Category Archives: Quality of Life

Post #68 – Resources I used to rehabilitate my knee: Part I – Diagnose and Fix Structural Issue

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A little over two years ago, I hurt my knee. I was doing some vigorous aerobic workout style dancing. I might have twisted my right knee and it started to hurt really badly. I thought it would be fine in a couple of weeks by giving it the usual TLC. But it took over two years to heal it. And it turned out to be quite an opportunity to learn.

Whenever I talk to my contemporaries, the topic of knee pain comes up frequently. So, I thought I would share here my journey of healing my knee pain and more importantly the resources I found useful. Trust others will find this information useful.

In this Part 1 of this series of blog posts, I share different resources for diagnose and fix the structural issues with my knee.

History and Background

You see I have been dealing with knee pain off and on for a long time. About 30 years ago, I took up the goal of running a marathon. I started the training. Ran my first 5K and then my right knee started hurting when I would run. Could not figure out how to run pain free. So, that was the end of my marathon running goal.

Since that episode, over the last thirty years, I have been working on bringing my knee functionally to 100%, judging by the capacity and capability of my left knee. It is still not there 100%, but it is the closest it has come to that goal in thirty years.

Resource #1 – Orthopedic Doctors

My first stop was to get my knee checked out by an orthopedic doctor. I even picked a practice specializing in Sports Medicine. They did a quick X-ray, showed me the picture and pointed out that I had a mild case of osteoarthritis in my knee.

So, what do I do then? I was told not to run. And, if I was to run, maybe use a knee brace. I bought a brace. Tried running with it. Did not really work.

Over the years, the pain went away but it did not really allow me to run. However, I became comfortable with a variety of activities, jumping rope, skiing, rollerblading and so on.

And this time around, which is about two years ago, another trip to the orthopedic knee specialist. A quick X-ray, was showed the picture and told that now I had mild-to-moderate osteoarthritis. Nothing broken, nothing torn. This time, my options were: a) Steroid injection in the knee, b) Injecting gel, if I got permission from the insurance company, c) Take ibuprofen, or d) Do nothing.  Learned that the steroid injection was not simply to relieve the pain but was also therapeutic, since it would relieve the inflammation. So, I chose to get the injection.

Other options offered at the orthopedic specialist’s office are arthroscopic surgery and knee replacement surgery.

Orthoscopic surgery was very popular up to a decade or so ago. These have lately fallen out of favor. Clinical trials done during the last few years have shown that orthoscopic surgery is no more effective than the placebo in the form of sham surgery.

Knee Replacement is an option only when the pain is so severe that you can no longer tolerate the pain whether awake or sleeping since the cartilage has pretty much worn out.

My experience – Orthopedic specialists are a great resource to find out if I broke anything or tore anything for which they have solutions. For osteoarthritis, other than a steroid injection basically, wait until the knee is ready for replacement.

Resource #2 – Hyaluronic Acid

A quick take on hyaluronic acid from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469223/

“…Viscosupplementation with intra-articular hyaluronic acid is a treatment option in knee OA that is included in the professional guidelines for treatment of this joint disease, but potentially should apply to all synovial joints in order to reduce pain and improve joint lubrication. Exogenous HA can enhance chondrocyte HA synthesis, prevent the degradation of cartilage and promote its regeneration. Moreover it can reduce the production of proinflammatory mediators and matrix metalloproteinases involved in OA pathogenesis. This mini review highlights the evidence of hyaluronic acid in reducing osteoarthritis symptoms and structural damage, as well as its ability to delay prosthetic surgery. Viscosupplementation should be considered as a long-term therapy.”

Basically, hyaluronic acid is a gel that if injected into the knee joint improves joint lubrication, reduces inflammation and may also regenerate cartilage improving the structure of the joint. Treatment may have to be repeated over time as a long-term therapy.

Typically, insurance companies do not cover this therapy. It is known to relieve knee pain and improve joint functions. Some orthopedic specialists may offer it. But mostly these are offered by those doctors practicing alternative therapies, e.g., functional doctors, chiropractors or doctors of osteopathy.

