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  Fundamental MedicineTeresa Gryder, ND

What to Do for a Shoulder Injury

9/13/2018

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Shoulders are complicated. They're not like the hip, with a deep socket that makes them stable. The socket for the shoulder is a shallow divet on the front face of the shoulder blade, and the parts are held together by a collection of sinew, muscle and bone known collectively as the shoulder girdle. The shoulder has the biggest range of motion of any joint in the body, and because of this it is more vulnerable to injury.

The bones of the shoulder girdle are the shoulder blades and collar bones. The breast bone is considered part of the axial (midline) skeleton and serves as a kind of keystone in the arch of the shoulder girdle, keeping the shoulders wide. The shoulder blades are big flat bones that slide around on your upper back. They are held in place by sheets of fascia and the muscles that attach to them. The sinew of the girdle is fascia, tendons and ligaments. When these strong connective tissues are disrupted the whole thing falls apart. When all the parts are strong we can swing from trees like other primates, do hand stands and push-ups, reach forward to do fine work with our hands, throw a spear or a ball, swim long distances and reach the finest liquor on the top shelf. You may never realize, until you injure one, just how many things a shoulder does.

There are many ways to hurt your shoulders. You can tear the labrum, which is a disc of cartilage inside the joint that provides padding and a connection point for some tendons. You can injure the rotator cuff, which is a set of four small muscles and their tendons that comprise the deepest part of the joint capsule and help prevent dislocations. The supraspinatus tendon is one of the most commonly injured parts of the rotator cuff, and the injuries accumulate with age. We also are more likely to have arthritis and impingement syndromes with age. There are lots of muscles outside the rotator cuff that can get torn up. You can stretch or rupture the ligaments that hold the collar bones in place, most commonly the AC (acromioclavicular) ligament but there are others. You can tear the big muscles of the shoulder or you can even completely dislocate the ball from the socket, which can damage lots of things including nerves and blood vessels. You can make such a mess of your shoulder that you think you will never be able to pick up your own arm again, but unless you have ruptured tendons, it may heal on its own. You can even function without some of the tendons; the body has redundancy and it adapts. Given time and the ingredients for healing, our bodies can do amazing things.

I am a whitewater kayaker. Kayaking is almost as hard on shoulders as throwing or swimming. Not only are your shoulders part of the propulsion linkage for paddling, but they are used for balance in bracing, and for righting yourself when you flip over by using the Eskimo roll. I have injured my shoulders many times, and I have supported a lot of friends and patients as they go through shoulder injuries and surgeries. The most recent time I was injured I thought it would require surgery. I took 6 months off from kayaking (which was a long time) and my return to the river was gradual. After a year I was getting after it—without having surgery. People who get surgery rarely have outcomes better than that. Shoulder injuries are painful and slow to heal. The good news is that they usually do, you just have to be patient enough and keep moving.

Most people will go see their primary care doctor when the injury is painful, interferes with daily activities or favorite sports, and doesn’t get better fast enough. If you go to a doctor for your shoulder, you should get a proper shoulder exam. The doctor should test your strength and range of motion with a bunch of strange challenges. They’ll tell you to push out. Pull in. Lift your elbow against my hand. Pat your belly. If the doctor doesn't do a thorough exam, go to another doctor. The shoulder is complicated, and not every doctor is an expert on it. A person who knows the anatomy of the joint and how to examine it will be able to diagnose the injury better than all the fancy imaging in the world. This is called a clinical diagnosis, and with shoulders a good clinical diagnosis is more useful than imaging. With a good exam and clinical diagnosis you get better information about the prognosis and treatment for your shoulder than what you can get from an MRI, but again, this all depends on your doctor having knowledge and exam skills specific to the shoulder.

