Health & Healing from the Pain Healers Alliance: March 2022

Tuesday, March 15, 2022

ESSENTIALS ON SHOCKWAVE TECHNOLOGY

For pain and (MSK) injuries, new treatment techniques, protocols and innovations continue to advance throughout the clinical market. Over the past several decades, NON-INVASIVE technologies (including PEMF, BIOFEEDBACK, NEUROSTIMULATION, COLD LASER etc.) have held widespread appeal to those seeking alternatives to pain medications and other conventional treatments.

Low-Intensity Extracorporeal Shock Wave Therapy (LI-ESWT) - simply referred to as SHOCKWAVE THERAPY is a multidisciplinary device used in orthopedics, physiotherapy, sports medicine, urology and veterinary medicine. Shockwave therapy utilizes an acoustic wave which carries high energy directed to tissue to treat chronic conditions that has failed with traditional treatments. The high energy that is produced promotes regeneration with the ability to repair bones, tendons, and other soft tissues.

Extracorporeal Shockwave Therapy (ESWT) was first introduced into clinical practice back in 1980 as a treatment for non-invasive lithotripsy but within the last two decades, it has been used as a method for musculoskeletal disorders and the stimulation of bone growth. This device has gained popularity in the treatment of various orthopedic conditions including plantar fasciitis, shoulder tendinopathy, elbow tendinopathy, patellar tendinopathy and Achilles tendinopathy. Recently, shockwave treatment has been extended to treat other conditions, including femoral head necrosis, patellar knee jaw, osteochondritis and calcified shoulder tendonitis. [1]

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“GOING WIDE” AFTER THE BASE LINE

by: Dr. Robert L. Bard / Diagnostic Imaging Specialist

The research benefits of using ultrasound scanning in therapeutic monitoring allows for tremendous flexibility in exploratory detection. Once we have established the initial Base Line of the ‘before and after’ scan, having probe in hand empowers the diagnostician to go deeper and wider- allowing for more answers and possibly finding other pathologies. After we looked at the obvious muscle abnormality, the question is to go back and see what's causing the problem.

Upon observing what’s under the white skin area, there appears a very thick white band (FASCIA covering the muscle) between the two dark layers of the subcutaneous fat and the muscle. We notice that the fascia splits into two levels with the upper arrows, denoting the top part of the split and the lower arrows showing the bottom part of the split. The black area in the split is filled with fluid indicating the fascia lining is abnormal and this is a way that we can follow the cause for the muscle irritation in future tracking. For now, we see an immediate cause and effect, which is the inflamed fascia lining and that the therapy does in fact calm down the muscle. Ultrasound imaging provides the opportunity to follow the treatment and see how the facial abnormality is healing. So we have a way of finding pathology and then discovering the causation and documenting treatment progress as well with non-invasive imaging, that is brilliant.

Public Service Announcement:

LEARNING FROM THE PROS:
A Spotlight on a Top Clinical Professional

URAN BERISHA is a Shockwave Therapist with over 7 years of education in Physiotherapy and is a staunch advocate for non-invasive therapeutics from Alberta Canada (www.unpainclinic.com) with a third practice in Kosovo. He currently supports the clinical advantages of Shockwave therapy for his patients mostly for MSK injuries and chronic pain. He is also a professional trainer in the use of Shockwave technology for clinicians (www.iloveshockwave.com). In an exclusive interview, Mr. Berisha stated having conducted over 50,000 treatments of MSK injuries in his 11-year tenure as a specialist in Shockwave therapy. Through the innovative engineering of sound vibration, “Shockwave influences full tissue treatment, treating the dysfunction as well as stimulating regeneration at the same time. You're highly involving the nervous system into the healing process... not just cell stimulation."

CLARIFYING ACTUAL SHOCKWAVE

There are many devices out there that can confuse the market, but to clarify, there's one type of (true) shockwave. And then there is a RADIAL PRESSURE WAVE (using air/pneumatic system) that is not a shock wave at all, but they tend to sometimes use the name shockwave in North America. The true shock wave is generated from three types of applicators, which is an electrohydraulic, electromagnetic, and piezoelectric system- that's the same as lithotripsy.

Personally, I combine both shock waves because a radial pressure wave it's more for tissue treatment. So, it would help a lot more for correcting the dysfunction, treating the muscle, relaxing, the fascia, whereas the true shock wave is more cell treatment. Shockwave stimulates angiogenesis (new blood vessels growth) and then stem cell activation leading to tissue regeneration. So, by combining those two, starting first with radial pressure wave, then doing the shockwave, you always get better results. The typical treatment plan of Shockwave Therapy consists of initially 3-5 sessions done in between 3-15 days and follow up six weeks after the last session. As far as a PREVENTIVE measure, Shockwave can be used on a regular basis (safely) one session every couple of months or every six weeks. It may prevent the prior injured tissue from recurrence, but also it removes restrictions in that area, so it keeps blood flow going and constant & active cell regeneration. Shockwave is often used on athletes as natural maintenance.

