Nuvasive NeoDisc

Nuvasive is manufacturing a Cervical Disc Replacement called “Neo Disc” or “NeoDisc”.   It’s my understanding this replacement disc has been in use in the UK for a few years, but here in the United States it is still undergoing Clinical Trials.

The Neo Disc is much different than previous disc implants as it contains a center core that provided disc absorption properties.

Spinal Kinetics M6 Cervical

M6 is an entirely different approach but also aims to offer multi-dimensional movement via an Artificial Nucleus, Artificial Annuylus, a Sheath and Fixation Plates.

Link: Spinal Kinetics M6-C

The M6-C has some scary looking keels to be sure, but it also looks very rugged and will hopefully stand the test of time.  At the time of this writing I know of no Clinical Studies in the United States so you’ll be heading to Europe if you believe this is your best option.

Which Cervical Implant is Right for You?

There is no correct answer, and you’ll here it time and again… every case is unique.  I like the idea behind the Nuvasive NeoDisc because it looks to be the least invasive and most likely to naturally replicate the movement of a natural disc.  Unfortunately only time will tell how these devices all will work out for the long haul.  Technology is rapidly improving… make the “right” choice and you could enjoy a lifetime of pain free living, the “wrong” choice and you may look forward to revision surgery.  This is the way it is – “It is what it is” and that sucks for many of us, but it also offers hope.   Whatever you choose it’s in your best interests to learn as much as you can (There are many excellent Forums you can research on; my favorite being Mark’s iSpine.org.

Neo Disc Information

Details NuVasive NeoDisc Implant

Cutaway Spinal Kinetics M6-C

Conspiracy, bias, or just plain stupidity? Part II.

Introduction

In a previous newsletter, I broached the subject that there appears to be something “fishy” about the portrayal of natural products in the major medical journals. I questioned whether the major medical journals are truly presenting accurate information and pointed out that even the editors or former editors of prestigious journals like the Lancet, New England Journal of Medicine, and British Medical are simply extensions of the marketing departments of major drug companies.

Previously, a review published in the Journal of the American Medical Association estimated that 95% of medical studies in the most prestigious journals contain false or misleading statistics. To illustrate the nature of the problem, let’s take a look at the most recent “negative” review of fish oils against cardiovascular mortality.
In case you missed it, in early April 2006 the media headlines claimed “Fish oil Supplements have no Effect on Heart Disease or Cancer.” The source of these false statements was a review article published in BMJ (British Medical Journal).1 What the study concluded and what the media grabbed a hold of was that the “Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.” That is far different than saying that they do not have benefit. So, what is the truth behind the headline? Read on. But, before you do I want to stress here first is that the use of a high quality fish oil supplement is one of the most important tools in the prevention and treatment of many diseases. That fact is irrefutable based upon a large body of clinical evidence from double-blind, placebo-controlled trials.

What did the Study Really Say?

According to the lead author of the study, Dr. Lee Hooper:

“We did not report that ‘long chain omega-3 does not offer any protection from heart disease’, that ‘omega-3 fats have no effect on total mortality, combined cardiovascular events, or cancer’ or that omega 3 fats are of ‘no benefit’ – this is not what we found, or what we reported (despite our being misquoted in much of the press).”2

That is very interesting. So, what Dr. Hooper and his group actually found by looking at the data was that omega-3 fatty acid intake was associated with a 13% reduction on mortality. I think that finding is quite in line with what one might expect. While long-chain omega-3 fatty acids from fish oils clearly reduce the risk for heart attacks and strokes (previous reports show somewhere between 25-40%),3-5 it is highly unlikely that they would impact other causes of mortality. Therefore, when selecting total mortality as the study’s endpoint we need to make some adjustments. For example, given that heart attacks and strokes would account for between one-quarter to one-half of all deaths in the populations studied it would be expected that long-chain omega-3 fatty acid intake would reduce total mortality somewhere between 6% (25% reduction x 25% heart attack and stroke deaths) to 20% (40% reduction x 50% CHD deaths), or an average of 13% overall. Hey, wait a minute. That 13% reduction is exactly the same number that Dr. Hooper found in his analysis of the results from the randomized trials using fish oil supplements. Interesting, isn’t it?

Some Issues with the Study

First of all, the study was not a new study at all. What it was is a detailed review and meta-analysis. The authors of a meta-analysis review the medical literature and then select published studies to include in their analysis based upon the studies meeting certain criteria. A meta-analysis is almost always fraught with methodological issues and this study was no different.

One of the first issues to mention is that the biggest problem with meta-analysis type reviews is that they are often the collection of poorly designed studies. If all the studies are of high quality and well-designed, a meta-analysis can be quite helpful to illustrate statistical significance because the total number of subjects is often greatly increased. However, if the meta-analysis includes a very large poorly designed study it can tip the scales to a very wrong conclusion. That appears to be exactly what happened in this particular meta-analysis. In fact, the overall conclusion of the meta-analysis can be changed from “no benefit” to “clear benefit” simply by eliminating one flawed study (DART-2). This study should not have been included in the first place because of its poor methodological quality. I am not making that judgment. TheU.S. Department of Health and Human Services’ Evidence Report from 2005 states that this study is of very poor methodology.7 One of the biggest problems with the study was that the dietary instructions were only given at the start of the 9-year study and again after 6 months. Lack of compliance was obviously a huge problem. The study failed to demonstrate compliance in 98% of the subjects. Again, if this study is excluded (as it should have been) the results are also changed from “no benefit” to “clear benefit.” Clearly, the results of the well-designed studies show considerable benefits from a higher intake of the long-chain omega-3 fatty acids from fish oils.

Another huge problem with the meta-analysis is that many of the studies utilized based the intake of omega-3 fatty acids upon dietary questionnaires. These sorts of food frequency questionnaires used have been sharply criticized because they are often so inaccurate. So, what should researchers use instead? Well, in evaluating the role of omega-3 fatty acids they should rely on blood measurements. For example, in one study published in the New England Journal of Medicine that measured the levels of the long-chain omega-3 fatty acids EPA and DHA in the blood it was demonstrated that these omega-3 fatty acids produced a very clear reduction in heart attacks.8 The group with the highest intake of EPA and DHA had an 80% reduced risk of a fatal heart attack compared to the group with the lowest intake.

Next, I have a big issue when the effects of fish consumption are linked to the effects of the long-chain omega-3 fatty acids. Sure, fish is the best natural source of the long-chain omega-3 fatty acids, but our fish supply is also tainted with mercury, lead, pesticide residues, and other harmful compounds. Mercury has been known to increase the risk of cardiovascular disease. While fish oils may protect against heart disease, is the benefit of eating fish counteracted by a higher intake of mercury? Apparently not as results from another study published in the New England Journal of Medicine show that while higher body levels EPA and DHA were associated with a decreased risk for heart attacks, the higher the body mercury level the greater risk of a heart attack.9 Researchers concluded that the high mercury content of fish may diminish the protective effect of fish intake against heart disease. So, it is entirely inappropriate to lump fish consumption into the analysis of the health benefits of the long-chain omega-3 fatty acids.

