Pain Management

Pelvic Floor Dysfunction

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Pelvic floor dysfunction is a common cause for chronic pelvic pain in women. An often-overlooked piece of the puzzle is pain stemming from laxity at the pubic symphysis and sacroiliac joints.

The pubic symphysis is a joint at the front of the bony pelvic ring. It consists of a fibrocartilaginous disc wedged between the two pubic bones. There are 4 ligaments that reinforce the pubic symphysis.

These ligaments can become more lax over time. Ligamentous laxity can occur due to athletics, trauma, the hormone relaxin during labor and delivery, or wear and tear from the variety of forces it undergoes on a daily basis, including traction, compression, and shearing.

Hypermobility at the sacroiliac joints often co-occurs with laxity at the pubic symphysis, since the pelvic bones are interconnected. Pelvic instability can cause spasm of the pelvic sling muscles, resulting in chronic pelvic pain.

Prolotherapy injections to the weakened pelvic ring ligaments will cause in increase in blood supply and regenerative cells to the area, stimulating repair of the lax ligaments. New collagen is added to the ligaments, strengthening them. Once stabilized, the pelvic ring resumes its purpose of being a stable base for pelvic floor muscles, reducing muscle spasms and pelvic pain.

Dr. Boston treats patients with chronic pelvic pain at the Akasha Center for Integrative Medicine at 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com (310)-451-8880.

Wellness

I just found a tick! Do I have Lyme disease?

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Summertime is around the corner, and hopefully we will all be outdoors enjoying the warm weather.  Unfortunately, ticks also enjoy warm weather.  There has been a lot of confusion lately about ticks and Lyme disease, so we should talk about it.

First of all, only deer ticks can transmit Lyme disease. Lyme is a spirochete bacterium that is transmitted through the tick’s saliva into the human that the tick is biting. So, we need to know what kind of tick it was. Deer ticks are brown or red/brown with 8 black or brown legs. If it has a white mark on it’s back, then it is not a deer tick. Before they are engorged with blood, the adult deer tick is about the size of a sesame seed and the nymph (teen) deer tick is the size of a pinhead. Once they are engorged with blood, they can be much larger.

Second of all, a deer tick has to be attached and feeding, for >=36 hours in order to transmit Lyme.  So, if the tick is discovered before 36 hours, or is discovered with a flat, non-engorged body, then there is no chance of Lyme transmission.

The key is finding and removing the deer tick before 36 hours.  

Tell all your campers going to sleep away camp that they should do a full body check for ticks once a day.

 When doing a body check for ticks after spending time outdoors, make sure to include the armpit, behind the knee, the groin, behind ears, and the scalp.

The way to remove a tick is to use fine-nose tweezers to grab the tick as close to the attachment point to your skin as possible. Lift with a steady, firm direction backwards from the skin. Do not squeeze the tick body, nor twist, nor use a match or fingernail polish, as these methods can make the tick express more saliva into the bite wound. After removing the tick, wash the skin and hands with soap and water. If the head is left in the skin, leave it in place as digging to remove it can cause trauma, and natural skin sloughing will eliminate it in a few days.

If you find a deer tick that is estimated to have been attached for >=36 hours, then your doctor can prescribe you a single preventative dose of an antibiotic to prevent Lyme if given within 72 hours of removing the tick.

There is no benefit in blood testing for Lyme at the time of the bite, as a positive blood test will not be apparent until 2-6 weeks after the bite.

If you develop a rash that looks like a target symbol, which is called erythema migrans (EM), then you do have early Lyme and need 14-21 days of antibiotics. EM occurs in 80% of patients, usually within 1 month following the tick bite.

During the first days or weeks of infection, patients often have nonspecific symptoms like fatigue, sore joints, headache, or enlarged lymph nodes.

If you found the tick after it was attached for 36 hours and develop neurologic or cardiac symptoms, then you could have early disseminated Lyme and could require intravenous antibiotics.

You may benefit from supportive treatments to optimize your immune system, methylation, and gut health during the stressful time of the tick bite. See your health care practitioner to guide you.