"Today, we are firm with its use on muscle, bone, tendon, skin, kidney stones, nerve ligament and even heart regeneration where shockwave has been applied in (and instead & during) open heart surgery. There are currently over 4,000 studies in different areas of use, but it's still not enough. Practitioners are using from different perspectives- like one from Taiwan that has been tested since 2006 for pancreas regeneration. There are actual studies that they have found 200-300% improvement in blood circulation within six weeks after the initial three sessions of shockwave treatments. These same trials have demonstrated that Extracorporeal Shockwave Therapy is safe and can restore blood flow in the microcirculation in patients with a wide array of disorders from Ischemic Limbs in Patients with Peripheral Arterial Disease to the expression of nitric oxide (and vascular endothelial growth factor) to Erectile Dysfunction.

PROCESSING SOUND

Shockwave has been used widely in medicine since the better part of the 1990s starting in the Urology to the Orthopedic fields (for kidney stones, non-union fractures, bone regeneration, skin, wounds, burns etc) with first kidney stone treatment performed in Munich Germany on February 2, 1980. Shockwaves are very powerful mechanical sound waves and extremely short in terms of wavelength (10-60 nanoseconds) and they release no heat or cold into the tissues. They reach over 12 cm deep by breaking down scar tissues or adhesions that are not allowing the healing and then stimulate biological regeneration to that specific spot.

If we compare focal ultrasound (HIFU) to Shockwave, in reality, uses shockwaves but just a longer wavelength that releases heat. But the very technology that they are now they're using for Alzheimer’s and Dementia that they're calling 'ultrasound' -- in reality, when you look at the ingredients, it's exactly the same as our Shockwave.

FIELD APPLICATIONS

Mr. Berisha referenced a practitioner who runs two clinics in the Dominican Republic- managing professional baseball players. To replace chemical stimulants and therapies, Shockwave therapy was issued to optimize athletes for muscle performance. This proves you can successfully optimize as an athlete, you can treat an athlete and you can maintain an athlete. So as with soccer games in Europe, if a soccer player has Achilles’ tendon issues, they can actually maintain the athlete to go through the game without taking any breaks, keeping it under control- then undergo regeneration treatment after the game.

A GAME-CHANGER IN MODERN PRACTICE MODELING: THE BLUE ZONE MARKET

Fact: a significant number of patients undergoing long, drawn-out treatments QUIT their therapies due to little or no progress. Mr. Berisha shares the widely common concerns that many hands-on clinicians have about therapeutic innovations like Shockwave and its effects on the bottom line of their business format. Where a device like a shockwave has proven to advance functional results to the patient within a few short visits, Mr. Berisha sees this only as a POSITIVE BUSINESS ASSET. His modern and progressive thinking shows a strategic paradigm for success; "All my clients pay cash (for off label treatments) and because they do, they demand results. So when you are put in that position to get paid based on results, then you are forced to think differently." He continues, "It's important that I open the mindset of every single practitioner to see the long-term solution. Many modalities work slowly, 'dragging out' treatments for many weeks or months. Something like Shockwave can get a response or wrap up a patient's of Plantar Fasciitis treatments in about three sessions or so, I tell them that 'I hope I never see you again for this problem'. Happy clients like this become my brand ambassadors where I never need to do any marketing. This converts your practice into a booming business - putting you in a blue zone market.

* The information in this segment is part of NYCRANEWS.com MedTech Reviews and is published for informational purposes only and is not published for any commercial or marketing purposes. No material on this site is intended to be a substitute for professional medical advice or scientific claims- and is presented only ANECDOTAL findings pertaining to the effects and performance of the products/technologies being reviewed.

ESSENTIALS ON SHOCKWAVE TECHNOLOGY (continued from part 1)

Common musculoskeletal conditions that have been successfully treated with shockwave therapy is lateral epicondylitis, greater trochanter pain syndrome, calcific tendonitis of the shoulder, tendinopathy of the hamstrings, patellar, and Achilles, plantar fasciitis, and shin splints. These chronic conditions can be very painful for the sufferers and frustrating for clinicians. Shockwave therapy was initially utilized in the treatment of kidney stones in the early 1980's [2]. Shockwave uses that concentrated direct energy to increase blood flow, to stimulate cell repair, and promote natural healing processes. The depth of treatment can be from 3 cm to 12.5 cm depending on settings and target areas. The application of these acoustic waves creates microtrauma to capillaries which encourages new healthy capillary formation. Shockwave therapy decreases calcified structures.

Therapeutic Ultrasound has been a standard treatment for decades. Both US and Shockwave therapy employ acoustic waves, non-invasive and utilize a coupling median (gel) to the tissues being treated. The major differences are Shockwave Therapy utilizes lower frequency waves and no thermal effect to the tissues. Current treatment sessions are 4-6 visits with each treatment sessions lasting 10 minutes. Many people feel pain relief after the first visit. Results vary on location and severity of the condition.

