Confusion in DEXAland

This a follow-up to two previous posts about my experiences with DEXA scans:
http://bit.ly/2BQlpEC
http://bit.ly/2YDvu2x

When I was in high school, my parents were friends with a couple called Bob and Marge. In old age Marge, a small, sweet-faced woman, developed catastrophic bone loss and was forced to wear a sort of metal cage to hold her body together. She was in constant pain and spent much of her time in bed.

Osteoporosis is a real and serious condition that can destroy your life if it gets out of hand. At this point, the only therapy accepted by the medical establishment is a group of drugs called bisphosphonates, which are not all that effective and should probably not be used long term because of an increasing risk of side effects such as fractures of the femur and osteonecrosis of the jaw. In order to avoid taking bisphosphonates, I have been using a program of impact exercises for the hip and spine, initially based on research by Dr. Larry Tucker at Brigham Young, as described in the previous two posts.

The decision to start bisphosphonate therapy should not be taken lightly. This is why it is so important for there be clear, consistent, and reliable data on the patient’s actual condition, both in the present and as time goes on. This year, as every year, after the DEXA had been completed, I asked the technician to print me a copy of the report from the machine. (Copies of pages from the 2019 and 2018 reports are included in this post.) I immediately noticed that my spine, which had been shown as osteoporotic since 2015, was now back in osteopenia territory; it had improved by one whole standard deviation within the past year.



The technician told me that this year’s report would look different from last year’s because this year the machine (modestly named the Lunar Prodigy Advance DXA System) had read L1-L4 instead of the L1-L2 it had looked at last year. I asked whether the change was an actual improvement or whether it was just a statistical artifact because the machine was looking at four vertebrae instead of two and she said it was an actual improvement. She also alerted me to the fact that the machine would now go back and change the numbers from all the spine readings of previous years so that the 2019 and 2018 reports would not match up. The hip readings for both years were about the same.

Looking at page 1 of each of the two, the 2018 report said that my spine was osteoporotic at 0.798 g/cm² whereas the 2019 report says that the 2018 reading was osteopenic at 0.931 g/cm². It also revises the WHO Classifications to show osteopenia for all past years, even though previous reports have shown osteoporosis in the spine since 2015. The % Change vs. Previous column shows no significant change in the past year!

How to make sense of this? It appears to me that machine is looking at two different dimensions of spine health and bringing them together, rather awkwardly, on page 1. This looks like poor scientific practice. What is really serious, though, is that it conceals the improvement in my spine from anyone to doesn’t actually look at the two reports side by side.

The radiologist probably didn’t do this. The linear structure of electronic health records means that the 2018 report was probably buried about fifteen screens down. Who has time to scroll through all that—and why bother when the report appears to be giving you the information you need already? A week later a nurse from my doctor’s office called to say that my doctor was recommending I take a bisphosphonate. I pointed out that my spine seemed to have improved and that my hip readings were stable. My guess is that the radiologist recommended the drug in order to be protected from liability and my own doctor, who probably didn’t have time to look at one report much less two, just took his or her word for it.

I still wanted to know what had prompted the Lunar Prodigy to look at two additional vertebrae so I emailed GE, the manufacturer. No response. I’m reserving judgment until next year about the big improvement in my spine but I do believe that the exercises are protecting my spine and hip bones at least as well as bisphosphonates would and without the added risks.

Maintaining Bone Density in My Spine with a Simple (but Time-Consuming) Exercise

In October of 2016 I wrote a post about jumping to retain bone mineral density (BMD) in my hipbones http://bit.ly/2BQlpEC. Jumping seemed to help my hipbones, though I had to increase from 15 minutes twice a day to 30 minutes twice a day to reach the point of “no significant change.” My hips were still osteopenic but the T-scores, comparing my BMD with a young adult, were mostly in the low 2s, whereas my spine was over 3.

Since impact exercise seemed to work for hips, I came up with the following impact exercise for the spine:

Sit on the floor with knees bent up, feet flat on the floor, hands flat on the floor a little behind your hips, fingertips pointing forward. Lift yourself onto your feet and hands, a bit like a reverse table in yoga. Then bring your hips down sharply to bump on the floor. It is important to keep your feet pulled in fairly close to the hips so that you land on your bottom, not your tailbone.

I started doing this exercise with a small clock in front of me, one bump every 30 seconds for 15 minutes twice a day. I now try to do 30 minutes twice a day, though I don’t always get there. I’m experimenting with doing more jumps and bumps per minute to see whether that makes any difference. It took more than a year for me to see improvement, but the last two DEXA reports (3/18 and 3/19) show “no significant change” for the spine as well the most of the hip readings. The T-score for my spine is now in the 2s.

I do these exercises while watching the PBS Newshour (the only news show I can tolerate) and old movies on TV. Two hours is a lot of time to spend and I realize that most people couldn’t or wouldn’t do this. On the other hand, I am post-menopausal. These exercises might work faster for younger people. What really needs to happen is for someone to build on the insights provided by this research, either by finding a way to intensify the exercises or by inventing a machine that would deliver impact to the hip and spine without harming the body.

Doctors continue to remind me that I am at increased risk for fracture and I’m sure that’s true, though I’ve never actually broken a bone in my life. They continue to recommend that I take bisphosphonates. Medical science has known for a long time that these drugs can have horrific side effects, particularly with long-term use (See this 2011 post from the University of British Columbia http://bit.ly/2YDEHrx.) The side effects are supposedly rare, yet I keep hearing stories about women who have experienced them. Perhaps they are not so much rare as under-reported.

People with advanced arthritis or similar disabling conditions will probably not be able to use impact exercises. For those who can, impact exercises offer an alternative to the uncertainties surrounding bisphosphonates.

The Moral Conundrum of Max the Cat

We gave him a comfortable home, improved health, food, toys, and love–but we took away what he valued most.

