Archive for the ‘Clinical information’ Category

Try all your pain relief options before reaching for ibuprofen

Friday, July 31st, 2015

FDA recall

I try to avoid fear mongering on my posts but I have been feeling a growing moral pressure to tell the new ibuprofen story for some time.  After reading how long term higher dose ibuprofen use can have the same heart attack or stroke risk as Vioxx, the time felt right to update you all on the issue.  Vioxx was banned by the FDA as unsafe. (The Lancet 2013 382:9894;746-8)

Ibuprofen (aka Advil©, Motrin© etc.) seems harmless enough.  Maybe you’ve worked out too hard, maybe you have arthritis, maybe bad period pains.  For many mild pain patients, this pill can be quite a satisfactory pain management tool. I have taken it myself occasionally.  It certainly is more forgiving than acetaminophen (Tylenol© and other brand names), where even one or 2 pills past the regular dose can land you in hospital with liver damage.

However what I see in my clinic is that people keep taking it.  They come to rely on it.  Some athletes and military personnel even call their daily dose of ibuprofen “Vitamin I”.  And like many chronic self-medicating patients, over time the dosage and the risks go up as the benefits diminish.  I see multi-year users describing how the pain goes down just a couple points, say from a 6/10 to a 4/10 yet when they started the drug totally eliminated the pain. So now they have all this risk just for a minor nudge of pain levels.  Not worth it.

They masked the pain and prevented themselves from learning about the cause and effect their choices had on their body.  If you can learn where cause and effect impact your life, your quality of life will blossom in many profound ways.

Basic common sense suggests that it is better to understand and change the root cause of the pain rather than trying to suppress it once injury occurs.  Working with a professional such as myself will allow you to identify why you have that inflammation so often – and no its probably not aging!  I discuss everything with patients from shoe choices to making sure you vary your workout routine based on your body type.  The treatments I offer can eliminate the need for the drugs completely and can even help with issues like weight loss.

Take the example of arthritis.  I will post more about arthritis later, but a sneak preview here is the fact that the bone changes themselves do not cause the pain directly.  Arthritis pain is now understood to be very complex, and involves changes to the immune and nervous systems.  Note that many people with the bone changes do not have any pain at all!  You cannot predict pain levels just from looking at an x-ray.  Obesity is ofetn the difference between pain or no pain.  Seeing me to kick the ibuprofen habit for osteo-arthritis allows you attack the reasons for the pain in a safe, controlled manner.

So what are the risks with ibuprofen?

Well for example, a dose of hard exercise normally causes minor intestinal tears in healthy people.  These tears usually heal up just fine.  But the ibuprofen makes them worse and can can even slow the repair, so over weeks and months you are causing quite a bit of damage.  Beyond the digestive damage directly, weakening the lining of the gut causes all kinds of other inflammation such as in joints or the heart, or blood vessels – especially those in the brain. (from “Medicine & Science in Sports and Exercise” December 2012 44:12; 2257-62).

The Physician’s Desk Reference 2015 lists several other issues.  Cardiovascular risk including stroke and heart attack.  Renal papillary necrosis (the tissue has died) and other renal injury leading to possible kidney failure, liver failure, blood pathologies.  All noted that risk increases with duration of use.

All of this risk is really quite unnecessary.  Call me, call your PT DC DO LMT etc. etc. and start living pain free without damaging your health.

I found this chart on Pinterest.  It is not complete, e.g. does not have the cautions about using if you are diabetic or asthmatic,  but I hope you find it informative.  (You have to click on it to see the detail…)

NSAID risk

 

 

 

 

Try this simple way to reduce colitis, IBS, weight gain, metabolic syndrome.

Friday, February 27th, 2015

Intestines

Emulsifiers may possibly be causing or promoting your symptoms, especially E466 (carboxymethylcellulose) and E433 (polysorbate-80).  See reference below.

Research findings in mice do not always apply to humans, and good science needs to reproduced independently before coming to firm conclusions.  But the latest research about emulsifiers in food suggests such a simple, cost effective diet change that I think we can try this experiment on ourselves.  Try a few weeks to months avoiding foods that contain either of these additives.  See how you feel.  You are at absolutely no medical risk if you try this, there is no nutritional value to these E numbers.  The only risk is you may have to change ice cream brand or similar.

