of cortisol (the original bioidentical human hormone) given four times per day.

Here is a summary of the usual recommendations for home remedies for treating rheumatoid arthritis. Using electro acupuncture can be very useful for controlling chronic pain, but you still need to work out the cause for your particular case of RA.

2) High Blood Pressure

Most cases of high blood pressure (hypertension) are simply there without a particular cause. It used to be called “essential hypertension”, a fancy name meaning “essentially, we do not know the cause”. The doctor will start treatment with drugs to bring high blood pressure down. Before that the doctor is supposed to ask you to make a good effort to change your life style (cutting out additional salt, exercising, weight loss), but this is often glossed over and drugs are used right away. Drugs for hypertension are not harmless; here are some of the side effects.

The medical textbooks are not very clear on what causes high blood pressure. With renal causes (narrowing of a renal artery) a stent can be placed, the cause is treated and the blood pressure normalizes. As indicated, essential hypertension is the name for the majority of other cases of high blood pressure where officially no cause is known. Patients are usually put on life-long antihypertensive medications, often several drugs in combination, to bring the blood pressure down to 120 over 80.

Despite the notion that we do no know the cause of high blood pressure, we do know that a number of factors can contribute to developing high blood pressure: too much salt in the diet, too much nicotine from smoking and too much alcohol consumption.

A lack of nitrates from green vegetables can cause high blood pressure as well. Nitrates are necessary for the body to produce nitric oxide, a powerful messenger that dilates blood vessels lowering blood pressure. It is produced every second by the lining inside the walls of your arteries. Greens and vegetables, particularly beets, provide nitrates for nitric oxide production.

Nitric oxide, along with omega-3-fatty acid and prostaglandins are important in relaxing the arterial walls, thus lowering high blood pressure.

We also know that in diabetes and obesity high blood pressure is very common, because inflammatory substances circulate in the blood, which interfere with the normal production of the blood pressure lowering nitric oxide.

Treating high blood pressure with the conventional drugs will mask the real underlying causes.

The DASH diet has helped a lot of people to get their blood pressure under control. However, the limiting point in that diet is the amount of grains that are allowed. In my opinion, wheat and grains, starches and sugar are all empty calories and only stimulate your appetite because of the high leptin and gliadin content from wheat and wheat products. According to the cardiologist, Dr. William Davis, cutting these out will cure not only many cases of hypertension, but also diabetes and obesity. Many physicians have criticized him, but in my opinion his work is on solid researched ground. If a patient honestly gives lifestyle changes a try, many side effects and deaths from antihypertensive drugs could be avoided.

3) Gastritis and duodenal ulcer

You see your doctor, because lately you regurgitate acidy stomach contents. You may be diagnosed with gastritis and get a prescription for an acid suppressive drug. But before you take proton pump inhibitors (PPI) study the side effects here.

The interesting part is that many chronic gastritis cases are associated with a bacterium called H. pylori. Unfortunately it is now known that cimetidine, ranitidine and particularly PPI’s are treating the acid problem (the symptomatic treatment of acid suppression seems to work), but on the longer term they encourage H. pylori to grow more, particularly in the stomach. The bacterium undermines the lining of the stomach and the duodenum and interferes with the production of the protective mucous production, which is meant to protect you from gastritis and ulcers. Dr. Murray explains that the cause of gastritis, gastric ulcer and duodenal ulcer is the breakdown of the mucosal barrier (Ref. 3, p.73-75). So the symptomatic treatment of the H. pylori infection with triple therapy (2 antibiotics and a PPI) may be the medical treatment commonly accepted as the norm, but it does not cure H. pylori in many cases. Some patients develop diarrhea from a Clostridium difficile super infection as a result of the antibiotics from the triple therapy requiring even more expensive antibiotics for that condition. This only happened, because the patients’ symptoms were treated instead of the cause. The cause of gastritis and duodenal ulcers is a weakening of the lining in the stomach and the duodenum resulting in a breakdown of the mucous barrier. In some people dietary habits play a role, like too much cereal and wheat consumption with too little alkaline vegetables in the meals to neutralize the acid formation (see Ref. 2 for more details). However, when a simple licorice compound (DGL, which stands for deglycyrrhizinated licorice) is given, the symptoms from gastritis, acid reflux, and ulcers in the stomach or duodenum disappear. DGL supports the lining of the stomach and duodenum and reestablishes the defense against the acidy milieu. Not only that, but after a few weeks of DGL treatment all of the findings on endoscopy such as inflammation and ulcerations disappeared. Dr. Murray states that he has not encountered a case of gastritis or ulcer that would not have responded. It appears that the cause of gastritis and ulcers in the stomach and duodenum is not from too much acid, not from H. pylori infection, which appears to just be a concomitant infection, but actually is due to a breakdown of the barrier in the lining of the stomach and duodenum, which responds to DGL. The other interesting thing is that you can buy DGL in the health food store; the dosage is two to three chewable tablets on an empty stomach three times per day. According to Ref. 3 it needs to be taken 8 to 16 weeks, after which there is a full therapeutic response. Pepto-Bismol is another coating substance that is available over the counter and works well for minor stomach upsets.

