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  Fundamental MedicineTeresa Gryder, ND

A Lifestyle Disease

7/30/2020

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One thing that has become increasingly apparent is that this pandemic virus is deadly to those who are already weakened by life, and harmless to many who are young and strong.  There are many possible explanations to this phenomenon, and I want to share with you my thoughts on why.

Very young children for the most part don't get the infection at all.  This is likely because their mucosal immunity is strong.  Mucosal immunity is the defenses that live in our noses, throats, and intestine, specifically defensin, cryptidin, and secretory IgA.  There are antibodies called IgA in our saliva.  These things are capable of disposing of a virus before it even gets started infecting our cells.  Most American adults don't have strong mucosal immunity, but in children it is highly effective.  "Secretory IgA can be measured directly in stool, saliva, and breast milk to assess the degree of mucosal immunity," but in modern medicine this parameter is rarely if ever measured.  It is however possible to make it stronger in adults, by the way that we live.

Older children and young adults can be infected and carry the virus but they are less likely to get badly sick.  This is at least in part because the T-cells of their immune system are strong and active and can find the virus and kill it, and because they have lower levels of inflammation so they don't go into cytokine storm.

Middle aged adults are starting to have more chronic health problems, and this is what makes a person susceptible to a very bad case of the virus.  Being obese is one of the worst risk factors.  In the news they talk a lot about heart conditions and diabetes, but these things are strongly linked to obesity.  Obese people have higher levels of inflammation throughout the body, including in the liver which clogged with fat, and the brain which responds by getting depressed. Obesity also impairs the immune system, reducing mucosal immunity as well as the T-cell response and letting the virus get a foothold and grow.

Older adults most often have an assortment of health conditions.  The ones who've gotten overweight or obese are unlikely to survive when they get the virus.  The ones that are lean and active might survive, like the 100 year old veteran in Portland who got it and came out topside.

The lesson from these patterns is clear.  If you are declining into the diseases of abundance which are so common in America, you are at risk.  Being medicated for your high blood pressure and excessive blood sugar will not save you.  If you maintain a healthy body weight and exercise vigorously you are less at risk.  Covid-19 is a lifestyle disease, it is sorting us out by our most basic level of health.

If you would like to work on your basic health, nobody is better suited to help you than a naturopathic doctor.  Conventional physicians are too busy fulfilling the requirements of their network and insurances to really study on diet and lifestyle.  They want to do what we do, but they can't, not in a 15 minute visit.  Changing your diet and lifestyle and increasing your base health, is a gradual process.  You can start today by cutting out some sugar and moving your body just a little bit more.  Good luck!! 

If you'd like a health assessment and tips on how to improve your particular situation, feel free to touch base with me.  I'll ask you to do a diet diary (you can download the form on the bring page in this website) first so I know what you eat.  I'll want a full list of the medications you take, and the supplements.  Then we can talk on the old fashioned telephone.
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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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SEVEN ALLERGY SEASON TIPS

5/25/2018

 
The long version on this topic went out in a newsletter, but for those of you who are not subscribed, here’s a quick checklist of ways that you can reduce your dependence on drugstore remedies during allergy season. Now that we know benadryl can contribute to dementia, the last thing we want to do is take that every day.

1. Tolerate some symptoms. A runny nose is rinsing allergens out of your head, and that is good. If you want to help your runny nose do its job instead of taking some drug that dries you up and makes the allergens stay in there, try using a neti pot.

2. Exercise daily. Cardio immediately changes the balance of your immune system and makes you better able to fight infections and less prone to hayfever.

3. Eat a clean diet rich in fruit, veggies and fresh fish, and limited in meat and cheese. Mangos, blueberries, cherries, raspberries, ginger and hot peppers have been shown to reduce allergies. Fast food, leftover fish, and aged meat and cheese definitely increase allergies. Kids who eat fast food have a much higher risk of developing allergic asthma.

4. Limit allergic exposures. This includes changing your sheets and dusting your house, cutting back on foods you are sensitive to, not using soaps that you sometimes react to, wiping down your pets, and generally trying to live in a minimal-allergen environment.

5. Increase Omega 3 fatty acids—You can take fish oil or you can change your diet to consume more fresh fish and certain nuts and seeds, specifically walnuts, chia, flax and hemp. Eggs are allowed because there are omega 3’s in the yolk.

6. Be nice to your intestines because leaky gut is another allergy trigger. Avoid stress, eat fermented foods, avoid NSAIDS, and keep going back to that clean diet with lots of veggies. Make sure you are eliminating every day. A happy intestine reduces your risk of allergies and autoimmune disease.
​

7. If you drink alcohol, go easy on beer and wine and try mixing drinks with clear liquors instead. Wine contains sulfites which worsen allergies. Gin contains juniper berries which are a fairly strong anti-allergy medicine. And there’s something about gin and tonics that’s perfect when the weather turns warm.

Biped Ponderings I: Keeping Your Hustle On

3/14/2015

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Walking.  We figure out how to do it after crawling for a while.  We do it for decades without a second thought.  We skip and run, we carry loads and climb ladders and live life on two feet.  Walking is effortless.  

When an injury happens, suddenly walking isn't so easy.  We must learn how to walk again, step by wobbly step, using crutches, rails and the strong arm of a friend. Over the years our injuries accumulate.  It isn't many few decades after we stop crawling that we begin to stiffen up and slow down.  Arthritis brings persistent pain into our paces.  

Healing is spontaneous most of the time, and sometimes we get knees repaired or joints replaced.  When walking isn't so easy, we appreciate just how important it is.  Our ability to walk is part and parcel with our lives.

Walking speed correlates directly with life expectancy in our later years.  Fast walkers live longer.  Overall, not in every specific case.  When congestive heart failure (CHF) strikes and we are confined to our beds, walking can save us or kill us.  Research has shown that most people with CHF get better when they begin a program of walking.  A few individuals have worse outcomes, early, the rest of have better outcomes, period.

Walking is a test and if you pass, you live.

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    Author: Teresa Gryder

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

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