Another mistake is pooling the data with both the long-chain omega-3 fatty acids from fish oils with the short-chain omega-3 fatty acids alpha- linolenic acid. While the data on the beneficial effects of the long-chain omega-3 fatty acids is quite solid, for alpha- linolenic acid the evidence is less convincing and randomized controlled trials are lacking. One of the studies included in the analysis that should not have been was conducted not on fish oil, but rather a margarine containing alpha-linolenic acid (ALA) – that’s the omega 3 found in flax – versus a margarine with linoleic acid (an omega-6 fatty acid).10 Again, including this study appears inappropriate and its exclusion may have changed the picture entirely.

Lastly, it has been stated that “conducting a meta-analysis study on the effectiveness of omega-3 fats for mortality, cardiovascular disease and cancer, without considering the impact of excess omega-6 fat in the diet, is akin to reviewing the efficacy of a healthy diet without factoring the effects of smoking.”11 In other words, a high omega-6 to omega-3 fatty acid ratio would counteract the impact of an increased omega-3 fatty acid intake and make the results difficult to interpret. The reason omega-6 fatty acids counteract the effects of the omega-3 fatty acids relates to the production of eicosanoids (prostaglandins, thromboxanes, and leukotrienes) from omega-6 fatty acids. Chronic excessive production eicosanoids derived from omega-6 fatty acids is associated with an increased risk heart attacks, thrombotic stroke, arrhythmia, arthritis, osteoporosis, inflammation and cancer. The overall benefits of a higher intake of omega-3 fatty acids appears to be related to reducing the omega-6 to omega-3 fatty acid ratio and availability of omega-6 fatty acids for eicosanoid synthesis.

Final Comments

The bottom line is that a pharmaceutical grade fish oil supplement is one of the key foundation formulas for good health. In fact, the development of these high quality fish oil products is one of the major developments in nutritional medicine. In previous newsletters and throughout my website I have continually stressed the importance of supplementing the diet with these long-chain omega-3 fatty acids. Based upon the totality of research, in order to significantly promote health and reduce the risk for cardiovascular disease the daily dosage of EPA and DHA combined should be at least 1,000 mg per day.

The specific product that I recommend is RxOmega-3 Factors from Natural Factors. It is one of the few fish oil products that truly is a pharmaceutical grade product. Each capsule provides 400 mg of EPA and 200 mg of DHA – the exact ratio used in so many of the clinical studies. So, two capsules daily easily achieve the recommended dosage. [eRegimens note: NSI Mega EFA is the same product as Natural Factors RxOmega-3 Factors]

Key references:

1. Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 2006;332:752-60.
2. Hooper L, Riemersma R, Durrington P, et. Al. Authors’ reply – omega 3s and health. BMJ.com April 7, 2006.
3. He K, Song Y, Daviglus ML, Liu K, Van Horn, L, Dyer AR, Greenland P. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004;109:2705- 11.
4. Whelton SP, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol 2004;93:1119-23.
5. Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trial. Am J Med 2002:112:298-304. 4. Burr ML, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. European Journal of Clinical Nutrition 2003;57:193- 200.
6. Burr ML, Ashfield-Watt PA, Dunstan FD, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003; 57:193-200.
7. Effects of omega-3 fatty acids on cardiovascular disease. http://www.ahcpr.gov/clinic/epcsums/o3cardsum.htm/dec.2004
8. Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med. 2002;346(15):1113-8.
9. Guallar E, Sanz-Gallardo MI, van’t Veer P, Bode P, et al. Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002;347:1747-54.
10. Bemelmans WJ, Broer J, Feskens EJ, et al. Effect of an increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) study. Am J Clin Nutr. 2002 Feb;75(2):221-7.
11. Tribole EF. Excess Omega-6 Fats Thwart Health Benefits from Omega-3 Fats. BMJ.com March 27, 2006.

This information may be freely copied and distributed only if unaltered, with complete original content including:  © Devin Starlanyl, 2011.

Chronic Sinusitis: A Common Perpetuating Factor?

In far too many instances, in my opinion, researchers have found one potential initiating or perpetuating factor associated with fibromyalgia syndrome (FMS) and assume that they have found THE CAUSE or THE CURE. In most cases, the development of FMS or full-blown bodywide chronic myofascial pain (CMP) is multifactorial. There may be a heterogeneous collection of factors that initiate and/or perpetuate the central sensitization if it is FMS. I have found that the key to success in dealing with FMS, just as in dealing with CMP, is to identify as many perpetuating factors as possible and control them as much as possible. I think I have found a hitherto unsuspected cause of, or at least contributor to, some cases of central sensitization, and perhaps a successful therapy for it.

Research indicates that FMS may be central nervous system (CNS) sensitization resulting from an immune response leading to spinal glial activation (Staud 2004). At the Focus on Pain (Travell) Seminar in Orlando, Florida, in 2003, Dr. Linda Watkins, Director of the Interdepartmental Neuroscience PhD program, explained her research at the University of Colorado in Boulder. Her team is investigating the onset of chronic pain and the mechanism causing central sensitization. They have found that the CNS can be sensitized by many factors, including infection and trauma, but the key to the sensitization is the activation of spinal glial cells. [More on Dr. Watkins’ presentation is found elsewhere on the Focus on Pain handout on this website.]

A team lead by Joyce DeLeo, MD, at Dartmouth-Hitchcock Medical Center in Lebanon, NH, found that the CNS neuroimmunological cascade response leading to chronic pain states may also be linked to opioid tolerance (DeLeo, Tanga, Tawfik 2004). They found that the changes in CNS glial cells and proinflammatory cytokines that contribute to central sensitization can decrease the effectiveness of opioid medications. This team also found that neuroinflammation and interstitial swelling can be integral parts of central sensitization. I have found that interstitial swelling can be tied to pain levels in some patients with FMS and CMP. Also of interest is their observation of cellular adhesion molecules in the lumbar spinal cord following peripheral inflammatory stimuli. This may indicate a similar process occurring in the central nervous system similar to the myofascial cellular adhesion in response to mechanical or biochemical trauma. This team provided another piece of the puzzle.

Another piece, and a big one, came with the presentation of a paper on March 23,2004, at the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Francisco.

A Mayo Clinic team of physicians lead by David A. Sherris found that airborne fungi commonly found in the mucus linings of the sinuses can adversely affect individuals prone to chronic sinusitis. These fungi provoke an immune response, which in turn attacks the fungi, resulting in symptoms of chronic sinusitis. Could this immune response provoke central sensitization? The team ran a placebo controlled, double blind pilot study using Amphotericin-B intranasally. Seventy percent of the linings of the sinus membranes of those patients on the drug decreased in thickness, and the symptoms abated. Approaching chronic sinusitis as an immune disorder creates a different perspective.

Dr. Sherris, now interim chair of the University of Buffalo Department of Otolaryngology, is using the Amphotericin B nasal spray the team used on his patients. He reports on WebMD that this study may indicate the first ever treatment for the cause of chronic sinusitis, rather than a symptomatic approach.

In 1992, an article linked chronic rhinitis to FMS (Cleveland, Fisher, Brestel, et al. 1992). This team studied 47 consecutive patients with allergic rhinitis in a general allergy clinic and found congestion in 91%, rhinitis in 87% and postnasal drip in 83%. Forty-nine percent met the ACR criteria for FMS, and the team concluded: “Rhinitis…is associated with fibromyalgia and may be an underdiagnosed but important causative factor.”