If the injury is severe and you have good insurance, your doctor may send you for an MRI and refer you to a surgeon for a consult. If you go this route, odds are good that the surgeon will want to operate. After all, that is what they do. This is when you should slow down and take some deep breaths. Do not rush under the knife. It is common to be told that you should get it done immediately. Take that statement with a grain of salt. If a tendon is completely ruptured, the muscle will dissolve away if it is not reattached soon, so that is a reason to get it done now. If that's not the case then get a second opinion. Odds are good that the second opinion will be different from the first, and if that is the case, you can go with the one you trust more, or get a third opinion for a tie breaker.

In most cases doctors will suggest physical therapy before considering surgery. Surgery is something to avoid unless it is really necessary. Shoulders can be badly hurt and refuse to work at all, and then later recover completely, or completely enough that you can do everything you want to do. So do not give up. If you decide to do physical therapy, do the exercises and keep after it. Over time you will learn more exercises and graduate to harder ones. Save the instructions and make a notebook of shoulder exercises for yourself. The same exercises you use to rehabilitate after an injury may be useful in the future for prevention.

If you decide that surgery is indeed what you must do, shop around for the best shoulder surgeon in your region. Surgeons will usually tell you that they do not know what they will do to your shoulder until they stick a camera in there and start working on you. But each surgeon has a slightly different approach. Ask about the procedures that they do most, and their strategies with regard to the shoulder. Find out as much as you can about their approach and philosophy and compare surgeons with each other. Surgeons don’t always communicate very well—they may prefer their customers anesthetized. Get someone to go with you to your consults to make sure you get the information you need. Find a surgeon you trust.

If you decide to avoid the knife and heal up your shoulder yourself, it's important to be gentle with yourself. Healing up from an injury usually takes less time than healing after a surgery, but for shoulders both are slow because there’s not a lot of blood circulating inside the shoulder joint. PT’s can offer expert advice about what kinds of exercises to do. Your average personal trainer could do you harm.  Therapeutic shoulder exercises usually involve bands or light weights, and having good posture really helps. You will want informed recommendations on diet, botanical medicine and other alternatives to enhance healing. I can offer those things and provide referrals for injection therapies (prolo or PRP), hydrotherapy and other treatments as needed. Depending on your injury it could be 6 months before you feel comfortable returning to your usual activities, and a year or more before you are all the way back up to speed. Definitely keep exercising however you can, because keeping yourself fit supports your body's efforts to fix any injured parts.

Keeping moving is always key. It's OK to rest a body part for a little while when it's hurting from an injury, but move the rest of you, and move the hurt part as soon as you can stand to.  If you keep a shoulder still too long it can freeze in place and it is excruciating to break a frozen shoulder free. Learn the exercises to strengthen the small muscles of the rotator cuff and the big muscles of the shoulder girdle and do them properly. Develop routines for moving your shoulder through its entire range. Swing like a monkey, do push-ups and other intense exercises only when your shoulders are ready.

If you need help or encouragement in making decisions about surgery, or for healing a shoulder whether they operated or not, I would be glad to assist. I can help you find the right shoulder surgeon if you need one, and come with you to appointments to be your medical advocate.  I have a great protocol for surgery prep to increase your odds of an excellent outcome, and I can set you up with a recovery protocol specific to you and your needs. While PT’s specialize in exercises and conventional doctors give meds and do surgery, I can help with all the other ways to support healing. You can use the contact form on this website or contact me directly for more information.
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How to Swallow a Fistful of Pills

6/10/2015

 
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Swallowing isn’t easy to do when you’re thinking about it.  When you eat it happens automatically.  When you have a fistful of medications or supplements to get down, it can be unpleasant.  There are few things worse than getting a large bitter pill stuck in your craw.

A 2015 study showed that 3/10 adults averaging age 50 would rather die than take a daily pill for the rest of their lives, and another 1/5 would gladly pay $1,000 to avoid having to take a daily medication.  If taking pills is this undesirable, why don’t more people make the diet and lifestyle changes that would free them from pill taking?  The answer is of course complex.  During our lives, almost all of us will choose to swallow pills, if not longterm, at least long enough to give us relief from a temporary ailment.