Dr. Bren Boston sees patients at the Akasha Center for Integrative Medicine at 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com   (310)-451-8880

Longevity, Wellness

Just in time for Mother’s Day…How Exercise Can Help Your Motherhood

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I’ve always had a bit of a Type A personality. Probably most doctors do, how else can you make it through medical school? Having a Type A personality means that my sympathetic nervous system, my fight or flight instinct, can make me a bit on edge sometimes. It also helps me get stuff done. But, too much of a good thing, is a bad thing. Exercising is the main way I balance my sympathetic nervous system, burning off the excess adrenaline, helping me to be less uptight and less irritable. And, any mom knows, you are a better mom when you are feeling more relaxed, less uptight, and happier.

Staying fit by eating healthy foods and exercising regularly is also my mood stabilizer. When I go running, I am flushed with a sense of optimism that comes out of nowhere. It just washes over me, and my mind is flooded with creative ideas and positive thoughts. Natural endorphins and improved blood flow are the biological causes of these uplifting brain waves. These happy feelings spill over into my interactions with my kids, helping me to enjoy the precious moments and to tolerate the gripes with aplomb.

Staying fit also gives me energy. One of the biggest complaints I hear from moms is that they feel tired. I can honestly say that I have great energy due to an endurance built up from regular exercise 5 days a week, and sleeping 8 hours a night. Having energy allows me to play joyfully with my kids.   I can tell they are in tune with my energy, and it brings us closer together. I also feel good about setting an example for them of how exercise can be a fun part of your weekly routine, something to look forward to, not to dread.

Being healthy is important for longevity. I want to be there to see my kids grow up into adults, and to be a grandparent to their children. In fact, I don’t just want to be there for my grandkids, I want to be running around with them, babysitting them, and keeping up with them. Exercising, specifically weight training, gives me noticeable muscle strength that I am aware of when toting heavy grocery bags without flinching or lifting my kids into a bear hug.

Being fit is an important aspect of my self-esteem. What you see on the outside is not nearly as important as what is on the inside, but the real you is stuck inside your body. Keeping your vessel healthy and fit is a way to honor the real you, the soul, that lives within. Being fit allows me to feel comfortable in my clothing, and to feel good about my body. I don’t have a perfect body, but I do have a strong, energetic, healthy body, and that helps me be the mom I want to be.

If you are a mom who is looking to jump-start her fitness and weight loss plan, I would love to see you at the Akasha Center of Integrative Medicine for a comprehensive wellness plan.   Akasha Center for Integrative Medicine, 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com   (310)-451-8880

Uncategorized, Wellness

HIV: It Hasn’t Gone Away

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I read an article in the January 2016 issue of the Journal of Family Practice titled, “HIV Prevention: A 3-Pronged Approach” by N. Yagoda, MD and R. Moore II, MD.

I have been thinking about HIV lately because I know many college students who are blossoming in their new-found freedom and sexual exploration, and they are not thinking about HIV at all. HIV is not in the headlines anymore, and therefore it seems to be less powerful in helping young adults to choose protected versus unprotected sex. This is despite the fact that total HIV incidence has failed to decrease in the last 25 years.

Per the article, there are more than 1.2 million people living with HIV in the USA, and 12.8% of them are unaware that they have it while only 30% of those diagnosed with HIV are receiving treatment to suppress the virus.  This means that the virus is out there, multiplying unchecked in almost million people in the US alone.

RISK FACTOR:  Unprotected sex.

RISK FACTOR:  IV DRUG USE.  In my realm of pain management, a scary truth is that a considerable number of people who become addicted to prescription pain medication eventually switch to injected heroin because it is a lot cheaper. In calm suburbs across the country, there are regular people who are secretly injecting drugs due to addiction and finances.  Intravenous drug use, or even sex with a person who uses IV drugs, is considered a major risk factor for contracting the HIV virus.

The 3-pronged approach to HIV prevention mentioned in the article includes  1) screening all individuals ages 15-65 for HIV, 2) pre-exposure prophylaxis for high-risk patients (taking anti-viral medications to reduce the risk of contracting HIV), 3) harm reduction.

Pre-exposure prophylaxis is for individuals who cannot or choose not to avoid risky behavior for a period of time in their life.  The downsides include possible drug resistance, high cost (although insurance covers part of it), stigma for those who seek to protect their sexual health, and possible affects to the kidney.

