Rheumatology and Orthopaedics– may be hard work to sort but pain is highly motivating

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By Dr Sarah Myhill and Craig Robinson

Preamble - issuing of new chapters to My book Ecological Medicine

Date of Issue - June 2021

This page is a copy of the new updated Chapter 47, Rheumatology and Orthopaedics– may be hard work to sort but pain is highly motivating , from My book Ecological Medicine - The Antidote to Big Pharma and Fast Foods.

Ecological Medicine has 79 chapters and 5 appendices. It is an ongoing project and as I extend my knowledge, I will add new ideas all the time by updating already existing chapters.

So that people who have already bought Ecological Medicine do not feel as if they have an out of date copy, I will make these updated chapters available free online as they are written. Also, at regular intervals, Ecological Medicine will be reprinted and these reprints will incorporate all the chapter updates that have occurred since the last print.

You can purchase the whole book from these links

Download of revised Chapter 47 "Rheumatology and Orthopaedics– may be hard work to sort but pain is highly motivating", Ecological Medicine

You can download this new chapter here:

Chapter 47 - Rheumatology and Orthopaedics– may be hard work to sort but pain is highly motivating

Introduction

Just as ‘The Prostates’ accepted ever more frequent visits to the toilet, we are given the clear impression by doctors that pain and degeneration are an inevitable part of ageing……….. “old age does not come alone”. So many of my patients are told “what do you expect? it’s your age”. Nonsense! These problems are not inevitable as evidenced by a look at the historical evidence:

The opening comments of a 1974 paper by Charles L Short in ‘Arthritis and rheumatism’ – the Official Journal of The American Rheumatism Association Section of The Arthritis Foundation, are:

“The antiquity of rheumatoid arthritis, first clearly set off as an entity by Landre-Beauvais in 1800, is of more than historic interest. If the disease is actually of relatively recent origin, an environmental cause becomes likely. It is reasonably certain that it was identified by Sydenham in 1676. But studies in human palaeopathology, while revealing unmistakable examples of ankylosing spondylitis dating back to prehistoric times, have as yet failed to provide convincing evidence of the existence of rheumatoid arthritis prior to Sydenham’s description.”

In addition, studies of 6000-year-old Native American skeletons found few signs of arthritis, despite the joint stress of their physically active lives. See the Smithsonian article ‘What a 6,000-Year-Old Knee Can Teach Us About Arthritis’ LINK - "Knee arthritis old problems much more common today"

The body is excellent at healing and repair – I now have 3 patients whose hip or knee replacement surgery has been cancelled and they are drug free and pain free as a result of Groundhog interventions vis: PK diet, nutritional supplements, physiotherapy and quality sleep. Given the freedom from inflammation, the energy and raw materials to heal and repair, the correct hormonal environment, stimuli and time, it will. This gives us the principles of treatment for all.

Treatment of inflammatory or degenerative conditions

Here we are talking about such conditions as:

  • Bones and joints: osteoarthritis and inflammatory arthritis (rheumatoid, ankylosing spondylitis, psoriatic etc)
  • “Fibromyalgia and rheumatics”
  • Connective tissue with:
    • bursitis (housemaid’s knee, golfer’s elbow, jeep bottom),
    • tendonitis (tennis elbow, student’s elbow, frozen shoulder,)
    • blood vessels (small and large vessel vasculitis including temporal arteritis)
    • nerves – pain syndromes, post herpetic neuralgia, trigeminal neuralgia (see neurology chapter)
    • skin – premature ageing, SLE systemic sclerosis or scleroderma

In order of importance:

Do not symptom suppress with drugs

Pain is a vital symptom that tells us what is possible and allows us to safely use our bodies. Worse, many drugs used in rheumatology inhibit healing and repair and this accelerates the underlying pathology. Studies of patients receiving NSAIDs (Nonsteroidal anti-inflammatory drugs) for their hip arthritis showed that they needed surgery sooner than those who do not receive NSAIDs. Please see ‘The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs’, Journal of Prolotherapy. 2010;(2)1:305-322., Ross A. Hauser, MD - LINK - "The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs" with the conclusion:

“For those using NSAIDs compared to the patients who do not use them, joint replacements occur earlier and more quickly and frequently.”

Look for the cause of the inflammation - see chapter 16.

My view is the conventional distinction made between degenerative and inflammatory arthritis is almost irrelevant to intelligent treatment – good results are achieved with the same basic approach. We know arthritis is an inevitable part of metabolic syndrome partly because sugar is directly pro-inflammatory, partly because it encourages microbial overgrowth in the gut and body and partly because magnesium deficiency is an inevitable part of.

