The container that holds and/or heats liquid or solid food as well as water may be more important than its contents. In the last 3 decades, there has been a 500% increase of plastics used in our immediate environment to include cups and bottles. The three worse offenders are Phthalates, Biphenol A and styrofoam. These bind to various hormone receptors such as estrogen and thyroid and are known as Hormone Disrupters. Also the Styrofoam hydrocarbons in cups or other bottles can cause cancer.
Phthalates, or phthalate esters, are esters of phthalic acid and are mainly used as plasticizers (substances added to plastics to increase their flexibility, transparency, durability, and longevity). They are primarily used to soften polyvinyl chloride. Phthalates are being phased out of many products in the United States and European Union over health concerns. Phthalates are used in a large variety of products, from enteric coatings of pharmaceutical pills and nutritional supplements to viscosity control agents, gelling agents, film formers, stabilizers, dispersants, lubricants, binders, emulsifying agents, and suspending agents. End applications include adhesives and glues, agricultural adjuvants, building materials, personal care products, medical devices, detergents and surfactants, packaging, children’s toys, modelling clay, waxes, paints, printing inks and coatings, pharmaceuticals, food products, and textiles. Phthalates are also frequently used in soft plastic fishing lures, caulk, paint pigments, and sex toys made of so-called “jelly rubber.” Phthalates are used in a variety of household applications such as shower curtains, vinyl upholstery, adhesives, floor tiles, food containers and wrappers, and cleaning materials. Personal care items containing phthalates include perfume, eye shadow, moisturizer, nail polish, liquid soap, and hair spray. They are also found in modern electronics and medical applications such as catheters and blood transfusion devices. The most widely used phthalates are the di-2-ethylhexyl phthalate (DEHP), the diisodecyl phthalate (DIDP) and the diisononyl phthalate (DINP). DEHP is the dominant plasticizer used in PVC due to its low cost. Butyl benzyl phthalate (BBP) is used in the manufacture of foamed PVC, which is mostly used as a flooring material. Phthalates with small R and R’ groups (attached organic molecules) are used as solvents in perfumes and pesticides.
Phthalates are easily released into the environment because there is no covalent bond between the phthalates and plastics in which they are mixed. As plastics age and break down the release of phthalates accelerates. Phthalates in the environment are subject to biodegradation, photodegradation, and anaerobic degradation and, therefore, they do not generally persist in the outdoor environment. Indoor air concentrations are generally higher than outdoor air concentrations due to the nature of the sources. Because of their volatility, DEP and DMP are present in higher concentrations in air in comparison with the heavier and less volatile DEHP. Higher air temperatures result in higher concentrations of phthalates in the air. PVC flooring leads to higher concentrations of BBP and DEHP, which are more prevalent in dust.
People are commonly exposed to phthalates, and most Americans tested by the Centers for Disease Control and Prevention have metabolites of multiple phthalates in their urine. Because phthalate plasticizers are not chemically bound to PVC they can easily leach and evaporate into food or the atmosphere. Phthalate exposure can be through direct use or indirectly through leaching and general environmental contamination. In the Midwest, many fish in streams are banned from human cosumption because of the adulteration of the water from public and private landfills. Diet is believed to be the main source of DEHP and other phthalates in the general population. Fatty foods such as milk, butter, and meats are a major source of toxicity, since they more rapidly absorb these lypophillic chemicals. Low molecular weight phthalates such as DEP, DBP, BBzP may be dermally absorbed. Inhalational exposure is also significant with the more volatile phthalates. Looking at the Recycling triangle on the bottom of the container will give more information than you need.
The actual risks of BPA are still a matter of public debate, but over the past decade, a growing body of scientific studies has linked the chemical to breast and prostrate cancer, infertility, obesity, and neurological and behavioral changes, including autism and hyperactivity. Bisphenol A is also an endocrine disruptor, it can mimic the body’s own hormones, which may lead to negative health effects if the dosage is high. There are theories that it may contribute to body fat development. A September 2008 study in the Journal of the American Medical Association found that higher levels of urinary BPA is associated with cardiovascular disease, diabetes and liver-enzyme abnormalities.