4) Chronic back pains and insomnia

Many people see their chiropractor for chronic recurrent back pains and their physician for insomnia to get sleeping pills. It all depends what the underlying causes are of back pains and insomnia.

If there is a misalignment in the spine, a chiropractor doing manipulation would be a reasonable approach and the back pain symptoms often disappear. However, thyroid deficiency or adrenal gland insufficiency or adrenal gland fatigue may be the cause of back pains and muscle cramps. Unless the underlying cause is treated (in the case of hypothyroidism treatment with thyroid hormones), the back pains will stay. In fibromyalgia where muscle pains are all over the body, the standard treatment with antidepressants and pain pills just will not do it on the long-term. These patients require a detailed work-up with analysis of the hormonal status. Often they are suffering from a lack of thyroid hormones, a lack of sex hormones (in women a lack of estrogen and progesterone, in men a lack of DHEA and/or testosterone). But they may also have weak adrenal glands and a lack of growth hormone. An anti-aging physician (A4M) can order the appropriate tests and treat the underlying causes.

Fibromyalgia patients often have insomnia (sleep disorders). Dr. Lichten (Ref.4) recommends GABA in small doses (125mg to 250 mg) at bedtime along with 500 mg of L-tryptophan. He also recommends 4000 IU – 5000 IU of vitamin D3 (as often insomnia patients are deficient in vitamin D3) as well as 500 mg to 1000 mg of magnesium. If this alone is not sufficient, melatonin, 1 mg to 3 mg at bedtime will be beneficial. Dr. Lichten cautions that GABA leads to tolerance quickly, so it should only be taken 5 days out of 7 to allow the body’s receptors to recover. This alternative approach to treating insomnia will prevent many patients from getting addicted to sleeping pills (hypnotics).

5) Asthma symptoms

Not every case of asthma needs steroid inhalers and salbutamol or other bronchodilator inhalers as treatment. This link shows that low thyroid can also cause asthmatic symptoms of wheezing and shortness of breath. It is important to listen to the patient’s symptoms, but the treatment will only be successful when the cause is treated. Dr. David Derry described in this link how many of his severe asthma patients had iodine deficiency and low thyroid hormones and no longer had to see him when iodine treatment and desiccated thyroid hormone replacement was given as treatment. This goes against what the standard recommendation for asthma treatment is, but it seems to get patients unhooked from dependence on steroid inhalers.

Steroid dependency from anti-asthmatic inhalers can suppress the adrenal glands and lead to adrenal gland insufficiency.

The adrenal glands are vital for coping with stress as the more stress you are under, the more your pituitary gland produces ACTH hormone, which in turn stimulates the adrenal glands to produce cortisol. However, a significant percentage of patients with asthma that been on corticosteroid inhalers for a long time, experience a suppression of the pituitary gland and the adrenal glands cannot produce the required stress hormones; in other words, adrenal fatigue or adrenal insufficiency can set in.

This is an example where during the treatment of asthma symptoms were controlled with corticosteroid inhalers, but the stress hormone circuit was undermined to the point where the patient experienced another disease (called a “iatrogenic disease”, a disease from the side-effects of drugs). Treatment of adrenal fatigue is described in this link.

Conclusion

Medicine can become quite complex as these examples show. Many times physicians tell their patients that the cause of their symptoms is not known. However, this is not always true, but conventional medicine continues to hold onto the old dogmas. With the third example above (gastritis and duodenal ulcer), until the mid 1980’s the original theory in medicine was that too much acid production would be the cause of these conditions and treatment concentrated on suppressing acid production. Then the new theory came up that H. pylori, a bacterium would be the cause of chronic inflammation, which together with too much acid would cause the condition. That is why physicians now treat it with the triple therapy, a good deal for Big Pharma, but a bad deal for many patients. They still do not get cured, but develop a worsening of their conditions as H. pylori growth proliferates, particularly from the PPI’s, which undermines the lining of the whole stomach. As pointed out above DGL, a simple licorice compound, which is available in health food stores, can strengthen the lining of the stomach and duodenum, which at the same time gets rid of the H. pylori problem without any other drugs.