This approach follows some very sensible advice  –

If you do not recognize the ingredients in the list on your packaged food or if they sound like chemical names, don’t eat it.

Follow this standard and with very few exceptions you will be eating whole foods.  While its possible that some additives are safe, the research is rarely sufficient for people at risk for inflammatory disorders.  The E numbers mentioned above have been “approved” for years but the fine, detailed research is obviously still happening.  Since these additives are not crucial to sustain life there is no real point in consuming them.  The take home message is that when it comes to the food industry, approval happens faster than research.

Reference:

Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome  http://dx.doi.org/10.1038/nature14232 

 

Do you think its age causing the trouble?

Monday, July 21st, 2014

In many cases I see, it’s not really age.
Our bodies need three things to be thrive –
…Good Sleep
……..Good Nutrition
…………..and Good Movement!

Many of my over 80 patients (and even younger) experience poor mood coming from how their body just isn’t what it used to be. I regularly hear “My mind is so much better than my body but I don’t know why.”

My response is that the answer is obvious – the mind has received all the attention! They do crosswords, listen to music, watch TV, read, socialize. But over the course of the day they are largely immobile. Use it or lose it, if you spend time with the “equipment” it lasts longer.
The amount of movement you need to feel a lot better is not a lot of movement. This is the surprising thing.

Of course if you do Tai chi and take a regular class you will feel improvement.  But in my clinical experience many people can increase mood and reduce pain by developing the habit of moving something every 15 minutes. Just like a dog or a cat – every few minutes, move something for a few seconds.  Reach up in the air, jab a few shadow boxing moves, lift one leg, then the other.  Even people with severe disease who are in bed can usually find some part of their body that can move freely. Even just straightening up and breathing deeply once or twice can help.

The classical chinese medical view is that the blood flows to where function is happening, the function happens in places where the mind engages that function.

For the average person, who is well enough to walk into my office when they come for a session,
Here’s the plan to start:

Every 15 minutes over the course of your day, stand up.
Every 15 minutes move your arms or your legs for 7 to 10 seconds, try a variety of directions including up and behind the back.
Move within a range of motion that causes no pain what so ever, no matter how small a movement this may be.
Give it a week and see how you feel!

What does getting better look like when using Chinese medicine and acupuncture?

Thursday, November 21st, 2013

Progress and clinical success at my clinic can be experienced quite differently compared to using drugs or surgery.

• For people who had complete relief or otherwise fully achieved their clinical goals, we can look back in their chart and see that some treatment days or weeks were better than others.

• Sometimes people notice improvement right away, sometimes over the next day or two. We know the results of an office procedure within 1-2 days of the session.

• Sometimes the treatment can occasionally irritate the problem initially and then feel better later. When symptoms return, they are less intense than pre-treatment.

• It is normal for symptoms to fluctuate anyways, especially those influenced by activity and stress levels. We keep track of it all, looking for the trend and adapting care as events warrant.

• Before treatment starts, it is not common for people to follow their symptoms with a high level of detail especially objective detail. After we start working on the issue, we tend to pay more attention which of itself can change the experience of the problem.

• In general there are 2 phases of healing. First we deal with the legacy of the situation, i.e. the accumulation of stress on the system from the past. There is then a phase where healing the past is over and we then aim to increase performance out of the affected system, so that damage from ongoing circumstance (perhaps beyond our control like a job situation) do not cause trouble.

It can be difficult remembering how bad a situation was before care started. If you are not certain how you are doing, lets talk about it and look through your chart. I once had a patient with knee pain who was sad that she could not hike 5 miles like she used to, even after 3 weeks of care. 3 days before her next session she had tried the long hike and failed due to pain. I was able to reassure her with her chart notes.

At her first appointment, she could not walk from the car park to the office and had to have her husband drop her off due to the pain. She had been this bad for 6 months before acupuncture, while in hesitation about whether to do surgery or not. On the day we addressed her progress concerns, she had come in unaided from the car park and in fact had several 1-2 mile hikes in her chart (from second week of care), where she only had 1/3 to 1/2 the pre-treatment pain level.

This was an otherwise normal, emotionally healthy person who simply lost track of this fine level of detail due to being very busy in her life, and also feeling the sting of recent failure.

