Blogs

All About Stem Cells: What Are They And Where Do They Come From?


By Jessica Kelner, D.O. - February 5, 2020

STEM CELLS: WHAT THEY ARE AND SOURCES 

The field is evolving so quickly now that our use of stem cells is evolving. The FDA’s governance on stem cells is also evolving. Even the language used to describe stem cells is evolving.
When we reference stem cells in regards to regenerative medicine, we are really talking about mesenchymal stem cells (MSCs).

A mesenchymal stem cell is an adult cell that performs as a messenger signaling cell that is very potent and signals tissue-specific stem cells and site-specific stem cells to activate. You can think of them as cellular packets of high potential that are directed to where the body has a need to fix something. In medical parlance, mesenchymal stem cells are “multipotent" adult cells, which can produce more than one cell type in the body, but not all types. MSCs are found in bone marrow, umbilical cord tissue, adipose tissue, and amniotic fluid.

MSCs can differentiate into osteoblasts (bone forming cells), adipocytes (fat tissue) and chondrocytes (Cartilage cells) as well as myocytes (muscle cells). MSCs have immunomodulatory effects. They secrete cytokines and immune receptors which regulate the microenvironment of the tissue.

AMNIOTIC STEM CELLS (ASCs)
Amniotic stem cells (ASCs) are a type of mesenchymal stem cells (MSCs). ASCs can develop into many different types of tissues such as skin, cartilage, cardiac, nerves, muscle, and bone. Consequently, ASCs have been implicated to provide many potential medical applications, especially in organ and joint regeneration.

Amniotic stem cells work really well for many, many people. Amniotic stem cells are obtained after a live birth C-section from a healthy mother. Amniotic stem cell come from the amniotic fluid, which has cells and growth factors and the micronized tissue from the amniotic sac, that will work as an allograft. An Allograft is tissue that is transplanted from one person to another to facilitate a structural component for regrowth. The FDA classifies the use of amniotic stem cells as a tissue allograft. The body can use it and build new tissue on top of it. It is almost like a mini-surgical procedure. You get growth factors and stem cells in the amniotic fluid, and more stem cells, plus a grafting effect from the micronized tissue.

Not every practitioner uses both the tissue and the fluid; not every company’s amniotic stem cell product has both. My preference is to use both when injecting joint/ligaments/tendons, for example, because it gives the patient the graft and stem cells.

The source of any kind of stem cell product is important. As is the case so often in life, some companies create a much better product than others.

Stem cells from amniotic tissue are a fabulous choice for professional athletes, for example, who want to get right back in the game. Different kinds of stem cells trigger different kinds of healing. The key is that amniotic stem cells do not trigger an inflammatory healing response. If we used stem cells from adipose tissue or bone marrow, athletes would be sidelined for about three weeks because the body would be using inflammation to promote the healing process. When platelets (clotting factors in our blood) and red blood cells are in the mix, you get an inflammatory response; stem cells from amniotic fluid/tissue do not contain these blood components. Amniotic stem cells are great for people who desire the least amount of down time.

BONE MARROW STEM CELLS (BM-MSCs)
Stem cells sourced from your own bone marrow are the most used stem cells in the world. Bone marrow was the original source of MSCs and is still widely used. Using bone marrow won’t necessarily give you the largest number of mesenchymal cells, but it gives you a nice mix of mesenchymal cells, growth factors, red blood cells, platelets, and hematopoietic cells (cells that make your blood regrow).

Blood and bone marrow stem cells were found to rescue patients with bone marrow deficiencies about 40 yrs ago. The result of this work produced the national bone marrow registry, which was established in the United States in 1986. Use of adult bone marrow-derived stem cells brought to the forefront, the limitations that these types of cells are thought to have. Bone marrow-derived stem cells are reported to be more difficult to extract from the marrow cavity, in normal aging, because the red marrow space changes to a yellow marrow (fat-filled) as a consequence of aging. Optimal stem cell aspirates from the marrow are found in young donors (18–19 yr of age).

