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Perfomance Artist “Artists are athletes” The athlete • High school/collegiate • Performing artist • Governed by parents/ state and federaladministration/ medical community • Geared to finish the season • Low endpoint for source of income • Governed by parents • Geared to finish the performance • High dependance for life time income(tolerance) • More exposure to alternative treatment Sir William Osler/ Hippocrates “Food is the best medicine” Andrew Weil, MD www.Drweil.com conservative in herbal medicineground breaking in western medicine reintroducing the concepts of nutrition and healing Act 1: The Injury massage doc therapist Injured guy Electron microscope • A twist, roll, bend or fall occurs with immediate pain • Stiffness and spasm set in by one day • Other areas start to spasm in a week • Soft tissue (ligament, tendon and muscle) gets over stretched and torn off its connecting points to bone. • The tissue reacts by sending more blood to the area and heat/redness prevail • Compensating areas start to fail when they can’t do the work of the originally injured part When tissue is torn/stretched: • Inflammatory phase starts day 0-5 • Bleeding • PMN’s • Macrophages and platelets stimulates GF • Proliferative phase from day 5-21 • GF stimulates endothelial cells, fibroblasts and myofibroblasts • Macrophages continue • Maturation phase from day 21-whenever • Fibroblasts • Increased collagen and tensil strength The Problem Act 1, Scene 1: Inflammation • When tissue damage occurs, the “cascade” starts phospholipid Arachadonic acid Arachadonic acid Pg cytoprotection Normal tissues *stomach *kidneys *platlets *endothelium Pg Inflammatory response Inflammatory sites *macrophages *synoviocytes *fibroblasts Regular nsaids block here: phospholipid Nonselective cox2 Arachadonic acid Arachadonic acid Pg cytoprotection Normal tissues *stomach *kidneys *platlets *endothelium Pg Inflammatory response Inflammatory sites *macrophages *synoviocytes *fibroblasts Steroids block here: phospholipid corticosteroids Arachadonic acid Arachadonic acid Pg cytoprotection Normal tissues *stomach *kidneys *platlets *endothelium Pg Inflammatory response Inflammatory sites *macrophages *synoviocytes *fibroblasts Cox 2 blocks here: Cox-2 phospholipid Arachadonic acid Arachadonic acid Pg cytoprotection Normal tissues *stomach *kidneys *platlets *endothelium Pg Inflammatory response Inflammatory sites *macrophages *synoviocytes *fibroblasts Act 2: The Villan and the Hero • • • • Rest Ice Compression Elevation • NSAID’s • Therapy • Steroids(injection or pills) • Muscle relaxers and narcotics Non steroidal antiinflammatory agents acetic acids diclofenac, etodolac, indomethacin, ketorolac, sulindac, tolmetin fenamates meclofenamate, mefenamic acid propionic acids fenoprofen, flurbiprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, oxaprozin nonacidic nabumetone salicylic acid diflunisal, salsalate oxicam meloxicam, piroxicam cox-2 inhibitors celcoxib, valdecoxib Generic and Trade Names • • • • • • • • • • • • • • • • • • Diclofenac potassium fast release Diclofenac sodium delayed Etodolac Indomethacin Ketorolac Sulindac Tolmetin Mefenamic acid Fenoprofen Flurbiprofen Ketoprofen Oxaprozin Nabumetone Diflunisal Celecoxib Valdecoxib Meloxicam Piroxicam • • • • • • • • • • • • • • • • • • Cataflam Voltaren Lodine Indocin Toradol Clinoril Tolactin Ponstel Nalfon Ansaid Orudis Daypro Relafen Dolobid Celebrex Bextra Mobic Feldene ROID’S • • • • • Not anabolic’s Prednisone Medrol dose pack Kenalog Celestone Pain pills • • • • • • • • • Acetominophen Tylenol with codeine Vicodin Ultram Morphine elavil flexeril Skelaxin zanaflex Act 3: Secondary Effects From the meds From the inactivity • Sleep is disturbed and fatigue starts • Joints above and below the area of pain stiffen up and are hard to stretch • Chronic pain and immobility result in weight gain and lack of exercise, carb hunting occurs and depression starts • More muscle spasm more pain less tolerance • Due to chronic spasm the sleep cycle is disturbed and memory/concentration off • Due to immobility, the muscle/tendon units involved with the injury become stiff and sore (trigger points) • Stagnation starts to affect emotion and body wants satisfaction previously found with endorphin-rush, now found with medicines or foods/alcohol/drugs • Serotonin gets depleated and depression starts along with side effects from new addictions Side Effects from Medicines • • • • • • • • • Allergy to nsaids Reflux/ulcers Kidney damage Hypertension Diarrhea Asthma flare up Bleeding Drug interaction Steroid dependance • • • • • • • • Drowsiness Dry mouth Poor coordination Dizziness Blurred vision Addiction Drug interaction Liver toxicity The COX II controversy • • • • • • Initially made to protect the stomach Selective for cox 2 receptor Less stomach ulcers New data that vioxx caused heart attacks Celebrex is under study by the FDA Pulled off but ok’d for now? Act 4: The Alternative • Herbal meds • • • • • Acupuncture Massage PT Manual Therapy Modalities • Diet GAIT Study • Glucosamine/chondroitin Arthritis Intervention Trial • University of Utah/NIH funded • First large-scale multicenter center clinical trial with dietary supplements for treatment of knee arthritis • Testing the effectiveness of short term(6month) treatment in pain reduction • 20% reduction in pain in 24 weeks with moderate to severe pain using combo Zyflamend by new chapter • • • • • • • • • Holy Basil Turmeric Ginger Green tea Rosemary Oregano Scutellaria Hu Zhang Chinese Gold Thread and Barberry If Relief by Natures Sunshine • Turmeric Root • Mangosteen • Andrographis Paniculata • Boswellia Gum • White Willow Bark • salicin Postgame by ameriscience • • • • • • • • • • • Manganese Devils Claw Glucosamine Hcl Vitamin C Potassium MSM Hyaluronic acid Bromelain Papain Lipase Amylase Back to basics The Anti-inflammatory Diet • • • • • • • • No dairy No pork or beef No alcohol Cut back on wheat Stop smoking Get 7+hours of sleep Hydrate all day Stretch, yoga, tai chi Early movement important Hang up the towel Epilogue: “Back” to basics • Avoid injury by knowing when to quit, stretching, maintaining proper diet • Get help immediately (as the cascade starts) • Relative rest/ice/ • Supplements • Meds if necessary, stop etoh and tobacco • Know what you take and watch side-fx • Maintain stretching and proper diet and sleep • And when ready…….