As with many “non-traditional” treatment techniques that doesn’t fit into the current health care model, many insurance companies will not cover Shockwave therapy because of the lack of clinical studies. One study, recently looked at the effects of Shockwave therapy on tendinopathies and the results showed Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life.[3] Though not yet cleared/approved by the FDA, more and more providers are employing LI-ESWT for off label use of the treatment of Erectile Dysfunction (ED). According to a 2013 report by Ilan Gruenwald, "Shockwave may possess unprecedented qualities that can rehabilitate erectile tissue. The clinical improvement in subjective erectile function together with the significant improvement in penile hemodynamics following LI-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED." [4]

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029898/

2) https://www.hopkinsmedicine.org/health/conditions-and-diseases/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl

3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029898/

4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607492/

Disclaimer: The information (including, but not limited to text, graphics, images and other material) contained in this article is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice or scientific claims. Furthermore, any/all contributors (both medical and non-medical) featured in this article are presenting only ANECDOTAL findings pertaining to the effects and performance of the products/technologies being reviewed - and are not offering clinical data or medical recommendations in any way. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, never disregard professional medical advice or delay in seeking it because of something you read on this page, article, blog or website.

Monday, March 7, 2022

PAIN 101: WHAT IS PLANTAR FASCIITIS?

Written by: Josh Tiberius Schueller

As the weather begins to change and the days get longer, many people strap on their running shoes and hit the pavement. Spring officially begins the start of running season. 5k, 10k, 25k, marathon, and triathlons, seem to be available in every town across America. Organized races have become as American as apple pie and high gas prices. Several years ago, I became motivated to run my first 25K. I bought a new pair of shoes, downloaded the training guide, and dedicated myself to become the next great runner. As a Physical Therapist, I felt like I had a leg up (no pun intended) on my fellow runners. I knew the stretches, the form, and the proper treatments. My training was going well. I was following the trainers guide with perfect accuracy. Two weeks before my big day, after a long run I felt some pain in the bottom of my right foot. My initial reaction was just overuse from my long run. I iced it when I got home. The next morning, I couldn’t walk when I got out of bed. Immediately, I knew what I had—Plantar Fasciitis (PF). In the clinical and runner’s world, PF is a curse word no one wants hear.

PF affects approximately 3 million people per year. PF is the inflammation of a thick band of tissue that connects the heels bone (calcaneus) to the toes on the underside of your foot. The most common symptoms is sharp, stabbing pain in the bottom of your foot that is worse in the morning and after long periods of inactivity. When getting out of bed in the morning, the bottom of your foot can feel like someone had pounded a spike through the bottom of your foot. The increase tension and stress of repetitive pounding (such as in running) can cause microtears in the plantar fascia causing inflammation and pain.

As in many musculoskeletal injuries the traditional model of ice, rest, and NSAIDS are recommended. Normal recovery can last for months. The current landscape of “finding the cure” for PF is essentially throwing as many things as you can against the wall and hope something sticks. If you google “plantar fasciitis treatment” you will find thousands of options. The treatment of PF is more quantity than quality. The main goal is to immobilize the plantar fascia in a neutral position while decreasing inflammation. Home remedies for treatment consists of stretching, toe socks (stretches out toes), rolling bottom of foot on a frozen water bottle, or a trigger point release over the plantar fascia using a golf ball (feel about as good as driving a nail into it).

Basic physical therapy will offer stretches (plantar fascia and calf), soft tissue massage, exercise and modalities (electrical stimulation, US, Iontophoresis). More sophisticated treatments involve ART (Active Release Technique), mobilization of cuboid, and low dye taping. More aggressive treatments may consist of injections into plantar fasciitis, complete immobilization, and possible surgery depending on the severity and lack of healing with normal treatments.

Many treatment options are available online that advertise anything from a sleeve to a night splint, to relief splints. Millions of dollars are spent each year in advertising to draw in the desperate suffers of PF. New advancement in treatment has focused on Low energy shockwave therapy (ESWT) to block pain allowing the tendon to heal.

In my clinical and personal experience with PF, I have found a severe lack of successful treatment options. Treatments neither rectified the situation or improved function. In my experience the most effective treatments would:

1. Restore the biomechanics of the foot (cuboid mobilization)

2. Treat and control inflammation- non pharmacologically. A wearable product that can deliver pain relief and anti-inflammatory qualities that can be worn multiple hours per day and night. Current modalities are worn for short periods of time.

3. A functional immobilizer of the foot to keep pressure off the plantar fasciitis- similar to what a low dye taping does for the foot, while allowing normal walking.

Plantar Fasciitis is a challenging, difficult and often time frustrating injury that effects millions of people per year. PF is not considered a serious injury on the spectrum of musculoskeletal injuries so there have been a lack of attention to effective treatments. Many suffers are active competitive people who struggle with the lack of effective treatment. These people have to take weeks into months off from training because of this injury. Traditional treatments have been lackluster in results which has spawned “gimmicky” devices that have flooded the market. The need for a safe, effective treatment for PF is apparent. These devices need to be validated to decrease consumer fraud. The health care professionals need to realize that traditional treatments of ice, rest, and immobilizing are not effective for active people.

