Transcript Sir William Osler/ Hippocrates

Perfomance Artist
“Artists are athletes”
The athlete
• High school/collegiate
• Performing artist
• Governed by parents/
state and federaladministration/
medical community
• Geared to finish the
season
• Low endpoint for
source of income
• Governed by parents
• Geared to finish the
performance
• High dependance for
life time income(tolerance)
• More exposure to
alternative treatment
Sir William Osler/
Hippocrates
“Food is the best medicine”
Andrew Weil, MD
www.Drweil.com
conservative in herbal
medicineground breaking in western
medicine
reintroducing the concepts
of nutrition and healing
Act 1: The Injury
massage
doc
therapist
Injured guy
Electron microscope
• A twist, roll, bend or
fall occurs with
immediate pain
• Stiffness and spasm
set in by one day
• Other areas start to
spasm in a week
• Soft tissue (ligament,
tendon and muscle) gets
over stretched and torn
off its connecting points
to bone.
• The tissue reacts by
sending more blood to
the area and
heat/redness prevail
• Compensating areas start
to fail when they can’t do
the work of the originally
injured part
When tissue is torn/stretched:
• Inflammatory phase starts day 0-5
• Bleeding
• PMN’s
• Macrophages and platelets stimulates GF
• Proliferative phase from day 5-21
• GF stimulates endothelial cells, fibroblasts and myofibroblasts
• Macrophages continue
• Maturation phase from day 21-whenever
• Fibroblasts
• Increased collagen and tensil strength
The Problem
Act 1, Scene 1: Inflammation
• When tissue damage
occurs, the “cascade”
starts
phospholipid
Arachadonic acid
Arachadonic
acid
Pg
cytoprotection
Normal tissues
*stomach
*kidneys
*platlets
*endothelium
Pg
Inflammatory response
Inflammatory sites
*macrophages
*synoviocytes
*fibroblasts
Regular nsaids block here:
phospholipid
Nonselective cox2
Arachadonic acid
Arachadonic
acid
Pg
cytoprotection
Normal tissues
*stomach
*kidneys
*platlets
*endothelium
Pg
Inflammatory response
Inflammatory sites
*macrophages
*synoviocytes
*fibroblasts
Steroids block here:
phospholipid
corticosteroids
Arachadonic acid
Arachadonic
acid
Pg
cytoprotection
Normal tissues
*stomach
*kidneys
*platlets
*endothelium
Pg
Inflammatory response
Inflammatory sites
*macrophages
*synoviocytes
*fibroblasts
Cox 2 blocks here:
Cox-2
phospholipid
Arachadonic acid
Arachadonic
acid
Pg
cytoprotection
Normal tissues
*stomach
*kidneys
*platlets
*endothelium
Pg
Inflammatory response
Inflammatory sites
*macrophages
*synoviocytes
*fibroblasts
Act 2: The Villan and the Hero
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Rest
Ice
Compression
Elevation
• NSAID’s
• Therapy
• Steroids(injection or pills)
• Muscle relaxers and narcotics
Non steroidal antiinflammatory agents
acetic acids
diclofenac, etodolac, indomethacin, ketorolac, sulindac,
tolmetin
fenamates
meclofenamate, mefenamic acid
propionic acids fenoprofen, flurbiprofen, ibuprofen, ketoprofen,
naproxen, naproxen sodium, oxaprozin
nonacidic
nabumetone
salicylic acid diflunisal, salsalate
oxicam
meloxicam, piroxicam
cox-2 inhibitors celcoxib, valdecoxib
Generic and Trade Names
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Diclofenac potassium fast release
Diclofenac sodium delayed
Etodolac
Indomethacin
Ketorolac
Sulindac
Tolmetin
Mefenamic acid
Fenoprofen
Flurbiprofen
Ketoprofen
Oxaprozin
Nabumetone
Diflunisal
Celecoxib
Valdecoxib
Meloxicam
Piroxicam
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Cataflam
Voltaren
Lodine
Indocin
Toradol
Clinoril
Tolactin
Ponstel
Nalfon
Ansaid
Orudis
Daypro
Relafen
Dolobid
Celebrex
Bextra
Mobic
Feldene
ROID’S
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Not anabolic’s
Prednisone
Medrol dose pack
Kenalog
Celestone
Pain pills
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Acetominophen
Tylenol with codeine
Vicodin
Ultram
Morphine
elavil
flexeril
Skelaxin
zanaflex
Act 3: Secondary Effects
From the meds
From the inactivity
• Sleep is disturbed and
fatigue starts
• Joints above and below
the area of pain stiffen up
and are hard to stretch
• Chronic pain and
immobility result in weight
gain and lack of exercise,
carb hunting occurs and
depression starts
• More muscle spasm more
pain less tolerance
• Due to chronic spasm the
sleep cycle is disturbed and
memory/concentration off
• Due to immobility, the
muscle/tendon units involved
with the injury become stiff and
sore (trigger points)
• Stagnation starts to affect
emotion and body wants
satisfaction previously found
with endorphin-rush, now
found with medicines or
foods/alcohol/drugs
• Serotonin gets depleated and
depression starts along with
side effects from new
addictions
Side Effects from Medicines
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Allergy to nsaids
Reflux/ulcers
Kidney damage
Hypertension
Diarrhea
Asthma flare up
Bleeding
Drug interaction
Steroid dependance
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Drowsiness
Dry mouth
Poor coordination
Dizziness
Blurred vision
Addiction
Drug interaction
Liver toxicity
The COX II controversy
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Initially made to protect the stomach
Selective for cox 2 receptor
Less stomach ulcers
New data that vioxx caused heart attacks
Celebrex is under study by the FDA
Pulled off but ok’d for now?
Act 4: The Alternative
• Herbal meds
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Acupuncture
Massage
PT
Manual Therapy
Modalities
• Diet
GAIT Study
• Glucosamine/chondroitin Arthritis Intervention
Trial
• University of Utah/NIH funded
• First large-scale multicenter center clinical trial
with dietary supplements for treatment of knee
arthritis
• Testing the effectiveness of short term(6month)
treatment in pain reduction
• 20% reduction in pain in 24 weeks with
moderate to severe pain using combo
Zyflamend by new chapter
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Holy Basil
Turmeric
Ginger
Green tea
Rosemary
Oregano
Scutellaria
Hu Zhang
Chinese Gold Thread and
Barberry
If Relief by Natures Sunshine
• Turmeric Root
• Mangosteen
• Andrographis
Paniculata
• Boswellia Gum
• White Willow Bark
• salicin
Postgame by ameriscience
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Manganese
Devils Claw
Glucosamine Hcl
Vitamin C
Potassium
MSM
Hyaluronic acid
Bromelain
Papain
Lipase
Amylase
Back to basics
The Anti-inflammatory Diet
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No dairy
No pork or beef
No alcohol
Cut back on wheat
Stop smoking
Get 7+hours of sleep
Hydrate all day
Stretch, yoga, tai chi
Early movement important
Hang up the towel
Epilogue: “Back” to basics
• Avoid injury by knowing when to quit, stretching,
maintaining proper diet
• Get help immediately (as the cascade starts)
• Relative rest/ice/
• Supplements
• Meds if necessary, stop etoh and tobacco
• Know what you take and watch side-fx
• Maintain stretching and proper diet and sleep
• And when ready…….