Styrene is made from benzene which has been clearly shown to be carcinogenic. The migration of styrene from a polystyrene cup into the beverage it contains has been observed to be as high as 0.025% for a single use. That may seem like a rather low number, until you work it this way: If you drink beverages from polystyrene cups four times a day for three years, you may have consumed about one foam cup’s worth of styrene along with your beverages. Styrene migration has been shown to be partially dependent on the heat and fat content of the food in the polystyrene cups/containers—the higher the fat content and the temperature, the higher the migration into the food. Entrees, soups, or beverages that are higher in fat (like a bowl of three-cheese chili or tall cupful of Triple-Cream Frappa-Mocha Java Delight) will suck much more of the styrene out of the polystyrene container than water. Some compounds found in beverages, like alcohol or the acids in “tea with lemon,” may also raise the styrene migration rate.
PLASTIC CODE IDENTIFCATION: Containers with a 3, 6, or 7 on the bottom are the most dangerous of all. They contain a dangerous and volatile chemical called BPA, and should be avoided at all costs. Containers with a 4 or 5 on the bottom are generally considered safe. But you should probably use them sparingly. And you should never use them in a microwave.
Containers with a 1 or 2 on the bottom are the safest. These include clear water containers, as well as most cloudy containers you normally find containing water or milk. These containers, called PET and HDPE, are safe for storing food and drink. But again, you should never use them to microwave.
The #7 recycling label is a catchall indicator for plastics made with a resin other than those in the #1 to #6 designations, or made of more than one resin. The #7 category not only includes polycarbonate, but also includes compostable plastics made of organic material and other types of plastic that do not necessarily contain BPA (Bisphenol-A). For example, the new Everyday™ line manufactured with Eastman’s Tritan™ copolyester is a #7, but does not include BPA.
Of all the seven grades of commercial plastics available to manufactures on today’s market, unlucky #7 has the worst track record for leaching the chemical known as BPA into liquids or foods likely to be consumed by humans or animals. The reason is because unlike the other six composites, containers bearing the number seven are made of a composite of leftover scraps that have been ‘repurposed’ and most likely purchased at a discount. The new Nalgene water bottle is made of a “copolyester” plastic manufactured by the Eastman company with the trade name Tritan. So are new bottles by Korand Campelbak. All trumpet the fact that their bottles are BPA-free, with the implication that BPA-free is the equivalent of safe. But there is no way of knowing because the ingredients that make up Tritan have been kept secret. They could include another dangerous chemical. Since the ingredients have not been identified, no one can say. All that is known about the Tritan bottles is that, like polycarbonate, they fall into the #7 category of “other” plastics in the identification system.
When purchasing cling-wrapped food from the supermarket or deli, slice off a thin layer where the food came into contact with the plastic and store the rest in a glass or ceramic container or wrap it in non-PVC cling wrap. Avoid storing fatty foods, such as meat and cheese, in plastic containers or plastic wrap. Hand-wash reusable containers gently with a nonabrasive soap; dishwashers and harsh detergents can scratch plastic, making hospitable homes for bacteria.
“Microwave-safe” or “microwavable” label on a plastic container only means that it shouldn’t melt, crack or fall apart when used in the microwave. The label is no guarantee that containers don’t leach chemicals into foods when heated. Use glass or ceramic containers instead. Some scientists feel that the microwaves change the healthy vibrational frequency of the food to a unnatural and less compatible with our digestive/metabolic system.
Monday, March 29, 2010
Wednesday, March 24, 2010
Diabetes and Obesity Prevented
Victoza (liraglutide)-was recently approved by the FDA to treat Type 2 Diabetes, and its ugly cousins cardiovascular morbidity (illness) and mortality (death). But will prove more valuable in the long run to prevent this 21st century epidemic. In at least 30 double blind, well-conducted research protocols, this drug performed better than any weight loss drug on the market. With a caloric restricted diet and proper exercise, this is the best product to be approved for our fattening population. Moreover, compared to other drugs, there was less muscle loss and the fat that was lost was the more dangerous intra-abdominal lard. It is well known that these fat cells release dangerous cytokines that travel to other tissues such as blood vessels causing plaque, and to nuclei producing cancer. A growing number of corpulent folks develop a fatty liver (hepatic steatosis) that quietly in some leads to cirrhosis. This drug prevents these problems as well as diabetes.
