DRUG THERAPIES FOR HEALTHY BONES: FLUORIDE

December 20, 2010

I used to prescribe sodium fluoride because it stimulates bone formation. But the bone formed turned out not to be of high quality—and sometimes even abnormal—resulting in dense, but fragile, bones and increases in the rate of fractures. Side effects include gastrointestinal problems and joint and/or bone pain, and it is potentially toxic in high doses. With newer, far better options, the benefits no longer outweigh the drawbacks, so my advice is to avoid it.
However, studies are under way on lower doses in special slow-release formulations that may build bone and decrease fractures, as well as reduce or eliminate side effects. Low doses (45 to 75 mg daily) are already used in Europe, with apparently satisfactory results, but haven’t been approved by the FDA here as of yet. More study is needed, but perhaps lower doses that keep fluoride safe and effective will bring this drug back into favor. It should be a relatively inexpensive option if it does prove useful in the future. If it does make a comeback, you may want to take it along with calcium and vitamin D supplements, and possibly another medicine that blocks bone breakdown.
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RHEUMATOID ARTHRITIS: JOINT PROTECTION GUIDELINES

December 12, 2010

Respect your pain. Increased pain is a warning that you are overtaxing your joints. You should heed this warning and modify the activity.
Balance rest with activity. Organizing your schedule so that you alternate energy-intensive activities with more restful ones will stretch your energy reserves and protect your joints as well. Conserving your energy by avoiding unnecessary tasks will leave you with more energy to exercise and do the necessary ones.
Maintain your muscle strength. Strong muscles provide additional support to your joints and help protect them from undue stress.
Avoid activities that cannot be stopped. Try to steer clear of prolonged activities that leave you no room or opportunity to rest. Consider that standing in a long line without being able to sit down will leave you fatigued. With some planning you can avoid peak hours and long lines at the post office, bank, and grocery store. Carrying a package for a long distance – across a parking lot, for example – is another activity that can wear you out. Again, the best way to avoid this is to plan ahead: keep a portable or fold-up cart in your car. This will allow you to transport the object without exerting much energy and to take small rest breaks during the trek if you need to.
Avoid positions that promote deformity. Sometimes ligaments and muscles become stretched with the inflammation of arthritis. This may result in unequal forces being exerted across the joints, creating a situation in which the joints drift, or change their alignment. This is known as joint deformity. The word deformity is frightening for most people. The use of the word within this setting, however, merely describes a change in the normal positioning (and, sometimes, function) of joints.
Utilize the largest joint and the strongest muscle available to complete a task. It makes good sense to call upon your most powerful joints and muscles to perform any given task. In this way you avoid putting stress upon smaller, less powerful joints and muscles. Consider the task of lifting a heavy book. If you pick the book up between your thumb and fingers, the fingers and wrist will have a great deal of stress placed on them. Instead, if you pick the book up by sliding your hands underneath the book, palms up, and then lifting it, your arm muscles and elbows will do the work, and you’ll avoid putting extra stress on your wrists and fingers.
Avoid remaining in one position or using muscles in one stationary position for long periods of time. Remaining in one position for too long promotes stiffness or a gelling effect on inflamed joints. Muscles also become fatigued when you use them from a stationary position for long periods. (Think about how your muscles begin to cramp when you write for lengthy periods without stopping or readjusting the pencil or pen.) Stiffness of joints and muscles can be avoided by changing to a different position every fifteen to twenty minutes. Frequent stretching also helps prevent joints from losing range of motion. Again, take frequent breaks, stretch, and change positions before muscle fatigue sets in.
Utilize splinting as needed. A splint is a fabricated support that is designed to stabilize inflamed joints. In RA, a splint has three basic functions. It can be designed to (1) rest an inflamed joint by partially or completely immobilizing it; (2) protect a weakened joint from injury by supporting it; and (3) improve function of a damaged joint.
Splints should only be used if they decrease pain and inflammation or improve function. There is no good evidence available that splints prevent deformity. On the other hand, it has been proven that incorrect or prolonged use of splints can lead to increased stiffness, decreased strength, and decreased motion. If you believe that you are receiving no benefit from a prescribed splint, discuss this with your physician or occupational therapist.
Utilize assistive equipment as needed. There are numerous catalogues listing accessories that are useful for people who have arthritis – so many, in fact, that the choices may be overwhelming. Our advice is to use as little in the way of assistive equipment as possible because these devices can actually interfere with your ability to function independently if you rely on them too heavily or if you use too many of them. This is not to say that there aren’t many situations in which a specific item can help you considerably and spare your joints from excessive stress.
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BACH FLOWER REMEDIES: ASPEN – THE CASE OF A NEWLY WED GIRL

December 6, 2010

I remember the case of a newly wed girl whose family life was saved from ruination by the timely administration of Aspen Remedy’
Case no 1. Mrs. Swarnjit Kaur, a very beautiful girl coming from a well to do family was married to a handsome boy of an equally well-to-do family. Both families were very well-known to each other and were already having common relatives. So there was no trauma of a new bride entering an unknown family. The girl received as much love and affection in her husband’s house as she got in her parental home. Yet she did not appear to be properly adjusted.
For the last 6 months she avoided meeting people in her in-law’s house. Her in-laws were very sociable people with very large number of friends and relatives. When these people came to see the bride, to offer their blessings and gifts, she would gratefully accept the gifts with a smile and a few words, but would soon retire to her room. Evidently she was avoiding sitting in society. This placed her in-laws in a very awkward position. They could not explain why the new bride could not adjust in the new family and mix freely with others.
I cajoled her in confiding to me, that she was subject to fits of unspecified fears at odd times. She had consulted several doctors but nobody had a clue to her malady. She avoided sitting in new society due to her ASPEN’ fear. Because if she got a fit of her unspecified fear while sitting in new society, it would put herself and her parents-in-law in a very awkward position having to explain to one and all “What is wrong with the new bride”? Besides it would in. ite unnecessary gossiping amongst not-so-sincere ‘well-wishers’.
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