Monday, July 26th, 2010
I’ll cut right to the chase: I’ve torn my meniscus. The meniscus is the cartilage that acts as a shock-absorber in your knee, also preventing bones from rubbing on one another. It’s a pretty common whoopsie, and it’s likely that mine has been there for a while, I just made it extra mad by Warrior Dash-ing, taking on an “extreme” (per its name) lifting program, and starting up with running again. What’s just as common is the knee-jerk response (pun totally intended!) to have arthroscopic surgery, especially here in the United States. So common, that while it’s still a surgical procedure to repair or remove all or part of the meniscus, it’s still often lightly referred to as a “treatment” in the biz. Um… If you have to knock me out cold with anesthesia for something, it’s beyond a “treatment”. I just had a facial two weeks ago, I know the difference.
I’m sure most reading this already have an inkling that I’m not a fan of surgery. This is mostly true. I’m all about it for life-saving procedures. For less critical situations, I want more facts first. Being a chiropractor married to a physical therapist makes me both the best and worst patient ever for an orthopedist. The whole reason we stopped in to one the other week was because we were sure from our own analysis that something was wrong IN my joint, such as some torn cartilage, but we weren’t sure what exactly. After a 70 minute wait, some quick xrays, and about 10 minutes of the doctor’s assistant ruling out things we already had on our own, the doctor came in and spent a grand total of 90 seconds with me (tops) to say “torn meniscus, MRI to confirm, surgery will fix it no problem”. Well, 60 of those seconds were for that, the other 30 were spent on some snarky remarks about chiropractors and PTs, but that’s another rant…
I did schedule the MRI for a week later, but, after reasoning that it was not worth having one just for curiosity’s sake, I canceled. You see, I’d already decided I would not have surgery. Not just yet, anyhow. I’ve read enough stuff (see referenced articles at bottom for some examples) to know that, while having torn cartilage predisposes me to osteoarthritis, surgical repair of it does not improve that. Likewise, short-term (1 year) post-op recovery is particularly unsuccessful in females, through an as yet unknown mechanism. As a doctor, I’ve been around a lot of sloppy knees, many of which have had repairs to either the ACL (anterior cruciate ligament) and/or the meniscus. Throw into the mix my husband’s personal (he’s had 2 meniscectomies, 1 repair and he’s not a fan) and professional experience, and a recent random $.02 from a medical doctor that was decidedly anti (would you believe my GYN was discussing his torn meniscus with me during my pelvic exam? LOL), my own intellect-plus-intuition was confirmed and I decided I didn’t need a mugshot of my own meniscus. Probably best that I don’t know exactly what’s up, thus setting mental limitations on what I can achieve on my own. On that note, the orthopedist did mention that he believes I’ve been pretty much fine for so long because of all of the muscle in my legs. Score! It definitely added to my resolve to see what else I could achieve to on my own to support my knee for the time being.
So, what’s on deck? Well, my in-house PT has me on some specific exercises and modified ADLs (activities of daily living—example: I have to walk down the stairs one step at a time, injured leg leading. It takes forever!), and he performs this cool low grade joint mobilization on my knee that makes it feel so much better for a good bit. I’m on ice after activity and a therapeutic dose of ibuprofen for the short-term as we tackle the swelling and inflammation. Large amounts of glucosamine are in play as I build up my reserves of joint tissue making compounds, and sleep is an even higher priority these days. Acupuncture and massage will continue to play a role. The former because I know it’s capable of healing me on many, many levels as a whole person, not just as a knee with a person attached to it. The latter to keep trigger point development in surrounding tissues at bay while my knee is so sloppy. I’m so inspired and intrigued by meditation and guided imagery for healing, I’m investigating some programs for that now. I wear a knee brace. The compression feels good and I’m less gimpy after a lengthy stint of sitting. But, really, it’s mostly there to remind me not to be a jackass, especially while exercising. I don’t run, lift (with my legs), or jump, and I avoid bending my knees past 90 degrees. For example, while yoga is on the menu, my instructor knows to make sure I don’t fold up my knee during child’s pose, so I modify with a ton of blankets or stay on all-4s with something under my knees. I’ll admit it, I got depressed quickly. This is a BIG change for me, activity-wise. So I made a list of what I CAN do to make myself feel better. Here tiz: yoga, swimming, deep water aqua aerobics, NordicTrack, pilates, upper body lifting, biking, elliptical. (The cardio machines are not much of a consolation, but I have caught up on some reading.) Anyhow, I’ve learned to really like some of that stuff and my weight has held pretty steady, so I’m happy for now. Beyond that, everyone I work with is in the know, so I’m less tempted to demonstrate things that might make me regret having done so later in the day when my knee is barking.