Additional video: Plantar Fasciitis Stretches & Exercises

FROM 'ASK DOCTOR JO'*- These plantar fasciitis foot pain treatments should help relieve pain. Plantar fasciitis is basically an inflammation of the fascia on the bottom of the foot. It can lead to foot pain and make it hard to walk. One great treatment for Plantar Fasciitis is using compression socks, like the Eversport ones in the video. Compression socks can help you be active again by providing support for your aching feet. Their compression helps relieve pain and discomfort without cutting off circulation. They are comfortable to wear and are slim enough that you can wear your regular socksover them without it feeling bulky.

THE SCIENCE AND ART OF MEDICAL DIAGNOSTICS

Written by: Lennard M. Gettz, Ed.D & Noelle Cutter, PhD.

Edited by: Dr. Bobbi Kline

Medical diagnosis (Dx) is the information-gathering and analytical process of identifying a patient's actual condition. It is a process of recognizing symptoms, often for the sake of treatment based on direct examination (both observational or through technologies). The accuracy of the data or physiological information collected from the patient is crucial in identifying the correct diagnosis and therefore the most appropriate treatment, and depends on the performance of the technology used, scanning protocols (blood tests, imaging per se) and the interpretation of the processing licensed clinician.

Diagnosing the condition of a complex patient can have its challenges primarily because physiological symptoms are not always obvious or specific. Where certain signs may appear to be one of various possibilities, a rash or a bump under the skin could mean many things, and it may take more than one type of exam to offer the information needed for a complete picture. Even the most popular or recognized screening/early detection technologies (ie.blood tests, genetic tests or medical scans) could not claim 100% accuracy, but an experienced diagnostician can navigate the collected data toward a more reliable diagnosis.

The science of diagnosing ranges in complexity from a standard doctors' annual visit, to validating efficacy of a drug treatment (as with a clinical trial), to even more complex patient assessments such as determining the right course of treatment on patients with challenging disorders with limited global data such as new viruses or rare diseases*. According to the NIH, Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatments. The Orphan Drug Act created financial incentives to encourage companies to develop new drugs for rare diseases. The rare disease definition was needed to establish which conditions would qualify for the new incentive programs. [1]

The "Art of Diagnosing" a complex disorder should be performed by experienced interpreters of collected data, or a collaborative team working on a complex patient case. Expert radiologists and clinical analysts (among others) have the ability of acquiring scans and quantitative data, and explore other possible biometrics to expand on the existing tests to form a wider set of possible conclusions. This level of detective work is often called upon during a "Second Opinion" test if a patient or leading practitioner is not satisfied with the initial report, most likely due to an inconclusive primary report or if "something doesn't feel right or make sense". This instinctive reaction fosters further digging or DETECTIVE WORK.

The clinical analysis field is organized in various types:

Descriptive (reporting on how the injury/disease occurred), Exploratory (why it occurred), Predictive (what can happen next) and Prescriptive Analysis (what treatment to recommend)- each offering a critical role in the end point of patient care.

[TBC- 'what makes a medical detective']

REF:

1) https://rarediseases.info.nih.gov/diseases/pages/31/faqs-about-rare-diseases

2) https://careerfoundry.com/en/blog/data-analytics/different-types-of-data-analysis/

INNOVATION NEWS:
The latest in Plantar Fasciitis wearable therapy

3/7/2022- A novel “dynamic” night splint aims to improve the efficacy of the therapy, and improve patient tolerability. The design allows a user to fall asleep with the foot in a natural plantar flexed position, then slowly cycles the foot between plantar flexion and dorsiflexion while the user sleeps. The electromechanical design delivers a preferred treatment (active rather than passive stretching), when the patient can most benefit from therapy (immediately prior to initial loading after prolonged inactivity), at a convenient time (while sleeping) and in a comfortable manner. Treatment is controlled and improvement is tracked through a mobile app.

The product is being developed by Kenai Design, with funding through an SBIR grant from the National Science Foundation. Eric Kolb, inventor and co-founder, recently showcased the device at the American Physical Therapy Association annual meeting. “We received positive feedback from many physical therapists who are frustrated with the poor patient compliance of traditional night splints. They really appreciated the benefit our device could provide for those with chronic plantar fasciitis and a number of other medical conditions. Kenai Design is continuing to refine the design and hopes to receive additional grant funding to ready the product for commercial use. They are looking to collaborate with clinicians and strategic partners to bring this exciting wearable technology to market.

ABOUT THE AUTHOR

Josh Schueller has dedicated his life's work to the support and treatment chronic pain and disorders with non-invasive, safe, effective treatment solutions. He is the current VP of Clinical Operations and Business Development at AxioBionics LLC. and the Clinical Director for Orthopedic Physical Therapy Clinics (Rockford, MI). As an active member of APTA, he holds advanced certification in Physical Therapy treatment techniques including the McKenzie method of patient empowerment. He has over 20+ years experience in the treatment of neurological conditions such as Spinal Cord Injury, Traumatic Brain Injury, CVA, Cerebral Palsy etc. In 2021, Josh is elected a clinical advisory role and educational advocacy for IPHA (Integrated Pain Healers Alliance) and has published research articles in pain management while co-launching the MedTech Reviews program of therapeutic devices. Today, Josh continues to support patient suffering from disabilities and has expanded his focus to contribute his expertise in treatment programs for Veterans and first responders.

