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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.

“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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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

The U.S. Preventive Services, which made the recommendation Monday, reported finding evidence that the benefits of treatment based on routine screening of this age group “are small to none.” However, treatment often causes “moderate-to-substantial harms,” including erectile dysfunction and bladder control and bowel problems, the task force said.

The new guidance is the first update by the task force on prostate cancer screening since 2002. Its last report concluded there was insufficient evidence to recommend prostate screening for men of all ages.

In recent years, there has been a growing debate about the value of the somewhat imprecise PSA blood test to detect cancer, as well as the value of treating most prostate cancers. A positive result from the test must be confirmed by a biopsy. And even then, there is no foolproof method of identifying aggressive tumors from slow-growing ones. A number of experts contend patients are being over treated.

“The issue of screening for is frankly an area of medicine that remains somewhat unsettled,” said Dr. Durado Brooks, a prostate cancer specialist for the American Cancer Society. “While it’s clear there is benefit to a significant number of men, it’s equally clear that many men end up being diagnosed and treated for cancers that would likely not have caused them any significant harm.”

Most major U.S. medical groups recommend doctors discuss the potential benefits and known harms of prostate screening with their patients and make individual decisions. And most agree such testing shouldn’t occur before age 50.

The federal task force, which sets the nation’s primary care standards, reviewed past research in reaching its conclusion and “could not find adequate proof that early detection leads to fewer men dying of the disease,” task force chairman Dr. Ned Calonge of Denver said in a statement.

The cancer society’s advice for screening differs from the task force’s because it doesn’t set a fixed age to stop screening, Brooks said. It suggests that men shouldn’t be offered screening if they aren’t expected to live another 10 years.

“That’s because every 75-year-old is not created equal,” said Brooks.

While some have health problems and aren’t likely to live long, others are “very active, very vigorous and have minimal health issues, and many of those men are going to live into their late 80s or 90s,” Brooks said.

Prostate cancer is the most common cancer in American men — about 220,000 cases will be diagnosed this year. It is the second leading cause of cancer deaths in men. But most tumors grow so slowly they never threaten lives.

Earlier this year, a study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating it right away. The vast majority were alive 10 years later without significantly worrying symptoms or had died of other causes.

Prostate cancer treatments are tough, especially on older men. Some doctors instead recommend “watchful waiting” to monitor signs of the disease and treat only if they worsen, but smaller studies give conflicting views of the safety of that approach.

The new guidelines from the Preventive Services were published in this month’s Annals of Internal Medicine.

http://www.annals.org/content/vol149/issue3/

A whole different world of treatment opportunities to vast to cover in a single post. Start with this link for information on Ayurvedic Medicine

TCM Traditional Chinese

Another system of Medicine that has been around for thousands of years, but today typically falls into the realm of “Alternative Medicine” in the eyes of westerners. I would encourage you to at least investigate the basics of Traditional Chinese Medicine.

I have been to a Chinese Medicine Doctor for acupuncture, and I have taken some Chinese Herbs, but beyond that I know little about the practice.

You may find treatmentd in either or both practices that work effectively for your pain problems.

Most people do not realize that oral vitamin consumption may only deliver as little as 5 to 15% of the vitamin to your system. People who are ill generally absorb even less! You’re intestinal tract is your “Second Brain” full of nerves and needs the care an attention the rest of your spine receive. Opportunistic pathogens in one area of the body may prevent another area of the body from receiving the healing attention it needs. The body is a whole!

This is a complex topic whose use extends from Mainstream to Alternative Therapies. The whole point is to bypass the digestive tract and deliver Nutrition/Drugs directly to the bloodstream.

Visit this link to learn more about Intravenous Therapy

Kinesiology, also known as Human Kinetics, is the science of human movement. It focuses on how the body functions and moves. A kinesiological approach applies scientific and evidence based medical principles towards the analysis, preservation and enhancement of human movement in all settings and populations. Kinesiologists work in research, the fitness industry, clinically, and in industrial environments. It is not to be confused with Applied Kinesiology, an alternative medicine technique.

Applied Kinesiology

Applied Kinesiology (AK) is a practice of using manual muscle-strength testing for medical diagnosis and a subsequent determination of prescribed therapy. It purportedly gives feedback on the functional status of the body.

AK is a practice within the realm of alternative medicine and is therefore different from “kinesiology,” which is the scientific study of human movement. AK has been criticized on theoretical and empirical grounds, and characterized as pseudoscience. With only anecdotal accounts providing positive evidence for the efficacy of the practice, a review of peer-reviewed studies concluded that the “evidence to date does not support the use of [AK] for the diagnosis of organic disease or pre/subclinical conditions.”

AK draws together many similar therapies. It attempts an integrated, interdisciplinary approach to health care. George J. Goodheart, a chiropractor, originated AK in 1964.  Subsequently, its use spread to other chiropractors, and a few physical therapists, dentists, and medical doctors. In 1976, the International College of Applied Kinesiology was founded.

Applied kinesiology is a system that evaluates structural, chemical, and mental aspects of health using manual muscle testing alongside conventional diagnostic methods. The essential premise of applied kinesiology that is not shared by mainstream medical theory is that every organ dysfunction is accompanied by a weakness in a specific corresponding muscle, the viscerosomatic relationship. Treatment modalities relied upon by practitioners include joint manipulation and mobilization, myofascial, cranial and meridian therapies, clinical nutrition, and dietary counseling.

