Archive for the ‘Healthy Aging’ Category

The good news about arthritis – it’s not as simple as you’ve been told…

Saturday, October 31st, 2015

“…they found that it is very common for people to be walking around without any pain who have terrible joints!”

 Knee pain pic

Western medicine is updating it’s understanding of why arthritis hurts – the answer is that they are not completely sure anymore.

For most of the 20th century, the arthritis story was very simple.  The patient was told “See these changes on the X-ray/ MRI? That’s what is causing the pain.”   Patients then feel educated while they wait for for the surgeon – back fusion, knee replacement etc. etc.  The expectation is, if no change to the bone and cartilage of the joint – no pain relief.

But in the 21st century, new information has made that picture become less clear.

Researchers began to ask questions:

For example, if the bone pathology causes the pain, why does it not hurt all the time?

Why do some people have flare ups of pain after overeating?

Why is it when people actually have corrective surgery, the pain does not always go away?

Finally they began to take X-rays and MRI’s of people who are totally without any pain or stiffness.  To their amazement, they found that it is very common for people to be walking around without any pain who have terrible joints!  Even when finding the dreaded “bone on bone” situation.

In fact, if radiologists have never met the patients and only look at the X-rays, they cannot predict which patient has no pain, which patient has pain and if so what kind of pain they have in terms of location, intensity and frequency.  Some predictability is possible for very severe cases, but even then, not always.

This is really good news – the patient can now explore all the other factors for why the joint may have pain and stiffness, with reasonable expectation of preventing or delaying surgery.

So what does cause the pain?

The research suggests that arthritic changes to joints happen against the background of many other changes to nerve physiology, tendons, ligaments, muscle and immune system physiology.  There can also be a significant stress/ psychological component.

Using the word”physiology” here very specifically refers to changes in gene expression, enzyme function, immune function lymph and blood flow changes, as well as biomechanical changes.  Many of which have been shown to be reduced or eliminated by electroacupuncture, bodywork, herbs, nutrition and lifestyle factors.  (I will have a more detailed post about the science of pain in a few weeks.  Try Googling “genetic control of central sensitization” if you are curious before then.)

This explains situations I see in the clinic.  I often have patients who have been told that they need surgery but wanted to try acupuncture first.  Well of course, those of you familiar to my practice know it’s not just acupuncture that they may need. These patients receive a thorough review of their current and past global metabolic situations before various procedures and options may be utilized.

What can be done about the pain and stiffness then?

old-couple-jogging-healthy-ageing

Consider the following situations for patients with osteoarthritic pathology seen on an X-ray or MRI. When I find trigger points in the thigh muscle, the arthritic knee pain can go away completely in 1 or 2 sessions.  When a patient regularly overeats on foods that cause inflammation, 3 or 4 weeks of digestive repair and lifestyle changes can also restore function.  Some folk are over exercising or doing the ‘wrong’ types of exercise, some are too sedentary and do not know how even just a little more activity will create a big change.  Some people do not even need office procedures at all but need to simply move the joint regularly throughout the day in the range without pain.  This will allow the lymphatic and blood circulation to improve.  Also common is pain in a joint on a limb that had previously experienced poorly healed strain and injury – e.g. clearing the effects of an old neck injury can help wrist or hand pain.

We you come to see me, I take the label from your surgeon’s diagnosis off the the table for a moment and look at the whole picture.  A good diagnosis means a good treatment, and understanding the whole person is the best route to the best diagnosis. Detailing what the body needs allows us to design treatments using many options to surround the problem and get stable progress.

Happy healing!

Still limber

 

 

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

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.

 

 

Eugene allergy season – acupuncture wins over antihistamines

Tuesday, March 31st, 2015

Sneeze

Hello, Willamette Valley folks!  Allergy season is is already creeping up on us, and our valley seems to be a tough area for this problem. One of my patients today mentioned how a family member had to leave Eugene simply because of severe seasonal allergies, despite trying all the available drug options.  I have heard several of these stories during my time here.

Medications can help a lot of people, but their effect is is really only providing a holiday from symptoms.  I have never heard of anyone taking Claritin© during allergy season and then finding a lasting benefit if they stop in the middle of the season.  But I have frequently seen long term benefit when Chinese medicine was used.

I want to share an interesting research paper with you about acupuncture compared to Claritin©, also known as loratidine.  I like this paper because I think it has a very low probability of bias, and it looks at this question of lasting benefit.  The paper has some limitations such as not allowing for any individual variation in treatment for patients with different background metabolic situations, but it is from the Clinic of Otorhinolaryngology at the teaching hospital in Dresden, Germany.  The link to the article is posted below.

A teaching hospital has most likely seen many patients with bad reactions to drugs.  I looked loratidine up in the Physician’s Desk Reference and found over 80 adverse reaction warnings such as fatigue, dizziness, nausea, decreased libido, and incontinence of urine. These last 5 were some of the more intense symptoms I saw in my clinic last season caused by this drug. Also, many of you may have seen the recent news about how long term antihistamine use increases your risk of dementia. So this acupuncture research is really quite timely.