Looking at the trend was all the reminder she needed to to continue care through to successfully getting back to her long hikes pain free. She did not need surgery within one year follow up, the medical cause of the pain was really one of trigger points and neuropathic pain more than being due to the findings on the MRI.

Returning to exercise safely & injury free (or “You’ll get there in the end”)

Monday, October 21st, 2013

Returning to physical activity is like making a camp fire. Making a camp fire means understanding fire’s nature, and acting appropriately.

How to make a nice roaring camp fire:

Start with a tiny spark from a flint or a wood drill.
If you add the spark to a log, it’s extinguished right away. If you blow too hard on the spark, that will overwhelm the spark as well.

The spark must be carefully cultivated with an understanding of its nature.

The successful spark goes on dry moss, maybe sawdust. Then more sparks form, then you can add more moss. Now, maybe a small wood shaving, then another. More moss, then a small twig. Never large pieces at this stage. Some gentle air from the breath is good now.

Then add several twigs, maybe some more moss. Then a bigger piece of wood, then large sticks. Now blow hard as possible, stoking the heart of the fire.

Now its ready for logs that will achieve the desired function of keeping warm.

This whole process totally fails if you push the envelope too soon. Yes, fire needs wood and yes it needs air, but these can smother the sparks if used at the wrong moment.

If you judge the small spark as being useless, you will never get the benefit from it. A large, warm fire has very humble beginnings but the beginnings exist and have power to develop.

Translate this analogy to exercise –

The goal of the first week or more is to simply get used to moving without triggering pain. Let the body be gently reintroduced to gravity and perhaps the kind of activity you intend to carry on with.

The goal is not to go for endorphins, stress relief, weight loss or other athletic performance. Get this goal correct and you are on the quickest path to victory. Anything else is risky.

Many people are hurting themselves by judging their own small spark of capacity to be useless and either overdoing it or deciding to do nothing.

I once had a patient only able to do 5 seconds of a shoulder qigong exercise I prescribed. This was case where workers comp covered work on the ankle but not the preexisting shoulder issue so she asked for a self-care protocol. But at 6 seconds, severe pain kicked in. This small functionality made her upset. She felt useless, thinking that 5 seconds was a fail. I recommended that she just do the 5 seconds. She was convinced that 5 seconds was completely pointless and we spent some time talking about this. She agreed to try the 5 seconds every day. After all, at 5 seconds at least there was no pain. In a few days she could do 10 seconds. In 2 weeks she was doing 10 minutes twice a day, and this finally took her into the range where the exercise made the shoulder feel pain free.

A more commonly used example I use for very overweight people over 75, who are in recovery from surgery or prolonged illness. I start these patients with 5 minutes per day on a playground swing. Sounds almost silly, but it moves a lot of lymph around and gets the body warmed up. From this innocuous beginning, within 6 months many can walk several miles a week or return to a keep fit class.

The moral is this –

It is totally irrelevant how small your abilities are when you start. Start where you are at, learn to enjoy the fact you have that much function at all. Development of your performance will then come without injury and with a deeper understanding of your own body’s needs.

Improving Your Diet: why its hard, why patience and neuro-plasticity will help

Tuesday, October 15th, 2013

‘Why do we eat food that creates trouble for us?’

We frequently create a nutritional culture based on how recipes make us feel in the short term. The meal size, the textures, and certainly the flavors, feel nourishing and efficiently banish hunger for at least a few hours. But unhealthy meals often make us denser, providing a strong feeling of fullness that can push away awareness of more subtle physical or emotional sensations.
This meal is like an antidepressant, and in fact, junk food alters brain chemistry along the same pathways that cocaine does. Our feelings of boredom or stress; feelings that we have given too much to others or that we deserve a treat for hard work or for dealing with difficult circumstances – these frequently make us reach for the sugar, fat and salt that successfully trigger our brains’ pleasure centers. Our brain is trained to place value on this experience. The numb feeling provides a nice distraction from the troubles. Real stress can be created when lose this distraction.

‘How does a person even know which meal is fulfilling the priorities of our health needs?’

