Aspirin

Aspirin has been prescribed for those with heart disease for the last 3 decades. It is known to make plaques in the blood vessels break up. The massive heart attacks happen due to artery blockage. If the lumen or inner lining of a vessel is narrowed, one small plug that comes along with stop any further flow. The ER has protocols that start with 4 baby aspirins in the case of anyone coming in for chest pain (or stroke) before anything else is done. This basic and old drug is still useful for saving lives. There are more complex drugs and procedures that are used now but for the sake of this review, we will stick with the basics. Aspirin is known by its generic name of acetylsalicylic acid. It falls into the family of nonsteroidal antiinflammatory medicines. This family works on the cascade of inflammation that starts with a break in the lining of the blood vessel. A cascade develops to signal to platlets (small blood particles that rush to form a "glue plug") to accumulate in the area of damage and stop up the hole. Some times if there is no tear in the blood vessel wall but inflammation present from cholesterol plaques or tobacco damage, a plug will form anyway and block the lumen. There are herbs that are thought to do the same thing like ginko biloba. The theory is that by allowing blood to be "plug free" it gets to smaller sized blood vessels with easy. Think of the blood as being slippery so it gets to the smallest spaces. One of the known side effects of ginko is to have bleeding thus the contraindication to it's use when on a blood thinner.

I believe the use of this antiinflammatory has multiple benefits. Controlling inflammation should be considered a basic concept with anyone who suffers from any disease process. It has yet to be researched if antiinflammatory control will help to modify a disease manifestation but all my patients are told that in addition to controlling the specific disease, an antiinflammatory diet is encourage to gain further health benefits and possible reverse the disease at hand.

Try adding this to your daily diet :
http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

Healing through sound

I have recently learned about the power of hard rock metal music when I go to push 430 pounds on the "smith machine" at Planet Fitness. Then it got me to thinking, how about I play soft music at the ER. I set up my music to play "Music for Brain Wave Vibration", bought some flowers, spread some lavender aromatherapy and tried to say hello to everyone no matter how hectic things were. So far, my shifts haven't sent me home wondering why I am working there, I have set the record for Yorkville Expresscare in highest number of patients seen and I am still blessed enough to save some lives. (I love this job!) Anyway, with the more than positive attitude I keep, I always see the cup half full. I feel the music is working for me and I believe a few others in the Emergency Department have picked up on a few things I do to make life rewarding.

Now there is more to music than just provoking imagery. There are technical hormonal chain reactions that occur when certain parts of the brain are stimulated (specifically with sound). The vibrational sounds of African drums, the flute of the Native American, Tibetan gongs.....all work along the same premise of healing by stimulating energy to move. In most parts of the world, the old theory is that every cell in the body has atoms and those small particles move. As those atomic size "things" move, so does energy that is generated through atoms, cells, human tissue, physiological organ functioning and finally human engineering. Injury works to block or slow energy, when the energy doesn't flow, something builds up but don't think of an electrical charge that is about to shock someone. The blocked energy usually show up in the form of back pain, headache, or more complex- heart disease or depression. I learned this through acupuncture that if needles can help "move" energy, patients will feel improvement. Can't explain this phenomenon though western research (and most insurance companies still don't agree with this form of healing) -but thats why people pay out of pocket when they get tired of playing the pill game.

Sound it just another part of healing that will help the mind body and spirit move together, may want to check out

http://www.brainwavevibration.com/

http://health.usnews.com/articles/health/brain-and-behavior/2008/07/17/music-as-medicine-for-the-brain.html?PageNr=1

http://www.rhapsody.com/tantric-music/kundalini-vibrations-2

relax

During this time of stress, winter darkness, tailgaiting minivan drivers on icy roads, poor economy, relaxation and stress reduction are the most important treatment plan for any doctor patient relationship. I usually rely of valerian but decided to take a break on the three time a day pill and went to the big KavaKava for a month. Kava Kava is harvested best from root of a plant and often spoke of as popular in the south pacific. It is said to improve well being and thought to stimulate gaba centers in the brain (valium). There was once a time when liver toxicity occured with use of kava kava but has since been cleared of scrutiny. Most bottles will state a limited use of the supplement but in this time of stress and seasonal affective disorder, the more powerful and limited use of kava kava is a nice alternative. Since it has been used for more than 3000 years, it is probably its modern preparation that should be investigated.....thus watch for the companies that are unknown or new or the cheapest on the shelf. Those that drink alcohol should be persuaded to stop during its use, (those are also the ones that should not be using alcohol during times of stress in addition)

Monavie and "wine bottle wannabees"

In my last blog from FAQ's, I spoke of taking a vitamin. Monavie users will proclaim great effects and improvements from the liquid. I always wondered how one drink could account for fixing diabetes, fatigue, joint pain, depression insomnia...... Sounds like snake oil and empty promises. I now understand how the supplements make claims. As noted, the average american diet stinks. The average american takes poor supplements. The average american does not exercise. At the least, if one cannot eat properly due to monetary constraints, at least substitute a diet product. Monavie and all the other "drinks in a wine bottle" essentially have plant bases nutrients that will bolster and average diet to provide building blocks for normal metabolism and cell function. If cells work more efficiently, body functions better. Thinking, reproduction, enzyme secreation, digestion, joint lubrication, muscle contraction.....