“Let’s see this prodigy!” I said to our handyman as he pulled the cat carrier out of his truck. He opened the cage and lifted out a tiny creature with round eyes and exquisite tiger and white markings. So we brought the kitten to our house and let him out to explore the back porch. Almost immediately there were piercing meows whose meaning was perfectly clear. “Where’s the farm? Where’s my family? I don’t like this!” Later it turned out that there were compensations: unlimited lactose-free milk, toys, soft pillows to sleep on, and lots of attention. It seemed OK for a while.

In an earlier post I recounted our first weeks with Max and Bella, the slightly older female kitten we adopted at about the same time. They got along well with each other and with our older cat Rowan. They played, learned new skills, and grew stronger. Years ago, we would have started letting them out at about this age. Our neighborhood was quieter then and our cats enjoyed exploring the yard and basking in the sun on the back porch. These days, it is simply too dangerous. There are more people and more cars. We even have birds of prey, possibly driven into town by the development of surrounding rural areas – owls, hawks and turkey vultures – that carry off small animals.

Like Rowan, Bella was content to be indoors, but for Max there was always something missing. In the morning about breakfast time, he would run around the house meowing, trying all the doors and windows. This would go on for about an hour. In the evening, the same routine for a slightly shorter time. He showed his contempt for our restrictions in other ways, like pulling a dish towel down on the floor and peeing on it.

Some people have suggested that Max might like a little fenced-in area outside, but I know better. What he wants is to be completely free. He comes from a long line of working cats and he wants to be doing the job he was destined for, killing stuff outdoors. As a barn cat, Max would have been exceptional. He is very smart; he recently taught himself to open the drawer under my bed. He loves challenges and risk-taking and isn’t afraid of anything. He gets up on top of the refrigerator and walks along the upstairs railing with ease. He is frustrated because his talents are being wasted; he has wound up in what is basically a spa for cats!

For a long time I tried to think of other options for Max – giving him to someone with a better yard for cats, even sending him back to the farm – but in some ways he is not well suited to be an outdoor cat. Though mighty in spirit, Max is not a large cat, only about ten pounds, and could be injured by a bigger animal. Max is also friendly and loves the company of other friendly cats and people. Outdoors, he would probably be lonely. He might even befriend a human passerby and get picked up as a stray. Max is also very fastidious and keeps himself clean at all times. When we first brought him home we got a damp paper towel and wiped off his tiny feet, which were dirty from being in the cat carrier. Once he understood what we were doing, he started purring.

As cats get older, they seem to develop a deeper attachment to the people and other cats they love. Max and Rowan take naps together. He and Bella chase each other around the house. Max is two-and-a-half now and the demands to go out are fewer and less intense. Nobody gets everything they want in life, not even cats.

An Alternative to Mohs Surgery for Basal Cell Carcinoma

Last summer I started to notice a spot on my nose. It looked a bit like a pimple but it didn’t go away. After a few weeks I went to a dermatologist and had a biopsy. Bad news: basal cell carcinoma, not the worst kind of skin cancer but not to be ignored. Doctors call BSC “the rat cancer” because it burrows under the skin, out of sight; there is no way to tell how much (or even where) it has spread.

The dermatologist told me that I should have Mohs surgery to remove the cancer. The procedure is for the surgeon to shave off skin a layer at a time, testing each layer as she goes, until a cancer-free layer is reached. There is no way to know ahead of time whether the surgeon will remove one layer or seven. In an area as delicate and contoured as the nose, a seven- layer procedure would leave a large wound that would take weeks or months to heal completely and might require plastic surgery. For me, that would mean canceling the annual scuba diving trip and possibly ending up with a permanent, unsightly mess at the end of my nose. Surely, I thought, there must be a better way.

And there is. It’s called superficial radiation therapy and it has become available within the last ten years. It is distinct from an earlier form of radiation therapy that was commonly used before the introduction of Mohs surgery, which became the standard treatment for BSC in the 1970s. SRT is not available everywhere and has advantages and disadvantages compared with Mohs. The experience of having an SRT treatment is similar to having a dental x-ray and takes about as long.

-  SRT is non-invasive, painless, and non-scarring. Like any surgery, Mohs causes bleeding, pain, and an unpredictable amount of scarring.

-  SRT requires 12-15 very short visits for treatment. Mohs surgery requires 2 visits, one of which may last all day. If there are unforeseen complications, further visits may be needed and, possibly, treatment by a plastic surgeon.

-  The cost of both types of treatment is about the same and both are covered by insurance.

-  The cure rate of Mohs is slightly higher, but both are above 90%.

-  SRT may increase the likelihood of getting cancer again, decades in the future. (If I’m around then, I expect that there will be much better forms of treatment available.)

For me, the good news was that SRT is available in Indiana. The bad news is that the best qualified facility is in Muncie, more than 2 hours from my house (more like 2.5, with road construction at both ends). But I did it anyway – 14 round trips between late September and early November of last year. The facility had an oncologist to determine the dosage but the actual treatments were done by a technician. At the time of the last few sessions I had some mild bleeding from my nose but that was the only discomfort. I’m so glad I did this!

 

More Reasons for the Eroding Trust between Patients and Physicians

I’ve just been reading an article by James F. Sweeney, “The Eroding Trust Between Patients and Physicians”, that appeared in the 4/10/2018 issue of Medical Economics. First, I appreciate the fact that Mr. (Dr.?) Sweeney is addressing this issue, which is a serious detriment to effective medical care. Lack of time and of any substantial relationship with the patient are the causes emphasized by Sweeney, but there are a number of others that deserve attention.

Standard of Care imposes constraints that encourage doctors to play it safe and avoid creative thinking. Especially in the field of oncology, the threat of liability intimidates many doctors and may cause them to see each new patient as a potential lawsuit. The treatments endorsed by Standard of Care sometimes reflect out-of-date science rather than the latest and best thinking in the field.

Reliance on randomized controlled trials (in addition to lack of time) means that patients tend to be treated by category. RCTs are useful as an overall indicator, but they don’t tell the physician anything at all about a particular patient.