Note - I am using the word allergy to describe a number of possible mechanisms which includes direct allergy to incitants, molecular mimicry which may extend to autoimmunity, low grade infection and probably other mechanisms yet to be discovered.

Allergy

Dr Honor Anthony, my friend, mentor and cancer researcher suffered arthritis. I recall her stating in 1985 “all arthritis is allergy”. At the time I thought that could not be right. I now know she was spot on – if not allergy to foods then “allergy” (see below #) to other incitants. Dr John Mansfield described a patient with osteoarthritis hip due to house dust mite allergy cured with desensitising injections. Dairy products are a major cause of allergic muscles. I now know allergy, or an inflammatory process that I call allergy, drives much arthritis.

Allergy to microbes that spill over from the gut into the blood stream. I suspect they get stuck in scar tissue (from historical damage – and we all have that!) where they drive inflammation (as the immune system tries to get rid). Indeed, the Danish surgeon Hanne Albert sees success using antibiotics to treat the osteoarthritic modic type 1 changes in the spine. Please see "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy" Eur Spine J. 2013 Apr; 22(4): 697–707., H Albert et al, LINK - "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy"

We know ankylosing spondylitis is driven by klebsiella bacteria and rheumatoid arthritis by proteus, both of which reside in the gut. Please see "The Link between Ankylosing Spondylitis, Crohn's Disease, Klebsiella, and Starch Consumption" Clin Dev Immunol. 2013; 2013: 872632, Rashid et al, LINK - "The Link between Ankylosing Spondylitis, Crohn's Disease, Klebsiella, and Starch Consumption" and "Rheumatoid Arthritis is an Autoimmune Disease Triggered by Proteus", Clin Dev Immunol. 2006 Mar; 13(1): 41–48. Ebringer et al, LINK - "Rheumatoid Arthritis is an Autoimmune Disease Triggered by Proteus"

The above means that for many the starting point to deal with arthritis is not the PK diet but the GAPs starter diet – you only consume meat and fish (and perhaps eggs). Once the arthritis has settled then you can move to PK.

Allergy to metals

Consider this possibility especially if pain starts following surgery or dental surgery in which metals are used. This can be tested for using Melisa tests available through Biolab.

Crystals stuck in the joints and connective tissue

These are extremely painful and result when crystals deposit out in joints and connective tissue. Clinical pictures include frozen shoulder, bursitis, post traumatic pain, muscle stiffness, lumbago, fibromyalgia, “rheumatics” and much more!

Conventional treatment is aimed at reducing the inflammatory response, but a true cure is effected by getting rid of the crystals. So let’s look at the possibilities:

Calcification

Clacification with crystals of calcium phosphate or hydroxyapatite. This is easily seen on X-ray as “ectopic” calcification in tissues, bursae, tendon and ligament insertions and bones (bone spurs, osteophytes) . Calcium phosphate also causes kidney stones. I suspect these ectopic calcifications arise because of magnesium deficient diets. These calcifications can be dissolved by magnesium. This explains why transdermal magnesium spray and Epsom salt baths (see chapter 34) are so effective in so many rheumatic conditions. Also take magnesium 300mgs (elemental weight) daily and vitamin D 10,000iu for its absorption.

80 patients with soft tissue calcifications were treated. 24 patients suffered from myositis ossificans traumatica, 23 from calcific bursitis (Duplay's disease), 6 from osteoarthropathy of elbow joint after severe craniocerebral trauma, 9 from calcifications round elbow joint after local trauma, 13 from calcifications round hip joint, 5 from calcifications in ligaments and tendons. About 75 per cent patients were cured. Calcifications disappeared or substantially diminished. Very good functional improvement followed in affected joints. Patients were treated with new method: local application of MgSO4 into calcification area was used for 2-20 weeks, peroral administration of Mg lactate was given for 4-6 months. There were neither complications nor side effects of this treatment. 

LINK - "Treatment of soft tissue calcifications with magnesium"

Oxalates

Calcium oxalate may cause any of the above clinical pictures including kidney stones. Measuring oxalates in urine helps to diagnose but some have normal levels. The principles of treatment are:

  • Tackle the fermenting gut – 80-90% of oxalates are produced endogenously from the fermenting gut: clostridia, moulds, fungi and yeast will ferment to produce oxalates. Conversely lactobacilli (as in kefir) and bifidobacteria help to breakdown oxalates – probiotic cultures may help.
  • Vitamin C is excreted as ascorbic acid and this dissolves oxalates. BUT some people will break vitamin C down to oxalate and this may worsen the problem - in this event there may be severe irritable bladder, pelvic pain and vulvodynia. In this case, glutathione 250mgs twice daily recycles vit C to prevent oxalate formation.
  • Low oxalate diet – the worst offenders are rhubarb, spinach and green leaves, chocolate, soya, almonds, tahini, fruits. See "Oxalate content of foods" and "Oxalate Org Website" BUT these foods are so good for us in other respects, so work on the fermenting gut first. There are no oxalates in meat, fish and eggs.