One review shows how neurogenic mechanisms can complicate sinusitis (Baraniuk 2001). Stimulation of nasal sensory nerves leads to pain and congestion. Pain receptors cause release of substance P, stimulating mucosal defense mechanisms. Sympathetic dysfunction then can cause sinuses to fill and the mucosal lining to thicken. Fibromyalgia is associated with sympathetic hypersensitivity.

I have been working on a review of 200 patient interviews picked at random from over 1000 interviews done between 1992 through 1999. [This review will be posted on the website.] These patients had diagnosed or suspected FMS and/or CMP. The patient interviews were reviewed to identify and assess possible symptom clusters and patterns. Almost all of the patients had at least one myofascial trigger point (TrP), and most of the patients had either CMP or a combination of FMS and numerous TrPs. Of the 200 patients, only 11 patients did not have either FMS or CMP. The most common symptom listed was post-nasal drip. Of the 189 patients with either FMS and/or CMP, all 189 had post nasal drip. This result was unexpected. The post nasal drip was frequently accompanied by sinus congestion and runny nose.

Specific head and neck TrPs can cause drippy nose and congestion. Trigger points in the sternocleidomastoid muscles (SCM) alone can cause, among other things, coordination problems, proprioceptor dysfunction, dizziness, imbalance, neck soreness, a swollen-glands feeling, runny nose, maxillary sinus congestion, tension headaches, eye problems (tearing, blurred or double vision, inability to raise the upper eyelid, dimming of perceived light intensity), spatial disorientation, postural dizziness, vertigo and nerve impingement (Simons, Travell, Simons 1999). Many of these symptoms mimic chronic sinusitis. A picture was developing.

Late in 2003 I had been given another piece of the puzzle, although I didn’t know it at the time.

I met with Lawrence Funt, DDS, MSD, Director of the CranioFascial Pain Center in Bethesda, MD. During an afternoon together, we discussed Janet Travell and the founding of myofascial medicine. We also discussed the Funt-Symptom Index (Funt 1988). During the course of a long career in pain management, Dr. Funt had noticed patterns of symptoms that occurred in patients in sequence, according to age and length of pain history. His patients between the ages of 4 and 6 years experienced clenching of the jaw, stuffy ears and headaches. Symptoms progressed, and by age 21 to 30 there appeared, among other symptoms, maxillary sinus pain that became increasingly frequent. This later fit into the puzzle. We also spoke of biofilms.

Biofilms are becoming increasingly important in medicine, science and technology. Bacteria and other organisms have developed a successful survival strategy. They grow in a slimy mass, covering themselves with protective polysaccharides. These biofilms develop on the surfaces of medical devices, in air and water treatment systems, and in human bodies. Organisms in biofilms are remarkably resistant to anything you throw at them. Counter agents need to get through the slime and kill all the organisms, or the buggies just multiply themselves right back, often with a resistance to the first counteragent used against them. The July 4, 2003, edition of Science gave a good description of biofilms as a community, with a layer of slime covering “…the entire community, protecting it from attacks by the body’s immune system.” That piece fingered biofilms as the culprit in bladder infections. Osteomyelitis, Cystic Fibrosis, prostatitis, and middle ear infections are biofilm infections (Costerton 1998).

Organisms in biofilms are protected against antibacterial chemicals and environmental predators. Nutrient limitations and the build-up of toxic metabolites favor the formation of biofilms (Donlon, Costerton 2002). This occurs often in FMS (Starlanyl and Copeland 2001) and in the area of a myofascial TrP (Simons, Travell, Simons 1999). Biofilms are associated with increased fibronectin, coaggregation and adhesions, and the production of endotoxins. Biofilms can also be formed by mycobacteria (Hall-Stoodley, Keevil, Lappin-Scott 1999). Organisms forming biofilms are resistant critters. They could be perpetuating factors in a number of cases of FMS and CMP.

Some of my review patients with long-standing symptoms had mentioned childhood dental problems. Others recalled frequent bouts of sinusitis and earaches. Sternocleidomastoid TrPs are common and cause a lot of symptoms that can be mistaken for sinusitis. Trigger points in the longus colli muscle can cause sore throat, persistent tickle in throat, and a lump in throat. Deep anterior neck muscles can refer to the laryngeal area. Cricoarytenoid TrPs cause regional muscle pain on talking, and a sore throat. Other TrPs can be responsible for ear pain, stuffiness of the ear, and temporary hearing impairment. One study found that of 111 patients with suspected chronic maxillary sinusitis, only 56% had that diagnosis verified. In 61 % of the patients in whom it could not be verified, dental infections and/or myofascial pain were the most common cause (Lindahl, Lelen, Ekedahl 1982). Possible patterns were emerging.

Chronic sinusitis (or its symptoms) is frequently treated by antibiotics. Patients often reported frequent antibiotic use during periods of their lives. The use of antibiotics would enhance fungal problems, although they might reduce congestion if there were a secondary bacterial infection. The drippy nose and congestion would return, because the fungi and immune response would remain.

Patients often mentioned chronic yeast infections. Women especially reported this, although some men and boys also mentioned gastrointestinal yeast problems or thrush. Many patients also had symptoms of reactive hypoglycemia or insulin resistance. Insulin resistant states provide a fertile home for fungi and yeasts. A subset of patients also reported mold sensitivity, although this was not one of the parameters of the review. Several patients also reported treatment with antifungals Nystatin and/or Diflucan. Some required Nystatin to be administered concurrently with any antibiotic therapy to avoid further yeast infection. Sensations of CNS swelling were reported, often linked with cognitive deficits. Some mentioned these worsened when sweets or other heavy carbohydrate meals were eaten, and some described easing of these symptoms with use of diuretics and/or higher protein diets.

Nystatin works in the gastrointestinal system to destroy yeast there. Diflucan works systemically, but what about the blood-brain barrier? This protective barrier prevents molecules from crossing over to the CNS. It is also a pesky obstacle to effective therapy of the CNS, as many medications can’t cross it. What if an immune response to fungi, possibly in biofilm, were a common instigating or perpetuating factor of central sensitization? Why would the Amphotericin B nasal spray used by Dr. Sheris and his team work better than Diflucan? Enter the last piece of the puzzle — I needed to try an experiment on my own.

Dr. Gunter Oberdšrster and his team have conducted a study to see if an inhaled ultrafine particle could cross along the olfactory nerve into the olfactory bulb (Oberdšrster, Sharp, Atudorie, et al 2004). They found that a particle could move into the CNS from the nasopharyngeal area. The study is not yet published but is in press and is available on the web. It was done on ultrafine particulates, but it indicates to me that a nasal spray might have a better chance of reaching the CNS and any fungi within.

The puzzle, while by no means complete, gave me enough for action. I was still hesitant, because Amphotericin B is not a medication to be used lightly. I had no experience with it as a nasal spray. I called my compounding pharmacist, George Roentsch, at The Apothecary in Keene, NH. He told me that compounded Amphotericin B nasal spray was generally used at 20 mcg/ml, required refrigeration and had a short shelf life, but his experience was that the spray used 5 times a day in each nostril for two weeks was sufficient to bring relief of symptoms without side effects. I spoke with my primary care physician and my allergist as well as my local myofascial trigger point doctor. With my history of severe FMS and CMP, plus Metabolic Syndrome, sleep apnea, a long history of mold and yeast allergies, immune therapy for multiple fungi, and frequent interstitial swelling, they agreed that I seemed like a good candidate for this therapy. I had other allergies and knew that this would do nothing for them, but I hoped that any CNS mold component and associated immune response might be brought under control.

