All medications have risks, whether they be a supplement or prescription drug. One example would be non-steroidal anti-inflammatory (NSAID) drugs such as Advil, Naproxen, Celebrex, or Diclofenac. Many people use these drugs long-term for menstrual cramps, headaches, aches and pains, arthritis or injuries. Long-term use can increase the risk for acute kidney injury or chronic kidney disease progression. They also raise the risk for cardiovascular events such as myocardial infarction (heart attack) and stroke. So it’s been suggested to avoid use of these medications for those with hypertension, heart failure or chronic kidney disease. This is difficult, especially for the elderly who typically have these health conditions but also need pain relief for treatment of osteoarthritis.

In a recent U.K. study, Diclofenac was associated with excess risk for myocardial infarction as opposed to Naproxen. Also, Ketorolac, another NSAID, can adversely affect kidney function more than other NSAIDs. Factor in dehydration, nausea, activity limitations especially after surgery, and acute kidney injury and you can see that the use of these meds can be a real danger.

With the opioid crisis in the forefront, nonnarcotic alternatives for pain control are in high demand. If you need to use an NSAID, there are some like Diclofenac that pose a higher risk for cardiovascular events and GI bleeding compared with other NSAIDs or Tylenol. There is little justification to use Diclofenac before trying other traditional NSAIDs. Better yet, it’s worth trying herbs such as Ginger, Curcumin and Boswellia (AKBA). Combining Boswellia’s activity with Curcumin and Tumeric can offer even higher levels of pain relief. CBD is also an amazing pain reliever if monitored well.
I always advocate plenty of fluids, avoiding food allergens and other inflammatory triggers and getting healthy sleep as the foundation for reducing pain and optimal wellness.

References: Dubreuil M et al. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis 2018 Aug; 77: 1137.
Schwenk, T. NSAID use in patients with hypertension, heart failure, or chronic kidney disease. Journal Watch 2018 Nov; Vol. 38 No. 22 p. 180.
Myers, C. Plants for pain relief. Health and Happiness 2019 Feb; p 12.

Here are the top 10 Health Breakthroughs of 2018:

10. Synthesized Antibiotics- There is a real concern regarding drug-resistant bacteria strains such as MRSA. Researchers in Britains University of Lincoln discovered a synthesized form of the antibiotic texiobactin that has already been used to treat infections in mice. The next step could be commercial drug use for humans to battle the growing epidemic of drug resistance.
9. Senescence Drugs- Some drugs are now being tested to kill old cells called “senolytics”. This will help extend our quality of life, not just our years.
8. Semiconductor technology- This can read the bodies vital signs on the skin. A thin plastic material laid over the skin can check heart rate, blood sugars and other readings that can be displayed on your Smart phone or sent directly to your medical professional.
7. CRISPR genome- Targeting the RNA of diseased cells has become more accurate and safe. Salk Institute scientists tested their technology against dementia which effectively restored healthy levels of proteins to the neurons affected by the disease.
6. Cancer vaccine. Human trials have been underway to treat patients with lymphoma which could present an all new treatment for the eradication of cancer.
5. Brain implants- A pacemaker for the human brain, or deep-brain stimulator, creates electrical impulses that could boost the memory of sufferers of epilepsy, Parkinson’s, and Alzheimer’s disease.
4. Ingestible Sensors: Track your gut health. This ingestible sensor developed by Australia’s RMIT University can measure the gases in your intestine that could help to diagnose gastrointestinal issues way before patients are symptomatic.
3. Cloning Monkeys- It’s been over 20 years since researchers cloned Dolly the sheep. Now China has cloned 2 monkeys which is the first time this technique has been used in primates. DNA was taken from fetal cells into eggs that had had their DNA removed, stimulated the eggs to develop embryos, and implanted them in female surrogates. Two female identical-twin long-tailed macaques’s were born. This could revolutionize research on disease.
2. Treating Muscular Dystrophy- Scientists corrected a gene mutation behind a form of muscular dystrophy in dogs. Duchenne muscular dystrophy is caused by a gene mutation that prevents the body from producing dystrophin, a protein required for strong muscle fibers. By using gene-editing technology we hope the same can be done in humans very soon.
1. Helping Paraplegics Walk- Having worked in the Neuro ICU treating para and quadriplegics, this is such a huge discovery! Researchers implanted tiny electrodes between patients’ vertebrae of paraplegics below the injury and delivered a weak electrical current to help amplify signals to the brain. After months of intensive physical therapy, one patient Jered Chinnock, could walk the length of a football field with assistance. “It feels,” he said, “like science fiction.”

Wishing all of you a Healthy and Joyful 2019!

References: The Week, December21/December 28, 2018. Pages 28-29.
Interesting Engineering.com. The 16 Most Remarkable Healthcare Innovations, April 7, 2018.

We are finding that “Age” is the most common risk factor for many diseases. So the older we get, the more likely we are to get heart disease, neurological conditions, diabetes and cancers. That puts us in a tough position. Of course we want to live a long life, but we want to do what we can to stay healthy and ideally avoid illness and disease.

So the question is, is aging a condition in itself that can be reset? Currently the oldest person on record is a French woman who died in 1997 at the age of 122! It is predicted that by 2040, Spain will have the longest-lived citizens reaching the average age of 86 years.