*SPECIAL THANKS: We wish to express our deepest gratitude to "ASK DOCTOR JO" for sharing her video series on pain relief of Plantar Fasciitis. Doctor Jo is a licensed physical therapist and a doctor of physical therapy. She graduated from the University of South Carolina Doctor of Physical Therapy program. Dr. Jo has worked in many different settings including: outpatient hospital-based rehab, acute care, inpatient rehab, outpatient sports medicine, and aquatic therapy. She has worked with a wide variety of patients ranging in ages from 1 to 92, including NFL athletes and great-great-grandmothers. Dr. Jo also runs the popular “Ask Doctor Jo” YouTube channel and website, where she exposes as many people as possible to the benefits of physical therapy, especially those who don’t have access to adequate healthcare. Ask Doctor Jo has hundreds of thousands of subscribers on YouTube, Facebook, and other social media channels.

2022 Integrative Medicine Review of Toxins

IN THIS ISSUE:

- Toxins and Health: A Personalized Medicine Perspective - Written by: Dr. Bobbi Kline

- Toxicology 101: A Threat to Firefighters Health - By Dr. Robert L. Bard,

- Video: Doppler Ultrasound Imaging & 9/11 related disorders

- Chronic Fatigue Syndrome: A Survivor's Journey

Toxins and Health: A Personalized Medicine Perspective

Written by: Dr. Bobbi Kline

We are all bombarded by potential toxins every day, all day. Many of these are the result of biological processes that are necessary for normal functioning of our bodies, including hormones such as estrogen and testosterone, oxygen for energy, even common nutrients such as iron or copper. Generally, as long as these processes are supported through the right diet, exercise and lifestyle, our bodies handle these without any problem.

The entire biological process that is designed to transform toxic compounds into nontoxic ones is termed biotransformation, more commonly called detoxification - or detox for short. There are typically multiple biological steps that end with eliminating these compounds from our bodies, and every step along the way involves proper functioning of various proteins called enzymes, transporters, and receptors. To make it even more complicated, these very processes designed to protect us from these toxic chemicals often create compounds temporarily that are actually even more highly toxic, before they are finally eliminated from our bodies in a form that is no longer harmful.

Getting the detoxification process to function at its best, with everything happening in the right sequence and having the right raw materials relies on our genetic code. If a person’s genetic code has small errors, in the form of single nucleotide polymorphisms (SNPs for short) [see: genetics vs genomics], this can cause one or more of these proteins to function sub-optimally. Over time, this can damage cells and their content including our mitochondria [see: mitochondria review] and DNA. This then predisposes to a wide range of diseases, including cancer. And if that person also has SNPs in the genes that are responsible for repairing this damage, that person’s risk is compounded.

Now imagine adding in the additional burden of toxins from our environment, and you can see that our natural processes can easily become overwhelmed. These toxins come in many different forms, ranging from the products we use in our daily lives (cosmetics and personal care products, tobacco products, household cleaning products, plastics used for food storage, medications etc) to occupational hazards including manufacturing processes, diesel and other fuels, industrial fires, and military burn pits [see 2/27/2021 Feature on military Burn Pits]. They also come from catastrophic environmental events such as forest fires, petrochemical spills, hurricanes and floods.

(To be continued in the lower half of this issue)

Toxicology 101: A Threat to Firefighters Health

(A reprise from Journal of Modern Healing- issued July 11, 2019) By Dr. Robert L. Bard, cancer diagnostic specialist (NYC)

After a decade past the 9/11 disaster, news broke of unique and advanced cases of CANCER arising in droves. A growing number of the same individuals exposed to the toxic fumes and plumes of hazardous particles in the danger zone have recently contracted aggressive cases of CANCER and were in immediate demand for medical care and desperate need for advanced research and support.

This spike in cases can only come from ‘dormant’ cells or recurrence (usually with a vengeance) – such as cases of cancer tumors in the lung, liver, prostate, kidney, brain, skin and even the eye. To troubleshoot each case, it would be advantageous to take a crash course in toxicology and to recognize the chemical compounds that BATHED all responders during the event. Understanding these chemicals can help us pursue their behaviors (on the body) and their long and short term effects.