I first went on a course of Diflucan therapy, with no change in symptoms. After allowing my body recovery time from the Diflucan, I went on the Ampho B nasal spray for 2 weeks. The deep congestion that I hadn’t been able to relieve since they took PPA (original Contac formula) off the market went away. The fluids in my body tissues are rearranging themselves. The TrPs are becoming more available to treatment, although I noted a phenomenon that others have reported.

As the central sensitization lessened, the TrP symptoms became more noticeable. The increase in myofascial pain was considerable at first, but I have TrPs in almost every layer of every muscle. My myofascia is unwinding, satellite and secondary TrPs are being eliminated, and bones are shifting back into a more normal position. This is not a comfortable process, but it is a necessary one to resume a higher standard of health. My pain level is down with less medication. I believe that one perpetuating factor in my life has been found and brought under control, at least somewhat. I have multiple allergies and the symptoms were further aggravating several of my medical conditions. After further research, I decided to go for retesting and resumed allergy shots.”

My blood levels are regularly monitored by Dr. Lynne August at Health Equations. We had been unable to get the cholesterol and triglycerides down with diet alone, and my health team agreed that the cholesterol could well be protecting me from something and I did not wish to return to cholesterol medications. After the Ampho B nasal spray therapy, my triglycerides dropped from 261 to 155, my cholesterol dropped from 350 to 287, my cholesterol/HDL ratio normalized, and the toxin load dropped. This is only one test, but the only thing that changed was the nasal spray therapy. Time and later blood testing will tell if the Metabolic Syndrome can be taken off my co-existing conditions (and perpetuating factors). This is all very recent, and I don’t know where my health level will stabilize. I know that there are other hidden perpetuating factors. The good thing about that is when a perpetuating factor is found, something can often be done. It just takes a little detective work and the right pieces of the puzzle.

This therapy is not a cure for FMS or CMP. Chronic sinusitis caused by an immune reaction to fungi may be part of the central sensitization process in some cases of FMS. It may be a perpetuating factor in CMP. We still don’t know how safe this therapy is.

This is all very new. It will take time and money for researchers to provide these answers. If patients have an indicative history, such as frequent yeast infections, reactive hypoglycemia or insulin resistance, mold sensitivity, resistant congestion and post nasal drip, I believe that this is a therapy that is worth considering.

Update October 2010: Ipratropium Bromide Nasal Solution 0.06% (Atrovent) is a prescription nasal spray that is anticholinergic. Trigger points can cause congestion and runny nose, and they are associated with excess acetylcholine at the motor end plate. This spray comes in a 15 ml spray bottle, and may be very helpful for these symptoms when TrPs are involved. Start carefully, with one spray one day, and check for any side effects.

Update: Current information indicates that intestinal permeability and insulin resistance are often some of the causes contributing to chronic illness. (Textbook of Functional Medicine, Jones DS, Quinn S, editors, 2005-6; see “functional medicine.org” on the web). More about this on a handout “Healing Dysfunctional Gut” on this website. In many cases, excess mucus production contributing to post nasal drip may be the body’s attempt to protect against gastric reflux (GERD). Many cases of GERD may be silent, without obvious heartburn symptoms but causing excess mucus, chronic cough, and dysruptive sleep. If you have unrestorative sleep, GERD, silent or active, may be part of this, and a sleep study that includes gastric monitoring may be what you need. Talk to your doctor about this possibility.

References

Baraniuk JN. 2001. Neurogenic mechanisms in rhinosinusitis. Curr Allergy
Asthma Rep 1(3):252-261.

Cleveland CH Jr, Fisher RH, Brestel EP et al. 1992. Chronic rhinitis: an underrecognized
association with fibromyalgia. Allergy Proc 13(5):263-267.

Costerton JW. 1998. Biofilms…A Growing Problem. Seminar: Center for Biofilm
Engineering. Maunco Seminars. [www.maunco.com/seminars/transcripts/
biofilms.htm]

DeLeo JA, Tanga FY, Tawfik VL. 2004. Neuroimmune activation and neuroinflammation
in chronic pain and opioid tolerance/hyperalgesia. Neuroscientist
10(1):40-52.

Donlan RM, Costerton JW. 2002. Biofilms: Survival Mechanisms of Clinically
Relevant Microorganisms. Clin Microbio Rev Apr p. 167-193. Funt LA. 1988. The pain doctors: the evolution of pain practice. Interview by Drs. John Herald and Michael P. Pecenka. Dent Manage 28(9):60-64, 66.

Hall-Stoodley L, Keevil CW, Lappin-Scott HM. 1999. Mycobacterium fortuitum and
mycobacterium chelonae biofilm formation under high and low nutrient conditions. J
Appl Microbiol Symposium Suppl. 85:60S-69S.

Oberdšrster G, Sharp Z, Atudorei V et al 2004. Translocation of inhaled ultrafine
particles to the brain. Inhalation Toxicol (in press).

Simons DG , Travell JG, Simons LS. “Myofascial Pain and Dysfunction: The Trigger Point
Manual”, vol I, edition 2. Baltimore, MD: Williams and Wilkins;1999.

Starlanyl DJ and Copeland ME. 2001. Fibromyalgia and Myofascial Pain: A Survival
Manual edition 2. Oakland CA: New Harbinger Publications.

Staud R. 2004. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol
16(2):157-63.

Personally, I enjoy the Bobs Red Mill Organic extra thick oatmeal.  For a 32 ounce package you’ll pay about $4 plus tax.  That’s about $2 a pound compared to the cost of Quaker Oats in Bulk at Costco for about $70 cents a pound.  So there is a definite premium to be paid not only for the “Organic” quality, but for the boutique type of product.  But in my view it’s worth it and here is why.  2 pounds of oatmeal is about 8 very large servings.  So that’s only 50 cents per serving to eat the very best oatmeal.  Compare that to the other foods in your diet on a per meal basis and you’ll find the cost of eating organic oatmeal from Bob’s pretty cheap!  Throw in the fact that these are “extra thick” which means more chewy and less pasty and you have a real winning combination.

For my daily breakfast I like to include a quarter cup of blueberries (or other in season fruit), banana slices (almond slices are great too), a sprinkle of cinnamon, a few teaspoons of honey, and freshly made almond milk (from the Vitamix).  This combination of nutrition just can’t be beat – yummy, filling, and packed with nutrients.

Bobs Red Mill gluten free products are also among the very best, but y0u’ll pay a significant premium for these above and beyond the premium paid for Bobs Organics.  For some people this is simply not an option financially, but for those that must eat gluten free and can afford the prices this is a god send.

Sadly most of Bobs Red Mill recipes advocate the use of Canola oil which in my view is toxic poison.  Sure Canola Oil looks healthy on paper, but it’s crap cheap junk oil.  Canola oil is made from a Genetically Modified Rape Seed… and I’m not going to get into why it’s such unhealthy crap oil here, only that it’s very disappointing that an otherwise good manufacturer could advocate it’s use.

Back on point – if you are looking for a very tasty wholesome Organic Oatmeal give the “Extra Thick” Bobs Red Mill Oatmeal a try.  I’ve tried many types of Oatmeal (Including Coaches Oats) and it simply doesn’t compare.

And before I forget… try the Organic Quinoa Flour to really boost the nutrition profile of your baked goods.