For those of you that are technically minded and are interested in the chemistry of allergic reactions, there are some lab test results in the paper that are worth looking at.  To keep it simple, let’s look at how the patients reported feeling after their treatment for allergies.  This study was actually looking at dust mite allergies but the physiology of seasonal allergies is almost identical, and with mites you can look at the effect of time without worrying about the change of season.

Sorry for the image quality here (this is a copy and paste straight from the paper) but I hope you can see a bar graph with red and blue columns.  Red is for acupuncture results, blue is for loratidine results.

Allergy bar graph

On your left side, you see how all the patients were feeling on the day after the last day of care, the right side shows how they were 10 weeks later.  87% of acupuncture patients reported improvement at the end of care, and 10 weeks later this was down to 80% of the patients.  So, OK, this acupuncture protocol did not work for every one but 80% after 10 weeks is still pretty good.

For the medication-only patients, on the day after taking their last pill 67% of them felt improved, but 10 weeks later none of the patients taking Claritin© were feeling any better; their symptoms had returned to pre-treatment levels.  After all the risk of side effects, none of the patients taking the drug felt any better after stopping the drug.

The doctors did not track adverse effects in this paper, but the number of patients in this study was not large enough to expect any dangerous adverse consequences of acupuncture, but would be large enough for drug side effects to be seen according to other research.

The moral of this story was that even poorly designed acupuncture treatments show a rather impressive result.  Bear in mind these patients were not offered any herbs or lifestyle/ diet modifications, and the treatments were not individually tailored to account for varying stress levels, other health issues, etc.  When I can treat with the full scope of my practice, surrounding the issue on many fronts, patients can see a benefit even a year later. And within 1- 3 seasons, they can find that they don’t need any further treatment of any kind.

Good luck this season!  And if you want to enjoy the outdoors without medication, give me a call.

 

 

The Effectiveness of Acupuncture Compared to Loratadine in Patients Allergic to House Dust Mites 

downloads.hindawi.com/journals/ja/2014/654632.pdf

Autumn ~ Healthy choices to enhance longevity

Tuesday, September 30th, 2014

Autumn

 

Saying goodbye to summer and embracing the cold…

There is a basic question that Chinese medicine tries to answer with all seasonal advice.  That is “How can I adapt to a new climate without draining my reserves?”

Adapting to the change of season requires energy to be spent by our metabolism.  We may notice everyday examples like a burgeoning preference for hot chocolate over summer’s ice cream, or how our pets are napping more even though the weather is not extreme yet.  I noticed how 50 degree weather this morning made me reach for a hat and coat, but I also remember last February when a 50 degree day seemed almost t-shirt weather.  Same temperature, different metabolic setting.

The ancient physicians thought that this multitude of tiny adjustments our bodies make can be made as efficiently as possible, or not at all.  If transition happens harmoniously, less stress is incurred and we stay healthy.  Otherwise we increase the probability of getting sick or otherwise drain resources best used for healthy aging.

The details may vary a little with individual health situations, but the following are very commonly good ideas for most folk:

  • Cover up.  It’s time for long sleeves, long trousers/ dresses hats and light scarves that cover up the acupuncture points GB 20 and Du 14, 16.  Doing this now before the real cold will harmonize the “wei qi 卫气” assisting the immune system to get ready for the winter viruses.  Right now it’s better to sweat into cloth than have the wind get down to the pores.
  • Warm up the digestion.  Main meals should not be raw salad dominant, but should focus on roasted or stewed seasonal vegetables.  Curried food is pungent and warming and perfect for the seasonal change.  Stay away from chilled, iced foods.  Soup is ideal – all that ‘digestion’ on the stove is that much less energy your body has to spend on the meal’s transformation, leaving the body lighter and quicker to adapt.
  • Spend a lot of time outside.  The more you can experience the seasonal changes around you, the more your own system takes the hint.  Have you ever noticed how outdoor cats get thicker, longer lasting coats compared with indoor-only cats who shed all year round?  My cat already has her winter coat, but I’ve seen indoor cats with summer thicknesses yet.  Be an outdoor cat.
  • Catch up on your sleep.  Sleep is where the maintenance happens.  If you’ve been missing sleep, try to nap or go to bed earlier so that you make up about 1/3 of the lost sleep.  A nap is totally worth the time as an investment in your health right now.
  • Exercise to clean the Lungs.  Focus mainly on cardio, qi gong, dance or anything that calls for lots of regular, deep breathing.
  • Cultivate your inner world.  We are naturally less physically active in the colder, darker months, so it is a good idea to spend more time on things your mind enjoys.  Creative writing, music, study, politics, art – try to add a little more to your week.  This slows down ‘cabin fever’ type stresses or seasonal affective disorder, but clinically I see another advantage as well, in relation to the Chinese idea of longevity.  I treat many people in their 80’s and 90’s who feel quite bereft at how physical limitations decrease their quality of life, yet their minds are are totally fine.  Or even younger folk who are injured and can’t play the way they would prefer.  I see that those folk with a lifelong, rich connection to their inner world are healthier and more content.  If your focus all year has been on external activity, this season, start to find out what inspires you on the inside and cultivate a rich relationship with it.

 

 

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!