At some time in your young life, someone asked you to swallow a pill.  Children don’t know how, and are usually given chewable or liquid medicines until they learn.  In old age it gets harder to swallow pills, so we end up looking for liquids and chewables again.  In the meantime, between childhood and old age, we’re supposed to be able to swallow them.  There are tricks.  Here is a primer.

There are two main kinds of pills that you’ll be asked to swallow; capsules and tablets.  Capsules are a little cylinder usually containing a powder.  Usually they float, though some of them sink.  Tablets, on the other hand, are made of a substance that is caked together into a mold.  They can be any shape but smart designers make them round or oblong.  Capsules are easier to split, and they usually sink.

It helps to know if your pills are floaters or sinkers.  It’s easier to swallow the same kind together.  You can test each pill in a glass or water, or in your mouth, to detect if it floats or sinks. Putting pills in a glass is a good way to see how long it takes the pill to dissolve, too.  (Aside: If you put a pill in a glass of water and it doesn’t dissolve in a day’s time, you probably aren’t getting anything out of it.)  Pay attention to which pills float or sink, and take the same kind together.

SWALLOWING PILLS THAT SINK

Sinkers are the easiest to swallow because they behave like food does, sitting on your tongue.  All you have to do is tilt your head back a little bit and let them slide to the back of your tongue, and then take a sip of water and swallow it.  It is also possible to simply place the pill(s) at the back of the tongue using your hand, then drink.  They will go down.

SWALLOWING PILLS THAT FLOAT

Floaters are tricker.  They are easiest to swallow with a bite of pre-chewed food.  If you need to swallow them with liquids, here is a trick.  With the pill(s) and a modest swallow of water in your mouth, assume your best military posture, with your neck long and chin tucked.  The pills will float to the roof of your mouth (your soft palate), and the good posture with chin tuck helps them move to the back.  When you feel the pills on the roof of your mouth, distract yourself and swallow, or take another sip to push them along.

WHEN YOU CAN’T SEEM TO MAKE YOURSELF SWALLOW

This usually happens when you are trying to swallow too many pills at once, or a pill that is so big that it scares you.  It floats around and threatens to dissolve and taste horrible.   It’s OK to swallow pills one at a time until you are ready to try more.

WHEN A PILL DOESN’T GO DOWN

Usually what happens, at least in younger folks, is that the pill gets stalled out in the throat somewhere, and the natural peristaltic movements of the esophagus bring it back into your mouth.  Slippery pills (like gel caps) slide back up easily.  Grainy or sticky tablets can get hung up and make you gag.  When a pill feels stuck, keep swallowing.  Take swallows of your drink or bites of of food, and keep doing it until it goes all the way down.  Some pills (like osteoporosis drugs) can hurt your esophagus if they get stuck.  Your doctor will warn you if your medications have this risk.

DISTRACT YOUR MOUTH

To swallow a bunch of pills at once, put them all in your mouth with a bit of water, and then using your tongue place one pill between your teeth and gums, and swallow the rest.  Something about storing the one pill distracts your mouth enough to get the rest of the swallow to happen normally.

TAKE PILLS WITH BITES OF FOOD

Liquids are harder to swallow than food.  Pills that are best taken with food are also easiest to swallow with food.  Basically you take a bite of food, and chew it until it is thoroughly chewed and ready to swallow.  Then pop a pill or three in there and swallow it.  You can chew a little more if needed to feel ready to swallow it, but try not to break up the pills.

There are more tricks, but those are the basics.  If you are like me, and struggle with swallowing pills, you may need some tricks.  Good luck to you.  May you heal quickly and no longer need pills.  May you find the medicine you need in sunshine and laughter, and the nutrition you need in food.