Victoza is an injectable prescription medicine that improves blood sugar (glucose) in adults with type 2 diabetes when used with a diet and exercise program. However, as an “off label use” it can be prescribed for prediabtes and 80% of obese patients have either Diabetes or Prediabetes. Insurance companies will probably not pay for off label use, although it may be cost effective to do so to save future expenditures. Victoza is in the class of natural hormones to control our metabolism, called Incretins and more specifically in humans Amylin. There are two in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed into our circulation and travels to the various target organ receptors in our brain, stomach and pancreas. In these Amylin decreases our blood sugar and the desire to eat. Victoza acts like the drug Byetta that has been on the market for 3 years, also taken immediately before meals by injection, but is degraded rapidly and must be given twice daily instead of once and is less effective.
Victoza is given any time during the day. The only significant side effect is nausea that usually goes away after several weeks. By itself, there is no low blood sugar, only normalization. There is a rare case of inflammation of the pancreas in the 4,000 of the test subjects and in animals a chance of an unusual cancer of the thyroid. It comes in 3 sizes of pre-filled pen like syringes. Other weight loss adjuncts can be given with it, such as HcG, inositol, and methionine.
There are two main incretin hormones in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed, goes into our circulation and travels to the various target organ receptorsThere are two main incretin hormones in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed, goes into our circulation and travels to the various target organ receptors.
Victoza and Byetta are registered trademarks.
Victoza is an injectable prescription medicine that improves blood sugar (glucose) in adults with type 2 diabetes when used with a diet and exercise program. However, as an “off label use” it can be prescribed for prediabtes and 80% of obese patients have either Diabetes or Prediabetes. Insurance companies will probably not pay for off label use, although it may be cost effective to do so to save future expenditures. Victoza is in the class of natural hormones to control our metabolism, called Incretins and more specifically in humans Amylin. There are two in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed into our circulation and travels to the various target organ receptors in our brain, stomach and pancreas. In these Amylin decreases our blood sugar and the desire to eat. Victoza acts like the drug Byetta that has been on the market for 3 years, also taken immediately before meals by injection, but is degraded rapidly and must be given twice daily instead of once and is less effective.
Victoza is given any time during the day. The only significant side effect is nausea that usually goes away after several weeks. By itself, there is no low blood sugar, only normalization. There is a rare case of inflammation of the pancreas in the 4,000 of the test subjects and in animals a chance of an unusual cancer of the thyroid. It comes in 3 sizes of pre-filled pen like syringes. Other weight loss adjuncts can be given with it, such as HcG, inositol, and methionine.
There are two main incretin hormones in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed, goes into our circulation and travels to the various target organ receptorsThere are two main incretin hormones in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed, goes into our circulation and travels to the various target organ receptors.
Victoza and Byetta are registered trademarks.
Sunday, March 14, 2010
A MAGIC INJECTION
Over the almost half-century that I have been doctoring, I have injected thousands of patients who were contending with local pain syndromes, using dozens of medications. These were in nerve roots, trigger/tender points, joints, tendon insertions and even into the spinal canal. In the last twenty-five years, I have used Sarapin as part of a healing, pain relieving cocktail. Although there are other specialists who do similar injections such as pain specialists, orthopedists, rheumatologists and prolotherapists, my medicines and or technique seem to work better.