Gout

Although gout can be prevented with drugs to reduce levels of uric acid in the blood, this really is symptom suppression. Uric acid is a useful antioxidant in the bloodstream. I subscribe to Dr Costantini’s theory that gout is a result of fungal infection with production of mycotoxins

Gout and/or hyperuricemia can be induced in fowl by the mycotoxins oosporein, ochratoxin and by oosporein-produclng fungi. Gouty tophi have been induced in primates by aflatoxin. Fungi produce preformed uric acid, preformed urate crystals, lipoproteins, glycosaminoglycans and glutamates, excess of which are found in gout

LINK - "FUNGALBIONICS-A NEW CONCEPT OF THE ETIOLOGY OF GOUT AND HYPERURICEMIA"

Costantini points out that fungi produce uric acid and that most anti-gout drugs are also antifungal. We know metabolic syndrome is the major risk factor for gout because fungi can only ferment carbohydrates. The treatment of course is to get rid of the source of the fungal infections with Groundhog Acute interventions. Essentially vitamin C to bowel tolerance is a good way of reducing fungi in the gut and the salt pipe with iodine is effective in clearing fungi from the upper and lower respiratory tract.

Calcium pyrophosphate

....causes pseudogout (chondrocalcinosis). Again, this is a magnesium issue and can be treated as above with oral magnesium and vit D, transdermal magnesium and Epsom salt baths.

Long-lasting Magnesium depletion is strongly associated with chondrocalcinosis.LINK - "Hypomagnesemia associated with chondrocalcinosis: A cross-sectional study"

Consume the raw materials for healing and repair - see chapter 35.

Take the basic package of supplements. If you have the time, make and drink bone broth. Bone building supplements such as glucosamine, chondroitin, silica, and boron are of proven benefit. Do not take high dose calcium. Magnesium is as important. They are absorbed by the same mechanism and so high doses of calcium inhibit magnesium absorption. Dairy products are a risk factor for osteoporosis. The key is vitamin D which improves absorption of calcium and magnesium from the gut and ensures its deposition in the right place ie bone.

Provide the energy to heal and repair - see chapter 30

I have seen cases of arthritis heal when hypothyroidism has been properly treated. Again, this illustrates the point that the immune system is responsible for healing and needs much energy to do so! I think this mechanism explains why niacinamide is of proven benefit – it improves mitochondrial function and therefore energy delivery. Quality sleep is also essential since this is when much repair goes on.

Do the right sort of exercise - see chapter 23

Healing is directed by lines of force. A problem for astronauts is the lack of gravity – their bones and connective tissues literally melt away as healing and repair lacks direction. This illustrates the point that the body is constantly building and breaking down. This makes perfect evolutionary sense – the body only permits sufficient energy to healing and repair as to meet demand – anything more and precious resources are wasted. Use it or lose it!

Ensure the right hormonal environment

The natural balance of building (anabolism) and breaking down (catabolism) is controlled by steroid hormones, (one of which is vitamin D). As we age our adrenal function declines and with that our anabolic hormones. Taking adrenal glandulars and testicular glandulars (yes – even women can do this safely) may well help. Do not take HRT.

Polymyalgia rheumatica - PMR

We are seeing epidemics of PMR. This condition is characterised by marked muscle stiffness, aching and pain which is much worse in the mornings and improves as the day goes on. Blood tests often show high inflammatory markers (ESR - Erythrocyte Sedimentation Rate, CRP – C-Reactive Protein, or plasma viscosity) but these may be normal. PMR responds so quickly and reliably to steroids that if there is clinical suspicion, I think one is justified in using this diagnostically! The sufferer feels cured in a day or two! But then we have to work out the root cause and this has to be done in parallel with a slow reduction in the dose of steroids. Not so fast as to allow the pro-inflammatory fire to blaze up again, but as quickly as possible to prevent steroid damage. We have to put the immune system in a straitjacket – see chapter 36. The patient needs to be in charge of this process since symptoms determine the rate.

Allergic Muscles and Cramp – both are extremely painful!

Muscle pain is one of the most severe pain that one can experience. Labour pains are, of course, muscle pains. Biliary colic and renal colic are also muscle pains - ask any sufferer how bad the pain is!