Conventional Medicine Not Always Supported by Science

10/10/2013

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Many people have this idea that naturopathic medicine is off in lala land somewhere, and that nothing about it is based on reality.  While this could be true for some practitioners, MY practice is based on what we can deduce from what we know and what we are learning.  I base my decisions on scientific findings, and not just one study, but composites of information that add to the big picture.  I advise against using unsubstantiated treatments, and against using any new pharmaceutical drug until it has been on the market at least 10 years.

Ironically, the treatments given by many conventional doctors are not based in science or even in common sense.  Sometimes a treatment idea gets broadly adopted before it has been really studied.  Once everyone thinks that is what works, they just keep doing it.  Patients demand treatments that have no evidence behind them at all.  It takes a lot of information to turn around public opinion after the people have been brainwashed by doctors.

Take chemotherapy for example.  Chemo is poison intended to kill the cancer.  In many cases chemo causes the death of a cancer-ridden patient.  Sure, there are specific cancers which respond very well to chemo, but there are many more that do not.  Doctors will sometimes give in to a patient's desire to "do anything possible" to help, even when they know that it will not help.  It is in fact easier to give people the poison they demand, than to explain to them why they won't benefit from it.

For another example, take a look at the ACIP schedule for vaccinating babies.  While I agree that vaccination is effective for preventing epidemics, there is little evidence behind the schedule.  Vaccinating a newborn for Hepatitis C is destructive, not helpful.  The schedule for vaccination is based on convenience.  Doctors stick the babies with multiple vaccines at every wellchild visit, and don't worry about possible negative effects (and lack of benefit) from that practice.  The vaccination schedule bears some research to make sure that we are building appropriate herd immunity while also not hurting anyone's baby.

I ran across this post about statins today.  Many people take statins. Statins are drugs that stop your body from making its own cholesterol.  There is no evidence to support the use of statins for preventing heart attacks, and they may actually increase the risk of heart attacks in women.  They're also linked to the formation of cataracts, crippling muscle pain, dementia, fatigue, diabetes and erectile dysfunction.  Doctors give statins when they want to lower someone's cholesterol and don't think they can get that person to change their diet and lifestyle.  The evidence says that diet and lifestyle are FAR more effective for adjusting blood lipids than statins are.

Oh and last but not least in my list of conventional medical madness is the idea that eating cholesterol makes the body's cholesterol go up.  For 20+ years the medical establishment has been teaching that if you eat too much eggs and bacon, you will have high cholesterol.  The truth is that your body MAKES cholesterol from pasta and bread.  Your body makes cholesterol because it NEEDS cholesterol.  Cholesterol is not evil.  If your cholesterol is too low, you are sick.  People get high cholesterol from being sedentary and eating too many carbs, not from having an egg breakfast and a full and active day.

Just because something is widely accepted as the state of medicine does not mean that it is the best we can do.  We can do better.  The status quo is for dead people.  Living people have the capacity to keep learning and trying new things.  I urge you to question everything that you think you know about healthcare and health. Many things that have been accepted for a long time are about to be turned on their heads.
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Healthcare in America is Mostly Sickcare

9/10/2013

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What I hear is that most everybody in America is frustrated about healthcare.  Maybe you have good insurance, but then the doctor doesn't listen, or the treatment doesn't work.  Maybe you're on pills and don't know what they're for.  Maybe you don't have insurance and flat out can't afford to get help.  Maybe you think something's wrong but don't want to confirm it because then you'd have to deal with it.  We all worry, and it's not easy to sort out what to do.  Doctor Google can be misleading, and sometimes terrifying.  The assortment of supplements at the store is overwhelming.  Everybody thinks they know what will help you, but they don't know your whole story.  They don't know the half of it.  It's not an easy situation.

I offer a win-win deal: I will take a thorough history and get to know you enough to have an idea how the parts of your life are affecting you.  Then I educate you about your options, including alternative and conventional therapies.  In the end, using real information you choose what you want to do.  Conventional medicine is the best answer for some situations and conditions.  Naturopathic medicine helps as long as you are willing to do more than pop pills and sit on the couch.  If I can't help you, I will help you find someone who can.  I consider it my job to provide you with current, personalized, unbiased information, not to keep you a slave to some treatment that only I can offer.