Not surprisingly, reaction to the news among dieters has been disparaging and defensive, as each person cycles through the Kubler-Ross five stages of grief, from denial and anger to bargaining, depression and acceptance.

“Now the health police tell us we can’t drink Diet Coke,” captures the tone on many of the diet blogs.

If it’s any consolation for diet-soda fans, the results presented at the meeting — based on preliminary analysis from a 2,500-person subset of the ongoing Northern Manhattan Study (NOMAS) — are far from definitive. There’s no way to tell yet, for example, what ingredient would be associated with strokes or whether lifestyle choices among drinkers are the real cause.

That said, is drinking diet soda safe? Of course not, especially when it is the main source of liquid refreshment every day. You’re drinking copious amounts of phosphoric acid, artificial colors, artificial flavors, and some laboratory-crafted chemical that tricks your brain into perceiving the sensation of sweet.

Diet soda is an alternative to regular soda, but neither is healthy. You are merely trading calories from sugar for chemicals of questionable nature.

Hooked on sugar

The proliferation of diet soda cuts to the core of what’s wrong with the Western diet. The Western approach is to remove the most obvious dangers from an unhealthy habit — in this case, removing the 12 teaspoons of sugar per can of fizzy water laced with acids, colors and flavors of uncertain origin — so that we can continue that habit in denial of other dangers.

The underlying problem is that we are addicted to sugar; beverages without a sweetener now seem bland. For the first million years or so of pre-human and human existence, water was adequate to quench our thirst. But apparently no longer.

Hold the sugar and corn syrup and pass the aspartame. Some doctors actually encourage dieters to drink diet soda to cut calories instead of recommending zero-calorie water or tea.

We see this “short-cut” diet phenomenon also among some people who want to be vegetarian. They eat vegetarian hot dogs and other faux-meat dishes made from heavily processed soy and vegetable meal loaded with salt, sugar and fat. This is likely unhealthier than the meat they are shunning.

So, similarly, at issue is that we are so addicted to meat that meals without it no longer seem satiating. To do vegetarianism right, you’d have to learn how to cook lentils, beans, grains and other staples of a vegetarian diet, and that’s too consuming for many people.

Writing on the wall

Studies on diet soda have been flawed, because researchers have discounted one important fact: Those drinking diet soda likely drink it not because they are health nuts but because they have a certain health condition. They are either overweight or diabetic. Thus, they are at risk for strokes, heart attacks and cancer regardless of the type of beverage they prefer.

One of the more impressive aspects of the NOMAS project is that researchers can control for weight and other health conditions. It’s inevitable that NOMAS and similar studies will tease out the dangers of drinking too much soda in general, either diet or regular.

It is a shame the United States cannot adopt Asia’s tradition of unsweetened teas, ubiquitous in shops and vending machines. But even otherwise healthy green tea in the United States is tainted with sugar or artificial sweetener — yet another example of corrupting a healthy alternative.

The bottom line is that dieters need to cycle through those Kubler-Ross stages to reach acceptance: Diet soda is no healthy alternative, and nothing beats water.

Source:  Yahoo News Live Science

“You can detect everything from diabetes to nutritional deficiencies just by examining the feet,” says Jane Andersen, DPM, president of the American Association of Women Podiatrists and a spokeswoman for the American Podiatric Medical Association.

The lowly left and right provide plenty of insightful data: Together they contain a quarter of the body’s bones, and each foot also has 33 joints; 100 tendons, muscles, and ligaments; and countless nerves and blood vessels that link all the way to the heart, spine, and brain.

Unresolved foot problems can have unexpected consequences. Untreated pain often leads a person to move less and gain weight, for example, or to shift balance in unnatural ways, increasing the chance of falling and breaking a bone.

So when the feet send one of these 18 warning messages, they mean business.

1. Red flag: Toenails with slightly sunken, spoon-shaped indentations

What it means: Anemia (iron deficiency) often shows up as an unnatural, concave or spoonlike shape to the toes’ nail beds, especially in moderate-to-severe cases. It’s caused by not having enough hemoglobin, an iron-rich protein in the blood cells that transports oxygen. Internal bleeding (such as an ulcer) or heavy menstrual periods can trigger anemia.

More clues: On fingers as well as toes, the skin and nail beds both appear pale. The nails may also be brittle, and feet may feel cold. Fatigue is the number-one sign of anemia, as are shortness of breath, dizziness when standing, and headache.

What to do: A complete blood count is usually used to diagnose anemia. A physical exam may pinpoint a cause. First-step treatments include iron supplements and dietary changes to add iron and vitamin C (which speeds iron absorption).

2. Red flag: Hairless feet or toes

What it means: Poor circulation, usually caused by vascular disease, can make hair disappear from the feet. When the heart loses the ability to pump enough blood to the extremities because of arteriosclerosis (commonly known as hardening of the arteries), the body has to prioritize its use. Hairy toes are, well, low on the totem pole.

More clues: The reduced blood supply also makes it hard to feel a pulse in the feet. (Check the top of the foot or the inside of the ankle.) When you stand, your feet may be bright red or dusky; when elevated, they immediately pale. The skin is shiny. People with poor circulation tend to already know they have a cardiovascular condition (such as heart disease or a carotid artery) yet may not realize they have circulation trouble.

What to do: Treating the underlying vascular issues can improve circulation. Toe hair seldom returns, but nobody complains much.

3. Red flag: Frequent foot cramping (charley horses)

What it means: The sudden stab of a foot cramp — basically, the hard contraction of a muscle — can be triggered by fleeting circumstances such as exercise or dehydration. But if it happens often, your diet may lack sufficient calcium, potassium, or magnesium. Pregnant women in the third trimester are especially vulnerable thanks to increased blood volume and reduced circulation to the feet.

More clues: Charley horses tend to rear up out of nowhere, often while you’re just lying there. They can be a single sharp muscle spasm or come in waves. Either way, soreness can linger long afterward.

What to do: Try to flex the foot and massage the painful area. You may also be able to relax the muscle by applying a cold pack or rubbing alcohol. To prevent cramps, stretch your feet before you go to bed. Then drink a glass of warm milk (for the calcium).

4. Red flag: A sore that won’t heal on the bottom of the foot

What it means: This is a major clue to diabetes. Elevated blood glucose levels lead to nerve damage in the feet — which means that minor scrapes, cuts, or irritations caused by pressure or friction often go unnoticed, especially by someone who’s unaware he has the disease. Untreated, these ulcers can lead to infection, even amputation.

More clues: Oozing, foul-smelling cuts are especially suspect because they’ve probably been there awhile. Other symptoms of diabetes include persistent thirst, frequent urination, increased fatigue, blurry vision, extreme hunger, and weight loss.

What to do: Get the ulcer treated immediately and see a doctor for a diabetes evaluation. Diabetics need to inspect their feet daily (older people or the obese should have someone do this for them) and see a healthcare professional every three months.

5. Red flag: Cold feet

What it means: Women, especially, report cold feet (or more precisely, their bedmates complain about them). It may be nothing — or it may indicate a thyroid issue. Women over 40 who have cold feet often have an underfunctioning thyroid, the gland that regulates temperature and metabolism. Poor circulation (in either gender) is another possible cause.

More clues: Hypothyroidism’s symptoms are pretty subtle and appear in many disorders (fatigue, depression, weight gain, dry skin).