Harm reduction is a group of strategies that help IV drug users avoid HIV transmission.  Needle and syringe exchange programs and opioid substitution therapy (methadone or buprenorphine) are examples.

The bottom line is that young people need to be educated about safe sex, which means using a condom correctly every time, even if other forms of birth control are already being used.  I recommend all college-bound teens to read a book titled, “Seductive Delusions” by Dr. Jill Grimes which goes through all the sexually transmitted infections (STI), the ways you can catch them, and how to treat them, in a very readable format.  I also encourage all people to consider screening for STIs, given that infidelity is common, and treatment for STIs is available.

Nutrition, Sports Medicine, Wellness

What to Eat to Heal from Surgery

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What you eat can affect how well you heal from an orthopedic injury or surgery. When your body has to repair injuries, create new bonds, and strengthen tissues, its performance will depend on whether it gets the building blocks it needs. Imagine your food being digested into molecules, and those molecules being absorbed into your blood stream to be delivered to the site of healing.

Protein intake should be spread out evenly throughout the day in meals and snacks. Branched-chain amino acids (BCAA) are metabolized in muscles to provide energy and promote protein synthesis. BCAA found organic poultry, grass-fed beef, fish, soybeans, lima beans, eggs and nuts boost healing after musculoskeletal injury.

Vitamin C is required to make collagen to repair tendons or ligaments and heal surgical wounds. Good sources include citrus, broccoli, strawberry, kiwi, and bell pepper.

Zinc enhances wound healing. It is found in free-range beef, oysters, pumpkin seeds, and cashews.

Beta-carotene is a precursor to Vitamin A and promotes stronger bones, healthy scar tissue, and elasticity of skin. Good sources are sweet potato, kale, squash, carrot, prune, apricot, and mango.

Antioxidants (Vit C, flavonoids, Vit A, Zinc, Selenium, B vitamins, folate) neutralize the damaging effects of free radicals and repair cellular damage from injury or surgery. Found in leafy greens like kale, vegetables, fruits, legumes, whole grains, lean meat/poultry, fatty fish, nuts and seeds.

Flavonoids reduce swelling and protect cells. Flavonoids are found in cocoa, tea, red wine, fruits, vegetables, legumes, garlic, turmeric, green tea, blueberries, apples, citrus, and pineapple.

EPA and DHA Omega 3 fatty acids reduce joint stiffness, improve bone health, and provide anti-inflammatory benefits. You can find it in oily fish such as wild salmon, sardines, and anchovies.

Iron is required for oxygen delivery to the site of injury or surgery, and for wound healing. In addition to animal products, iron is found in dark leafy greens, legumes, beets, raisins, and black beans.

Calcium and Vitamin D optimize tendon-to-bone healing after injury or surgery. Calcium is found in dark leafy greens, salmon, rainbow trout, white beans, and fortified foods like almond milk and oatmeal. Vitamin D is found in mushrooms, salmon, tuna, soy milk, and egg yolks.

Healthy fats from avocado, olive oil, coconut oil, nuts, and seeds will improve immune response and help your body absorb vitamins A, D, E, and K.  Avoid partially hydrogenated oil (in processed foods) due to their pro-inflammatory effect.

Fiber is necessary to avoid post-operative constipation. The pain medications required for orthopedic surgery, as well as the anesthesia used during surgery, can cause slowing of intestinal transit and constipation. Up your fiber intake from vegetables, apples, berries, prunes, whole grains, flax and chia seeds.

Pain Management, Sports Medicine

Why I Believe in Prolotherapy

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For someone suffering from joint pain, prolotherapy can be a safe and effective way to get them back to their usual activities. My opinion is that a targeted treatment at the source of the problem is a better option than a systemic treatment that circulates to the entire body. Prolotherapy causes proliferative cells to migrate to the weakened area, targeting the problem.

Chronic joint pain is an astronomically common condition, especially given our aging population. In fact, the majority of people over the age of 65 will have radiographic evidence of osteoarthritis. As we age, body tissues such as vertebral bones, spinal discs, and knee cartilage, lose height due to decreased bone density, loss of vascularity, wear and tear, and disc degeneration. While these tissues lose height, the ligaments connecting the bones remain the same length, causing these supporting ligaments to buckle. These lax, weakened ligaments can lead to segmental instability resulting in pain.