My personal slant is scientific.  I realize that many people consider Naturopathy to be quite "alternative".  Considering what has happened with pharmaceutical medicine, an alternative is much needed.  Naturopathic Medicine (as I use it) is a combination of traditional healing (forgotten in the age of pharmaceuticals) and the application of new knowledge about how our choices affect body function and healing.  Conventional medicine is not keeping up with the changing times. A simple change in your diet or lifestyle could do you more good than a drug that you take for the rest of your life (and save you a gazillion dollars).   Making informed, gradual improvements to your diet and lifestyle will save you money, increase your quality of life, and help you stay away from the doctor, the pharmacy, and the hospital.

If you are one of those skeptics who has avoided alternative medicine because you don't think naturopaths have any real training, come see me for a free 15 minute introduction. I would like to tell you how a science-minded skeptic like myself can embrace Naturopathy.  I can show you some of the great research that supports nonpharmaceutical and nonsurgical approaches to health.  There's plenty of it.

There are plenty of reasons to seek alternatives when facing the gauntlet of what insurance will buy for your health.  It's not cheating to get a second, or third opinion about any persistent health problem.  Before you take the toxin, or submit to the knife, it is wise to be sure that is what you need to do.

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Be Skeptical

8/31/2013

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In this day and age, it is necessary to second guess every information source.  So much "information" goes by that it becomes difficult to sort out what is advertising and what is not.  Even reporting about scientific research can completely skew the issue.  It doesn't pay to be gullible.

The problem is that we are wired to be gullible.  We humans would much rather trust in some comfortable authority figure and believe what they say, than to do all that research and work ourselves.  Figuring out the truth takes time...and sometimes the truth is elusive.  We just don't know everything yet.  We'd rather just believe.

Modern first-world culture is divisive and argumentative.  People agree to disagree more often than agreeing in substance.  As in other parts of our public arena, in the healthcare debate the shouting overwhelms reasonable conversation. Conventional treatments espoused by governments and establishment medical business may not be supported by the research. The policy came about when someone had to make a decision by a deadline using the best information available. We all do it.  We have to go on what we know, even if it is incomplete or incorrect. More information comes along, but established policy stays the same.  This is the downside of bureaucracy. Proponents of established methods will say that this must work because it is the rule, and don't worry about finding out the truth.

Alternative treatments are espoused by a wide range of practitioners and patients.  Often alternative treatments have little or no science backing them up.  Proponents say this works because they have seen it work, and maybe it did.  Just because there is no science doesn't mean it isn't true. Proponents also commonly claim that the science backs them up when it does not.

The Skeptic doesn't believe anything just because an authority said so.  The Skeptic asks questions, and studies the important questions, so as to be able to know if someone is speaking from a position of knowledge and perspective, or blowing a lot of hot air.  The Skeptic realizes that real information or falsehoods can come from any side, and runs every morsel through an internal fact-checker.  The truth is a moving target, and the skeptic is ever on the hunt.
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Obamacare

6/3/2013

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Speaking of mixed feelings....  I learned today that the penalty for not participating will be $95.  That's only $15 more than a Portland Parking ticket.  Of course, there is the possibility that decent care might result from being covered within this system.  But not necessarily.  I have a deep distrust, and dislike, of health insurance and what it has done to healthcare in America.  Mandating health insurance is... un-American.  Letting health insurance control what care is given and to whom is no better than socialized medicine.  It simply puts the power in the hands of megacorporations that are already mixed up with our government.  And it requires that everyone's personal health information go into an electronic medical record, supposedly to improve care, but potentially useful for other projects.  If the government would decide what care to provide based on what has the best outcomes for the most people, I would be less opposed to that.  It's not a simple situation, that much is for certain.  The best answer is just as the bumpersticker says: don't get sick.
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Lyme Disease Month

5/16/2012

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May is the month designated by ILADS to increase awareness about Lyme Disease.  Infections are on the rise, or at least, lots more people are being diagnosed now than ever before.  More infected ticks are being found too.