Medical offices frequently don’t have accurate, long-term medical records for patients. With the advent of electronic records, decades of precious data on individual patients were discarded and lost. Unless the patient herself has kept hard copies, the doctor must make recommendations based on a couple of years of test results. Adding to this problem is the lack of compatibility among EMR systems.

The connection between medical practice and science is becoming more tenuous. Protocols for some tests are not followed correctly. (My favorite example is the taking of blood pressure, when medical offices don’t have you sit quietly for a few minutes beforehand, the correct protocol. Then they tell you that you have high blood pressure.) We hear confident statements that calcium supplements promote heart disease, when the evidence for this is shaky at best. Medical practice tends to cherry pick scientific studies and highlight those that support what it is already doing.

In spite of substantial scientific evidence supporting the role of diet and exercise to good health, many medical practitioners discount their importance. Ads for medical practices and hospitals featuring photos of overweight doctors and nurses are clear evidence of this attitude.

Current medical practice tends to reject, even scorn, any therapy that isn’t part of the conventional canon. After developing painful scar tissue in my shoulder and arms, I was successfully treated by a chiropractor with myofascial therapy (MRT) and active release technique (ART). Conventional medicine’s recommendation? Pain meds or surgery.

These are all features of medical practice today that are causing physicians to lose credibility in the eyes of their patients.

Foot Surgery the Easy Way

I was born with curly little toes on both feet. That never bothered me until the past year, when the left one decided to curl out a bit more and started rubbing against the insides of formerly comfortable shoes and boots. For a while, I babied it along with band aids and pads but finally it was time for a visit to my wonderful podiatrist Dr. Hoffman (introduced in Respect the Feet).

“What have you done this time?” he asked. I explained that I thought I was getting a bunion. Instead, he identified it as a type of hammer toe, a condition that is often treated by breaking the toe and inserting a wire; big incision, lots of pain, weeks of recovery time. Instead, Dr. H proposed a minimally invasive 10 minute procedure in which a tiny incision is made, the tendon is nicked, and the patient goes back to normal life immediately.

So I did that. The worst part of it was the shots to numb the foot. After that, I really felt no pain at all, either during the procedure or later. Dr. H offered an antibiotic and suggested an over the counter pain med, but I said “No, thanks” to both of those. The only real hassle was keeping the dressing dry for a few days, which meant showering with a towel and a plastic bag around my foot. Now I’m back to wearing my regular shoes and boots. Dr. Hoffman scores again!

Got IBS D? This Probiotic Yeast Could Be Your NBF.

In 2014 my doctor at the time ordered tests in an attempt to find the cause of my longtime gut problems (discussed in Trouble Down Below). The tests came back negative except for the observation that a few Blastocystis hominis (BH) organisms were seen. At some point later on, I mentioned this to a GI specialist and he said, “Oh, that’s nothing!”

In general, this seems to be true. In 2000, approximately 23% of the US population was infected with this protozoan, most with no symptoms at all. (In less developed countries, the percentage is much higher.) BH tends to run with IBS and with colorectal cancer but the relationship is not clear. For a few unlucky people, it can cause major digestive upsets lasting weeks or months.

During a trip last month I started to have diarrhea, acid reflux, and intermittent queasiness. Since I do sometimes have digestive upsets when I travel, I didn’t think much about it. When I got home, the other symptoms went away; the diarrhea got worse­­—many, many trips to the bathroom, often in the middle of the night. Before calling my nurse practitioner to see about ordering tests, I did some online research to see what treatments were likely to be. One word: antibiotics.

I’m not totally against these medications; if I have a life-threatening bacterial infection, an antibiotic is certainly what I want to be taking. In my present situation, though, I had reservations. Antibiotics don’t always work for bowel problems. They can also do long-term damage to the immune system by killing off good bacteria in the gut and they may have unpleasant side effects, like diarrhea and yeast infections.

I started looking around for other options and came upon a yeast called Saccharomyces boulardii (SB). This probiotic is a veritable Swiss Army knife of beneficial functions and has been studied for decades. It has repeatedly been shown to work well against diarrhea, sometimes as well as or better than antibiotics. SB is believed to be a strain of baker’s yeast (S. cerevisiae) and is completely safe and without side effects, except for people who are allergic to yeasts. SB can be combined with antibiotic treatment to help support bowel function; since it’s not a bacterium, antibiotics won’t kill it. SB has been shown in some studies to be effective against Candida albicans, ironic because they are both yeasts. There are also researchers who are looking at various uses of SB for cancer patients.

I started taking SB 250 mg. three times a day. The tests came back showing—you guessed it—Blatocysitis hominis! After a few days with not much change, I went online again and discovered a French study from 1996 about diarrhea in 30 people with AIDS (under Clinical Studies in PWAs). The subjects took 3000 mg of SB per day, six times the normal daily dose. After two days, they saw significant improvement, at eight days their bowel function was normal.

I started taking 3000 mg per day of SB and also saw significant improvement after two days. For me, it took about three weeks to get back to normal. I plan to continue at the same dose for another couple of weeks, then gradually reduce it. Given the possibility of an allergic reaction, I think it was just as well that I tried the lower dose first.

SB is sold under the brand name Florastor, $20 for 20 250 mg capsules, cheaper on Amazon and Ebay. CVS has a generic version that is sometimes on sale. Swanson, the online supplement store, sells its own version, $5.99 for a bottle of 30. Are they as good as the brand name, or better? I don’t know but I plan to experiment later on. Given my gut situation, I expect to be taking SB indefinitely, and happily too!

Layers of Pain

I picture them as cobwebs­ — layer upon layer of cobwebs — binding my muscles, tying them to my bones, pinching sensitive nerves, but unlike cobwebs they are not diaphanous and fragile. These are bands of scar tissue, solid and persistent flesh, and I have them all over my body, palpable reminders of all the times I have misused my muscles over the years: the too-heavy load of books or groceries I just had to carry, the meetings that caused my neck and shoulders to tense up for an hour or more, the overly ambitious stretch in yoga class. 