Poor posture (head forward, slumped during prolonged sitting, rounded lower back) exacerbates the laxity of ligaments in the neck and low back. The laxity of ligaments causes an instability which stimulates proprioceptive nerve fibers and can lead to chronic muscle spasm in the body’s attempt to stabilize the area. Prolotherapy is an injection treatment using safe, natural, proliferant substances such as dextrose, to stimulate the body’s natural healing cascade where the ligament and tendon join to the bone. Prolotherapy treats the cause of the chronic pain by correcting the ligament laxity.

Prolotherapy has been shown to be effective in treating knee osteoarthritis by combining intra-articular (inside the joint) injections of proliferant solutions with ligament and tendon injections to stabilize the knee joint. Studies have shown improvement in pain, function, and stiffness when using prolotherapy to treat knee OA.

Clinical trial literature is growing which supports the use of prolotherapy in osteoarthritis, low back pain, ligament and tendon injuries. A newer use of prolotherapy has been gaining momentum called neural prolotherapy. Neural prolotherapy involves multiple subcutaneous injections of proliferent solution to treat the hundreds of small nerve fibers under the skin which can contribute to chronic pain when chronically activated.

While it does not work for everyone, proliferative therapy is a worthwhile technique in the tool kit of treatments for joint pain. Prolotherapy has fewer side effects than medications and fewer risks than surgery or platelet-rich plasma (PRP). Prolotherapy is far less expensive than PRP while studies show the two treatments to have similar outcomes. Prolotherapy is an effective modality when combined with weight loss to offload the joint and a focused exercise program to strengthen supportive muscles.

You can schedule a prolotherapy consultation at the Akasha Center in Santa Monica by calling 310-451-8880.

 

 

 

 

 

Pain Management, Sports Medicine

Prolotherapy for Knee Pain

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If knee pain is stopping you from exercising, then you can expect your knee pain to get worse, not better. Studies have shown that exercise is crucial for people with arthritis. Prolotherapy can help people with knee pain get back to an exercise routine.

Prolotherapy is safe injection technique that can significantly decrease the pain of knee arthritis.

A study looking into the therapeutic effects of prolotherapy for moderate knee osteoarthritis appeared in the April 2015 issue of Therapeutic Advances in Musculoskeletal Disease. The study found that knee pain, range of motion, and function were all improved after 3 monthly prolotherapy sessions, and the benefit was maintained throughout the 6-month study duration.

Osteoarthritis (OA), the most common form of arthritis, typically onsets after age 40.  OA is due to the gradual loss of joint cartilage which can lead to bony endplate changes.

The most important thing we can do to delay or prevent OA is to keep our body mass index (BMI) in the ideal range from 18-25. You can calculate your BMI using your height and weight here: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Our body is just a skeleton frame and was not meant to carry lots of extra weight. Imagine if you had to carry 20 lbs of bricks strapped to your back at all times.  That is no different than being 20 lbs overweight.  Extra weight is going to wear down your knees, hips, and the discs in your lower spine.

Keeping your muscles strong and limber is critical for joint health. Muscles, tendons, ligaments, cartilage, and joint-space fluid are the only things standing between bone-on-bone. When you keep the supporting structures in prime health, you protect the intraarticular surface inside the joint.  If you cannot pound the pavement due to knee pain, you can use swimming or a recumbent bicycle to achieve optimal muscle strength and cardiovascular fitness.

Other things we can do to prevent osteoarthritis include eating a healthy diet filled with nourishing antioxidants, amino acids, and nutrients. An anti-inflammatory diet with organic vegetables, fruits, beans, herbs, nuts, seeds, and whole grains like quinoa (not flour products) should make up the bulk of your food choices.  Healthy sources of fats like avocado, coconut, olive oil, nuts, and wild salmon should replace the unhealthy sources of fats found in processed foods.

Staying hydrated is necessary to avoid drying out the cartilage inside the joints. The synoviocytes (the cells that line the weight-bearing joints) produce a fluid that helps buoy the bones like hydraulic fluid.  When this fluid dries out, the joint is more likely to have bone-on-bone friction. The spinal discs contain a gel-like center that tends to desiccate with age, and benefit from daily hydration. Men should drink 3 liters water/day and women should drink 2 liters water/day.