Without any immediate food sensitivities in the body, the effects of diet on our health appear very slowly. In fact, the conventional wisdom that says steamed vegetables and fish is “healthier” than a bacon cheeseburger came from over a hundred years of scientific research looking into the food behaviors of tens of thousands of people. The immediate benefit of ‘healthy food’ is very difficult to perceive in an individual in a short span of time. Give an average, healthy person a fish and another person a cheeseburger, measure their vital signs then re-check in a few hours. Both would be absolutely fine. No wonder making the change is difficult. On a meal by meal basis one needs blood analysis to see any difference.

‘How does change happen?’

As we begin to make a diet change, we rely on our intellect to understand that our diet is not nourishing our health needs. We read or hear lectures about what foods foods are currently thought to be disease promoting or disease preventing. We frequently hear conflicting information as well, just to add to the difficulty. In the beginning, we simply do not have the direct experience of cause and effect. And of course there can be frequent feelings of guilt or even shame as our intellect is found to be insufficient to fight all the emotional energy around leaving the old ways behind.

But after a time a new feeling happens. We have more energy, our digestion improves, our bodies feel lighter and we work more efficiently. Symptoms of inflammation improve. Weight can be lost. As we experience the reality of cause and effect, our emotions change. Instead of placing value on the numbing, short term effect of unhealthy food, our minds learn a new way of perceiving value. This happens by a process scientists call neuro-plasticity, the ability of our minds to be reshaped by experience.

Our emotions now relate to time in a new way. The experience of feeling great over the course of several weeks outweighs the immediate gratification of numbness. We have changed the part of ourselves that responds to food from one that enjoys the break from feeling bored or stressed to the part that feels forward looking and healthy.

So the moral of the story is be patient and observe, your brain will handle the rest.

No flu shot this year? Or said ‘yes’ to the flu shot? Start prevention now!

Wednesday, October 9th, 2013

If you have already decided that the flu shot is not for you, read on.

If you have decided that you need the injection this year, I totally support your decision. It is obvious that some people’s risk factors require this extra level of protection. Yet the following advice may still be relevant as the flu shot does not come with any guarantee that it will work completely.

In Chinese medicine, preparing for a problem is considered superior than being caught be surprise by the trouble.

What can you do?
Science and Chinese medicine agree – your immune system is influenced by diet, exercise emotions and genetics. Try googling “psychoneuroimmunology.” But science is not yet developed enough to establish how well things are working until you get challenged with a germ. Your own intuition and experience is frequently an important guide in this case.

How can Chinese medicine help?
Chinese medicine is able to look at the individual and understand what works well and what is weak even before symptoms arise. All returning patients of mine can come in for a free cold/ flu-prevention planning session. We will review your current situation and see what areas need support to limit illness during cold and flu season.

Some people need herbs, some just need an adjustment to their diet or pattern of exercise. Some need acupuncture. Some need help through a new stress. Individualized care has as many solutions as there are human situations.

For many of my returning patients, who have taken my advice over the years, they don’t need to change a thing and can look forward to staying healthy during the cold weather.

If you have not been in to see me before, give me a call on my mobile (541) 228-4822 and I’ll do my best to answer any questions you have.

No matter what you decide to do, I wish the best of health this season!

Exercising outside during cold weather

Wednesday, October 9th, 2013

If you want to cultivate all the benefit that your body derived from summer training, be mindful how Cold and Damp can not only damage your system in the short term, but in the long term as well.
Stay warm.
In Chinese Medicine, the advice to stay warm is very specific – keep the joints used in your exercise warm, dry and wind protected. This regularly means that the athlete must stay covered up to the extent that they feel slightly “too” warm for the large percentage of workouts aimed at maintaining fitness. Workouts that try to push the envelope can be handled a little differently.
Folk that wear shorts and T-shirts to train outside in cold weather will rapidly chill the entire body once they finish the workout. This uncontrolled chilling runs the risk of lowering your resistance to disease. Digestion, joints, the immune system and even aspects of the menstrual cycle can become more subject to imbalance and disease with chronic exposure to the elements. These preventable imbalances can build up over time. And remember, in Chinese medicine prevention is always preferred to treatment.
Warmth increases blood flow and keeps flexible, shock absorbing tissue pliant. Warmth allows enzymes involved in muscle, tendon and ligament repair to work better.
Ice is fine after a workout, when the affected area is not trying to perform. Icing within 24 hours of a workout can speed up recovery time and is great for managing some types of injury. But this kind of icing is applied to specific, limited areas when the rest of the body is warm
If you want to maximize health as you age, keep warm, dry and wind protected during any outside physical activity for most of your workouts.