Historical Note - The Romans had some interesting cures for labour pains – mothers to be were encouraged to partake of a drink, which had been powdered with sow’s dung and fumes from hyena loin fat were used to bring forth an easy delivery. Maybe this was more distraction techniques than actual relief! (Sarah – this did not work for me. Nothing did!)

Back to the diagnosis of allergic muscles and cramps, which is made more difficult because we often see delayed reactions, starting 24 or 48 hours, after allergen exposure and lasting for several days. Muscles can only react in one way, which is with contraction and this can vary from a low-grade cramp to muscle tics or jumping, to acute lancinating pain so severe that the sufferer literally collapses. Typically, this just lasts a few seconds or minutes. One moment agony, the next moment fine. The sufferer appears to be a right old hypochondriac! I have never seen a rheumatologist diagnose allergic muscles because he never asks the question why. The mechanism is as above – tissue damage with bruising followed by sensitisation, commonly to dairy products. Pain is triggered by stretching the affected muscle. Initially any stretch will cause it; then, as things settle down, only a sudden stretch will cause it. The sufferer protects himself from the pain by moving slowly. Other muscles in the vicinity of the allergic muscles may also go into spasm to protect against sudden inadvertent stretching and this causes a more generalised muscle spasm and stiffness.

Gentle regular exercise, such as walking, may be helpful and indeed some patients find that they have to exercise very intensely and very regularly to keep the problem at bay (if the allergen has not been recognised). Heat, hot bath, and gentle massage help to relax the muscle in the short term, but the first movement after these interventions has to be done carefully or the spasm will trigger. Diazepam affords some relief because I suspect it makes the irritable, allergic muscle less twitchy. I have two patients with "stiff man syndrome" who have been much improved by identifying and desensitising to allergens (dairy products and metal allergy).

Cramp, restless legs, jerking muscles, twitching muscles, tics

  • May be part of the above allergic muscle.
  • May arise from dehydration. To hydrate the body needs not just water but also salt (to hold water within cells) and fat (to waterproof and provide a semi-permeable membrane) and heat (to power the fourth phase of water). Between layers of tissues I suspect magnesium is vital to enhance the friction reducing effects of the fourth phase of water.

Interested readers should consult "Fourth Phase of Water: Beyond Solid, Liquid & Vapor" by Gerald Pollack. LINK - "Fourth Phase of Water: Beyond Solid, Liquid & Vapor"

Pinched nerves eg sciatica, carpal tunnel syndrome, spondylosis, scoliosis

I suspect these conditions are too often ascribed to impingements of bone and wrongly treated as a result. Actually, the body is extremely good at reshaping bone as I discovered myself. I experienced Lhermitte’s phenomenon after the first occasion of breaking my neck when I fractured all 7 cervical vertebrae. If I flexed my neck, I felt a massive sensation of pins and needles down the whole of my body because of pinching of the spinal cord. I refused surgery and this symptom disappeared after 4 months.

Historical Note - Jacques Jean Lhermitte (20 January 1877 – 24 January 1959) was a French neurologist who studied spinal injuries during World War I, cementing his interest in neurology and leading to a later interest in neuropsychiatry. He has [at least] eight medically relevant eponyms bearing his name. Readers interested in eponymously named diseases are directed to "List of eponymously named diseases" It is of note that only a few diseases are named after patients. Sometimes diseases or syndromes are named after fictional characters such as ‘Havisham Syndrome’, named after Miss Havisham, of Dickens’ ‘Great Expectations’ to describe a behavioural disorder usually observed in the elderly, characterised by gross self-neglect, and a lack of self-consciousness about personal habits. [Charles Dickens, English author (1812-1870)] Interested readers can see Gillian Anderson play her wonderful portrayal of Miss Havisham here - Miss Havisham Interrogates Pip - Great Expectations - BBC One (Well so Craig tells me, but he is a little biased when it comes to Ms Anderson!)

Pinched nerves may result from allergic muscles or tissue swelling with oedema due to:

  • Hypothyroidism - see chapters 5, 13 and 29
  • Inflammation - allergy or chronic infection – see above! Also, chapter 16 and “The infection Game”.
  • Mercury poisoning (perhaps any metal allergy). Mercury in particular accumulates in intervertebral discs. Scoliosis can be effectively treated with detox to get rid of toxic metals combined with physiotherapy. See the work of Rebecca Dutton who linked scoliosis in children to mercury in vaccinations.
  • Poor hydration – of course this depends on water, but also minerals, fat and warmth. Remember the fourth phase of water demands heat to hold water in the frictionless graphite configuration
  • Mechanical damage with poor quality healing and repair – see chapter 35 (especially vit D 10,000iu, niacinamide 1500mgs, boron 20mgs, organic silica 200mgs)
  • Poor posture – consult a physiotherapist or osteopath

Craig was diagnosed with sciatica from his right buttock down the right leg. He experienced a recurring sharp shooting pain that had originally started when he had suddenly pulled the muscle, and after that it just seemed to keep on coming back….coming back that is until he became strict on the PK diet, since when he has had no re-occurrences. The triggering allergen must have been a food type that he longer eats.

