1830 S. Alma School Rd
Bldg 7, Ste 135
Mesa, AZ 85210
(480) 839-2273
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PAINFUL COMBINATION – STATINS FOR CHOLESTEROL AND ARTHRITIS
I just left a meeting where I found out one of our members had been hospitalized for kidney failure following rhabdomyolysis (muscle damage). The first thought to pop into my mind was statins. This may or not have been the case, but it is a well known association with taking statins to lower cholesterol.
Since their introduction, the statin class of drugs (think Lipitor, Crestor) has been on a pedestal. By 2003, Lipitor was the best selling drug in history. Just like every drug, the statin class of drugs has a dark side and contributes to conditions such as muscle damage, heart damage, liver and kidney problems, diabetes and cancer.
The sad part about all this is that basically, statins absolutely suck at preventing a first heart attack (the data is somewhat better for 2nd heart attacks, but still trumped by dark chocolate…). There is no other way to describe it. I have review the absolute effectiveness of statins in previous posts. Compare this to the effects of natural approaches:
- Nuts to lower cholesterol
- Berries to improve and protect your heart
- Honey helps to protect the heart
The bottom line is that statins are a very ineffective at preventing a first heart attack (overall, lowers absolute risk of having a heart attack about 1%, the risk of dying from a heart attack even less) and there are natural approaches that are much more effective and safer and cheaper. Worse, there are side effects that are high prevelant and occasionally life threatening.
However, if none of the above side effects really concern you, here’s a new one to add: Damaging rheumatoid arthritis.
In this particular study, researchers found a strong association (absolute 7.3% increase–that means an extra 7 cases of RA for every 100 patients treated with statins) between statin use and rheumatoid arthritis. Keep in mind that RA is one of the most debilitating forms of arthritis.
All because of the use of a drug that will make your numbers look better, but don’t actually fix anything. Lifestyle is the ONLY thing that can do that.
DECLINE IN SKELETAL MUSCLE MITOCHONDRIAL FUNCTION – (05-16-05)
Decline in skeletal muscle mitochondrial function with aging in humans
While we know that skeletal muscle declines with age (a condition referred to as sarcopenia) but the exact mechanism has not been pinned down. Less building of muscle? Increased breakdown?
This article points to my particular “demise of Western civilization as we know it” reason which is oxidative stress and mitochondrial dysfunction. While my wife does not enjoy my deep discussions of mitochondria oxidative phosphorylation over dinner, when my “mitochondrial dysfunction as the root of all evil” book hits the shelves as a bestseller I’ll be able to stick my tongue out at her…
GET RID OF OSTEOARTHRITIS WITH SOFT TISSUE APPROACHES – (12-03-07)
Chondroitin for Osteoarthritis of the Knee or Hip
This review found minimal or no benefit to the use of chondroitin for arthritis of the knee. Before we jump to conclusions… How many people in these studies with knee/hip pain was actually coming from the joint itself? The answer, of course, is that we don’t know. Degenerative joint disease = pain in clinical studies but that just isn’t always true.
For a physician that addresses soft-tissue components of injuries, how often does a knee loaded with arthritis get complete relief with some solid soft tissue approaches? I can personally say that aggressive soft tissue techniques like Graston can sometimes bring complete relief for many OA sufferers. Did we fix the OA? Of course not–but in these cases the soft tissues were the primary pain generators. So we could assume that any type of joint support would not be effective in these cases.
So, in these studies, did they rule out non-joint related pain generators? More of a rhetorical question because of course they did not.
EFFECTIVE ELBOW PAIN TREATMENT FOR COMPUTER USERS
There is no doubt that our bodies were designed with a brilliance that defies description. However, I’m pretty sure that, when it comes to the development of the computer, the powers that be are slapping their foreheads saying, “I didn’t see THAT coming…” Prolonged times spent on the computer are clearly detrimental to our physical being.