Scientists have used animal studies to better understand the cellular and molecular processes that cause the deteriorations of aging. There are 4 broad groups according to Tamara Tchkonia and Dr. James L. Kirkland of the Mayo Clinic. These groups include chronic inflammation, cell dysfunction, changes in stem cells that make them fail to regenerate disease, and cellular senescence, the accumulation in tissue of aging cells that accompanies disease.

Researchers have found that old cells secrete proteins, lipids and other substances that increase inflammation and cause destruction of tissues. Apparently, healthy young people have few of these aging cells, but after age 60, they begin to accumulate and their increasing quantity correlates with the disabilities of old age.

Could there be a remedy that removes these old cells while leaving young cells? Well, we’re getting closer.
In one study with mice, old cells were sensitive to a combination of 2 drugs; dasatinib, a cancer drug, and quercetin, a plant flavonoid. They improved cardiac function and exercise capacity in old mice delaying the symptoms of osteoporosis and prolonged healthy old age. I mean isn’t that what we all want?! Healthy quality years as we age.

Some drugs are now being tested to kill old cells called “senolytics”. For example a drug called Metformin which has been used for 60 years to treat diabetes has been shown to be effective against several age-related diseases. Maybe we can prevent a host of age-related diseases- cardiovascular, cancer, dementia- that can help us not only live longer but with fewer disabilities related to aging.

Of course healthy eating, exercise, inner and outer connection through friends, family, community, religion or spiritual practices are the foundation of health. But maybe certain medicines can optimize and prolong good health. There are trials underway in humans looking at drugs and nutrients that will tackle all of the difficult causes of aging to help extend our health span so we can live healthier in our older years.

NYT – How Long Can People Live?

Many of us have experienced that annoying buzzing sound known as tinnitus. It’s thought of as more of a symptom than as a diagnosis. It affects more than a million people worldwide and has been chronicled as far back as the first century AD. Only 20% of people with tinnitus seek treatment. That is most likely due to the fact that most tinnitus comes and goes and is tolerated to a degree in which we can function. Although in the United States, almost one third of patients who request treatment report symptoms that are debilitating.

Tinnitus is variable with the quality and loudness of the buzz, hiss or ringing that is often described. Prevalence increases with age, smoking, male gender and ethnicity, with the non-Latino white population statistically at greater risk. Some conditions such as diabetes and other autoimmune diseases are risk factors for tinnitus. A history of loud sound, which can be recreational (those crazy late night concerts!), occupational or environmental also can predispose a person to tinnitus.

The majority of tinnitus cases are considered Primary which is defined as having no identifiable cause. On the other hand, Secondary tinnitus has an identifiable cause which can include a long list of conditions such as certain medications (NSAIDS, chemotherapy, antibiotics), inner and outer ear disturbances, neurological and vascular causes, infections and nutrient deficiencies. Persistent tinnitus (lasting more than 6 months) can impact ones quality of life and can lead to depression, anxiety, insomnia and neurocognitive decline. It can really be devastating!

The cause of tinnitus is alittle more complicated than we once thought. It is not simply a cochlear (inner ear) phenomenon. It has to do with the damaged stereocilia (inner ear organelles of hair cells) located in the cochlea that exhibit an increase in a spontaneous firing rate in response to lost frequencies which are relayed to higher structures in the brain. It appears to be a maladaptive neural plasticity as it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, according to research by Shore and colleagues (Shore, SE, Roberts LE, Langgguth B. Maladaptive plasticity in tinnitus- triggers, mechanisms and treatment. Nat Rev Neurol. 2016;12(3):150-160.

So, what to do?
First, lab testing should be done to rule out causes of tinnitus. Imaging is usually unnecessary unless one questions a tumor or vascular cause. When no underlying pathology is identified for tinnitus, then a patient should be sent for a full audiology evaluation. Management involves treatment of perceived loudness and treatment of comorbid symptoms such as depression, anxiety, sleep disturbance, etc.
The leading recommendation made by The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) is cognitive behavioral therapy (CBT). The sound cannot be eliminated but the patient’s response to the sound can be modified. Tinnitus Retraining therapy (TRT) is another form of habituation therapy that has been successful. Unlike CBT, which is the idea that behaviors are modifiable thoughts that can be changed by teaching coping mechanisms such as relaxation, TRT aims to eliminate the perception of sound. A patient wears a device similar to hearing aids using broadband noise that closes the gap between silence and the perception of tinnitus. This device is worn for 6 hours a day for 12 months.

Other alternative non-medical therapies include Chinese herbal medications such as Ginko biloba, vitamins, zinc, manganese, and melatonin. Cannabinoids, which is a plant that contains hundreds of chemicals that each act differently on the brain may have an inhibitory effect on neurotransmitter release. Other modalities such as yoga, meditation, physical therapy and mindfulness have helped patients feel more relaxed but they had no effect on the severity of tinnitus.

Of course prevention cannot be underestimated. Occupational noise and recreational use of music devices put people at heightened risk for hearing loss and tinnitus. If you are suffering from tinnitus, see a practitioner for evaluation to help your symptoms.

Reference: Gillian Ross, W, Danielsen, R. What’s the Buzz? Treatment Strategies in Chronic Subjective Tinnitus. Clinician Reviews. September/October 2018/Vol 28,NO 10. p. 34-41.