Prolotherapy that has been used for over 60 years heals tendons, joints, and muscles by injection of curative substances of which an irritant initiates the therapeutic process by proliferation of new cells. It is also called sclerotherapy because it hardens limp tissue. Proliferants used in Prolotherapy are basically substances that lead to new collagen formation. Collagen is the naturally occurring protein in the body that makes up ligaments and tendons. Prolotherapy solutions help strengthen these structures by initiating the first step in the wound-healing cascade, which is local inflammation. Once the inflammation has begun, fibroblasts are stimulated. These are the cells that make the collagen. New collagen is produced, making the ligaments and tendons stronger and tighter. The solution I now employ contains Serapin from the pitcher plant and 50% glucose as the proliferant. No cortisone is used because the inflammatory process is therapeutic and the steroid is anti-inflammatory
Prolotherapy that has been used for over 60 years heals tendons, joints, and muscles by injection of curative substances of which an irritant initiates the therapeutic process by proliferation of new cells. It is also called sclerotherapy because it hardens limp tissue. Proliferants used in Prolotherapy are basically substances that lead to new collagen formation. Collagen is the naturally occurring protein in the body that makes up ligaments and tendons. Prolotherapy solutions help strengthen these structures by initiating the first step in the wound-healing cascade, which is local inflammation. Once the inflammation has begun, fibroblasts are stimulated. These are the cells that make the collagen. New collagen is produced, making the ligaments and tendons stronger and tighter. The solution I now employ contains Serapin from the pitcher plant and 50% glucose as the proliferant. No cortisone is used because the inflammatory process is therapeutic and the steroid is anti-inflammatory
The Pitcher plant (Sarracenia purpurea) is also known as Eve's Cup, Fly Catcher, Huntsman's Cup, and Water Cup. It looks like a pitcher or water jug. Like the Venus flytrap, it catches and “eats” small bugs. The Pitcher plant has been used for stomach and digestive problems, for urinary tract disorders, and formerly as a cure for smallpox.
Since it has been used medicinally for several millennia, it has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of pitcher plant may not be known, but I have found this to be an excellent and extremely safe medicine. Sarapin is a biological medicine – which means it is derived from a naturally occurring source (the Pitcher plant). It works by stopping pain signals and initiate healing in the nerves. It does not affect any other nerve functions or motor functions as does local anesthesia such as lidocaine.
Research published by Bernard Judovich MD in 1935, who did not only original in vitro research, but also used this preparation in over 5,000 patients, found it to be almost a miracle drug. He was chief of the Intercostal Neuralgia Clinic at the University of Pennsylvania Graduate Hospital. Later, he taught C. Hollander, the father of modern day Rheumatology who in the late sixties mentored my best friend Chucky Kahn. Dr. Hollander was chief of Rheumatology at the University of Pennsylvania Medical School for three decades and published the definitive textbook on joint injections. It was Dr. Kahn who taught me the science and the art of this technique 35 years ago.
Research published by Bernard Judovich MD in 1935, who did not only original in vitro research, but also used this preparation in over 5,000 patients, found it to be almost a miracle drug. He was chief of the Intercostal Neuralgia Clinic at the University of Pennsylvania Graduate Hospital. Later, he taught C. Hollander, the father of modern day Rheumatology who in the late sixties mentored my best friend Chucky Kahn. Dr. Hollander was chief of Rheumatology at the University of Pennsylvania Medical School for three decades and published the definitive textbook on joint injections. It was Dr. Kahn who taught me the science and the art of this technique 35 years ago.
Toxicity tests on Serapin published by William Bates, MD in the Ohio State Medical Journal in 1942 revealed that it was harmless and no evidence of tissue coagulation or sclerosis could be found. In that it is an alkaline extract, which releases an ammonium ion from the organic matrix, it was theorized that this was the active ingredient in the solution. It is known that this ion does affect nerve conduction, but Sarapin does more. Perhaps the plant's special amino acid content, because of the organisms it ingests, it was postulated that there was another yet unidentified biological fraction of the plant that is in the mix that is the active ingredient along with the ammonium molecule. We know the C fibers in the nerve carriy the pain sensation and this chemical tells them not to. Acute pain is a useful mechanism for us to know that there is something wrong that must be remedied. But once it has been identified and there is no easy fix, then to quiet these C fibers makes sense. Serapin does not only that, but also initiates the healing process.
Science probably will never know the true mechanism of action because SarapinR lacks profitability and marketing. As a biological medicine that has been in use for over 70 years, Sarapin cannot be patented. As a result, it can be made and sold on the open market without the huge price mark-up that are afforded to patent protected medicines. (Patent protection is the same reasons why branded drugs are so much more expensive that generic drugs that have the same chemical composition.) Not surprisingly, Sarapin has never had the financial sponsorship of a large pharmaceutical company to pitch it to doctors via the pharmaceutical company’s national network of drug representatives. I tend to believe in success and despite the fact that more research is needed, my patients have had much success. I use lots of it. Thank God there is a manufacturer.