What to do: Insulating layers of natural materials work best for warmth. (Think wool socks and lined boots). If you also have other nagging health complaints, mention the cold feet to your doctor. Unfortunately, however, aside from treatment with medication in the event of a thyroid condition, this tends to be a symptom that’s neither easily nor sexily resolved.

6. Red flag: Thick, yellow, downright ugly toenails

What it means: A fungal infection is running rampant below the surface of the nail. Onychomycosis can persist painlessly for years. By the time it’s visibly unattractive, the infection is advanced and can spread to all toenails and even fingernails.

More clues: The nails may also smell bad and turn dark. People most vulnerable: those with diabetes, circulatory trouble, or immune-deficiency disorders (like rheumatoid arthritis). If an older person has trouble walking, sometimes the problem can be traced to the simple fact that as infected nails grow thicker, they’re harder to cut and simply go ignored to the point of pain.

What to do: See a foot specialist or your regular physician for care and treatment. In serious cases, over-the-counter antifungals are usually not as effective as a combination of topical and oral medications and the professional removal of diseased bits. Newer-generation oral antifungal medications tend to have fewer side effects than older ones.

7. Red flag: A suddenly enlarged, scary-looking big toe

What it means: Probably gout. Yes, that old-fashioned-sounding disease is still very much around — and you don’t have to be over 65 to get it. Gout is a form of arthritis (also called “gouty arthritis”) that’s usually caused by too much uric acid, a natural substance. The built-up uric acid forms needlelike crystals, especially at low body temperatures. And the coolest part of the body, farthest from the heart, happens to be the big toe.

“Three-fourths of the time, you wake up with a red-hot swollen toe joint as the first presentation of gout,” says podiatrist Andersen.

More clues: Swelling and shiny red or purplish skin — along with a sensation of heat and pain — can also occur in the instep, the Achilles tendon, the knees, and the elbows. Anyone can develop gout, though men in their 40s and 50s are especially prone. Women with gout tend to be postmenopausal.

What to do: See a doctor about controlling the causes of gout through diet or medication. A foot specialist can help relieve pain and preserve function.

8. Red flag: Numbness in both feet

What it means: Being unable to “feel” your feet or having a heavy pins-and-needles sensation is a hallmark of peripheral neuropathy, or damage to the peripheral nervous system. That’s the body’s way of transmitting information from the brain and spinal cord to the entire rest of the body. Peripheral neuropathy has many causes, but the top two are diabetes and alcohol abuse (current or past). Chemotherapy is another common cause.

More clues: The tingling or burning can also appear in hands and may gradually spread up to arms and legs. The reduced sensation may make it feel like you’re constantly wearing heavy socks or gloves.

What to do: See a physician to try to pinpoint the cause (especially if alcohol addiction doesn’t apply). There’s no cure for peripheral neuropathy, but medications from pain relievers to antidepressants can treat symptoms.

9. Red flag: Sore toe joints

What it means: Rheumatoid arthritis (RA), a degenerative joint disease, is often first felt in the smaller joints, such as the toes and the knuckles of the hands.

More clues: Swelling and stiffness usually accompany the aches. This pain tends to be symmetrical; for example, it happens simultaneously in both big toes or in both index fingers. RA develops more suddenly than degenerative arthritis, and attacks may come and go. Women are almost four times more affected than men.

What to do: A full workup is always needed to pinpoint the cause of any joint pain. For RA, there are many medications and therapies that can minimize pain and preserve function, though early diagnosis is important to avoid permanent deformity. (In the feet, the toes can drift to the side.)

10. Red flag: Pitted toenails

What it means: In up to half of all people with psoriasis, the skin disease also shows up in the nail as many little holes, which can be deep or shallow. More than three-fourths of those with psoriatic arthritis, a related disorder that affects the joints as well as the skin, also have pocked, pitted nails.

More clues: The nails (fingers as well as toes) will also thicken. They may be yellow-brown or have salmon-colored patches. The knuckle nearest the nail is also likely to be dry, red, and inflamed.

What to do: A variety of medications can treat both psoriasis and psoriatic arthritis and can restore the nail bed surface in many cases, especially if treatment begins early.

11. Red flag: Being unable to raise the foot upward from the heel

What it means: “Foot drop” (also “drop foot”) signals nerve or muscle damage that can originate well north of your feet — as far as your back or even shoulder or neck. Certain chemotherapy drugs can also cause trouble lifting the front part of the foot while walking or standing.

More clues: There may be pain and numbness as well, though not necessarily. Sometimes the pain is felt in the upper leg or lower spine, where a nerve is pinched (by damage or a tumor). In some cases, the foot drags when the person walks. It’s rare for both feet to be affected.

What to do: Report this serious symptom to your doctor. Foot drop can be completely reversible or permanent, depending on its cause and treatment.

12. Red flag: Dry, flaky skin

What it means: Even if your face or hands tend to be powdery-dry, don’t dismiss this skin condition on your feet. You don’t have to be a jock to contract athlete’s foot, a fungal infection that usually starts as dry, itchy skin that then progresses to inflammation and blisters. When blisters break, the infection spreads.

(The name comes from the moist places the fungus thrives — places athletes tend to congregate, such as locker rooms and pools.)

More clues: Athlete’s foot usually shows up between the toes first. It can spread to the soles and even to other parts of the body (like the underarms or groin), usually due to scratching.

What to do: Mild cases can be self-treated by bathing the feet often and drying them thoroughly. Then keep the feet dry, including using foot powder in shoes and socks. If there’s no improvement in two weeks or the infection worsens, a doctor can prescribe topical or oral antifungal medication.

13. Red flag: Toes that turn patriotic colors

What it means: In cold weather, Raynaud’s disease (or Raynaud’s phenomenon) causes the extremities to first go white, then turn blue, and finally appear red before returning to a natural hue. For reasons not well understood, the blood vessels in these areas vasospasm, or overreact, causing the tricolor show.

More clues: Other commonly affected areas include the fingers, nose, lips, and ear lobes. They also feel cool to the touch and go numb. Women and those who live in colder climates get Raynaud’s more often. It typically shows up before age 25 or after 40. Stress can trigger Raynaud’s attacks, too.

What to do: See a doctor about medications that can widen blood vessels, which reduces the severity of attacks.

14. Red flag: Feet that are really painful to walk on

What it means: Undiagnosed stress fractures are a common cause of foot pain. The discomfort can be felt along the sides of the feet, in the soles, or “all over.” These fractures — they often occur repeatedly — may be caused by another underlying problem, often osteopenia (a decrease in optimum bone density, especially in women over age 50) or some kind of malnutrition, including a vitamin D deficiency, a problem absorbing calcium, or anorexia.

More clues: Often you can still walk on the broken bones; it just hurts like heck. (Some hardy people have gone undiagnosed for as long as a year.)

What to do: See a foot doctor about any pain. If, for example, you’ve been walking around Europe for three weeks in bad shoes, your feet may simply be sore. But a 55-year-old sedentary woman with painful feet may need a bone-density exam. An X-ray can also reveal possible nutritional issues that warrant a referral to a primary care provider.