As part of our evaluation of all occupational illnesses contracted by first responders, we enter the world of TOXICOLOGY- the branch of science focused on the effects and detection of poisons. It is also the discipline overlapping chemistry, biology and pharmacology- studying the adverse effects of chemical substances on living organisms. In pursuit of first responders’ safety as far as chemical effects on the body, we connected with Professor David Purser of the Hartford Environmental Research (UK), a renowned toxicology expert who conducted major reviews on fire-exposed carcinogens published worldwide. “9/11 was unusual in that a major environmental hazard resulted from the dust cloud released as and after the Towers collapsed,” says Prof. Purser. “The dust inhaled by responders at the time, and afterwards working at the site, has resulted in serious ongoing and developing health conditions and to this day. For fires in general, there is also increasing evidence and concern regarding FF exposure to carcinogens, especially from soot contamination to skin and clothing following attendance at incidents and during training.” An abstract from Prof. Purser’s latest presentation – “ Toxins Including Effects of Fire Retardants, During Fires and Post-Fire Investigation Activities” indicates a remarkable breakdown of some of the major toxins and carcinogenic compounds that the average firefighter would be exposed to. (See complete article)

MPR-TV reports on Advanced Cancer Doppler Imaging. Meet Dr. Robert L. Bard (award-winning cancer diagnostician and expert imaging specialist). Get the facts about the many new 9/11 Cancer Cases 18 years since the terror attacks- and how we are waging a new war with advanced technology like the use of 3D/4D Doppler Histogram Scans.

IN THE NEWS

THE 2022 POST-MILITARY CRUSADERS COALITION
2/11/2022- A 2022 initiative by community leaders launched the PMCC or Post Military Crusaders Coalition to launch an action plan for health resources for injured American veterans. Similar to the First Responders Cancer Resource project, this campaign supports all veteran advocates and service members support organizations by offering educational initiatives, alternative therapeutic modalities, sustainable diagnostic technologies and clinical research programs.

"GETTING MY LIFE BACK FROM CHRONIC FATIGUE SYNDROME" 2/15/2022- Mrs. Suzanne Wheeler of Minneapolis, Minnesota is celebrated as IPHA NEWS' Researcher of the Month. After years of suffering a life-altering disorder that currently continues to challenge the scientific community of its root causes, Mrs. Wheeler explored “outside the conventional box” of opioid prescriptions, uncovering alternative solutions that got her back on her feet and joining life again. Invoking CHANGE against all odds by diligently searching for what’s beyond the convenient takes courage and conviction. It is this level of academic strength and strategic leadership that comprises the Alternative Health and Wellness community. (see full feature on Mrs. Wheeler's PEMF review)

Public Service Announcement

Toxins and Health: A Personalized Medicine Perspective (continued from page 1) by: Dr. Bobbi Kline

These toxins enter our bodies through a variety of ways including our lungs, skin, eyes, and digestive tract and get eliminated primarily through sweat, urine and feces. At every point along the way there is the potential for short-term and long-term damage. The reality is that over 80,000 chemicals are currently in use in the U.S.(1), most of them under-regulated or unregulated. While we cannot avoid them, raising awareness of toxin sources and how to minimize exposure is a key part of minimizing their impact on our health.

This exposure starts before birth, with an EWG study demonstrating 287 toxins present in the cord blood of babies at birth. But these are not limited to newborns, they are found everywhere in our environment and include mercury from coal-fired plants, perfluorinated chemicals (PFC’s) present in nonstick cookware coatings, organochlorine pesticides including DDT, polychlorinated napthalenes present in wood varnish, and polyaromatic hydrocarbons (PAH’S) from burning gasoline and garbage.

Beyond a person’s genetic code and environmental exposure, there is another powerful element: food. All of the proteins in our bodies require nutrients from our diet to function properly. This is another area where personal choices can make a big impact that toxin exposures will have. The ultimate health outcomes of various toxin exposures are the result of a complicated equation that takes into account the interaction of total exposures with our ability to handle them. Each person, depending on their genes and their exposures, will have differing levels of risk. This is why two people can have the same apparent exposure, and one person ends up with multiple cancers over their lifetime and another does not.

While we can’t avoid these chemicals, we don’t have to feel hopeless. Some simple strategies that everyone can do are to minimize exposure chemicals in their everyday routines, stay well hydrated, eat the recommended 5 servings/day of colorful fruits and vegetables, and maintain a high fiber intake. Managing emotional stress and regularly exercising at an intensity high enough to sweat are also key components to helping your biochemistry function well.

There are also numerous strategies being used in integrative and functional medicine. These include use of specific herbs, nutrients, and bioactives that both support the body’s natural systems as well as help bind and eliminate toxins more effectively. Other therapies that work on an energetic level, including acupuncture, are also being used with some success.

PERSONALIZED MEDICINE is promising to be an even more effective approach. By leveraging each person’s unique genomic blueprint, we can see where their vulnerabilities are and use that understanding for both prevention and treatment (3). With this deep knowledge of the “hiccups” in each person’s detoxification process due to SNPs, a personalized strategy can be used to reduce both exposure and potential effects of these toxins.

Newer technologies may further enhance our ability to personalize prevention and treatment. In particular, I feel exosomes are an exciting prospect. (4) While much research still needs to be done, I see the potential to target specific toxins and/or locations after acute exposures to interrupt their damaging effects.