Science probably will never know the true mechanism of action because SarapinR lacks profitability and marketing. As a biological medicine that has been in use for over 70 years, Sarapin cannot be patented. As a result, it can be made and sold on the open market without the huge price mark-up that are afforded to patent protected medicines. (Patent protection is the same reasons why branded drugs are so much more expensive that generic drugs that have the same chemical composition.) Not surprisingly, Sarapin has never had the financial sponsorship of a large pharmaceutical company to pitch it to doctors via the pharmaceutical company’s national network of drug representatives. I tend to believe in success and despite the fact that more research is needed, my patients have had much success. I use lots of it. Thank God there is a manufacturer.
Monday, March 8, 2010
SHOULDER PAIN
The three main causes of chronic (long standing) shoulder pain are Impingement Syndrome (from the Rotator Cuff)-72%, Adhesive Capsulitis (Frozen Shoulder)-12% and Bicipital Tendinitis-6%. The other 10% are from rare problems that are not obvious such as a missed fracture or bone tumor. Of course this assumes that you went to a good doctor that has ruled out a pinched cervical spinal nerve or one of the several shoulder bursas that can become inflamed. The main source of impingement is where the insertions of the Rotator Cuff tendons enter onto the head of the upper arm bone (humerus) from the scapula. There are only narrow conduits for the muscle/tendon to enter and exit. With damage to these insertions such as injury or tear of the tendon/muscle they are unable to slide through that narrow space without a slight hang-up that produces anything from discomfort to pain or distinct inability to do that required motion.
The rotator cuff is made up of four muscles from the scapula. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is made up of four muscles and their tendons. These combine to form a " cuff " over the upper end of the arm (head of the humerus). These are the Supraspinatous, Infrascapular, and the Terres Minor on the back side and the Subscapular on the underside of the scapula. Depending on the specific tendon involved there are 5 different anatomical sites that are impinged. The most common is with damage to the end of the Supraspinatus muscle. The pathology varies from just swelling of the tendon (Stage I) to a partial tear (Stage II) to a full tear (Stage III). Usually Stages II and III are related to acute trauma and commence right after the injury, while Stage I is due to overuse of that muscle group in overworking that muscle such as pitching or repetitive light weight lifting. Usually these problems occur in folks over the age of thirty.
Some of the signs of a rotator cuff tear include:
• Atrophy or thinning of the muscles about the shoulder
• Pain when lifting the arm
• Pain when lowering the arm from a fully raised position
• Weakness when lifting or rotating the arm
• Crepitus or crackling sensation when moving the shoulder in certain positions
Symptoms of a rotator cuff tear may develop right away after a trauma, such as a lifting injury or a fall on the affected arm. When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm. Symptoms may also develop gradually with repetitive overhead activity or following long-term wear. Pain in the front of the shoulder radiates down the side of the arm. At first, the pain may be mild and only present with overhead activities, such as reaching or lifting. Over the next several weeks, it is present when just moving the shoulder. The patient, however, has no problem lying on their shoulder in bed.
A pinched cervical nerve has more of a burning sensation and is brought on by moving the neck rather than the upper arm.. It also has a specific nerve root anatomic distribution called a dermatome noted on many charts of which one is up on your doctors wall. A specific test is a nerve conduction study or maybe an MRI of the neck which has as many false positives as negatives. The test that I recommend is a “drag pin exam” where the observer takes a safety pin and drags it lightly over the affected area of pain manifestation, the dermatone, and more “friction” is noted on the pin at the same time the patient feels an accentuation of the discomfort. Very rare problems such as thoracic outlet syndrome, or brachial plexus injury will take more studies to confirm, but can be usually ruled out by a good history of the cause and the symptoms. With the bursitis, the sensitive spot is directly over the anatomical location. Also movement of the arm will increase the pain at that tender place.