Up until last year I wasn’t particularly aware of scar tissue as a problem. About a year ago, I started getting pains in my upper arms while doing weight-lifting routines. For a while, I backed off on intensity, thinking that these were injuries that would heal by themselves. I tried heat and ice. Finally, after about six months of no improvement, my personal trainer suggested that I go to a chiropractor, a new experience for me.

The chiropractor turned out to be a man in his early thirties, a serious athlete, who has had more than his share of serious injuries. When he asked me to raise my straight arms from my sides to the highest point possible over my head, he was horrified at the condition of my shoulders. I couldn’t get to the top position and I couldn’t straighten my arms. (Years ago I had had a bad injury to my left shoulder, described in this post, and later to my right, the most overworked side because I am right-handed.) Over a number sessions, this movement improved until he was fairly satisfied with it. But I still had the pain in my arms and rotating my arms forward in a circular motion hurt my shoulders. By now the pain was bad enough that it was waking me up at night.

To treat the scar tissue in my shoulders, arms and legs, the chiropractor used two approaches: myofascial release therapy (MFR), where he presses firmly into tight areas, and active release technique (ART), where he presses into a tight area while I move my arm across a prescribed path. This process ranges from mildly uncomfortable to quite painful, but the benefits have been substantial. I can now sleep at night without pain, though my shoulders and arms are sometimes stiff when I first get up. I am starting to lift weights again. My range of motion is much better but still needs work, especially the right shoulder and arm.

All complex human relationships, especially marriages and doctor-patient interactions, require a constant readjusting of expectations. The chiropractor and I had both anticipated that my situation would be resolved in a matter of weeks, months at the most. It has now been over a year. During that time, symptoms have come and gone. For a while, I had trigger thumb in my right thumb; it lasted for a couple of months, then went away. At one point I mysteriously injured a nerve in my left leg and was hobbling around for a while. We worked on the left leg and that got better too.

Why is all of this happening to me right now? Age is probably a factor; I am 71 now. Another possibility is that in 2016 I stopped taking Premarin, an estrogen supplement I had been happily using for 36 years. Changes in hormones can affect muscles and nerves so this transition may have turned a tolerable situation into one requiring treatment. In any case, I am grateful that these therapies are available to me. Ironically, insurance won’t pay for interventions that are actually restoring me but it would pay for pain medication, which I certainly want to avoid!

How To Keep The Weight Off As You Get Older

One of the sad truths about aging is that you inevitably burn fewer calories than you did as a young person, even if you’re physically active, even if you eat a healthy diet. When you retire you may eat out more often and take more trips to foreign countries with delicious food, making the situation even worse.

At our house we have instituted a system of alternating big meals and small meals. A big meal is protein (often chicken or fish), vegetables, and maybe a starch plus a little fruit for dessert. A small meal is soup with a small piece of bread or a quarter of a frittata or a tuna melt, always accompanied by vegetable juice (bottled or homemade). We do three big and three small each week. On the remaining night we eat at a restaurant.

Lately we’ve been wanting to lose a few pounds so we’ve started a low food day every week or so, somewhat like the part-fasting diets that are popular now. Instead of fasting, we have the Mango Lassi with Anti-Cancer Spices for breakfast (plus coffee), the Pretty Good Almond BerryGreen Smoothie for lunch, and the usual kind of small meal for supper. After a few weeks we’ve lost a couple of pounds without too much pain.

The advantage of our system is that it is sustainable. With diets, you eventually go off the diet and the weight often comes right back. Our program incorporates enough foods we enjoy, including an occasional sweet dessert at a restaurant, so that we don’t feel deprived.

The New Cats

When our old cat Sadie Pearl died last year at almost 18 years of age, our 10-year-old, Rowan, was lonely and bored. My husband wanted to get another lady cat so we asked our handyman to be on the lookout for likely candidates at his farm, where most of our cats were born. Sometime in May, he started describing a litter of three kittens that were living there with their mother. Even though they were very young, he urged us to take one right away because he was afraid they might be killed by a predator. (Our cat Rowan was orphaned when his family disappeared under mysterious circumstances. He was adopted by the kind people at the farm, later by us.)

We arrived at the vet with a beautiful little tiger and white kitten and the vet’s assistant, a cat expert, said, “It’s a boy.” However, she just happened to have a female kitten, a feral cat one week older than ours, that might be a suitable friend for him. So we ended up with Max and Bella. The picture of the cats when they were small illustrates their personalities: Max looks straight at you, ready to take on any challenge; Bella tilts her chin up dreamily, like a medieval saint awaiting guidance from Heaven.

During the first few days, I wasn’t sure that we should keep Bella. She seemed slow, almost lethargic, and her hygiene left something to be desired; her little face was often smudged with food. The vet’s assistant then explained that she was a litter of one (very rare) and had been living alone with her mother in a garage, essentially a sensory deprivation capsule. Max was born into the rich environment of a farm with other cats, horses, and cows, along with plants and farm buildings to explore. 

Max is not only masculine but a super-male: full of muscle and bravado. Smart and athletic, he is constantly seeking out new challenges for himself. All of our kittens have had to learn about gravity the hard way, by venturing under the railing around the second floor stairwell and falling to the landing about 10 feet below. For the others, once was enough, but Max has repeated the experience because he wanted to learn how to walk along the railing, a skill that none of our other cats ever mastered. 

For the first months of her life, Bella remained a kind of slow, dreamy moonchild of a cat but sometime after she was spayed she seemed to become more energetic and more focused. She and Max have always play-wrestled but now she sometimes chased him. Sometimes she tries to get Rowan to play with her, by rolling on her back in front of him and making little chirping noises. Usually, he considers this beneath him and walks away, though he sometimes play-wrestles with Max.

When the kittens first came, Rowan was horrified. He seemed to feel that these were not cats but alien beings introduced into his home. Over the next weeks, though, he came to enjoy watching their antics and gradually to interact with them directly. Sadie Pearl, his previous companion, had not been much of a role model in this respect. Like many lady cats, she was rather a diva. The new cats, though, are both friendly, playful, and easy-going, a welcome diversion for an older gentleman cat.