Regardless of how good your ergonomic setup is, you were not designed for this. Headaches, neck pain, shoulder pain, elbow pain and wrist pain seem to come along in the box right next to the mouse and keyboard (in the box labeled “Do NOT open,” but you open anyway out of curiosity..).
Elbow pain, whether on the outside (lateral epicondylosis or tennis elbow) or the inside (medial epicondylosis or golfers’ / little leaguers’ elbow) can be a real bummer. Personally, I consider carpal tunnel as the opposite end of the same problem. Important to notice here is that I did not use the suffix “itis.” This is because this condition, like many others we deal with, are not actually a problem with inflamed tissues. Rather, it is a problem with the scar tissue that built up following an injury or overuse. Hence the suffix “osis,” meaning pathology of.
Luckily, there are a variety of ways that can effectively treat this condition.
- First and foremost is making sure your ergonomic setup is as close to ideal as possible.
- Soft tissue techniques like Graston or Fascial Manipulation can help greatly.
- Rehabilitation exercises with a Therabar called the Tyler twist.
Treatment in our office consists of a variety of techniques to treat this condition (check out our YouTube video here).
This particular study finds that soft tissue techniques used to treat elbow pain in computer users were effective at reducing pain (almost 80% improvement in 4 weeks), very much in line with what our office has experienced.
HOW TO STOP LEG PAIN FOR GOOD
As we get older, leg pain with walking becomes all too common. The medical term is claudication. The knee jerk (so to speak) reaction in medicine is to evaluate the vascular system and to see if blocked arteries are causing the problem. However, there are two main causes of claudication.
The first is the one we have already mentioned. Vascular claudication occurs when the patient is living a pro-atherogenic / prediabetic lifestyle. Over time, plaque builds on the arteries going into the legs and the muscles of the legs do not have the oxygen and nutrients they need to function when the demand for oxygen increases with activity. Exercise therapy and surgery to put a stent in the artery are two options. Unfortunately, the outcomes from surgery, quite frankly, suck.
In this particular case, prevention is clearly the best option.
The other type of claudication is called neurogenic claudication. This is caused when arthritis in the spine begins to shrink the opening for the nerves to come out of, a condition called spinal stenosis. It is a slow process that creeps up over the years.
The leg pain that comes on with neurogenic claudication has some differing characteristics from the vascular type. Pain in the legs is less predictable–sometimes it comes on after a minute, sometimes 10, sometimes 8. The pain with vascular claudication is much more consistent with the time to onset. Also, in neurogenic claudication, sitting down for just a minute or two can alleviate the pain quickly, while there is a recovery time in vascular claudication.
This particular study brings to light the fact that many patients with vascular claudication may also have neurogenic claudication as well (up to 76′%). If the physicians looking for vascular claudication are NOT also looking for the spinal component of the leg pain, outcomes may not be as good. The obvious problem here is the vascular specialist looking at the blood vessels is not all that likely to understand the need for a referral to a chiropractor (preferred) or neurosurgeon. The patient gets stuck with incomplete treatment.
For neurogenic claudication related to spinal stenosis, a specific chiropractic treatment called Flexion Distraction can work wonders. This requires a specialized table that applies a gentle traction to the low back, allowing some breathing room to the choked off nerves coming out of the lumbar spine. In conjunction with chiropractic care, the use of an inversion table at home can add additional benefits to your treatment plan.
The bottom line is, anyone with pain in their legs during activity should who is pursuing help from a vascular specialist should also seek an evaluation from a chiropractor who is familiar with Flexion Distraction to evaluate and treat any neurogenic claudication that might be present as well.
AVOID CHRONIC EXPOSURE TO NSAID – (11-05-07)
NSAID Use and Progression of Chronic Kidney Disease
Our society has unquestionably come to view NSAIDs like OTC ibuprofen and it’s prescriptive equivalents as relatively harmless ways to cope with “everyday” pain. The commercials make it sounds like these should be used with no more or less concern than a glass of water.