Another shoulder problem is Bicep Tendenopathy where this structure is damaged due to trauma and occurs acutely in people under the age of 30. Most likly there is a labial tear in the Gleno-Humeral junction. This results in instability of the shoulder joint and can lead to dislocation of the shoulder joint. When the arm is extended by the observer, immediately the patient feels this is an impending problem and will wince or push the observers hand away lest his shoulder will come out of the socket. In older people, the tendon may rupture and a “popeye” muscle will occur. In the past these were operated, but now we leave them be and they generally resolve with the knot shrinking over the years and only a small loss of bicep muscle strength. The other head of the biceps takes over.
Capsulitis or frozen shoulder is usually the result of unresolved tendon impingement. Rehabilitation with physical therapy helps, but they will never be as good as new. Certainly surgery is not the answer in that their rehab will be more prolonged and not as successful. Next week we discuss the magic of a shoulder injection.
The rotator cuff is made up of four muscles from the scapula. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is made up of four muscles and their tendons. These combine to form a " cuff " over the upper end of the arm (head of the humerus). These are the Supraspinatous, Infrascapular, and the Terres Minor on the back side and the Subscapular on the underside of the scapula. Depending on the specific tendon involved there are 5 different anatomical sites that are impinged. The most common is with damage to the end of the Supraspinatus muscle. The pathology varies from just swelling of the tendon (Stage I) to a partial tear (Stage II) to a full tear (Stage III). Usually Stages II and III are related to acute trauma and commence right after the injury, while Stage I is due to overuse of that muscle group in overworking that muscle such as pitching or repetitive light weight lifting. Usually these problems occur in folks over the age of thirty.
Some of the signs of a rotator cuff tear include:
• Atrophy or thinning of the muscles about the shoulder
• Pain when lifting the arm
• Pain when lowering the arm from a fully raised position
• Weakness when lifting or rotating the arm
• Crepitus or crackling sensation when moving the shoulder in certain positions
Symptoms of a rotator cuff tear may develop right away after a trauma, such as a lifting injury or a fall on the affected arm. When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm. Symptoms may also develop gradually with repetitive overhead activity or following long-term wear. Pain in the front of the shoulder radiates down the side of the arm. At first, the pain may be mild and only present with overhead activities, such as reaching or lifting. Over the next several weeks, it is present when just moving the shoulder. The patient, however, has no problem lying on their shoulder in bed.
A pinched cervical nerve has more of a burning sensation and is brought on by moving the neck rather than the upper arm.. It also has a specific nerve root anatomic distribution called a dermatome noted on many charts of which one is up on your doctors wall. A specific test is a nerve conduction study or maybe an MRI of the neck which has as many false positives as negatives. The test that I recommend is a “drag pin exam” where the observer takes a safety pin and drags it lightly over the affected area of pain manifestation, the dermatone, and more “friction” is noted on the pin at the same time the patient feels an accentuation of the discomfort. Very rare problems such as thoracic outlet syndrome, or brachial plexus injury will take more studies to confirm, but can be usually ruled out by a good history of the cause and the symptoms. With the bursitis, the sensitive spot is directly over the anatomical location. Also movement of the arm will increase the pain at that tender place.
Another shoulder problem is Bicep Tendenopathy where this structure is damaged due to trauma and occurs acutely in people under the age of 30. Most likly there is a labial tear in the Gleno-Humeral junction. This results in instability of the shoulder joint and can lead to dislocation of the shoulder joint. When the arm is extended by the observer, immediately the patient feels this is an impending problem and will wince or push the observers hand away lest his shoulder will come out of the socket. In older people, the tendon may rupture and a “popeye” muscle will occur. In the past these were operated, but now we leave them be and they generally resolve with the knot shrinking over the years and only a small loss of bicep muscle strength. The other head of the biceps takes over.
Capsulitis or frozen shoulder is usually the result of unresolved tendon impingement. Rehabilitation with physical therapy helps, but they will never be as good as new. Certainly surgery is not the answer in that their rehab will be more prolonged and not as successful. Next week we discuss the magic of a shoulder injection.