How I’ve Saved the Health Care System Thousands of Dollars

• Orthotics for problem feet, starting in my 40s, allowed me to do strenuous workouts and possibly to avoid later ankle, hip, and lower back surgery.
• Opted for acupuncture instead of surgery for rotator cuff injuries.
• In my 50s, used diet and exercise to lose weight instead of taking statins to lower cholesterol.
• Started taking protein supplements and proteolytic enzymes to retain and build strong muscles. Enzymes also help to heal injuries.
• Discovered that probiotics could alleviate long-term digestive problems, improve overall health. Drinking homemade vegetable and fruit juices may have helped too.
• Treated my psoriasis with biotin (Vitamin B7), not prescription drugs.
• In my 70s, began impact exercise (jumping) instead of bisphosphonates to improve bone strength.
• Currently receiving chiropractic treatment (myofascial release therapy and active release technique) for scar tissue in my shoulders and arms instead of taking pain meds or trying surgery.

Of these, only the orthotics are covered by insurance and even those have been said to be ineffective in some studies.Yet athletes use them all the time.

“Sorry, WebMD, Weight-Bearing Exercise Didn’t Help My Bone Density, Jumping Did.”

Bad news from last year’s DXA scan. My readings, which had floated around in osteopenia territory for years, had dropped. My right femur was down 5.2% compared with the previous reading and my spine was now osteoporotic, suggesting an increased risk of fracturing a vertebra.

Two factors, I think, accounted for this startling and unwelcome change. First, I think my dosage of Synthroid, which I need for my hypothyroidism, had been kept too high for too long. My doctor didn’t want to lower the dosage because my TSH was within the normal range, though just barely under hyperthyroid, for several years. It turns out that too much Synthroid can cause bone loss. Secondly, when the media came out with scare stories about how taking too much calcium supplement can contribute to heart disease (and where’s the evidence for that?), I foolishly cut back on the amount I was taking. The body is a proficient scavenger; if you don’t give it what it needs, it uses up what it has, in this case calcium in the bones.

Clearly, this trend needed to be reversed as soon as possible. The standard treatment for osteoporosis is one of the bisphosphonates, such as Fosamax or Boniva but, according to ConsumerReports, these are only modestly effective and can have dangerous side effects. A friend of mine took one of these drugs and experienced osteonecrosis of the jaw, in which the jawbone disintegrates and the teeth fall out. Not for me!

Fortunately I discovered some articles about the research of Dr. Larry Tucker of Brigham Young University and others, which involved jumping to increase bone strength in the hips. (See earlier post, “Maintaining an Imperfect Body: the Mini-Workout") The jumping routine is supposed to work for hips but the researchers say it doesn’t do anything for the spine; I decided it was an ideal opportunity to test the notion that weight-bearing exercise can help bone density. For the six months from 9/15 to 3/16, I did the jumping routine for 20 minutes, twice a day. During the same period, I did weight-bearing exercises for the back at a fairly intense level: 50 pushups, low rows with up to 80 pounds of weight, back extensions holding up to 30 pounds of weight. I also went back to a higher dosage of the calcium supplement.

When I had another DXA in March of 2016, the hip readings had stabilized but the readings for the spine had gone down 4%. If I had waited two years to do another DXA, the usual recommendation, I could have lost 16% from the bone density in my spine! Clearly, the heavy-duty weight exercises either hadn’t done anything or hadn’t done nearly enough for my spine.

What to do? Impact exercises had worked for the hips so perhaps I needed an impact move that would help the spine. In March I came up with a new exercise to target the spine and started using it for 15 minutes, twice a day. The results so far are promising but I’m not going to put it online until I’m sure it works. Stay tuned!

Food Synergy Pesto with Almonds and Anti-Cancer Greens

Garlic, along with leeks, onions, and other members of the alium family are among the top anti-cancer foods. Most people find it inconvenient to consume raw garlic but this recipe tones it down with parsley, lemon juice, and other flavors. Besides the garlic, the anti-cancer foods are parsley, arugula, and avocado.

For this quantity of pesto, I use a mini-blender. The full sized blender tends to slide over the tops of the ingredients in Step 2.

¼ cup sliced almonds

2 T avocado or olive oil

2 T water

1 teaspoon lemon juice

¼ ripe avocado, skin removed

1 clove garlic coarsely chopped

1 small handful of parsley

1 cup arugula, packed

¼ tsp. of salt, or to taste

1.  Lightly toast the almonds over medium heat, stirring a few times. They should be fragrant and slightly crisp, not brown. Pour onto a plate to cool.

2.  In the bowl of a small blender combine the oil, water, lemon juice, avocado, and garlic. Puree until it forms a smooth mixture.

3.  Add the parsley and puree until smooth.

4.  Add the arugula and puree to whatever consistency you prefer.

5.  Add the salt and the toasted almonds and pulse a few times. Repeat until the almonds are coarsely or finely ground, depending on your taste. I like mine slightly grainy, as you can see from the photo.

6.  You can serve this with pasta, as a garnish for soup, or in a sandwich. I like to spread it on whole wheat bread with slices of cooked chicken. Sometimes I top the pesto with a slice of cheese and broil at around 425 degrees until the cheese melts.

Other Food Synergy Recipes:

The Mango Lassi With Anti-Cancer Spices 

The Pretty Good Almond Berry Green Smoothie

More Food Synergy – and Evidence That It’s Doing Something

Once I had created the Mango Lassi with Anti-Cancer Spices, I wanted to make another drink that would feature anti-cancer vegetables and fruit. Green drinks run the gamut from bitter or sulfury at one end to super-sweet with sugar or fruit juice at the other. I haven’t been a fan of most of the ones I’ve tried.