ABOUT THE AUTHOR

ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group)

Dr. Kline is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://robertaklinemd.com/

(1) https://sitn.hms.harvard.edu/flash/2016/new-toxic-substances-control-act-end-wild-west-chemical-safety/

(2) https://www.ewg.org/research/body-burden-pollution-newborns

(3) Aronica L et al. Genetic Biomarkers of Metabolic Detoxification for Personalized Lifestyle Medicine. Nutrients. 2022 Feb 11;14(4):768

(4) Harischandra DS et al. Exosomes in Toxicology: Relevance to Chemical Exposure and Pathogenesis of Environmentally Linked Diseases. TOXICOLOGICAL SCIENCES, 158(1), 2017, 3–13

Wednesday, March 2, 2022

THE SITTING CULTURE: HIGH RISK OF DECLINE AND MORTALITY

INTRODUCTION

by: Robert L. Bard, MD / Josh Schueller, PT

Amidst our global pandemic, keeping the doctor away means heeding his or her lifestyle advice on prevention, early detection and taking in their research on what it means to truly stay out of trouble. Meanwhile, upon review of many Americans' health challenges and concerns, we assembled some of the most pertinent questions and concerns that weigh in on their decision making process.

Months into a new year awakens great opportunities to invest in HEALTHY CHANGE in your lifestyle. For the many Americans who live a sedentary lifestyle, most of us use time markers (like a new year) as a sensible time to re-dedicate to new challenges. Losing weight is the number one goal each year for most people - and the undisputed culprit to a non-active lifestyle drives unhealthy choice-making into a situational life trap. Meanwhile, other members of the community are situated with the inability to perform physical activities due to chronic pain or a debilitating disease (ie. spinal cord injury, traumatic brain injury or stoke sufferers).

In an interview with Dr. Jonathan S. Kirschner, physiatrist at HSS (Hospital for Special Surgery), we found his expertise, his thought process and his insight on certain health solutions to deliver remarkable value to us all- especially those affected in some way by the debilitating effects of the pandemic lifestyle.

2022 LIFE EXTENSION REVIEW

Adapted from an interview with Dr. Jonathan Kirschner

During the COVID pandemic, I see two types of people; people who move less and those who move more. Some people with more free time typically don't have to spend extra hours to commute. Now, they've got that time for themselves (instead of commuting) working from their home office. So that frees up more time for physical activity. Upon revaluing life and lifestyle in general, some people have the time to commit to things like learning about the importance of health and actually take actionable steps. Where people did not used to have time to join an exercise program, we now have the option (because of Covid) to watch exercise classes through Zoom and things like that.

There's enough data pointing the sedentary lifestyle as the main culprit to a wide array of medical issues- not only musculoskeletal issues like back pain, herniated discs, neck pain, neck strain with everyone at the computer because of covid, but also the metabolic effects of sitting. So if we’re not moving, we're at a high risk for gaining weight, developing diabetes and high blood pressure. Those are some of the consequences of our modern lifestyle with all this technology and computers, whereas in the old days we had to forage for food. We had to farm the food, lift bales of hay, walk to the water well and come back home. We are not doing those things now.

The best way to communicate all this is to not throw it out to the patient all at once; sometimes it’s better to make baby steps because it can be daunting. If the patient has a lot of weight to lose, or for anyone who has not been exercising, you want to start engaging them in an exercise program.

Every little bit that you can do helps and the first part is assessing where the patient is in their readiness to change. Some people are really just absorbing information, but are not ready to make that step -- others want actionable items or things that they can do. I can encourage them to get up and take breaks from the computer to slowly increase the amount of physical activity. A lot of doctors encourage walking- but then again, that's good and bad because patients think that’s all you’re supposed to do. But to walk for exercise, you have to walk briskly at a certain pace—and you have to walk a lot. When I tell patients that they need to start exercising more, there are really four pillars; One is AEROBIC EXERCISE. One is STRENGTH TRAINING. One is working on FLEXIBILITY and then the other is BALANCE. This is especially important in our older population because that can help prevent falls. But even in the younger population, the high level athletes, they have good balance, they have good muscle control of their flexibility and strength. Walking (in and of itself) doesn't really make you stronger or more flexible. So they have to do a little bit of all four.

MODERN HEALTH STRATEGY: INTEGRATIVE MODALITIES

There's no one-size-fits-all solution and a lot of what we're trying to do is individualize our treatments to the patient. One of the most important things I try to assess when I'm meeting a patient is to ask “what are your goals? What are your expectations? How can we meet those?” A lot of it is education to let them know what's realistic and what's not. A lot of my treatment strategies involve therapeutic exercise, engaging in physical therapy and there are different modalities even within that. There's manual therapy, there are different electrical therapies, there are ultrasound therapies to name a few. Other tools include complementary and alternative medicine and mind-body treatment which I'm a big proponent of because when you have physical issues, they can exacerbate the psychological side and vice-versa. Tools like acupuncture can be helpful for some people, but again, there isn't as I one-size-fits-all. We try to follow evidence based medicine protocols and an integrative approach.