Osteoporosis

This is now accepted as an inevitable part of ageing. Nonsense! It is entirely preventable and treatable – see chapter 38. Dairy products increase the risk of osteoporosis because the proportion of Calcium[Ca] to Magnesium[Mg] is high* and this inhibits Mg absorption and its deposition in bone. One can solve this simply with adequate doses of vitamin D (at least 5,000 iu daily) which improves absorption of calcium and magnesium from the diet and their natural assimilation in bone. The joke is that calcium and vitamin D are first line NHS prescriptions for osteoporosis, and these make the problem worse for two reasons – they contain no Mg and the dose of vit D is far too low (800iu) to have any significant effect. But this is good news for Big Pharma because the next line of management is their expensive bone builders – great work. Lifelong treatments make lots of money and lots of side effects!

The ratio of calcium to magnesium in dairy products is 10:1, whereas our physiological requirements are for 2 parts calcium to 1-part magnesium

However, an excellent treatment is strontium 250-500mgs daily. This is of proven value in reducing fracture rates and increasing bone density. Again, problems arise with prescribed strontium which uses an unnatural salt, namely the ranelate, and is made up with aspartame – which explains the risk of thrombo-embolism when Big Pharma strontium is used. See references in the Footnote below for the efficacy of strontium. Natural strontium chloride or citrate work well with no side effects.

Finally monitor response to treatment using heel ultrasound to measure bone density – this is accurate and involves no radiation.

Fractures

Clearly professional help is needed in all cases. But the principles for treatment are RICE:

  • REST - immobilise and protect the fracture site by wrapping with a generous wad of cotton wool then bandage firmly. This simple intervention greatly reduces pain.
  • ICE – cooling the fracture site reduces bleeding and bruising
  • COMPRESSION – as above
  • ELEVATION – again to reduce bruising.

Do not use painkillers because these inhibit healing and repair. The right amount of pain allows one to mobilise at the correct rate ie do what you can within pain limits since the lines of force generated in the process of such guides the laying down of new bone and connective tissue. These rules have allowed me to recover from fractures of the neck (3 occasion), and several other fractures: leg, collar bone, scapular, ribs, finger and possibly others. I have no residual pain.

Conclusion

  • Do not symptom suppress with drugs! Pain is painful in order to motivate one to make the difficult changes necessary to get rid of the pain!
  • Use your brain to work out the cause and have the determination to see it through.

Footnote

The efficacy of Strontium for the treatment of osteoporosis:

  • McCaslin, F.E. Jr., and Janes, J.M. The effect of strontium lactate in the treatment of osteoporosis. Proc Staff Meetings Mayo Clin, 1959, 34:329-334.
  • Marie, P.J., and Hott, M. Short term effects of fluoride and strontium on bone formation and resorption in the mouse. Metabolism, 1986, 35:547-551.
  • Gaby, A.R. Preventing and Reversing Osteoporosis, Prima Publishing, Rocklin, CA,1994.
  • Marie, P.J., Skoryna, S.C., Pivon, R.J., Chabot, G., Glorieux, F.H., Stara, J.F. Histomorphometry of bone changes in stable strontium therapy. In: Trace substances in environmental health XIX, edited by D.D. Hrmphill, University of Missouri, Columbia, Missouri, 1985, 193-208
  • Meunier, P.J., Slosman, D.O., Delmas, P.D., Sebert, J.L., Brandi, M.L., Albanese, C., Lorenc, R., Pors-Nielsen, S., De Vernejoul, M.C., Roces, A., Reginster, J.Y. Strontium ranelate: dose-dependent effects in establishing postmenopausal vertebral osteoporosis - a 2-year randomized placebo controlled trial. J Clin Endocrinol Metab, May 2002; 87(5):2060-6.
  • Meunier, P.J., Roux, C., Seeman, E., Ortolani, S., Badurski, J.E., Spector, T.D., Cannata, J., Balogh, A., Lemmel, E.M., Pors-Nielsen, S., Rizzoli, R.,Genant, H.K., Reginster, J.Y. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis, N Engl J Med, 2004, Jan 29; 350(5):459-68.


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