The reality is that this class of drugs is notoriously suspect in a variety of chronic diseases. We know that as little as 400 mg of ibuprofen can disrupt the integrity of the GI tract. Use has been linked to PROGRESSION of arthritis by inhibiting the ability of the joint surface to heal itself (and, in my clinical opinion, many chronic pain sufferers continue to accumulate new areas of complaints that never seem to heal, which I directly related to NSAID use). Liver damage is known. Here’s the real rub. Cumulative use adds up.
This is not a matter of taking this class of drugs a couple times per month. The likelihood of someone in today’s drug accepting society to hit high cumulative doses is great. And while kidney effects have been known as well for over a decade, the authors use some strong language in this study. “Chronic exposure to NSAIDs should be avoided.”
WHAT CAN INCREASE THE EFFICIENCY OF MITOCHONDRIA? – (08-13-07)
S-Adenosyl-L-Methionine Increases Skeletal Muscle Mitochondrial DNA Density and Whole Body Insulin Sensitivity
Wow!! While I somewhat remember that the methylation pathway and SAMe feed into glutathione (an essential component of one of the body’s most potent detoxifying ezymes and antioxidant enzymes),
I can honestly say using methylators like SAMe, B12 or betaine had not come to mind. Keep in mind this is a mouse study, however, anything that can increase the efficiency of mitochondria is a keeper in my book!
RISKS AND BENEFITS OF SPINAL MANIPULATION – (04-30-07)
A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain
Well, can’t tell you how upsetting this news is to me. Patient who were given exercises to do but did NOT receive adjustments were 8 X more likely to experience a worsening of their disability. Can I share probably one of the best kept secrets in healthcare?
Chiropractic care is more effective and more cost effective for many musculoskeletal conditions. Period. Add into that some aggressive soft tissue work and you’ve got a group of physicians that can rule the world.
AFTER EFFECTS OF WHIPLASH TYPE INJURIES – (04-30-07)
Fatty Infiltration in the Cervical Extensor Muscles in Persistent Whiplash-Associated Disorders: A Magnetic Resonance Imaging Analysis
As a chiropractor, I’ve obviously got some unique perspectives on this issue. It is well documented that a large percentage of patients who experience whiplash type injuries have significant pain 10 yrs later. I firmly believe this is the result of imcomplete treatment following the injury. Strengthening and stretching as done by standard physical therapy procedures will NOT address pathology within the muscles, and adjusting alone will also not impact the muscles either. Full recovery requires a strong approach to both the joints and the muscles.
This article probably won’t show up on the desks of insurance adjusters; many would have their injured patients believe they should be all healed up in a few visits.
RECIPE TO CREATE A DRUG USER
The Federal Bureau of Narcotics was formed over 80 years ago in 1930. In 1954, President Eisenhower formed a council to battle narcotics use here in the United States. In 1971 President Nixon coined the term “war on drugs.” This was further strengthened by President Reagan in 1982. Overall, untold billions of federal dollars have been spent on this effort. Man did we get it all wrong.
We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT! Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.
Codeine, OxyContin, Percocet, Vicodin, morphine, Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.
It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out. In the ER it is almost a given. High likelihood in urgent care. Still far too common in a primary care settings.
And then there are the non-steroidal anti-inflammatory drugs (NSAIDs). Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?
I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is. Arthritis / joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.
The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year. That’s with a “b.” Even uncommon side effects become magnified by this volume of use. Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.
So what does all of this have to do with this particular article? This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year. The results were surprising:
- Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
- Opioids were prescribed to 7.7% at 1 year from surgery
- Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
- Overall, an opioid prescriptions within 7 days of surgery made it 44% more likely to be a long term user
- NSAIDs were prescribed to 0.3% within 7 days of discharge
- NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
- Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users
Wow. Talked about generating a society that is addicted to drugs. And while this study looks at low risk surgery, how similar would the numbers be for neck pain? Low back pain? Knee pain or headache? Makes me happy to be a chiropractor.
Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?
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