Resource #3 – Platelet Rich Plasma (PRP) Therapy

PRP therapy for osteoarthritis of the knee works by injecting platelet-rich blood into the area surrounding the knee to help reverse existing tissue damage. Blood is comprised of four components. Most of your blood is liquid, known as plasma. The other three components are platelets, white blood cells, and red blood cells.

Platelets play a key role in the clotting of the blood. They also contain growth factors that could help tissues repair themselves by causing new cells to form.

PRP Therapy involves taking blood from the veins, about the quantity typically used for blood tests. They spin it to separate plasma and platelets from the red blood cells. They then inject plasma into the joint, where the cartilage might be damaged, typically where it hurts to touch and/or where inflammation in the joint is.

PRP is still not mainstream as a standard of care. Here is one article, comparting results of various studies on PRP And Hyaluronic Acid,  https://pubmed.ncbi.nlm.nih.gov/34785294/ . The bottom line from this study is: Patients undergoing treatment for hip or knee OA with either PRP or HA injections can expect to experience similarly beneficial short-term clinical outcomes.

My experience – I underwent three different applications of PRP. And found those to be beneficial.

Resource #4 – Stem cell Therapy

Stem Cell Therapy procedures are non-surgical injection-based procedures for people suffering from knee pain due to common injuries to the knee Meniscus, ACL, MCL, and other structures, or who are experiencing degenerative conditions such as Osteoarthritis. These procedures utilize concentrated repair cells that are obtained from your own bone marrow or blood to promote your body’s own natural ability to heal.

I visited folks at StemCellArts to see what they could do for my knee. The procedures they perform are done by orthopedic doctors who have a lot of experience and have developed specific protocols. However, the procedure tends to be quite expensive and is also quite involved, especially the part about extracting stem cells from bone marrow and culturing those cells.

Later, I also learned about the stem cells that are now harvested from umbilical cords, packaged and then distributed for doctors to use. This approach seemed to be rather inexpensive compared to using bone marrow. I underwent this procedure and found it to be quite helpful. In fact, a few months after the stem cell procedure, I asked the doctor if he would recommend repeating it. He recommended that once the joint is seeded with the stem cell, it was more helpful to do a PRP procedure to provide the joint more “fertilizer” in the form of growth factors. That is why I ended up doing the third PRP procedure.

My experience – My knee used to be tender to touch on the left side of the knee, where X-rays showed cartilage had eroded. After the stem cell and PRP procedures the tenderness and accompanying pain totally went away.

Bottom Line:

From my research and experience, I have found that it is important to find out what is the underlying structural issue for knee pain. It could be osteoarthritis, meniscus tears, tendon & ligament tears, overuse injuries or some other condition. In my case, it was osteoarthritis, clearly showing eroded cartilage in certain part of the knee joint. The resources that were useful to diagnose and repair the structural damage were:  

  1. Visit to the Orthopedic surgeon and imaging
  2. Steroid injection for relieving inflammation.
  3. Alternatively, ibuprofen for relieving inflammation.
  4. Hyaluronic acid or PRP treatment for joint lubrication and repair.
  5. Stem Cell therapy for repair or regeneration.

Of course, this is not medical advice, and you should check with a medical doctor about your specific situation.

 What are your thoughts or experience on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

Post #59 – What are our lifestyle choices for maximizing health and lifespan?

11 Sunday Feb 2018

Posted by in Life-Span, Living to 120, meditation, Mental Health, Nutrition, Optimal Exercise, Optimal Health, Optimal Nutrition, Puposely Living, Quality of Life, Stress, Supplements, TM, Uncategorized, Vitality, wellness, Yoga

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Lifestyle Choices for Maximizing Health and Lifespan

Unless you have been living under a rock on an isolated island, I am sure you have heard that lifestyle choices have big impact on both your health and how long you live.

Living longer means not dying sooner.  And, to not die sooner, you must take actions that eliminate the various ways one dies.