A manual muscle test in AK is conducted by having the patient resist using the target muscle or muscle group while the practitioner applies a force. A smooth response is sometimes referred to as ‘a strong muscle’ and a response that was not appropriate is sometimes called ‘a weak response’. This is not a raw test of strength, but rather a subjective evaluation of tension in the muscle and smoothness of response, taken to be indicative of stresses and imbalances in the body. A weak muscle test is equated to dysfunction and chemical or structural imbalance or mental stress, indicative of a body dissatisfied with suboptimal functioning. The most common test is the arm-pull-down test, or “Delta test,” where the patient resists as the practitioner exerts a downward force on an extended arm. Proper positioning is paramount to ensure that the muscle in question is the prime mover, minimizing interference from adjacent muscle groups

Hydro Therapy is simply the use of warm water to help us relax or exercise or both. Hot Tubs, Swimming Pools, Therapy Pools, and even your Home Bathtub can serve as appropriate vehicles for this purpose. Today’s “Hot Tub” contains dozens of jets that can feel wonderful and allow us to release muscle tension and relax. You may have a high end “Whirlpool Tub” or built in Home Spa. Larger bodies of warm water allow us to move from relaxation into exercise, stretching and strengthening. So while passive relaxation has it’s benefit, if you can, try and find a warm water pool large enough to exercise in. Ideally the pool will be no deeper than mid chest level to the bottom of your neck (48″ to 52″) is just about right.

If a pool is too deep it can be dangerous should you become ill. If a pool is too shallow you won’t receive the full benefits of flotation and buoyancy. Water allows us to exercise without stressing the joints. As muscles relax and the forces of gravity are lessened we can enjoy stretching that would not otherwise be possible. An ideal temperature for exercise is 84 to 90 degrees. Much warmer and you’ll become uncomfortable with your movements and begin to sweat a lot. For just relaxation 100 to 102 degrees is wonderful. When the water temperature drops below body temperature and we are not moving it becomes uncomfortable, and water over 104 degrees is very dangerous to our bodies. In fact if your water temperature is above body temperature you should limit your sessions to 20 minutes. Water 104 degrees and higher for periods longer than 20 minutes can damage your internal organs.

Warm water can really help to reduce your stress levels. Often Hydro Therapy is combined with aroma therapy and music to complete the relaxation. It’s hard not to just relax when the pressure is taken off your injury. It’s like an anti-gravity experience where we become weightless.

Some Spas contain special “Neck jets” or “Lumbar jets” that just melt (at least temporarily) away your pain. The warm water dilates the blood vessels promoting healing, and a 20 minute session will help you fall asleep faster

Caveats: You’re skin is an organ and will absorb chemicals in water so ask your dealer about the least chemical solution to keeping the water pure and clean. Tubs will make you sweat and release toxins in the water so be sure to keep your Spa’s water clean. Do not exceed 20 minutes in water over 104 degrees (The limit at which you can set the Spa’s) as your internal proteins will start to cook! If the water feels too hot turn it down, anything over body temperature will make you sweat. Ask your Physician about Hydro Therapy for your condition. Hydro Therapy will not “cure” your condition, but it can go a long ways to making your pain more tolerable and will aid in your recovery most of the time. If prescribed by your Physician you may be able to deduct the expense of a Hydro Therapy Solution from your personal taxes.

Note: Not everyone is comfortable in water. Some people never learn to swim as youngsters, this is okay. That’s why we recommend to find a pool that is not too deep. Find a partner to go with you. Swimming and splashing is fun! Enjoy yourself.

Tips on Purchasing a Hot Tub

There are so many brands available and Hot Tub dealers come and go. Find a local dealer that has been in business a long time with an established track record. The tub is important, but even more important is the warranty and service for that warranty. Tubs require maintenance, you’ll need a source for chemicals. Pumps break, control panels break. Just like purchasing an automobile – think about the “Total Cost of Ownership” not just the up front cost. Be sure to “Wet Test” the tub before you buy! Wet testing is essential, because the tubs feel completely different with and without water. Wet testing means taking your swimsuit to the dealer and sitting in the tub for 10 or 15 minutes. Make sure you can control the jets, make sure the jets are not so powerful that they blow you out of your seat. Try all the seat positions to be sure they are comfortable to your body.

Different Types of Massage Treatments

• Deep Tissue – Targets deep layers of muscles and connective tissue
• Rolfing - A specific form of deep tissue work
• Trigger Point Therapy – Addresses Adhesions in the muscles
• Swedish – most common, long smooth strokes and kneading, circular motions
• Shiatsu – Finger pressure on acupuncture meridians
• Thai
• Many many more

My point in this post is not to cover every single variation of massage, but to point out there are treatments that may address your specific problem areas.

Therapies like Deep Tissue Massage are designed for relieving muscle contraction and reducing pain. Not all massage therapists are alike, some do not understand how to do this properly – this is a form of medical massage, as opposed to just a relaxing massage to reduce stress. All massage work has benefits. Try several different modalities and see what works best for you. Be careful of the oils the therapist uses – I like grapeseed oil.- as some oils contain fragrances and are toxic to the chemically sensitive. You’re skin will absorb these chemicals.

The only downside to massage treatments is cost. I would go everyday if I could afford the expense, or better yet I’d have the therapist stop by my home. Give massage a try, it’s great!

Video About Massage Treatments