15. Red flag: Toes that bump upward at the tips

What it means: When the very tips of the toes swell to the point where they lose their usual angle and appear to bump upward at the ends, it’s called “digital clubbing” or “Hippocratic clubbing” after Hippocrates, who described the phenomenon 2,000 years ago. It’s a common sign of serious pulmonary (lung) disease, including pulmonary fibrosis and lung cancer. Heart disease and certain gastrointestinal diseases, such as Crohn’s disease, are also associated with clubbing.

More clues: Fingers can be clubbed as well as toes. It can happen in just some digits, or in all.

What to do: Treatment depends on the underlying cause, so report this serious symptom to a doctor. (Physicians are also well trained to look for clubbed digits during exams.)

16. Red flag: Shooting pain in the heel

What it means: Plantar fasciitis — a fancy name for inflammation of a band of connective tissue (fascia) running along the bottom (plantar) of the foot — is abnormal straining of the tissue beyond its normal extension.

More clues: The pain starts when you take your first steps in the morning and often intensifies as the day wears on. It’s usually concentrated in the heel (one or both) but can also be felt in the arch or in the back of the foot. Running and jumping a lot can cause it, but so can insufficient support. You’re at risk if you go barefoot a lot or wear old shoes or flimsy flip-flops, have gained weight, or walk a lot on hard surfaces.

What to do: If pain persists more than a few weeks or seems to worsen, have it evaluated by a podiatrist. Stick to low shoes with a strong supportive arch until you get further advice and treatment (which may include anti-inflammatory drugs and shoe inserts).

17. Red flag: “Phee-uuuuw!”

What it means: Though smelly feet (hyperhidrosis) tend to cause more alarm than most foot symptoms, odor — even downright stinkiness — is seldom a sign something’s physically amiss. (Whew!) Feet contain more sweat glands than any other body part — half a million between the two of them! And some people are more prone to sweat than others. Add in the casings of shoes and socks, and the normal bacteria that thrive in the body have a feast on the resulting moisture, creating the smell that makes wives and mothers weep. (Both sexes can have smelly feet, but men tend to sweat more.)

More clues: In this case, the one olfactory clue is plenty.

What to do: Wash with antibacterial soap and dry feet well. Rub cornstarch or antiperspirant onto soles. Toss used socks in the wash; always put on a fresh pair instead of reusing. Stick to natural materials (cotton socks, leather shoes) — they wick away moisture better than man-made materials. Open up laced shoes after you remove them so they get a chance to fully air out; don’t wear them again until they’re fully dry.

18. Red flag: Old shoes

What it means: Danger! You’re a walking health bomb if your everyday shoes are more than a couple of years old or if walking or running shoes have more than 350 to 500 miles on them. Old shoes lack the support feet need — and footgear wears out faster than most people think, foot specialists say.

More clues: Blisters (too tight), bunions (too narrow), heel pain (not enough support) — if you’re having any kind of foot trouble, there’s at least a 50-50 chance your shoddy or ill-fitting footwear is to blame.

Older people are especially vulnerable because they fall into the habit of wearing familiar old shoes that may lack support, flexibility, or good traction.

What to do: Go shoe shopping.

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Calmare Pain Treatment Device

This is NOT an advertisement. We make ZERO income from promoting or recommending the treatment option.  In fact I have not yet tried Calmare due to cost ($150 per session on average). I have an appointment scheduled with a Pain Treatment Center that uses the Calmare Device and hope it works!

Update Jan 31, 2011: I had one 45 minute treatment with the Calmare Pain Therapy system today. The treatment itself is not very painful. Once the surface electrodes are attached variable current is applied by the technician until you reach a point where you can feel the device but it is not causing you pain by itself. Electrodes are placed near your primary pain source but not on them. When current is applied it feels a lot like a pin prick. There is a small amount of electrical “twitching” which you may feel as well. The amount of sensation you receive is actually much less than from electronic acupuncture therapies. There is nothing that actually penetrates your skin. In short you shouldn’t have any fear of being hooked up to the device. Of course if you have a pacemaker you should tell your Doctor as that could be a problem.

Does it work? I don’t know yet. I do feel some relief in my neck area and my arms but it has only been a few hours, so I don’t know of the pain relief will “stick”. I also feel relief after heated ultrasound and massage. So who knows? Unfortunately I do not have the means to complete the standard 10 session protocol. However if you do… you should give this treatment option a serious run… it could prove life changing for you! For me? If I had the money I would continue on with treatment but sadly I don’t. Like most pain therapy there is a real cost – and it’s often expensive. At this point most insurance companies will not pay for the Calmare Pain Therapy.

While FDA Approved most insurance companies still consider this investigational and will NOT cover the cost (Isn’t that usually the case?).

For those of you who have “Tried Everything” this is another option.  I am NOT an expert on the Calmare Treatment, but I have read the material on how it works.

What makes Calmare Pain Treatment different is it is not intended to BLOCK pain signals, rather to retrain the brain into believing these signals are NOT pain (At least that is my understanding of the process – I hope to learn more soon).

Please watch the video and visit the Calmare Site to learn more.  I aplogize for the pop up window – But I believe this could be a Breakthrough for many pain patients; perhaps even the one drug free pain solution that actually works for you!

Company Website

Calmare Pain Treatment Company Website

Video about Calmare Pain Treatment

Please enjoy this article which explains a newer technique being used in Europe and Canada to avoid Fluoroscopy during interventional injections.

Chronic Pain Management Revolutionized

A promising new development for the 20 to 30 per cent of Canadians suffering from chronic pain is on the horizon. Sunnybrook is now using ultrasound guided procedures to manage this condition, making it the only academic health centre in Canada and one of only two in North America to do so.

As a leader in innovative care experiences, Sunnybrook’s use of this effective, but uncommon, new tool is showing substantial benefits on many fronts – patients’ quality of life, cost savings, and lowered wait times.

Sunnybrook’s pain management clinic sees patients from all over Ontario, which can result in substantial wait times. However, the use of this innovative measure in managing pain reduces wait times considerably by cutting down hospital visits.

“The use of ultrasound guidance saves patients from making several trips to the hospital and cuts wait times from approximately nine months to three months,” says Dr. Michael Gofeld, a staff physician at Sunnybrook’s Anesthesia Department and Pain Management Program, and one of the first staff members to introduce this innovative technique to the hospital. “Unlike other tools used for pain management, ultrasound guided procedures can often be carried out immediately following a patient’s consultation, which means there is no need to book a separate appointment.”

Although ultrasound guided therapy is quite new in chronic pain management, it has shown significant benefit when compared to fluoroscopy (X-ray), which is the more traditional imaging method to guide injections. X-ray requires a separate radiation-proof room, expensive equipment and additional staff. Therefore, if a patient has to undergo several procedures, and X-ray is the only option, it adds substantial cost to the health care system and prolongs wait times.

Fluoroscopy does not allow physicians to see the nerve, which makes them rely mainly on bone anatomy. “Ultrasound is radiation-free and allows us to see the nerve and avoid damage of structures such as the nerve itself, blood vessels and internal organs, which I believe makes it is absolutely superior to fluoroscopy,” says Dr. Gofeld, who is also an assistant professor in the Department of Anaesthesia at University of Toronto.

In cases where surrounding tissues must be visible in order to safely inject the needle, such as procedures performed on the neck, ultrasound guidance has proven to be exceptional as X-ray can not provide the same level of confidence. CT or MRI can also be used for that purpose, but both methods tend to be expensive and untimely; ultrasound is described by Dr. Gofeld as being a faster and much more reliable process.