Not only is my PT really smart, he's exceptionally handsome! 
What’s my point in telling you all of this? I’m not that unusual, for starters. This sort of thing happens all of the time, to people with fewer resources of information regarding alternatives. People like me are the ideal study subjects, in fact, because we are not professional athletes who are worth so much on the field, it’s considered a bad career move to not get duct-taped, spit-polished, and shined up until the next injury. Likewise, we are not children who might develop improperly if not repaired quickly. We are also active. Sedentary folks, especially those with other factors working against them, such as extreme obesity, are less likely to be studied too. So the information I have gathered showing that surgery does not provide an increase in favorable outcomes (ex. Pain reduction, decreased arthritis incidence, better functioning) is completely relevant to me. Finally, surgery will always be there. Once we re-evaluate my progress in 6 weeks, we’ll alter the plan, if needed. That plan may include surgery. Or the surgical option may play out years from now. Who knows? But I’m smart enough to know that if the knee being so dysfunctional starts to affect surrounding joints badly (ex. hip, lumbar spine), and surgery could correct that situation, then “duh”. Right now, the “duh” would be not trying to rehabilitate sans surgery.
The over-riding theme for the post is: Do your homework. We’re in a “patch ‘em up” society, especially in America. Get second and third opinions until you feel good about whatever decision you make. Know what you’re willing to do. Seek the advice of a variety of practitioners. Regarding ACL and meniscus repairs in those with formerly healthy knees, did you know that outcomes were equal between patients who had surgery + rehab as compared to patients who had rehab only? And that no study on those same knee surgeries in particular has been able to demonstrate a more favorable outcome for those receiving surgery? Kinda makes me think my husband should be making as much as an orthopedist! Especially when you consider the time involved with one versus the other. Nevertheless, check things out. It’s YOUR body. YOU’RE the boss of it. Always make informed decisions regarding the care and maintenance of it. And be flexible enough that, when new information and technology is available to you, YOU can change your mind. A win-win.
http://www.sciencedaily.com/releases/2010/06/100629081630.htm
http://www.sciencedaily.com/releases/2010/07/100722075224.htm
Monday, April 26th, 2010
Depression—Are you SAD?
It’s a rare person who isn’t ready to slap the snot out of someone (everyone) by March due to SAD (season affective disorder). Assuming they have the energy and motivation to do it, that is. By then you’ve used up any Vitamin D you stored up from the previous summer and the well has run dry during the gloomy-gray winter months. There’s a reason it’s called a “sunny disposition”, after all. I’ve found that several studies are out there on sunlight therapy (aka heliotherapy, alluded to earlier) with regard to depression and anxiety. One in particular showed no difference in effectiveness between Prozac and UV therapy. The UV therapy, by the way, was delivered at 10,000 LUX—enough to equate to a good blast from good old Mr. Sun. In other words, both were effective, not one more than the other. They did find sunlight therapy to work much quicker than Prozac, doing so without any toxic side effects. Finally, they found no advantage to treating with both Prozac + sunlight therapy. So apparently you can’t double up on the happy pills and the rays for the ultimate high, sorry! 