After months of experimenting, I’ve come up with this combo, where the rich flavor of almond and grapeseed oil tames the strong flavors of the greens. The raspberries, lemon, and stevia add just enough sweetness. One of the advantages of the blending process is that you can use the fibrous parts of the vegetables that normally get thrown away, like the stems of the broccoli and parsley. The anti-cancer foods in this drink are the two cruciferous vegetables, the parsley, and the raspberries. 

The Almond Berry Green Smoothie

Time: 15 minutes including cleanup
Servings: 1 large drink

½ cup sugar-free almond milk
1-2 tablespoons water

½ cup ice

2 teaspoons grapeseed or peanut oil

1 cup of light, leafy cruciferous vegetable, such as kale or arugula, firmly packed

1/3 cup of dense cruciferous vegetable, such as broccoli, cabbage, or cauliflower coarsely chopped

1 small handful of parsley or ½ celery stalk

¼ lemon, peel removed

2/3 cup raspberries or blueberries

1-2 packets stevia

Add almond milk, water, and ice to the container of a blender.

Add the remaining ingredients in the order given.

Pulse 20 times to chop the solids, then puree for a slow count of 30 or until mixture is smooth.

If the mixture is too thick, add a little more water. If you taste too much of the cruciferous vegetables, add another teaspoon of oil. If you want a sweeter drink, add more stevia.

Notes:
I drink this smoothie every day at lunchtime and sometimes follow it with a half ounce of dark chocolate, another anti-cancer food.
 

Almond milk only lasts about a week after opening and I’ve only been able to get it in half-gallon containers, way too much for my needs. Kitchen stores sell little trays for extra large ice cubes, almost 4 oz. (1/2 cup). I freeze portions of almond milk and take them out one at a time. When you do this, you will add water rather than ice to the one-cup measure and you will have to puree about 2-3 times as long because of the extra frozen liquids.

I've read that cruciferous vegetables contain small amounts of various toxins. In order to limit exposure to any one toxin, it is recommended that you vary the ingredients of the smoothie on a regular basis.

Tip for Storing Vegetables: Many vegetables will keep longer if they are wrapped in a paper towel inside of the usual plastic bag. If the paper towel gets wet, it should be replaced with a dry one. For greens that come in a plastic clamshell, open the container immediately after you get it home, before storing it in the refrigerator. Put a paper towel on top, shake the container a couple of times, and re-close the lid. Store upside down (paper towel down) in the refrigerator. Each time you reopen it, remove any leaves that are starting to yellow, replace the paper towel if it is wet or stained, and shake the container before putting it away. This helps to keep the leaves from packing down, getting too wet, and spoiling.

One Way to Re-Use Plastic Clamshells: I give relatively clean and undamaged clamshells to a guy at my gym. He passes them along to Amish farmers who use them when they make butter and cheese.

Help for Prostate Cancer? Some studies have indicated that lycopene, which is found in tomatoes, may help against prostate cancer. To get a worthwhile amount of lycopene you need to use processed tomato products, such as tomato juice and tomato paste, not fresh tomatoes. You can add a tablespoon of tomato paste to this drink, which doesn't affect the flavor much. With this, use a bit more water and less ice. I like the Italian tomato pastes that come in a tube. Some of them are double concentrated, which presumably means twice as much lycopene. My favorite brand is Mutti, but there are others. American brands in cans work just fine too.

Other ideas for prostate cancer: quit eating red meat and processed meats like bacon and sausage; if you're overweight, lose a few pounds (see the new post How To Keep The Weight Off As You Get Older); if you're sedentary, get up and move around.

The Evidence That It’s Doing Something

I’ve complained about my digestive malfunctions elsewhere in this blog (Trouble Down Below, http://bit.ly/1UzEueJ. Last year I started drinking the mango lassi (http://bit.ly/1OqfiFg) and the Pretty Good Green Smoothie. Over the next couple of months I noticed that my fingernails were stronger and my skin looked better. 

This week I was doing my usual pedicure routine: remove old polish, file nails and calluses, wash and push back cuticles, and apply new polish. After the old polish was gone I noticed that there was a distinct difference in color between the upper and lower parts of the nail; the lower part was a nice, healthy-looking pink, while the upper part was yellowish. The dividing line comes 1/3 to halfway up the nail. 

6/15/2016

6/15/2016

Toenails take 12-18 months to grow out so this change represents a process that started 6-9 months ago. Mid-December, six months ago, is when I started with the drinks. Nothing was different about my foot care routine so this seems to represent a metabolic change of some kind. What sort of change is it and what are the implications for my health? I have no idea but I wish someone would check it out.

Update: Here are my feet six weeks later, seven and a half months after I started with the drinks:

7-27-2016

Update on nails, 2/2/2018: I've now been using the Mango Lassi and the Green Smoothie for more than two years and I think I understand what's happening to my toenails. For a number of years, the nails on some of my toes had begun to lift off the nailbeds (onycholysis). In the time since I started using the drinks, the toenails have started to reattach themselves, in effect lengthening the nailbeds. The same thing is happening, in a less obvious way, to my fingernails. Perhaps this is an indication of improved physical condition.

Food Synergy: New Cancer Research and a Recipe

Recent research is suggests an increasingly important role for nutrition in preventing and treating a range of conditions, including cancer. In the 1990s, scientists at the University College of Medical Sciences in New Delhi studied mice that had been exposed to a carcinogen that caused breast tumors in 100% of them. When nutritional substances were administered beforehand, the risk of developing cancer was reduced from 50% for the mice who ingested one substance to 90% for those who ingested four nutrients together (described in David Servan-Schreiber’s book, Anti-Cancer: A New Way of Life, p. 110).

At Sainte-Justine Children’s Hospital in Montreal Richard Béliveau, PhD, and his team worked with immune-deficient mice that had been injected with cancer cells. Mice that were fed a cocktail of anti-cancer nutrients stayed in better health and developed less serious, slower growing tumors, results discussed in Béliveau’s 2006 book Foods That Fight Cancer.