Flu Vaccination – shaping the discussion

Sunday, October 11th, 2009

I have support for both camps – those who are for and those who are against flu vaccinations.

This is a brief discussion touching directly on recent conversations I have had with professionals and patients.  A more detailed report with actual data and references is in progress.

The decision tree for whether to vaccinate not for the flu is not straightforward.  It is a tangled forest.  I offer my patients’ a discussion, and my opinion is on a case by case basis.  Unlike many of their other health care providers who are rather aggressive in their opinions for or against the vaccines.

Some practitioners try to cast doubt on the patient’s sanity for choosing either option, when there is as yet no single answer for everyone.  This is one opinion I am absolutely unwavering in – you cannot berate lay people for making decisions concerning highly complex technical issues.  Especially on this topic, where the risks involved in either course of action are so rare, and the technology is so new.

All we can say for certain is that some people are fine after vaccination, but some are not.  Some don’t even get symptoms from being infected with flu, some people die (even without a pre-existing condition).  In the effort to derive statistics for the two possibilities, the results are still to be determined.  When the statistics do come out, they will not be as accurate as those, say, in 20 years from now when the technology will exist to have the genetic data of the study group included in the analysis.  Our immune systems are the most diverse part of our species’ genome, and scientists are already trying to incorporate genetic data in the decision tree to match the right med with the right patient (not just the right disease).

The pro vaccination argument is simple – if you can remove yourself from harm’s way while preventing your body from becoming a carrier of harm, then you should.

Yet the 2 flu strains in the news are not widespread killers, we are not dealing with Ebola or even HIV.  Taking some time to think it through is not irresponsible. The fear of medication is not devoid of rationale.  There are some cogent arguments to be considered using any technology, especially technology aimed at our DNA (the immune response involves chromosomal changes in cells that produce antibodies).

I will take just one argument against vaccination that has not been widely discussed in my search of the world’s main media sources.  And one that perhaps could be fixed if there is political will to do so.

Fundamentally the reason to hesitate comes down to a simple issue of trust.

The drug companies and the government have really dropped the ball on this one, given the problems known to the public in the healthcare industry:

  1. We are just a few months past the largest criminal fine ever imposed on a company’s bad behaviour.  Pfizer was fined $2.3 billion for misleading people about inappropriate use of a drug.  We are still trying to understand how widespread this corruption is in the industry.
  2. We are in the middle of understanding the extent of how professionals have been influenced by financial incentives to minimize knowledge of problems.  In some areas of technology, completely objective, independent opinion can be distressingly hard to find.
  3. The vaccine makers have legal “immunity” (a very dark irony) from prosecution for any harm that may arise from using the product, removing a fundamental right of consumers to use products under the safety of accountability.
  4. It is very difficult to get an accurate list of ingredients in the bottle.
  5. The product has been rushed to market so there has not been time for excellent science to be used in analyzing the results.
  6. Science regularly takes years before risks in medications come to light.  We appear to have entered permanent guinea pig status.  If we are pro vaccine, what is the effect of getting vaccinated every year for the rest of our lives?
  7. The decision to not test all flu cases for H1N1 may make sense from a cost-benefit analysis, but it is an appalling public relations move.

Science has maintained a party line of “Trust us” since the first modern technologies arrived.  Such an un-nuanced approach is ignorant of history.  All technological mishaps happen after scientists say “there is no evidence for harm.” All mishaps with medication safety occurred because the drugs require years of study and because we are still learning how to get all the work done in the pre-release stage.  Technological success is regularly achieved after the mishaps, but we must remain free to choose what part we wish to play in story of a technology’s development.

Flu Season

Friday, October 9th, 2009

There is a great deal one can do to stay healthy during this time.   My clinic offers help for 3 situations:

  1. Preparing the immune system before you have been infected.
  2. If infected, getting ahead of the symptoms before they start.  Remember, exposure does not automatically mean you will develop symptoms!
  3. If symptomatic, reducing the severity and duration of symptoms.

Treatment can begin at any stage but I strongly encourage everyone to come in at stage #1.