Prozac/sunlight study http://ajp.psychiatryonline.org/cgi/content/abstract/163/5/805
http://www.psycheducation.org/depression/LightTherapy.htm#evidence
(Note: fluoxetine is the generic for Prozac)
Aging—The sun’s rays doing us wrong
Okay, this is a tough one. I mean, no wait… the cancer one is a tough one, but that’s also largely a matter of genetics and balance. I mention appropriate sun exposure, not “burn the beejeebers out of yourself starting in infancy”. I hope you got that. But the incidental adding-up of just living life in the light showing up as brown spots and wrinkles and such? Oy. Again, genetics come into play here. But you don’t just inherit genes, you inherit habits. And as much as I’ve hit lightly upon the fact that not getting enough sun can age you on all levels, it can fast-track you to looking like Magda from Something About Mary as well. Balance, people. And know yourself. We harp on it with your eating and your training, the sun is no different. Anyone 25 and under, pay close attention to those of us in the 40+ crowd. In fact, one of my heroes, Seanna of MP4, is a perfect example of knowing herself, gathering information, and applying her own experience and knowledge of her genetic potential to her lifestyle choices. In fact, stop reading this and head over to her Wednesday posts now. And bring a pen and notepad! It’s not all about habits and good sense with regard to the sun either. Seanna and the rest of the team know that what you eat can affect how you “per4m”. All of you, including your skin! Here are some of the power players for your skin, acting as protectants from the elements, even the sun:
-Dark green leafies (we’ll bring them up until you’re all eating them daily)
-Dark chocolate (you’re welcome, but before you head for the sugary bars keep in mind the best form is the really dark stuff and raw chocolate, aka “cacao”—which is not sweet as-is)
-Fatty fish, such as salmon, mackerel, and sardines
-Green and black teas
-Fruits and veggies, esp the deepest and richest in color, eat from the whole palette!
Articles about foods that protect your skin. They mention exactly the same foods, but expound on them more if you’d like to know how/what they help (I do!). If nothing else, they back up the MP4 food ethic!:
http://food-facts.suite101.com/article.cfm/sunscreen_in_your_food
http://www.emaxhealth.com/1020/66/31859/five-foods-protect-sunburn-and-skin-cancer.html
How’s the High Horse, Heath?
There’s so much more to say that I just can’t go there even if I want to. And I really need a minute and some space to reiterate the best point(s) I made above: Know yourself; know your family history; make wise choices with regard to appropriate exposure, products, clothing, and nutrition, and make them consistently. I am absolutely positively not “for” jackassery of any sort, including sun exposure. But I do feel like we are in a time period when something natural with proven health benefits is being maligned to the point of causing a public health crisis. Additionally, I feel that common sense has flown out the window. Complete avoidance of the sun is not appropriate for most beings, but too many wallets stand to be filled by fueling a fear of exposure to it. How sad that the products they peddle may actually be a major cause of what we fear will happen.
So what do I do? Well, I know that I don’t have a family history of lethal skin cancers, but that if people in my family do dumb stuff (read: nothing) when in the sun, they sometimes have to have something scraped off a forearm here or there, or have something biopsied (such as those who repeatedly fry their bald heads for years on end…Dad…). I also know I used to tan well/easily as a child, I rarely if ever burned (thanks, Mom), but I don’t as well anymore due to the whole stuck-indoors phenomenon. Sooooo, I do gradually build up a “base layer”* in summer (Seanna is now cringing) because I live in Atlanta, sun is going to happen, and I’d rather have the natural protection this offers versus an always-unacceptable sunburn. And if this bod is going anywhere near the equator, I do hit the tanning beds for this purpose, but only those considered “safe” via the standard set by those in medicine who are pro-heliotherapy. (reference below, don’t trust the 19 year old behind the counter at your local salon, just sayin’…). Oh, and I never purposely tan my face. My family gets those brown spots too, and I have some from: a) having a family tendency; b) being a jackass as a younger gal; c) hormone replacement therapy.
I get my Vitamin D tested (I’m at an optimal level of 55), I take Vitamin D3 (which is the only way I’m at 55), I eat all of the foods mentioned above, and I get outdoors whenever I can, exposing as much of my skin as I can depending on weather, setting, and decency standards. But I don’t overdo, I wear sunscreen (a more “natural-ish” one, yes it is chalky and white and takes forever to soak in), I have good eyewear and a fabulous wide brimmed pink hat with a sun protection rating, and I embrace shade. Oh, and sometimes I mess up. But that’s where the consistency comes in. I’m counting on it bailing me out of the boo-boos.
There’s so much more, like sunlight’s positive effect on bones, PMS/women’s issues, Alzheimer’s, heart health, and pain management. And things I’m forgetting to mention even. I didn’t even touch on sunlight and athletic per4mance or even get too in depth about Vitamin D. See my post from a month or two ago for more on those last things. There are links in it for blood testing for your own Vitamin D levels, as well as other information. And don’t forget to get your annual head-to-toe checks at the dermatologist! Be smart, be safe, be beautiful—inside and out, always in all ways!