 A 2013 study headed by Madhwa Raj, PhD, at Lousiana State University Health Sciences Center tested ten nutrients and found them to be ineffective when used individually. However, when researchers selected six of the nutrients and administered them together, 100% of breast cancer cells were killed with no side effects for normal cells. http://bit.ly/1rGEZN3

Live human beings will not necessarily respond the same way as mice or cells in a petri dish. Unless there is more research, these intriguing results will probably be ignored by conventional medicine. Financing such research is likely to be a challenge when a positive result will enrich only grocery store owners. In addition, there may be ethical limitations in designing such studies for people who already have cancer or some other serious illness.

As a creative project, I decided to develop a drink that included four easily purchased foods similar to the nutrients used in the LSUHC study. It is not the most delicious mango lassi you have ever tasted­ – the ginger taste still comes through – but it is certainly drinkable. Will it really help anyone’s health? There’s no way to know for sure, but the drink is cheap, easy to prepare, and safe, unless you’re allergic to one of the ingredients. As an added bonus, the four spices I have used show promise against Alzheimer’s as well as cancer. I’ll be drinking my mango lassi every day along with my usual breakfast.

The Mango Lassi with Anti-Cancer Spices

Time: 15 minutes including cleanup
Servings: 1 large drink

Caution: Turmeric can leave a vivid yellow stain that may be impossible to remove. To avoid damaging clothing and countertops, wear an apron, measure over a plate or cutting board, and wash measuring spoons immediately after use. By itself, turmeric is not well absorbed by the body: mixing it with black pepper and olive oil improves bioavailability, the reason for the somewhat tricky procedure here.

Before you start: Cut a medium banana into thirds and freeze it in a plastic bag.

Ingredients

1 green teabag

4 oz. boiling water

1/3 medium banana, previously frozen

¼ teaspoon wasabi powder

2 level tablespoons vanilla whey protein powder

1 heaping tablespoon Greek yogurt

¼ teaspoon powdered turmeric

1/16 teaspoon black pepper

1/2 teaspoon olive or avocado oil

Raw ginger about the size of you first thumb joint, peeled andsliced across the grain

A handful of frozen mango or pineapple chunks, or a combination (1/2 – 2/3 cup)

Cold water (optional)

½ packet of stevia (optional)

1. Brew teabag in hot water and let cool while you prepare the other ingredients.

2. To the container of a blender add the 1/3 banana, wasabi powder, whey protein powder, and Greek yogurt.

3. Place a clean tablespoon on a plate or cutting board. Measure turmeric and put it in the tablespoon. Measure black pepper and add it to the tablespoon.

4. Pour olive oil into a measuring spoon over the blender container but don’t add it yet. Lift the tablespoon with the spices and hold it under the olive oil. Add the olive oil to the turmeric and pepper and use the measuring spoon to blend it into a paste in the tablespoon. Now add the paste to the blender and wash both spoons.

5. Peel the ginger and chop it into small pieces – you should have about two rounded teaspoons – and add that.

6. Add the mango chunks and the green tea. Squeeze the teabag to get out all the liquid.

7.  Pulse the mixture 15-20 times to chop hard ingredients, then puree for a slow count of 30.

8. If the drink is too thick, stir in some cold water. If it’s not sweet enough, add stevia.

Note: Ginger is easier to peel and chop if you wet it first. Thanks to Real Simple magazine for this tip.

Update: I have recently learned that I am deficient in alpha-linolenic acid. The fix for this is to take one tablespoon of flax seed oil per day. When I add this to the mango lassi, I find that it cuts back the ginger taste. Flax seed oil is expensive so I probably wouldn't use it if I didn't have the deficiency.

Update: The next post has another example of food synergy, The Almond-Berry Green Smoothie: http://bit.ly/1twNQC6.

http://bit.ly/1twNQC6http://bit.ly/1twNQC6

The Negative Placebo - Why Fitness Buffs Avoid Doctors

My personal trainer never visits a doctor. Neither do many of the weightlifters at the gym where I go. Part of it probably has to do with unease about appearing naked in front of a near-stranger, as well as a dislike of needles and other painful features of medical treatment. But fitness buffs have more fundamental reasons for their negative view of doctors.

     1.  They anticipate that the doctor won’t respect their values.

Fitness buffs are people who have spent years of their lives studying and fine-tuning their bodies. They have learned exactly how far this muscle will stretch and how much weight that one will lift. They know what foods and supplements work best with their particular body type. One of the rewards for this hard work is a precise sense of what and how the body is doing (proprioception). If something starts to go wrong, they usually sense it. Fitness buffs believe that proper diet and exercise can keep most people healthy most of the time.

Doctors aren’t taught much about diet and exercise in med school and they don’t learn more afterward. Many don’t exercise themselves; some are overweight. Ads for hospitals and medical practices frequently display photographs of these out-of-shape physicians, a good indicator that they haven’t gotten the message about diet and exercise either.

Doctors tend to give more credence to test results than to the patient’s own intuition about how she is doing. Some believe that patients are actually better off taking an FDA-approved medication or than trying to exercise. “People who can take statins are the lucky ones,” an MD told me once.   
 
2.  They don't want to be exposed to a doctor's negative attitudes.

The pursuit of fitness is based on hope and aspiration. The workouts I do each year are harder than the ones from the year before. The increased strength, flexibility, and versatility have enhanced my confidence and sense of well-being. In spite of scores of studies to the contrary, many doctors believe that exercise doesn’t work. I smiled when I read a post on Kevin MD by an orthopedic surgeon expressing appreciation for personal trainers and surprise that they could make a significant difference. 

Some doctors worry about injury; they recommend moderate exercise and advise people to “know their limits.” Fitness buffs believe that gently but persistently pushing against your limits is the path to better health. Each person needs to discover what amount and intensity of exercise works for him or her.

Doctors also believe that patients won’t follow a serious and consistent exercise program so they don’t even suggest it.