Here's an story I give to my young athletes to help with understanding. You can buy all the protein powder in the world to take in building muscle but if 3-4 meals a day are not met as a basic staple, the muscle will still be short changed and not grow no matter how much exercise is performed. In fact, it will only be a matter of time before muscle will not sustain the loads and breakdown (tear). Also known as "hitting the wall" or "bonking".

Bottom line is that if a proper diet is maintained, proper sleep is met, proper exercise is reached and stress is controlled or "neutralized", plant supplements may not be necessary. For those of us that don't meet the average daily requirements above, (which is a large portion of the US) there may be an appreciable difference in the way we feel during the day by taking the "garden in a wine bottle" product. Try one of the products for a month or two but keep everything in your life stable for the trial so all variables are controlled to truely state if the supplement has provided a change in the way you feel, the way you sleep or the dose of the prescription medicine you are on.

Regarding making a decision on which product to try, a scientific approach would be to see the ORAC value of each of the biggest companies. Brunswick lab has the patent on ORAC testing and they have performed a few head to head studies but you will have to search and pray they are the true results.

http://brunswicklabs.com/orac_definition.shtml

If a supplement like Thai go, Monavie, Noni, Xengo....is to help make the body's systems work better, it should have an ORAC test label with it. (This seems to be the only thing that can be tested and compared.) Most of the people who distribute for each of the companies will have a share in selling the product to you but they are truely good products that will probalby provide a good proportion of the daily requirements that are missed in an average diet. Just do you homework before trying and have an endpoint to decide if it is helpful or not.

vitamin D

Whenever I ask people about if they take vitamins....the answer is usually no or its "I take Centrum". When I ask women on osteoporosis medicine, most say they take calcium but not vitamin D. Research is being released that people who live above the geographic line that goes between virginia and san francisco have a higher episode of heart issues during winter months. The theory is that with less sunshine, skin cannot convert/make vitamin D. The only exception is the eskimos that supposedly ate alot of fatty fish (full of omega 3 and vit d).

http://www.ncbi.nlm.nih.gov/pubmed/2839537

The biggest disease most doctors know of is ricketts from the 60's. We don't see the disease as often and most of my memory comes from old pictures drawn in the illustrations of Netter. Cod liver oil used to be supplemented and but now with the advent of the supplement industry, the shelves of your local healthfood store, pharmacy, gym, herb shop....will be overflowing with choices. As stated above, the most popular choice is usually the one with the best TV commercial time (centrum). Another reason many docs would hesitate to recommend more than the old RDA (recommended daily allowance) for vit D is that due to ADEK. These are the vitamins that are fat soluble. Of all vitamins, A D E and K can bind with fat and accumulated to "dangerous levels". Best advise I can give is to get a blood test 2-3 times a year. For Chicago I recommend Xmas and 4th of July. I'm a practical guy/doc and those two holidays are easy to remember, (xmas is alittle hectic but even if the blood is done right after the holiday is fine and it also can be applied to money left over in the HSA or FSA that work has taken out of the paycheck before end of the year). There are standard tests from the hospital that are ok. Levels I have read that are good to maintain are 30-50 ng/ml (75-125nmol/L). This depends on age and which months of the year we are in.

http://query.nytimes.com/gst/fullpage.html?res=9402E2DA1239F93BA15752C0A9659C8B63

A great test is the Spectracell test. Some of my patients with bluecross get it paid for. It takes about 4 weeks to get results but very well done and yields great information on blood levels of minerals and vitamins. (Also a great test for "fractionating" the different precursors to cholesterol so you get more risk factor analysis for heart disease)

http://www.spectracell.com/lab/fia5000.htm

Sometimes asking nicely from the customer service person on the back of the insurance card may get you somewhere. If not covered, it may be worth it to see what the standard blood tests from the hospital or docs office will check first.

When supplementing, look for vitamin D3, its easier to absorb than D2. Personally, I take 2000 IU daily and sometimes up to 4000 IU depending on if it's winter in Chicago. No sunlight usually means the skin is not creating vit D and I usually don't sit out in the sun except for when I do laps at the outdoor pool during the summer and even then I am sun blocked with lotion. There's new information about the association between artery plaque build up and thin bone. The thicker the plaque, the thinner the bone.

http://www.springerlink.com/content/w6w6224700t40025/

Science has yet to interpret the association but vitamin D supplementation can be useful in both. Calcium is also good but studies are coming out with limits on Ca++ since it may add to plaque build up. Read on it yourself and talk to your doc, we will soon see associations between vit D deficiency and heart disease from the NIH. For now the institute is still cautious in its recommendation.

http://www.nlm.nih.gov/medlineplus/news/fullstory_59774.html

The Saguil Approach is to utilized standard doc office to assess risks for osteoporosis and heart disease. Get a level of mineral, vitamins, antioxidants and lipids from blood twice a year. Time the blood tests to coincide with before supplementation and 2-3 months after starting to check blood level progress. Cut back on caffeine and alcohol. Cut back on high cholesterol foods, increase intake of multicolored fruits and veggies daily. EXERCISE!!! Stress reduction. Loose weight. Repeat.