*http://articles.mercola.com/sites/articles/archive/2008/3/15/vitamin-d-in-your-skin.aspx (how to tan, nutrition, how anti-tanning is “killing us”)
**http://articles.mercola.com/sites/articles/archive/2006/11/11/can-a-tanning-bed-be-healthy.aspx (tanning beds)
Monday, February 15th, 2010
By Heather Morgan
Is that your telomere, or are you just happy to see me?
A much more professional subtitle to this post would have been something like “Long-term physical activity has an anti-aging effect at the cellular level”, but, not only has that been used by an article already, it just wasn’t as much fun. Indeed bigger is better, at least when it comes to your telomeres—something I’d better define before going forward. According to Wikipedia: “A telomere is a region of repetitive DNA at the end of a chromosome, which protects the end of the chromosome from deterioration”. {yawn, right?} Here’s a more entertaining explanation I dug up: “Just as those plastic nibs keep your shoelaces from fraying, cellular tips called telomeres protect your DNA from fraying when cells divide. When telomeres are tattered, they’re harder to use. That’s what causes cells to stop dividing and growing and replenishing your body—which means more aging for you.”
As you may or may not recall from prior biology classes, all of a cell’s DNA is copied during cell division, including the telomere. All but their DNA strands’ very tips, that is. So each time a cell divides, the telomere gets shorter and shorter. Once these little end caps get too short to protect the rest of the cell’s DNA, the cell stops dividing, starts to age, and eventually dies–a process also known as “senescence”. Sort of a pretty word for a bummer situation, no? But wait, there’s more! Studies have shown that even more devastating than replication problems is the effect of free radical activity, which evidently shortens those little guys quicker than you can say “biological clock”.
Of Mice and Men
The short of it? Short telomeres are associated with speedier cellular aging and death, which means compromised immune functioning, which then means lowered resistance to just about anything you don’t want to happen to you, be it a cold, cataracts, or cancer. Longer (and more stable overall) is optimal with regard to telomeres in the minds of lab geeks sweating it out in an effort to figure out what makes our cells into old farts fast. And regarding the free radical damage, the ability to withstand and recover from stress is imperative for keeping your telomeric population saying “me love you long time”. That being said, unless you are a nematode worm, Great Frigatebird, or knockout mouse, this might not mean that much to since the majority of this sort of information has been found by studying those sorts of critters. (Quick note: Apparently “knockout mice” are not really hot looking rodents, but, rather, lab mice that have had one or more gene(s) turned off for research purposes. Who knew?)
Good news though, my non-nematodes. Enough data has been gathered on human subjects to at least make an association between telomere length and longevity. Dr. Dean Ornish and colleagues were able to demonstrate just such a connection in 2008. They took a bunch of men and “subjected” them to several activities such as a 3-day retreat, a diet low in sugar and rich in whole foods (esp fruits and veggies), moderate aerobic exercise, breath work, and relaxation techniques. (I don’t know about you, but I’d have liked to have known where to sign up to be a test subject for that study). After 3 months they found that telomerase—the enzyme responsible for stabilizing and preserving telomeres—was up by 29 percent in all subjects from which data was sufficient for analysis. Again, just as with critter studies, this might not be significant to you if you: a) are not a man, b) do not have low-risk prostate cancer (all study participants did). But it’s an association nonetheless, and it was evidently worthy of publication in The Lancet Oncology.
Move it or lose it
Let’s get more specific to you, the athlete/health nut/person turning 40 this year and occasionally having moments about it. (oh wait, that last one is me…) I’ve got really, really good news for those of you who are consistently active, and even better news for those of you who have been for quite some time and have no intention of stopping. Ever. Just last year (2009) some researchers received the Nobel Prize in Physiology or Medicine for uncovering more about the nature of telomeres and how our chromosomes are protected by telomeres and their guardian enzyme telomerase.