          3.  Doctors do crisis intervention, not health maintenance.

Although orthotics for problem feet can prevent devastating knee, hip, and lower back injuries in later life, this painless and inexpensive treatment is seldom recommended. Protein supplements and proteolytic enzymes can help older patients retain muscle but they are usually dismissed, along with supplements in general. If there were personal trainers in doctors’ offices, they might be able to implement some of these useful therapies and broaden a few minds in the process.

  

          4.    Doctors are relentless in their search for disease, sometimes finding it where it doesn’t exist.

Fitness buffs like to think of themselves as healthy people. Doctors are trained to discover illness and to empathize with those who are suffering. Many fitness buffs don’t have annual physical exams because they fear that a misapplied test or misinterpreted test result will redefine them as sick, setting off a cascade of unnecessary interventions. I don’t have the option of staying away because I need renewals of the two or three medications I take and occasional blood tests to monitor my thyroid. Every year my doctor suspects me of harboring a different illness; every year I have to prove that I am healthy.

Heart disease and stroke are the major killers of people in the US. Stress can be a significant contributor to these illnesses. A recent study showed that women who had false positive mammograms had a greater risk of developing invasive breast cancer in future years. The researchers thought that the radiologist might have detected some subtle feature that anticipated the change. I would like to know whether these false positive women also had a greater risk of heart attack and stroke in future years. Perhaps the anxiety associated with the repeated tests contributed to future illness of several kinds. For fitness buffs, the stress involved in visiting a doctor may be too high a cost for any possible benefits.

The truth is that both fitness buffs and doctors have important information to contribute. If those insights could be shared in a context of openness and mutual respect, everyone would benefit.

Note: After following @RogueRad on Twitter, I realize that I should have called this The Nocebo - but some of my readers probably haven't taken Latin in school.

Maintaining an Imperfect Body: the Mini-Workout

Every body has them­­ – the trouble-making areas where pain, weakness, or disease tend to crop up. Sometimes they’re hereditary, sometimes the result of the wear and tear of decades of life. One of the perks of getting older is that these areas become familiar companions, not exactly friendly but no longer intimidating.

Over the years I’ve identified six or seven muscle groups or parts of my own body that are likely to cause problems. This year I’ve started doing a mini-workout of seven exercises every morning to monitore, stretch, and strengthen those areas. I also do an eighth move which is an experiment; if it turns out not to work, I’ll quit doing it. The whole series takes about 15 minutes.

Neck. When my father was in his sixties he developed a pinched nerve in the back of his neck that was very painful. Advised by his doctor, he started using a traction device to relieve the pressure on the nerve. To strengthen the muscles in the back of my neck and maintain flexibility I do this:

- Lie down on a flat surface and raise my head 2-3”. Stay in this position and count. Over several months I’ve worked up to 100. I take a break by bending forward toward my feet. I grab my heels (but that’s not essential for a good stretch).

- I return to the first position but this time I turn my head to the right and to the left as far as I can, like shaking my head “no” slowly and deliberately. I go up to 30 reps on this one.

- When I was a child I used to sleep on my stomach all the time, which meant that my face was turned to one side. As an older adult, I started to lose flexibility in the ligaments at the base of my skull so I work on them. I lie on my stomach, turn my face to one side and count. With all neck exercises it’s important to do them gently and work up gradually.

Calf and Hamstring Muscles, especially on the right side. My legs have pretty good strength and flexibility but my range of motion is limited in some exercises. This is not because of arthritis – I don’t have much of that – but because I have tight, bulky calf muscles, especially on the right side and little sore spots in the calf and hamstring. A massage therapist told me I have scar tissue in those areas.

- The sore spots are in different places each day so I start by doing sleeping child pose to see where they are. (Sleeping child is the yoga pose where you kneel with your forehead on the floor and sit back on your heels.) When I find a spot, I rub and push into it with a circular motion to loosen the area. Usually there are three or four spots.

- I check my work by standing up, then sitting down into a squat and counting. Then I stand up without using my hands. Sometimes I have to stop in the middle and work on more sore spots.

Lower Back. In old age my aunt and uncle on my father’s side both had lower back problems. (My uncle had a disastrous back surgery that crippled him for life.) With that in mind, I do five superman reps. Lying on my stomach with arms stretched out in front of me I lift my upper body for a count of 25. For this one, it’s important not to tilt the head up but to look down at the floor.

Upper Back. As a young adult, my upper back muscles were so weak I couldn’t do a single push-up. P90X changed that. I do 50 of these, though I don’t go very deep on the last 10.

Sit-ups. Rounding out the core group, I do 50 sit-ups.

Balance. My right leg is a bit shorter than the left so my balance is not great. I stand in a doorway on one leg and count to 10. Then I close my eyes and count to 30. If I get shaky, I grab the door frame. Same on the other side.

Back Strength and Flexibility. Using a pull-up bar, I lift myself as high as I can. I can’t do a full pull-up yet but I’m making progress.  Holding onto the bar but with my feet on the floor, I stretch through the whole length of my back and count to 75. If I’m in a hotel room I skip the pull-up and use the top of a piece of furniture for the stretch.

Jumping. My last bone density test showed that I was losing bone mineral density faster than I would like. I read about a study that showed that a 10 or 20 jumps with 30 second breaks in between significantly improved BMD in the jumpers as compared with the non-jumping control group.

We’ll see if this routine works for me. As for the cause of the lower BMD, I’m guessing that the dosage of thyroid hormone I take for hypothyroidism has been too high for too long. My doctor has lowered the dosage. I had also cut back on my intake of calcium supplement after reading scary stories in the media. That was probably a mistake and I’ve gone back to what I was taking before. 



Update 12/31/2015:

An article in the Wall Street Journal a  couple of weeks ago persuaded me that I shouldn't be doing situps anymore. I now do variations on plank for one minute, followed by 25 rollouts using an ab wheel. 

My personal trainer explained to me that the central ab muscle, the rectus abdominis, is designed to be a stabilizer and is meant to be stretched out flat, not curled up. Doing appropriate exercises will improve its appearance as well as being safer.