Supplements can be helpful for joint health.  Glucosamine sulfate 1500 mg/day with Chondroitin 1200 mg/day has been shown to help reduce cartilage loss in several studies.  Resveratrol is an antioxidant derived from the skin of grapes that is associated with longevity and may protect joints.  Fish oil (omega 3) has an anti-inflammatory effect.  Anti-inflammatory herbal blends like Akasha’s InflaRegulator are a healthy way to decrease your joint swelling.  Akasha’s Joint Ease is a selective kinase response modulator that is useful for flares of joint pain.

Treatment focus has shifted away from removing damaged cartilage, to preservation of as much cartilage as possible while enhancing the healing cascade.

Prolotherapy is injections of a proliferative fluid to the intra-articular joint space and the extra-articular supporting structures where tendons and ligaments attach to the bone surrounding the joint.  The result is a stimulation of the body’s natural healing cascade and a stabilization of the supportive structures of the joint.

Prolotherapy is available at the Akasha Center for Integrative Medicine in Santa Monica, CA.  Call 310-451-8880 to make an appointment with Dr. Boston.

www.akashacenter.com

Nutrition

Gluten: Evil or Not?

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Gluten is a hot topic, and this is a great article (“Should We All Go Gluten-Free,” by W. Balistreri, MD, see link below). My quick summary is that 1% of the population has celiac disease, and these folks absolutely need to be gluten-free all the time.

For the rest of us, you need to understand that processed foods are the greatest evil, so if you switch from wheat-flour cookies to gluten-free rice flour cookies, you are still just eating processed food cookies. Gluten-containing foods also tend to be high in sugar, and easily converted to more sugar once you eat them, spiking your insulin and leading to food coma and other negative effects.

The best approach would be to strive for a diet rich in plants that still look like plants (organic vegetables, fruits, beans, nuts, seeds, grains that look like grain, NOT FLOUR – think quinoa). No matter how many vegetables you eat daily, you could benefit from eating MORE VEGETABLES in place of what ever other food you are eating.

Does this mean you have to avoid all gluten all the time? Not necessarily. It means to minimize all flour-based products, even gluten-free ones, to the margins of your diet.

If you have gastrointestinal problems, then you should test for celiac antibodies before you go gluten-free, and then do a 1-month food elimination diet (including eliminating gluten), to see if you improve. Food sensitivity blood tests can guide your elimination diet. After a month, you can see how your symptoms have responded to the elimination and re-introduction of foods.

I love to guide people through this process at the Akasha Center for Integrative Medicine in Santa Monica.
http://www.medscape.com/viewarticle/857971?nlid=99603_491

Nutrition, Sports Medicine, Wellness

HYDRATION

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Hydration…I consider it my 3rd full time job after being a mom and a doctor. That’s how important it is, and also how much of a hassle.

The human body is 60% water, and all of our cells function optimally when we are well-hydrated. When we don’t drink enough water, our brain feels tired, foggy, and headachy; our muscles and joints feel sore and unlubricated, and our skin looks dry and papery. Our body’s ability to detox is hampered when we don’t drink enough water to flush through our kidneys and liver. Water is also imperative for healthy gut function, avoiding constipation and the build-up of toxic sewage in our large intestines when things aren’t moving along.

So, how much water should you drink? In general, a good rule of thumb is that women should drink about 2 liters of water a day, and men should drink about 3 liters a day.

I use a 20-oz glass water bottle that has a silicone sleeve, and I drink about 4 refills a day of filtered tap water. I make sure I drink my first 20 oz of water before my cup of coffee in the morning as a reward. It is time-consuming and makes me have to stay close to a bathroom, but I notice immediately if I don’t drink enough water…by feeling sluggish, brain-foggy, and tired.

You need even more water when exercising. The American College of Sports Medicine says that you should drink 3-8 oz water every 15 min while exercising for less than an hour, or 3-8 oz of a sports drink every 15 min if exercising for more than an hour.

Can you drink too much water? Yes. If you drink too much water, you can dilute your electrolytes which can be dangerous.

So, stick to the guidelines, and rejuvenate your dry cells to a nourished state every day.

Wellness

Do I Need Heavy Metal Detox?