Turmeric for sore joints and muscles

The active ingredient from the plant is curcumin. Many studies have been started on the healing properties of curcumin. It is thought to work as a cox2 inhibitor. Sooner or late, we will hopefully see the documented positive results on paper. A few good supplement companies produce combination supplements for inflammation which include the herb. If suffering from inflammation and muscle soreness, consider a few of brands mentioned below. The positive result is that turmeric is also used in certain cultures for healing stomach ulcer. The typical prescription for swelling and inflammation is an NSAID (nonsteroidal antiinflammatory drug). Motrin, ibuprofen, advil are one form of the family of nsaids. Motrin at high dose works well for pain, swelling and even fever. A common side effect is an upset stomach due to its side effect of decreasing the protective layer of mucous that lines the stomach. The family also flares up ulcerative colitis when used. Thus the beauty of turmeric in being able to help with pain from a muscle strain, broken bones, joint swelling without causing ulcers. The national institute of health states that some studies indicate liver problems so until studies are completed, people with gallbladder disease should be careful in using this supplements. Turmeric is used in many Indian foods and give the yellow coloring to many dishes. Ayurvedic medicine practitioners rely heavily on the powder form for many ailments including cancer treatment.

Capsicum

There's a great topical drug that helps facilitate back pain control. We used to use it for Shingles (a form of viral herpes skin infections) which is very painful and sometimes leads to morphine sulfate use for control of pain. It's uses have been extended to standard pain issues. Many people will see it in the pharmacy next to the Icy Hot or Tiger Balm. Most folks pass right by it since packaging isn't eye catching. I've seen several great forms of capsaisin in the form of Zostrix cream (my personal favorite in the emergency room for people with back pain or neck pain) and salonpas adhesive patches (my personal favorite -most of my older relatives in the Philippines used to walk around with these pads stuck to them and before medical school I used to think of it a some form of voodoo). Any topical pain reliever is made to cause a sensation to the skin that will overpower normal sensation. Example, when a baby is given a cap/hat for the first time, kid usually pulls it off since it doesn't feel right. Soon after trying over and over again, the baby gets used to it. When applying zostrix to skin, it burns. It's a dull sensation but the feeling is like applying hot pepper to skin. Actually, the active ingredient is from hot peppers. The feeling is distracting to the person in pain and one of the methods of relief is to make them think about something else....well, hot pepper will make you do that!

The other relief in pain is more scientific and separates this component from the Icy Hots and Tiger Balms. RCT (randomized clinical trials) performed with capsicum the active ingredient in capsaisin cream, revealed it reduced the amount of Substance P to the area it's applied to. Substance P is a neurotransmitter found in pain fibers and when depleated, pain fibers don't fire to send messages of pain to the brain. Overall, pain sensation if reduced. Practical problem for the cream has always been accidentally applying too much or getting it in the eyes. One of the reasons I like the patches of Salonpas (walgreens) is you could cut as much of a size as you like and not get the hands greasy. Caution: there are salonpas patches at walgreens that don't have capsicum so read ingredients before you buy.

The place it comes from is the seed and little ribs found in red peppers. Different peppers have different ratings usually measured in Scoville heat units (SHU). This rating is usually talked about during the pepper eating contests of Texas. (some people have too much free time although I find myself attracted to watching this and hotdog eating contests while riding my stationary bike at Planet Fitness)

So far, I have not read any info on chronic use and becoming accomodated to it. There have been no other problems aside from people with allergies to peppers using it without reading ingredients. The Saguil Approach to proper use is to apply it 4 times a day and after achieving pain relief, work to stretch the triggered/spasmed muscle. Usually it will be painful at first like any stretch done properly. If continued on a regular basis, the stretch will lengthen muscle fiber and help overall to reduce pain and inoperability of the muscle causing the pain. More stretching leads to more blood flow to injured muscle and faster healing. Alone it may work for small spasms, for larger and more chronic areas, it would be an excellent adjunct to other therapies. Should always inform the massage therapist or physical therapist of it's use. I remember when doing my sports medicine fellowship, we used to comment on russian coaches spraying every injury they had with topical anesthetic and i would always laugh at the technique. Now that I am wiser-(herbally), they actually had a great technique overall in attempting to distract the athlete while ultimately stretching injured muscle. Now using it for a fracture .....not!

*Capsicum also comes in oral form....obviously since it is derived from pepper. But I think its best application it topically, as you will read from other posts, I prefer the use of turmeric, white willow bark boswelia for inflammation. In the future I will talk about arnica and tea tree oil.





(Altman RD et al, Semin Arthritis Rhean 1994, 23:25-33).

(Watson CPN et al Clin Ther 1993, 15:510-526)

(Diabetes Study Group, Diabetes Care 1992, 15: 159-165).