Here’s how the study went down. Four groups of folks were studied—two groups of professional athletes (runners, specifically) and two groups of healthy non-smokers who were otherwise “untrained”. In each category, one group averaged 20 years of age whereas the other group averaged 50 years of age. In case I just lost you, the four groups were: 20 year old athletes currently competing; 50 year old athletes who aren’t competing but are still rocking it; 20 year old healthy non-smokers; 50 year old healthy non-smokers. I’ll skip over the obvious finding that the fitness level of any age athlete was superior to any age untrained individual. Big duh there. The cool part was the concomitant finding that that “[t]he age-dependent telomere loss was lower in the master athletes who had performed endurance exercising for several decades.”
According to Ulrich Laufs, MD and Head Geek in Charge of the award winning study: {read with German accent} “The most significant finding of this study is that physical exercise of the professional athletes leads to activation of the important enzyme telomerase and stabilizes the telomere. This is direct evidence of an anti-aging effect of physical exercise. Physical exercise could prevent the aging of the cardiovascular system, reflecting this molecular principle.” A longer telomere, such as that of an athlete, is a more efficient one it seems. Animal studies back this up, showing that the enzyme-boosting effect of exercise has more positive effects than just keeping telomeres long and strong, such as protecting cells from deterioration and pre-programmed death in general. (Knockout mice on treadmills-what an image!)
Pimping your DNA
By now you might be thinking: “I’m physically active, I don’t intend to stop, I eat a super clean diet chock full of free-radical-fighting antioxidants, and I don’t smoke. What do I care?” Well, maybe nothing. But, heck, if my “Better with Age” post last week didn’t motivate you, maybe knowing that your healthy lifestyle really, truly operates to your advantage at the cellular level with regard to aging will. It goes well beyond a butt that doesn’t drop to your knees at 50+, or skin that defies the number of candles on your next cake. Clearly, being active-and staying that way-is now a proven way to slow the aging process, right down to your chromosomes. And we are likely only scratching the surface on that science.
On that last note, you might instead be thinking: “Holy moly. I’m already rocking all of those lifestyle factors. But I want to look and feel like I do right now in 40 years. What can I pop, shoot, freebase, or snort to make that happen?!” Well, not so fast. While one might initially think that if stretching your ‘meres can prevent awful things like cancer or diabetes (crow’s feet prevention aside) it’d be a great idea to take something to supercharge telomerase activity, I’m here to break the news that cancer cells have beat you to the concept. As cells become cancerous, they divide more frequently, rapidly shortening their telomeres. Initially this sounds like a victory of nature as we already know that means a cell will likely die soon. Oddly, however, cells can escape death by becoming full-on cancer cells and activating telomerase, lending themselves to a sort of immortality. Yikes.
As if the potential to initiate or perpetuate serious disease processes isn’t scary enough, give a thought to the potential issues with life extension. Using technologies to merely lengthen a lifetime can bring along with it the toll of living longer with illnesses associated with old age such as Alzheimer’s and heart disease, in addition to cancer. Cell biology researchers agree: “In the ideal case, the healthy citizens of a modern society will survive to an advanced age with their vigor and functional independence maintained, and morbidity and disability will be compressed into a relatively short period”. Summary: Focus on quality over quantity. And the take home point with regard to supplementing for Turbo-charged Telomerase? We are not at a point in the science to be monkeying around with anything outside of consistent long-term good lifestyle practices. So, while this science is relatively new, it is flooding the mainstream rapidly and you will no doubt be seeing ads for things promising to optimize your telomeres, “The Fountain of Youth”. Don’t fall for it. Go with what you know, and what you know to be safe.
In closing, I’ll leave you with my top tips for longer-more-sassy-and-stable telomeres according to what I read and was able to make some sense of before my eyeballs spun out of control.
Heath’s Tips for Going Totally Telomeric
References:
http://www.oregonlive.com/health/index.ssf/2009/11/you_docs_keep_your_telomeres_h.html (easy read)
http://en.wikipedia.org/wiki/Telomere
http://pubs.acs.org/cen/coverstory/8234/8234aging.html (this one is more heavy duty, more than just telomere stuff with regard to aging)
http://www.sciencedaily.com/releases/2009/11/091130161806.htm (the athlete study is referenced in this one; also, just search “telomere” on the Science Daily site as there’s a lot there about protecting them, links to cancer, aging)
