I have a hat that displays several life principles that I hold dear.  People often ask me what the words/symbols mean, so I decided to write a blog entry about it so that people can have a greater understanding, just in case we have little time to share words in the moment.  It has been affectionately named “A Legacy Hat” by a good friend:

“The D gets an A” (front)

Detroit will get an A when most participate in filling out the “Citizen Report Card” and of those that do, they get at least 8 A’s out of 15 possible grades.  This is my vision for the city of Detroit, and I feel that it is important to keep my mission and purpose in front of me at all times.

“Going Ghost” (left side)

This reminds me of the importance of staying in the present moment, which has two benefits; 1) it helps me make better (“authentic”), noticing that when I am angry or afraid I make bad decision choices, and 2) it prevents others around me who may be in a negative state, looking for a negative state to interact with, from seeing me.

Butterfly (back)

Recognizing that the present moment is the place to be, I have two strategies that help me get back to  the present moment when my mind goes to the future with fear or to the past with anger.  For the future, I ask myself what would gone feel like.  That is, what would if feel like if the matter that was causing fear was no longer an issue.  This does two very positive things 1) allows me to experience a positive emotion, without actually solving the problem.  We are more creative when we experience positive emotions, and more likely to solve a future concern, and 2) I can begin to form a more positive image that my subconscious can respond to vs. the negative image that has me gripped in fear.  This action creates a balancing energy to the fear and allows me to get back to the present moment, the whole process of which reminds me of the right wing of the butterfly.  With regard to anger, I ask myself “What is the positive meaning for this (anger/frustration producing event) in my life.  As I reflect on my life, I have certainly grown more from getting through my challenges, than living with my blessings.  I have come to understand, that many things that I find frustrating, usually make me a better person, when I look for the positive meaning.  Doing this creates a positive balancing energy to the frustrating event, and allows me to get back to the present moment.  This represents the left wing of the butterfly.  The body of the butterfly reminds me of the present moment itself.  The more I practice making butterflies, the easier and more natural it becomes.

“Currency” (right side)

The more current that flows through a light bulb, the brighter it becomes, providing light and clarity to the environment in which it finds itself.  Block the current on the front end, and the bulb is dim..  Block the flow on the back end, and again the bulb is dim.  This reminds me that I should not be slow in passing along my blessings.  As they come in, the quicker they are handed off to others the better for myself and the environment in which I ding myself.  When I hold onto blessings, it is no good for anyone including myself; holding on, without giving leads to a form of life obesity, and feeling unfulfilled.

So that’s a brief discussion of the hat.  Now the next time you see me you’ll understand, and if you agree with the principles, give me a high five.  Or better yet, join me in helping Detroit get an “A”:)

-jb

This post is still a draft as I need to expand and add additional references.  I wanted to post however because I want others to consider this issue, and my recommendations won’t change much.  Please provide any feedback in support or to the contrary.  I’m just trying to understand and help those in pain…

Concern

• I have been seeing several patients who seem to be taking longer to recover than expected.  Many times there have been secondary surgeries that have occurred and still members have trouble recovering.
• In these cases there seems to be a recurrent theme, in the presence of “tendinosis” that has been apparent on their MRI’s.  As I was not totally familiar with this term, I decided to do a literature search to get a better understanding.  I needed to make sure that this was a condition distinct from tendonitis, a term that I am very familiar with.

 Findings

• First, it has become clear that tendinosis and tendonitis are clinically distinct conditions.  The former being characterized by the lack of healing.  Histologically, the tendon seems devoid of inflammation, and thus healing.
• This is a clinical condition that does not respond to NSAIDs or steroids (which makes sense as there is no inflammation), and in fact there has been some concern raised that the NSAIDs may contribute to this condition [2,4,9]
• There seems to be some confusion concerning this amongst some practitioners who seem to use this term interchangeable and should not.  Its important, because practitioners may be using NSAIDs when they should not be.
• Risk factors for this condition appear to be excess sugar, saturated fat, elevated uric acid, and obesity [1,3,9].
• Not really an age related phenomena as it has been identified in those that are young. [9]
• There is some concern that this condition is also due to trauma/and overuse however there is some suggestion that this may not be he case noting the presence of this condition occuring in areas of the tendon with lower tensile strains.[12]   Also overuse tends to respond to rest, where this is not really the case with tendinopathy. [9]

 My Thoughts

• For the vast majority of people that present with this, I don’t think that it is due to trauma or over-use (unless at the extremes of exposure).  I think these events may allow for the condition to unmask itself, but the event is really not the cause. Note that for most, exercise is thought to build a person up, not break them down (unless they metabolically deficient).
• This acts more like a nutritional deficiency or toxicity than something due to trauma or over-use.
• I am not sure which  path is playing a greater role: an act of omission (nutritional deficiency), or an act of commission (toxicity), but these two circumstances may be working together.

 Recommendations

1) Correct Possible Error of Omission (deficiency): 

• Make sure the injured person is taking a general purpose multivitamin 2-3 times per day.  Not a mega vitamin (something closer to a one a day).  May be better to break this in half and take three times per day with a meal.  Supplements that need to be include are Vit D, Vit C, Zinc, Iodine (if iodized salt has been eliminated from the diet), and Omega 3 Fatty Acids.  Other nutritional considerations include: adequate protien, B Complex, Vitamin A, and Vitamin E.  One of my preferred supplements is Protegra which contains A,C,E, and zinc.