Living healthy, means taking actions to prevent all the ways one loses their abilities to enjoy day-to-day activities of life. Or, at least postpone the time as far into the future as possible before developing disabilities.

In both case, i.e., living longer and living healthy, lifestyle choices play crucial roles. But what are these life choices, besides the ones you hear all the time:  Eat Better and Exercise.

When I started to systematically pursue this topic of living optimal lifespan possible (my goal being 120 years), with optimal health span (my goal being no disabilities), I started enumerating all areas of life in which one can take some action to make this impact.

Of course, not everything is in our control. We did not come to this earth with guarantees. Unforeseen, random event, or events that are not in our control can ruin all our goals and plans. But the objective is to not let the possibility of events not in our control prevent us from taking actions that are indeed in our control.

So, here are all 13 dimensions of lifestyle that I have discovered so far that impact health span and life span. Each subject is a very extensive topic by itself.  I just very briefly summarize my personal take on these and may be an example of how I am attempting to address them in my lifestyle and where you can read about further in these blog posts.

1. Benchmarking Health: Knowing where you are is where I believe it has to all start. You go to doctor’s office and they take your physical measurements (height, weight), you vitals (pulse, blood pressure), order some measurements from the lab and then compare those with what should be “normal” for you. In Post #7 – Can biomarkers help in the quest for vitality and longevity?, I discuss the various measurements you can use as biomarkers for health. These days I measure:

Daily: Weight, waist, fat near navel and thigh, BP, SPO2, pulse, my over-all subjective state of my physical, emotional and mental health

Weekly: pH, Nitric Oxide, fasting glucose

Quarterly: Bloodwork through my primary physician – CBC (complete blood count), typical chemistry panel, Lipids (Cholesterol total, HDL, LDL, VLDL, Triglysrides), TSH, T3, T4 (Thyroid hormones), Male Hormones (Total and Free Testosterone, Estrogen, LH, FSH), Hydroxy-D, fasting glucose, A1c, PSA (for prostrate tumor screening), CRP, (for inflammation), Homocysteine (for heart condition)

Annually or Biennially: Telomere Measurements (DNA strands that dictate how long cells live), X-Rays of joints if I suspect arthritis etc., Ultrasound Study of Carotid and Aorta arteries, MRI’s to detect any tumors, eye-exam, hearing test, EKG.

Every 5 years: Colonoscopy, Stress-test.    

2.  Nutrition – That is everything that crosses our lips, what we eat or drink. I discussed the topic of nutrition in a series of eight blog posts on this subject of Optimal Nutrition, Posts #22 through #29.  additionally, Post #15, #31 and #32 discuss the topic of how and when to complement the nutrition with supplements.

 3. Exercise – Exercise is indispensable for building and maintaining muscle strength, flexibility, balance, endurance. There is also abundant proof that it helps with the metabolism, overall health and health of specific organs. I discussed this topic of exercise in blog post #30 – How much and what type of exercise do you need for optimal health?

 4. Maintaining Musco-skelatal Integrity: Pains in the back, knees, hips, shoulder, wrists and other various joints creep up. We may think that these pains just come out of nowhere. After all, we often notice that “yesterday it did not hurt and today it hurts”. So, it got be a random event. Right?

Reality is that unless there was a trauma caused by an accident, most of these are the result of repetitive movement in un-aligned joints. The underlying cause could be neglect of the muscles, ligaments and tendons surrounding joints or prolonged asymmetrical movements, e.g., always carrying a bag on the same shoulder, or playing games such tennis or golf that inherently require asymmetrical movement.

Yoga, myofascial massages, Rolfing, rolling with foam rollers, visiting a chiropractor for body alignment, weight bearing exercises for join strengths, e-cise routines designed by Pete Egoscue are methods I have learned for maintaining musco-skeletal integrity.  I discuss some of these in Post #30 – How much and what type of exercise do you need for optimal health? And Post #49 – What is the role of massage therapy in Optimal Health? Also, I discuss how you can use foam rolling for body alignment in Post #39 – Ever heard of foam rolling.