The problem with conventional medicine is that in many cases physicians still treat symptoms instead of treating known causes. Big Pharma supports this, as it is expedient for them to protect their multi billion-dollar industry. Patients need to demand that the causes of their diseases are being treated rather than the symptoms.

References

1. Dr. Edward M. Lichten: Textbook of bio-identical hormones. ©2007 Foundation for Anti-Aging Research, Birmingham, Michigan, USA

2. William Davis, MD: “Wheat belly. Lose the wheat, lose the weight, and find your path back to health.” HarperCollins Publishers Ltd., 2011.

3. Michael T. Murray, ND: “What the drug companies won’t tell you and your doctor doesn’t know”. Atria Books, New York, 2009.

4. Dr. Edward M. Lichten: Textbook of bio-identical hormones. ©2007 Foundation for Anti-Aging Research, Birmingham, Michigan, USA

Last edited Aug. 3, 2013

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Apr
01
2008

Short Daily Exercise Helps Chronic Pain Patients

Chronic pain can be an affliction that turns normal living and functioning upside down. Quality of life will be negatively affected, and often depression and anxiety are resulting mental problems. Effective pain relief is crucial, but often there are undesirable side effects to pain medication, and the patient will explore other avenues that bring a measure of relief. Amy Burleson, Psy.D. of the Cleveland Clinic’s chronic pain rehabilitation program found that chronic pain patients were physically deconditioned due to chronic pain and a chronic lack of physical activity. Depression and other mood disorder also were very common. A 10 minute exercise program was added to the treatment of a group of 28 patients who suffered of various chronic pains: back pain, fibromyalgia, neuropathy and migraines. Patients started a simple routine of walking on a treadmill, starting with a low speed of 1 mile per hour and increasing the speed every few minutes, till they walked at a speed of 3 miles per hour, a speed which was manageable for all patients. After 3 weeks patients found that their physical endurance had increased. They also experienced less depression and anxiety. Even more remarkable was the fact that the patients’ pain perception had diminished.

Short Daily Exercise Helps Chronic Pain Patients

Short Daily Exercise Helps Chronic Pain Patients

Likert scale scores which were used in the assessment of pain perception showed a drop from 7.32 in the beginning of the program to 2.75 at 3 weeks. It is obvious that even mild exercise has benefits for patients with chronic pain: the overall well being receives a noticeable boost through an approach that has no pharmacological impact, no side effects and has no high cost of health care.

More information on the right dose of exercise: http://nethealthbook.com/health-nutrition-and-fitness/fitness/right-dose-exercise/

Reference: Pain Medicine, Volume 9, Issue 1, Page 88-141 (January/February 2008)

Last edited November 3, 2014

Apr
01
2007

Disc Transplantation New For Herniated Disc

Back problems can be a source of chronic pain and it is a significant reason for disability in the general population. Often the patient lives with the problem, and treatment with pain killers or over the counter remedies proves to be useless. Once the symptoms are becoming more severe and there is a feeling of numbness that extends into the leg or foot, even the most stoic back pain sufferer will seek out medical advice. Tests such as a CAT scan or MRI scan will reveal that the reason for the chronic pain is a herniated disk.

The only treatment that could be offered has been a discectomy which is performed by an orthopedic surgeon. So far fusion surgery has been the modality of choice, which has the unfortunate consequence of predisposing patients to degeneration in other levels of the spine as the wear and tear following fusion surgery is higher at the adjacent levels.

Dr. Dike Ruan from the Navy General Hospital in Beijing reports about a new treatment in the form of disc transplantation instead of fusion. Artificial materials have been tested and the results have been very variable. Contrary to organ transplantation it is possible to work with donor material from non-related persons as the inert disk material does not cause transplantation rejection. The herniated disc is removed including the adjacent end plate and a fresh-frozen composite disk with end plate is introduced. Five patients who underwent the procedure had improved neurological status after three months. Also the bony union at the end plate was nearly complete after three months. Long term follow up, which continued for at least five years, continued to show improvement.

Disc Transplantation New For Herniated Disc

Disc Transplantation New For Herniated Disc

Contrary to organ transplants in which anti-rejection drugs have to be used, the disk transplants caused no immunological reaction. Motion and stability remained excellent, and only minor degenerative changes were observed after five years.

With further refinements, such disc transplants will likely become an effective alternative treatment for degenerative disc disease.

More information about disc herniation treatment suggestions: http://nethealthbook.com/arthritis/lower-back-pain/treatment-low-back-pain-2/disc-herniation-treatment-suggestions/
Reference: The Lancet, 2007; 369-993 and p.999

Last edited November 2, 2014

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