THE MINIMALLY-INVASIVE MOVEMENT

We want to provide the right treatment for the right patient at the right time and the number one rule of medicine is "do no harm". Typically minimally or less invasive treatments potentially do less harm. Some people would argue that maybe there's less benefit to those- and I tend to disagree. Anything that can help the patient in the simplest, the healthiest and most natural form I think is best. And that's why a lot of what we start with is really just education, looking at the quality of movement, doing physical therapy, strengthening and then when that doesn't help, that's when we think about more involved treatments, but overall I think the less invasive the better.

CELL REGENERATIVE THERAPY: WHAT IS PRP?

More than just treating symptoms new approaches in medicine are geared towards promoting healing and “regenerating” damaged or worn tissue including cartilage, tendons and ligaments. This field is known as “regenerative medicine” and can involve oral medications, intravenous solutions or injections. Regenerative substances can be derived from stem cells harvested from bone or fatty tissue, or from the blood itself. Even though stem cells were discovered in human cord blood in 1978, research in this field is still considered to be in its infancy. One of the more popular and well studied types of regenerative medicine involves Platelet Rich plasma or PRP. Other modalities may have benefits, but for the purposes of this review, we are focusing on PRP.

Platelet Rich Plasma involves taking a sample of a patient's blood, spinning it in a centrifuge, separating out the different components, and basically extracting/concentrating growth factors, then injecting it back into the patient. So, you're using your own body and your own blood to treat things. The idea is that we're taking a chronic injury and making it more acute. The body doesn't do as good of a job at handling chronic issues. But when you trick the body into thinking it's more of an acute problem then the body can heal that better.

There are certain cellular growth factors within the PRP, but you are also stimulating some of the local tissue responses as well. PRP is used for treatment of tendon tears or tendinosis which is chronic tendonitis- a degenerative condition within the tendon. It is used for osteoarthritis, it's used for cartilage and other soft tissue injuries like meniscal tears. The research shows that PRP probably is most effective for tendinopathy and specifically lateral epicondylitis- which is tennis elbow. I've done research on tendinopathy and PRP and also shoulder arthritis. Part of the issue with PRP is there's a lot of variability in how it's made, who manufactures it, how it's being used clinically and the proportion of the different cells and growth factors within it. There's Leukocyte rich PRP that has a lot of white blood cells in it. Leukocyte poor PRP has white blood cells taken out. By taking out the white blood cells, you are reducing the inflammation that's caused by the PRP so it's less painful. Some people think that might be better for osteoarthritis because you don’t want to create more inflammation- versus the Leukocyte rich PRP which is better for treating tendon issues because you want some of that inflammation to help remodel and heal the area.

SURVIVING THE CURE

We're sort of a victim of our own success. Take cancer as an example, it's great that we can treat cancer better now- and so patients are living either with cancer or after cancer. Whereas in the past, they would have succumbed to it. That's a good problem to have, but unfortunately, patients are suffering with the consequences of either the disease or the treatment. I treat cancer patients like my other patients, we're trying to improve their quality of life, their function, their mobility, but cancer patients, particularly tend to have things like neuropathy related to chemotherapy. They may have issues with swelling or lymphedema due to surgery. A lot of the cancer drugs, unfortunately cause wide spread musculoskeletal pain, a lot of breast cancer patients unfortunately take medicines that block different hormones that can cause pain. Similarly, men with prostate cancer, the testosterone suppression can affect bones and joints. So it's a good problem that people are living longer with and after cancer, unfortunately they can suffer with pain that impairs mobility, function and quality of life.

ADDICTION TO PAIN MEDS

Another downfall to certain medications is the addiction that they can cause. In the case of pain meds, we certainly want to help our patients with their pain and suffering and medication is one way to do that. But if we can do this in a way that doesn't involve medication or especially dangerous potentially addictive medications like opiates- the better. Instead, there are modalities like heat or ice and massage, meditating, breathing exercises, non-opiate medication or injections. We still need to learn more about the mechanisms of pain and the different chemicals involved - and not treating everybody with pain the same way. We shouldn’t just automatically give them a pill to reduce their pain. It’s important to do a deeper dive into the risk factors, what promotes the patient’s pain, find ways to adjust their lifestyle-- and then explore non medication options.

ABOUT OUR GUEST CONTRIBUTOR:

Dr. Jonathan Kirschner is a physiatrist at HSS in New York, NY. He helps patients to recuperate from injury or disease to enjoy a higher quality of life. He is a board certified specialist in Physical Medicine and Rehabilitation (PMR), Sports Medicine and Electrodiagnostic Medicine. He is also a registered musculoskeletal sonographer and uses ultrasound to both diagnose and treat neuromusculoskeletal conditions. He completed a subspecialty fellowship training in Sports Medicine and Interventional Pain Management and received the Earl C. Elkins award for achieving the highest score in the nation on the PMR board examination. Dr. Kirschner’s goal is to restore function, reduce pain, and promote an active, healthy lifestyle using conservative measures whenever possible. He has won awards for his teaching skills while as a resident and attending physician. He lectures extensively locally and nationally, has edited the Atlas of Ultrasound Guided Musculoskeletal Injections and has written numerous peer reviewed journal articles and textbook chapters on the non-operative treatment of musculoskeletal disease.

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