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Could my headaches, mood swings, insomnia, nervousness, irritability, joint pains, tingling, or fatigue be from exposure to heavy metals?  The answer is possibly.

Heavy metals, like mercury, arsenic, and lead, surround us in our environment.  Our body’s internal detoxification process can handle a certain low level of exposure to heavy metals.  If the level of exposure overwhelms our ability to excrete the metals, then we can be left with symptoms that require treatment.

In order to estimate the likelihood that you have been exposed to heavy metals, it is important to understand the common sources of metals in our environment.

MERCURY:  The most common source of mercury is seafood in our diet.  Larger fish (that eat smaller fish) tend to have more mercury.  The EWG (environmental working group) has a great consumer guide to mercury in seafood.  (http://www.ewg.org/research/ewgs-good-seafood-guide).  Other common sources of mercury include fossil fuel combustion, cement plants, waste incineration, steel production, thermometers, preservative thimerosal in multi-dose vaccines, and amalgam fillings for teeth.

ARSENIC:  Arsenic is a metal present in the earth’s crust, and can leach from soil and rocks into drinking water.  It can be found in some soil-derived foods like rice and grains.  Shellfish and seafood from arsenic contaminated water.  Pesticides and herbicides can contain arsenic (another reason to choose organic, no-spray produce).  Chicken that has been fed arsenic supplements for intestinal parasites (another reason to eat organic, free-range chicken).  Pressure treated wood and fossil-fuel combustion are also sources.

LEAD:  In the USA, the main sources are contaminated water or soil, lead paint, lead pipes, brass plumbing fixtures, and lead solder on copper pipes.  The plumbing sources cause lead-contaminated drinking water.  Lead is also in leaded gasoline, batteries, ammunitions, cables, wires, kohl eyeliner, glazes on some ceramics, and sometimes contaminated products from overseas.

You might have just one or multiple signs and symptoms of heavy metal toxicity.  Signs and symptoms of mercury exposure can include headache, insomnia, mood swings, nervousness, irritability, tremors, weakness, tingling, skin rashes, abnormal kidney or lung function. Signs and symptoms of arsenic toxicity include numbness, tingling, weakness, drowsiness, confusion, white lines in fingernails, darkening of skin, diarrhea, abnormal liver and kidney function tests, or cancer of skin, bladder, kidney, or lung.  Signs and symptoms of lead toxicity include irritability, fatigue, sluggishness, loss of appetite, learning difficulties, developmental delay, abdominal pain, vomiting, constipation, numbness, tingling, hearing loss, or joint pain.

The CDC recommends using blood levels or 24-hour urine collection levels to determine your how much heavy metals are in your body.  I recommend adding a heavy metal panel to your annual blood work if you eat fish more than twice a week, or if you have any concern about heavy metals in your environment.  Provoked urine tests in which a chelating agent is given prior to urine collection, are not recommended as they will show too many false positives.

Treatment is needed for anyone who is symptomatic or whose labs reach a certain threshold.  Treatment must start with removing the source of the heavy metals in your environment.  This might entail eating less seafood, choosing low-mercury fish, having your mercury amalgam fillings removed and replaced with resin-based composite fillings.  Investment in a water filtration system for your tap water is worth every penny, to ensure you are not drinking heavy metals.  Filtered tap water is preferable over water bottled in plastic due to plastic chemicals leaching into water, as well as the environmental impact of plastic waste.

A comprehensive heavy metal detox plan is available at the Akasha Center for Integrative Medicine.  Depending on your symptoms and labs, you might require chelation medication to help pull the metals out of your system.  Supporting the channels of elimination during the detox period is important in order to effectively reduce your metal burden.  Recommended supportive treatment includes supplements to boost glutathione which is the most important detoxifying molecule in your body, supplements to support the health of your liver which will be sent to task getting rid of your metals, a natural supplement to help bind the metals prior to elimination, fiber support to help you eliminate the metals effectively in your stool, colonics to remove toxic residue from your colon after the detox process has begun, and intravenous Myers cocktails with glutathione to optimize your immune system and hydration during the process of detoxification.

If you are interested in having your heavy metal labs checked or treated, you can call the Akasha Center for Integrative Medicine at 310-451-8880.  You can read about the Akasha Center at www.akashacenter.com.