5. Maintaining Optimal Dental Health: Good dental health not only impacts quality of your life, it can also impact how long you live.

The American Heart Association published a Statement in April 2012 supporting an association between gum disease and heart disease. The article noted that current scientific data do not indicate if regular brushing and flossing or treatment of gum disease will decrease the incidence, rate or severity of the narrowing of the arteries (called atherosclerosis) that can lead to heart attacks and strokes. However, many studies show an as-yet-unexplained association between gum disease and several serious health conditions, including heart disease, even after adjusting for common risk factors.

You may also have seen health and lifestyle surveys used for estimating life-expectancy that want to know if you floss daily. If you do the models give you credit for an extra 2 to 4 years of life.

In Post #47 – What does optimal dental health look like and how to achieve it?, I discuss this topic in greater detail.

 6. Maintaining Mind-body Connection: Our mind and body are inherently connected. Maintaining the connection between the two is essential for optimal health. Yoga, Tai Chi, Qigong, are some ways to develop and maintain mind-body connection.  I have very limited experience with Tai Chi and Qigong. I do, however, perform Yoga as part of my lifestyle.  In Post #11 – My first year of experience with Bikram Yoga, Post #12 – My second year of experience with Bikram Yoga, I describe how I incorporated Bikram Yoga into my lifestyle.

 7. Enhancing and Maintaining Brain: If we lose vitality of the brain, the quality of life suffers dramatically. Alzheimer and other forms of Dementia can often be very painful way of living. Evidence is mounting that for optimal brain health, we must keep the brain stimulated with right activities. All my life, I have been very focused on left brain type of activities. As I was turning 60, I decided to do something about it and started taking piano lessons to stimulate my right brain and prevent any premature aging of the brain. I discuss the activities for maintaining optimal health in Post #57 – Optimal Mental Health – what is it and how to achieve it?

 8. Stress Management: Stress is a root cause of many diseases. We have all experienced how stress can bring about disturbances in the digestive systems, back pain, high blood pressures, even heart attacks and strokes. Yoga and Meditation are two of the ways to manage stress. Perspective management is another powerful method. I got initiated in Transcendental Meditation over 30 years ago and I have been doing TM ever since with good benefits. I tackle the subject in Post #16 – What is stress really and why is it bad for longevity and health and Post #17 – Is meditation an effective antidote to stress.

9. Adequate Sleep: There is more and more evidence every day that inadequate sleep can cause all sorts of ailments. 7 to 9 hours of restful sleep is considered optimal. All my life, I thought the object of the game was to get away with as little a sleep as possible. Sleeping more than 6 hours every night is still a challenge for me. Although I am working on it to extend sleeping hours during the week and may be do some catch up sleeping during the weekends. Maybe I will tackle this topic in a future post. In Post #61 – How much sleep do we need? – I discuss the latest in sleep research.

10. Social Engagement: World-wide Study of Blue Zones, i.e., geographical areas where longest living people are clustered, showed a very surprising factor that contributed to long healthy life of people living there. Researchers found that people in Blue Zones are socially very engaged. Centenarians in these areas are engaged with tight knit groups of friends and family. So, the conclusion is that social engagement is an important factor in living longer and healthier.

 11. Purposeful Living: It is well known that death rates spike after the holidays and after major life events. Researchers deduce from studies of such phenomena that people live only as long as they find life meaningful.

Of course, it needs an ongoing effort to figure out what one can derive meaning from. One may find meaning in raising kids or grand kids, contributions to society, being the best spouse one can be or from “slaying some dragon”. Some people find meaning in their faith and service to God. Others find meaning in being of service to mankind or their fellow human beings. Yet others can find meaning in their job or career.

Viktor Frankel in his book: Man’s Search for Meaning, explores this topic beautifully. 