I have studied under two doctors who specialize in Lyme (Dr's Newman and Ambrose, see bottom for links).  I haven't been tested, but I would not be surprised to discover that I too carry the spirochete that causes it.  The fact of the matter is that lots of people have this parasite, but most of us don't have symptoms until we get run down or toxic, or otherwise challenged healthwise.  The unfortunate thing about having an assortment of parasites on board is that you feel fine until you don't, and then you go downhill quickly.

Lyme is caused by Borrelia burgdorferii, which is a very small bacterium in a spiral shape, ie. a spirochete.  Spirochetes are sneaky.  They don't get inside our cells like Chlamydia does, instead they have an assortment of defensive mechanisms that make it hard for our immune systems to detect and eradicate them.  They make slime barriers around themselves.  They shrink back into little hard cysts.  Once established in our tissues they are just about impossible to get rid of completely, even with intensive treatment.  A person who has this parasite needs to keep themselves healthy enough that the parasite doesn't cause them trouble.  And this is where naturopathic medicine comes in.

In naturopathic medicine, we may attempt to eradicate a disease-causing agent, but we are also interested in increasing the host's health so that such bugs are kept in check by our own bodies.  The disease-destroying treatments that are used for Lyme---either longterm antibiotics, or longterm antimicrobial herbs---are not enough.  If you have lyme, or if you think you have lyme, the best thing in the world you can do is get ahold of your diet and lifestyle.  It's easy to say, and oh so hard to do.  Believe me, I know.  But to start with, eliminate, or at least reduce, sugar and refined grains in your diet.  Eat a wide range of fresh organic vegetables.  Exercise daily.  Manage or avoid stress.  These basics, if actually employed and not just talked about, may have more effect than all the doxycycline and cat's claw in the world.  

Still, if you are struggling with severe symptoms, don't waste time, get help NOW.  And if you just got a tick bite, get help NOW, because at the beginning of an infection the spirochete CAN be eliminated.  Last but not least, if you have a way to do so, avoid getting deer ticks on you.  I don't mean that you should not go in the woods, but be aware about ticks, and avoid deer tick bites.  Learn when tick season is in your area.  Prevention is better than treatment 10 times out of ten.

Look it up:
International Lyme and Associated Diseases Society http://www.ilads.org/ 
Dr Satya Ambrose http://www.starfireclinic.com/#!about-us
Dr Daniel Newman http://www.rising-health.com/portland-or-holistic
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Dr Mate gets a great review on his book on addiction

1/29/2011

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http://addictiontreatmentmagazine.com/addiction/hungry-ghosts-book-review/

The book: In the Realm of Hungry Ghosts.  Great synthesis of science and DrM's broad experience.
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Coffee Interferes with the absorption of Thyroid Medication

1/23/2011

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Here's the list of stuff that is so far known to
Decrease your Absorption of Thyroid Medications:

*coffee (decreases absorption by about 1/3)
**antacids containing aluminum hydroxide
***ferrous sulfate (you know, iron supplements)
****calcium carbonate (calcium supplements and high calcium foods)
*****soy protein shakes 
(what about everything ELSE that has soy protein isolate in it?)
******Raloxifene/evista (pharmaceutical for osteoporosis)
*******chromium picolinate (supplement often given to diabetics)

The full scoop including abstracts for the studies can be found at:
http://www.denvernaturopathic.com/thyroidinterference.htm.  There you will also find the abstract of a study that demonstrates that taking your thyroid medication at bedtime may be more effective than taking it first thing in the morning.

Furthermore, I confess that I learn more great new stuff from Jacob Schor's email newsletter than from most of my professors.  You too can get on his email list at: http://www.denvernaturopathic.com/ .
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    Author: Teresa Gryder

    Integrative Physician and Student of Life, Medicine, and the River.

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