2) Correct Possible Error of Commission (toxicity):

• Stop use of NSAIDs and change to tylenol for pain relief.  If not able to stop the NSAID, decrease to the lowest dose possible to control symptoms
• Decrease consumption of sugar generally and fructose specifically.  Note that increasing the amount of fiber consumed will slow the absorption of sugar and minimize the generation of advance glycation end-products (AGEs) [1]  If you want to know about the problems with sugar please watch:  “Sugar: The Bitter Truth”.
• Decrease the amount of animal protein that is consumed, which may be causing problems in two ways 1) creating an acidic environment with an adverse effect on the body’s pH balance, and 2) increase the amount of saturated fat which one is exposed to which may also be a risk factor for tendinosis [1]

3) Support Efficient Repair

• Aerobic conditioning (exercise) not directed at the joint or area of concern.  This gives a general signal to the body of the need to repair and also speeds circulation to bring and remove items to the area of concern in a more accelerated manner.  The benefits of this general signal of repair was noted in Achilles’ tendon repair, where surgical repair on one side seemed to help the other side as well [ref].
• Mild stretching and no strengthening directed at the joint of concern for 30-60 days.  It is important to correct any errors of commission or omission before engaging the tissue that is not healing as to not worsen the problem.

Reflections:

• As I reflect on this I am noticing how this plan differs from care as usual, and I am reminded of a fire fighter that I consulted with who was complaining of shoulder pain after an injury.  He had been forced to retire 12 months after his injury, as he failed to recover with both physical therapy and surgery.  It was now 18 months post injury and he was requesting another surgery, as he was still in pain.    This plan was supported by both the firefighter and the surgeon.  The firefighter was directed to the movie “Forks Over Knives”, and decided to give a trial of change in both diet and lifestyle.  In 4 weeks he was nearly pain free. Let me state that again, in four weeks with a good diet (decrease sugar and animal protein, added greens like avocado, spinach, kale, and purples like beets and purple cabbage) and exercise (running 3 miles a day) his condition resolved to the point that he felt that he could come back to work.  Had we gone down this road one year earlier…???   Had this always been the road, he may never have hurt himself in the first place…???

Check out this one minute video.  I am not alone in my thinking and observations 🙂  NSAIDS and Healing.

Here is one more about sugar:  Toxic Sugar

References (more to come)

1. Michelle Abate et al., Management of limited joint mobility in diabetic patients, Diabetes Metab Syndr Obes. 2013; 6: 197–207.  Published online 2013 May 7. doi:  10.2147/DMSO.S33943
   PMCID: PMC3656815 // http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656815/
2. Caring Medical and Rehabilitation, Sports Injuries NSAIDS why we don’t recommend them, Internet 2013 // http://www.caringmedical.com/sports_injury/nsaids.asp
3. Mechelle Abate et al., Occurence of Tendon Pathologies in Metabolic Disorders, Rheumatology, 2013:52(4):599-608  //http://www.medscape.com/viewarticle/781970
4. Kai-Ming Chan et al., Anti-Inflammatory managment for tendon injuries – friends or foes, Sports Medicine, Arthroscopy, Rehabilitaiton, Therapy and Technology, 2009, 1:23 // http://smarttjournal.com/content/1/1/23
5.  Elzi Volk, Connective Tissue Part 1 – Tissue in Action, ThinkSteroids.com, Feb 1999 // http://thinksteroids.com/articles/connective-tissue-01/
6. Elzi Volk, Connective Tissue Part 2 – Pathphysiology of Connective Tissues, Influence of Nutrition and Pharmaceuticals, Thinksteroids.com, March 1999, // http://thinksteroids.com/articles/connective-tissue-02/articles/connective-tissue-02/
7. Elzi Volk, Connective Tissue Part 3 – Role of Micronutrients in Connective Tissue Healing, Thinksteroids.com, April 1999, //  http://thinksteroids.com/articles/connective-tissue-03/
8. Elzi Volk, Connective Tissue Part 4 – Glycosaminoglycans, Thinksteroids.com, May1999, // http://thinksteroids.com/articles/connective-tissue-04/
9. Sai-Cheun Fu, Deciphering the pathogenesis of tendinopathy: a three-stages process, Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, 2:30 // http://www.smarttjournal.com/content/2/1/30
10. Michelle Abate et al, Review: Pathogenesis of tendinopathies: inflammation or degeneration, Arthritis Research & Therapy, Vol 11 No 3 // http://arthritis-research.com/content/11/3/235
11. Martti Rechardt et al., Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis, BMC Musculoskeletal Disorders 2010, 11;165 // http://wwwbiomedcentral.com/1471-2474/11/165  // it should be noted in this article the use of the term tendonitis.  Authors used a clinical and not a radiological diagnosis, and these cases may well have represented those with tendinosis.
12. Ho-Joog Jung, Role of biomechanics in the understanding of normal, injured, and healing ligaments, and tendons, Sports Medicine, Arthroscopy, Rehabilitation, Therapy and Technology, May 2009, 1:9 // http://www.smarttjournal.com/content/1/1/9
13. Stefan Lakemeier et al, Expression of matrix metalloprotienases 1,3, and 9 in degenerated long head biceps tendon in the presence of rotator cuff tears: an immunohistological study, BMC Musculoskeletal Disorders 2010, 11:271 // http://biomedcentral.com/1471-2474/11/271
14. Steven Fenwich et al., The vasculature and its role int he damaged and healing tendon, Arthritis Research 2002, Vol 4 no 4
15. James Gaida, Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and peripheral fat distribution in women; a cross sectional study , BMC Musculoskeletal Disorders, 2010, 11:41 // http://www.biomedcentral.com/1471/-2474/11/41