12. Make Full-use of All Modalities of Medical Care: Modern medicine has developed amazing and miraculous treatments. By making use of the modern medicine one can live much healthier and much longer.  In general, the earlier you are able to catch a disease and the sooner you start treatment, better your chances are of a cure or at least minimizing the damage. Mantra for modern medicine is “early detection, early cure”

 Alternative schools of medicine, such as Ayurvedic, Homeopathy, Aquapuncture, Naturopathy, offer valid means for preventative care and whole-person healing.  Leveraging these modalities of medical care as appropriate can offer means for optimal healing and living. Here the rule is the age old wisdom: An ounce of prevention is better than a pound of cure.

I was even able to eliminate my severe seasonal allergies by working with doctors of Naturopathy and thus was able to totally change the vector of my health as I discuss in Post #8 – So, did I you tell you the story of my allergies. Also strengthening your immune system can have major consequences on how your body deals with diseases as I discuss in a series of Posts #51 – 54 – How to Optimize Your Immune System – Part I through Part IV

13. Making use of Genetics Science: There is of course the truth of genetics. Genes do play a role in how long we will live and what diseases we may have the tendencies to develop. Over the last few years, however, scientists are finding that inherited genes often do not determine your destiny, it is the lifestyle that can either turn those genes on or off. This is the exciting field of epigenetics.

 Studies from the filed of epigenetics do  give us opportunities to leverage genes.  Through genome mapping, we can find out what might be our tendencies and to what aspects of our life, therefore, we should pay particular attention. Over the last few years, I have gotten my telomeres measured – these are tips at the ends of genes that are considered to act like our lifespan clocks.  I discussed this in Post #50 – How to optimize your health by maximizing your telomeres. More recently, I have sent for genetic testing to be able to receive personalized genetics bases lifestyle coaching. I will share results of that experiences in a future post.

The percent of role of genes that we cannot do anything about is constantly shrinking all the time. Now it is believed that only between 5% to 15% of lifespan and health span is determined by genes that we have no control over.

Bottomline:

In summary, researchers have shown again and again that health span and life span depend upon one’s lifestyle choices. A holistic look at lifestyle choices means many different and distinct areas of life.

I shared my take on these dimension of lifestyle and some of my experience. Also, gave references to where you can find more information, whenever, I have already discussed that topic in more detail in my blog posts.

  1. Benchmarking Health
  2. Nutrition
  3. Exercise
  4. Maintaining Musco-skelatal Integrity
  5. Maintaining Optimal Dental Health
  6. Maintaining Mind-body Connection
  7. Enhancing and Maintaining Brain
  8. Stress Management
  9. Adequate Sleep
  10. Social Engagement
  11. Purposeful Living
  12. Making full-use of all modalities of medical care
  13. Making use of Genetics Science

What do you think?

Do you think there some other dimension of lifestyle that I did not address here that is also important?

I would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input. 

 

Post #49 – What is the role of massage therapy in Optimal Health?

14 Sunday Feb 2016

Posted by in Aging, Optimal Health, Puposely Living, Quality of Life, Reversing Chronic Diseases, Stress, Uncategorized, wellness

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After so many years, my wife and I finally surrendered to the suggestions of our trainer and started getting massages at least once a month. He had been telling us how massage can be great for recovering from the stresses left over from hard workouts.  And, about six months ago, we decided to give it a shot and get massages on a regular basis.

So, I thought I will take some time to do some research into the role of massage therapy and share the research and our own experience in this blog post.

man_massage_table

What Is Massage Therapy?

Massage therapy dates back thousands of years. References to massage appear in ancient writings from China, Japan, India, and Egypt.

According to National Center of Complementary and Integrative Health (NCCIH) of the National Institute of Health (NIH) the term “massage therapy” includes many techniques and the type of massage given usually depends on specific need, physical condition and the expertise of the massage therapist.

In general, massage therapists work on muscle and other soft tissue to help you feel better.  The following massages you hear most about in the US:

In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping.

Deep (tissue)massage technique uses slower, more-forceful strokes to target the deeper layers of muscle and connective tissue, commonly to help with muscle damage from injuries.

