Archive for the ‘Gynecology’ 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

 

 

 

 

Menopause Symptoms – they just don’t have to be that bad, because menopause is not a disease

Thursday, April 30th, 2015

Healthy older woman

I believe I have some good news for people struggling with this issue.  You don’t have to have the symptoms or at least the severity of the symptoms.

I have met many women who feel quite trapped by the situation.  They feel trapped between the choice having a low quality of life or feeling better with HRT but then having an increase risk of cancer later.  Or they feel somewhat hopeless against the power of family history and genetics.  They may not realize how much their own lifestyle choices can improve the problem.  They do not know that they have capacity to make changes for the better, as they are guilty about prior failures.

It is my opinion that menopausal symptoms like hot flashes, anxiety and insomnia, while common, are an abnormal response to a normal change.  This issue is not such a hard presentation compared to say blood loss – everyone with very low blood counts will feel awful.  But with hormones, a women with low numbers may not even notice anything.  Basically, issues like anemia are diseases, but menopause is not a disease.

For urban African and Asian women, only 40% have symptoms and a high proportion of these people do not report severe symptoms. 60% to 75% of Caucasian, urban Latin American and African American women report trouble and a high number have a significant reduction to quality of life.  Yet the actual hormone levels in different cultures are not significantly different over all.

I have seen daughters’ of really afflicted moms avoid trouble simply by taking better care of themselves and receiving treatment at my clinic.  Genetics may be the hand we are dealt, but how we play that hand is sometimes more important.

Western medicine does not have a clear definition of health in general practice.  They usually define health as an absence of disease yet have no measure of how hard the body is working to remain symptom free.  A person in balance has the metabolic resources to change without problems or without severe problems.  The idea of ‘balance’ and the Chinese Medicine view of balance relies on a personal relativity, which science as yet has difficulty studying.  Individuality by definition implies qualities not easily averaged.

But aspects of being in balance are making the news.   The home-based care advice given to patients for centuries in China and the last 10 years in Eugene by myself is, in the 21st century, now supported by the biomedical research.  You can play the game better, you can feel better.

Meditation in some studies knocks hot flash rates down 50%.  The presumption is that the thermo-regulation center in the brain is near to the brain areas reacting to adrenalin exposure.  Other practical methods of reducing adrenalin and stress help as well. Non-smokers or quitting smoking is a major factor.  Clearing excess alcohol and changing the standard american diet (sugar, fat, salt, caffeine) also improves outcomes in the research.

Now I must be cautious here – my reaction to remedies via lifestyle change is “Thank goodness the solution exists and it is all so simple” but many folk feel that the issues in the last paragraph are already major sources of guilt and an otherwise insurmountable obstacle. Try not to worry – I can help you make the process of change manageable and guilt free.  You may even become pleasantly surprised to find that even a 10-25% change is enough to get the job done and have a full night’s sleep, or the Chinese medicine is able to handle on it’s own.  In fact some patients only need to spend time and effort on the problem till the adjustment happens and then they don’t need the tools anymore – especially in cases where the symptoms arise because of the relative change of hormone levels, not the absolute blood levels.

Some women’s constitution may not even need the lifestyle adjustment.  Their system is strong enough that herbs or acupuncture alone is enough to leave the symptoms behind.  The simplest cases I have seen needed only about 3 weeks of acupuncture to get them feeling normal again.

As usual in my experience, and for regular readers of my blog, the best results in most cases happen when the problem is surrounded on many fronts.  Make a big impact on the system at the start, tail off as the problem fades.   Remember that menopause is not a disease and the annoying symptoms represent a difficulty adjusting to change.  Not many hot flashes can survive an onslaught of individually tailored herbs, acupuncture and adrenalin reduction.