Ultrasound guided procedures are becoming a widely accepted tool for regional anesthesia, but for pain management it is extremely new, and virtually unheard of despite its advantages. Related citations in medical literature are minimal when compared to those related to ultrasound anesthesia. Because of this, Dr. Gofeld explains that there is huge potential to begin a new chapter in pain research.

Sunnybrook is transforming health care through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and an affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres.  Sunnybrook specializes in caring for critically-ill newborns, adults and the elderly, treating and preventing cancer, cardiovascular disease, orthopaedic and arthritic conditions and traumatic injuries.

Source:  http://www.sunnybrook.ca/

New research suggests that devices suggested as “safe” by Government Agencies may not be so safe after all.

Unless you’ve had your cell phone permanently glued to your ear, chances are you’ve heard the recent health buzz: Mobile devices may cause cancer. While it’s true that the National Cancer Institute has ruled them safe, a growing number of independent researchers disagree.

Those experts point out that the FCC wireless regulations on cell phone safety are largely based on something called specific absorption rate (SAR) levels, or the rate at which our bodies absorb radiation. Most phones do comply with the federal standards, but SAR monitors only thermal effects. (In other words, if the radiation from your phone isn’t cooking your brain, it’s regarded as safe.)

But mounting scientific evidence suggests that nonthermal radio frequency radiation (RF)—the invisible energy waves that connect cell phones to cell towers, and power numerous other everyday items—can damage our immune systems and alter our cellular makeup, even at intensities considered safe by the FCC.

“The problem is that RF can transfer energy waves into your body and disrupt its normal functioning,” explains Cindy Sage, an environmental consultant in Santa Barbara, California, who has studied radiation for 28 years. “Here’s why that’s crucial: Overwhelming evidence shows that RF can cause DNA damage, and DNA damage is a necessary precursor to cancer.”

The 2010 Interphone study, the largest to date on RF exposure from mobile phones, has spawned a quagmire of controversy, says health researcher and medical writer Kerry Crofton, Ph.D., who spent four years reviewing RF science for her book Wireless Radiation Rescue: Safeguarding Your Family from the Risks of Electro-Pollution. Many groups, including the National Cancer Institute and the telecom industry, read the results of that study as a green light for wireless calling. Others, like Crofton, point out that because it was largely based on lower cellphone usage in the ’90s, the research has little bearing on today’s world, in which 285 million Americans have mobile phones and 83 percent of 18- to 29-year-olds are “wired” all the time and sleep with their cell phones next to their heads.

One thing the Interphone study did find? People who chatted via cell for just 30 minutes a day for 10 years saw their risk of glioma (the type of brain tumor that killed Ted Kennedy) rise 40 percent. As a result, many European countries are considering banning cell phones for children under age 6 (RF penetrates little kids’ brains more easily), and France has already banned all wireless technology in some schools and many public places, notes physician and epidemiologist Samuel Milham, M.D., a leader in the growing field of electromagnetic research.

All parties agree on this: More studies need to be done. In the meantime, it’s best to take easy precautions—and not just with mobile phones. “Never before in human history have we gone from one radiated environment to another,” says Crofton. “We’re going to wireless offices and living in wireless homes. Even beaches and parks are going wireless. We’re exposed everywhere.”

The good news is that you don’t need to ditch your gadgets. This advice will let you stay plugged in—and keep you healthy.

Cell Phones

When your phone is on (which it probably is even as you read this) it’s constantly sending and receiving RF signals to and from the nearest cell tower to keep you in service. The farther you are from a tower, the harder your phone has to work and the more RF it emits, explains David Carpenter, M.D., director of the Institute for Health and Environment at the University at Albany. The activity really amps up when you’re, say, driving through rural areas. Plus, within the close confines of a car, your entire core is exposed to the radiation.

The safer solution: Keep your phone off when driving until you really need it, says Carpenter. And no matter where you are, avoid holding a cell phone directly to your noggin (the Interphone study showed gliomas were more prevalent on the side of the head people continuously pressed phones to), always keep it at least six inches or more from your body (in your purse, not your pocket), and use either speakerphone or a corded headset (not a wireless headset). Or text up a storm. If you have a smartphone that’s loaded with games, music, and movies, turn your wireless settings off while playing or rocking out. Similarly, don’t ever use your cell phone as a bedside alarm clock without first disabling the wireless mode.

Cordless Phones

These stealth wireless threats “have become so powerful, they’re often as strong as cell phones,” says Sage. “The phone base is like a mini cell tower. It radiates 24-7 and can have a range of up to 300 feet.” Particularly suspect are digital enhanced cordless telecommunication (DECT) phones. Preliminary blind studies have found that, when sitting beside a DECT phone base, some people experienced arrhythmia, a troubling heartbeat irregularity that could eventually lead to stroke or coronary disease, says Sage.

The safer solution: You might feel somewhat retro, but “just get a corded phone with an extra-long cord so you can still walk around,” says Crofton. “They’re better, they’re cheaper, and they work in a power outage. Every time you replace a DECT with a corded phone, you’re cutting the RF levels in your home significantly.”

Wireless Routers

Your neighborhood coffee shop’s wireless Internet access may often seem like a godsend, but the router that’s needed to provide the service is continuously emitting high levels of RF (up to 200 feet out), and that constant exposure has been linked to deadly diseases. “If the whole body is radiated by a router’s RF emissions, the greatest concern is cancer, especially leukemia,” says Carpenter. Also, be aware of your at-home router and any plug-in wireless USB cards you often use.

The safer solution: Ditch your wireless router and plug your computer directly into a cable modem, says Sage. That Ethernet technology doesn’t leak RF and is often faster and more secure. If you just can’t give up your wireless router (e.g., if you live in a home with a handful of computer users), make sure you sit as far away from it as possible, says Crofton, and turn it off at night and whenever you’re not online. Another easy fix: Plug your router into a surge protector with a timer, and set it to go off each night so you don’t have to remember to flip the switch.

Laptops

“When you hold your laptop on your lap, what you’re essentially doing is radiating your pelvis,” says Carpenter, “so all the cancers that affect that area are of concern.” Indeed, early studies point to a heightened risk of testicular cancer for men who keep RF-emitting devices close to their belts. For women, adds Carpenter, “the studies aren’t quite there yet, but I think we can say that anything that might cause cancer almost always causes birth defects, so pregnant women—or those wanting to become pregnant soon—should take extra precautions.”

The safer solution: Keep your laptop off your lap (if you have to rest it there, buffer it with a sturdy pillow that’s at least six inches thick). Try to use a desktop computer at home and treat your laptop as an on-the-go convenience. One thing to keep in mind: Laptops are a high RF radiation risk only while connected to wireless Internet, so when you’re watching a DVD, fiddling around with your photos, or writing that dissertation, just disable your connection and you’ll be much safer.

Baby Monitors

“Baby monitors release more RF than cell phones do, and putting them next to a crib is very, very unwise,” says Carpenter. He points to a recent University of Utah study that shows RF radiation can penetrate almost entirely through a child’s brain, which doesn’t form completely until nearly 20 years of age. “It’s very clear from all the existing research that the younger the child is, the more vulnerable he or she is to the effects of RF radiation.”

The safer solution: Consider not using a baby monitor. If you absolutely must use one, place it far from your baby’s crib—at least 10 to 15 feet away.

Source:  Women’s Health