Sports massage combines techniques of Swedish massage and deep tissue massage to release chronic muscle tension. It is adapted to the needs of athletes.

Myofascial trigger point therapy focuses on trigger points—areas that are painful when pressed and are associated with pain elsewhere in the body. Examples of these are:

  • Accupressure – where therapist applies strong physical pressure on specific point on the body.
  • Reflexology – Similar to acupressure where pressure is applied to certain points on hands and feet.

But there are other massages that are not quite as common and are based on Indian medicine, Ayuerveda:

Marma-point Massage – where a therapist applies very gentle touch to some or all of the 107 different marma-points in the body to correct any imbalances in the body

Shirodhara – where warm oil is poured to the forehead

Abhyanga – oil massage is done by two people with synchronized movements

Massage therapy is sometimes done using essential oils as a form of aromatherapy.

Benefits of Massage

A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue.

While more research is needed to confirm the benefits of massage, some studies have found massage may also be helpful for:

  • Anxiety
  • Digestive disorders
  • Fibromyalgia
  • Headaches
  • Insomnia related to stress
  • Myofascial pain syndrome
  • Soft tissue strains or injuries
  • Sports injuries
  • Temporomandibular joint pain

According to Arthritis Foundation  regular massage of muscles and joints, whether by a licensed therapist at a spa or by self-massage at home, can lead to a significant reduction in pain for people with arthritis, according to Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, who’s conducted a number of studies on the benefits of massage, including on people with arthritis. In Field’s research and other recent studies on the effects of massage for arthritis symptoms, regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall function of the joints.

In a study published in Science Translational Medicine by Dr. Mark A. Tarnoplsky et al found that a short, 10-minute Swedish-style massage session can reduce inflammation, which can help your muscles recover after a hard workout.

And, then of course, there are studies that attribute the benefits of massage just to receiving a dose of human touch that offers all sorts of healthy responses from lowering blood pressures, depression, improving immunity to oxytocin release for increased bonding response.

 What are the risks of Massage Therapy?

Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take some precautions in people with certain health conditions. NCCIH recommend that:

  • In some cases, pregnant women should avoid massage therapy. Talk with your health care provider before getting a massage if you are pregnant.
  • People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep tissue massage. People who take anticoagulants (also known as blood thinners) also should avoid them. Massage should not be done in any potentially weak area of the skin, such as wounds.
  • Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider.

Our Experience

Over the years, my wife and I have received massages during vacations etc.  We received several different Ayurvedic massages at the Ayurrvedic Institute in Albuquerque NM every day for a week of an intense detox and cleanse program called Panchakarma.  I have also received locally in Maryland Marma-Point massages.  And, now for the last six month, we are receiving massages once a month.

I described my experience of relieving migraine using acupressure in another blog post.

Massages that we receive from the same person every month are very therapeutic in that the therapist is getting to know our body. She is able to adjust her technique based on what our body needs. I am able to tell her any specific issue I may have. Usually these tend to be some stiff muscles that she could pay attention to.  During and after the massage, she is the one who tells me where the stiff muscles are.

Areas around my shoulders and neck are where I seem to burry my stresses and are getting more and more limber as a result of the massages.  I can definitely feel the result of my relaxed muscles in my yoga practice.

I have found Ayuervedic massages to be totally blissful. It blows me away how such gentle touches at the Marma-points or pouring of oil on third-eye can totally transport my body into a meditative state.

Bottom Line

Regular massage therapy definitely is valuable in creating and maintaining Optimal Health.  Repeating from the NCCIH website:

  • A lot of research on the effects of massage therapy has been carried out.
  • While often preliminary or conflicting, there is scientific evidence that massage may help with back pain and may improve quality of life for people with depression, cancer, and HIV/AIDS.
  • Massage therapy appears to have few risks if it is used appropriately and provided by a trained massage professional.

What do you think?

What are your experiences and knowledge of massages therapy?  

Please share your thought by clicking on “Leave A Comment” link.

I would love to learn and share with others what I learn from you?