Monday, March 1, 2010
New Help for Diabetics and a Skinnier You
INCRETINS which were discovered in the saliva of a Gila Monster in 1965 have been on the market for the last two years in the synthetic form, mainly pramlitide with the brand name of SYMALIN . The incretins are at least two hormones that work naturally to balance insulin secretion and sugar (glucose) regulation from other endocrine target organs. There are two main incretin hormones in humans. They are GIP (glucose-independent insulinotropic peptide) and GLP-1 (glucagon-like peptide -1). Both hormones are secreted by the endocrine cells, L and T respectively in the intestinal lining in response to glucose in the gut. The glucose is from the break down of sugars and starches that we eat. The hormone, which is then absorbed, goes into our circulation and travels to the various target organ receptors. Therefore in addition to the food we consume this is yet another mechanism that controls our metabolic state and fat production. The excess calories that we absorbed if not going to manufacture protein produces fat! In yesteryear we needed this extra fat for times of famine. But now in times of plenty it is harmful and in those who are so genetically disposed, which is 25% of our population, leads to excess blood sugar (Diabetes).
The PANCREAS has both Alpha and Beta cells. The Beta secretes INSULIN and AMYALIN, while the Alpha, produces GLUCAGON. Glucagon stimulates the liver to release glucose from its store of glycogen and to manufacture glucose from fat and protein. This raises the blood sugar and is normally secreted in time of need and in adrenal response to stress. Hence glucagon is elevated in physical trauma and mental pressure which raises blood sugar. AMYLIN or artificially SYMALIN, suppresses Glucagon release thus lowering the blood sugar by slowing its production from the liver.
Symalin also binds to the receptors in the area postrema in the BRAIN. This causes satiety and suppresses the appetite. Moreover this substance again mimicking Amylin slows STOMACH emptying into the intestine causing less food (glucose) into the digestive tract for absorption. These mechanisms together lower the blood sugar in diabetics and decrease fat production in the normal person. Another form of Amylin is BYETTA also used to treat diabetes. Both of these are by subcutaneous injections. The Symylin is given before meals with insulin and the Byetta with or without insulin. It is more than coincidence both are manufactured by the same company, Amylin Pharmaceuticals, Inc. Both are overridden by a sudden decrease of blood sugar, but because of the extreme effect of taking insulin, the usual dose can be reduced by as much as 50%.
Since both Byetta and Symalin decrease appetite by controlling both the brain and stomach they do help to weight loss. I have given both in patients on off- label use for weight (fat) control usually in pre-diabetics to prevent weight gain and in real diabetes. In the future there will be a long acting Byetta given weekly and a Symalin combination. The later will be with two natural hormone look a-likes. LEPTIN and NEUROPEPTIDE –Y. All three of these will work in concert for weight reduction, which is so needed in the 21st century.
The PANCREAS has both Alpha and Beta cells. The Beta secretes INSULIN and AMYALIN, while the Alpha, produces GLUCAGON. Glucagon stimulates the liver to release glucose from its store of glycogen and to manufacture glucose from fat and protein. This raises the blood sugar and is normally secreted in time of need and in adrenal response to stress. Hence glucagon is elevated in physical trauma and mental pressure which raises blood sugar. AMYLIN or artificially SYMALIN, suppresses Glucagon release thus lowering the blood sugar by slowing its production from the liver.
Symalin also binds to the receptors in the area postrema in the BRAIN. This causes satiety and suppresses the appetite. Moreover this substance again mimicking Amylin slows STOMACH emptying into the intestine causing less food (glucose) into the digestive tract for absorption. These mechanisms together lower the blood sugar in diabetics and decrease fat production in the normal person. Another form of Amylin is BYETTA also used to treat diabetes. Both of these are by subcutaneous injections. The Symylin is given before meals with insulin and the Byetta with or without insulin. It is more than coincidence both are manufactured by the same company, Amylin Pharmaceuticals, Inc. Both are overridden by a sudden decrease of blood sugar, but because of the extreme effect of taking insulin, the usual dose can be reduced by as much as 50%.
Since both Byetta and Symalin decrease appetite by controlling both the brain and stomach they do help to weight loss. I have given both in patients on off- label use for weight (fat) control usually in pre-diabetics to prevent weight gain and in real diabetes. In the future there will be a long acting Byetta given weekly and a Symalin combination. The later will be with two natural hormone look a-likes. LEPTIN and NEUROPEPTIDE –Y. All three of these will work in concert for weight reduction, which is so needed in the 21st century.
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