Next to blood stem cells, the most widely studied stem cells in bone marrow are bone marrow-derived mesenchymal stem cells (BM-MSCs), also known as marrow stromal cells. In the adult, MSCs are found in highest concentration in the marrow cavity. MSCs are found at lower density in blood and in peripheral, adipose, and other tissues.

The procedure to obtain stem cells from bone marrow has gotten much simpler over the years. It is an out-patient procedure that takes about 45 minutes and requires only local anesthesia. The aspiration procedure is minimally invasive. A needle is used to withdraw bone marrow, which is the source of the stem cells. After the bone marrow is removed, it can be injected immediately to capture the platelets and all the other components in the marrow, or we can spin it down to concentrate just the stem cells, which are then injected directly into the site of the injury.

Note: People on blood thinners, people with cancer, and people with certain diseases are not candidates for bone marrow or adipose stem cell procedures.

ADIPOSE TISSUE STEM CELLS (ASCs)
Like bone marrow, adipose tissue is part of your own body. Adipose tissue is a fancy name for body fat. Adipose tissue stem cells (ASCs) are also considered as a type of mesenchymal stem cell (MSC). To obtain adipose tissue stem cells, a mini-liposuction procedure is performed to extract your own fat cells from just below the skin where stem cells are abundant. The tissue is mechanically micronized with filters to prepare it for immediate injection at the problem site.

There are more mesenchymal cells in fat cells than in bone marrow, and obtaining cells from adipose tissue can be less invasive than bone marrow (5). If a high number of mesenchymal cells is the primary goal, stem cells derived from adipose tissue will deliver.

UMBILICAL CORD STEM CELLS
As the name alludes to, these are sourced from the umbilical cords of healthy, newborn babies whose mothers have undergone a number of screening tests. The FDA classifies umbilical cord stem cells as a human tissue product. Umbilical cord stem cells may contain the highest number of those potent mesenchymal cells that signal healing of damaged body parts. These are adult stem cells meaning they are naturally limited in what other types of cells they can become which makes them very safe to use (3). Umbilical cord stem cells are also considered MSCs and are "multipotent", which means they are capable of forming many different cell types.

Over the last 20 years, umbilical cord blood has been shown to be therapeutically useful for rescuing patients with bone marrow-related deficits and inborn errors of metabolism (5). Umbilical cord blood offers advantages over bone marrow because cord blood does not require human leukocyte antigen (HLA) tissue matching.

MSCs can be isolated from umbilical cord blood, placenta, amniotic fluid, and from the tissue surrounding the umbilical cord vessels. The collection of MSCs from tissues that are discarded at birth is easier and less expensive than collecting MSCs from a bone marrow aspirate. During the collection of these tissues, there is no health impact on either the mother or the newborn. At least in theory, these cells may be stored frozen and then thawed to provide stem cells for therapeutic use decades after cryogenic storage.

There has never been a reported case of amniotic or umbilical stem cells – the two types of stem cells that you would source from someone else’s body – causing a rejection reaction. Stem cell therapy mimics a process that is ongoing in our body every day.

EMBRYONIC STEM CELLS (ESCs)
These are the most controversial type of stem cells of all sources. They are not allowed in the United States. They come to life when the egg and sperm first come together, first begin to multiply, and these first few cells are allowed to develop into every other kind of cell for a short period of time. Embryonic stem cells are "pluripotent". This means they can turn into any other type of cell in the body. They are not adult cells and that raises concern as to whether their use would promote cancer or other disorders. Because they are so primitive, it is hard to predict what they will do.

CULTURE EXPANDED STEM CELLS
Some practitioners use what are called “culture expanded stem cells.” These cells are grown in a lab with nutrients. There is some evidence that if you grow them in a lab, they are not as effective in the body, so you do not get the same benefits. They are only used in the United States for research at this time.

The number of our mesenchymal cells decreases with age. At age 30, we have a lot more stem cells in our bone marrow and adipose tissue than we do at age 50 or 60. That means our body has decreased tissue repair capacity as we get older. This is why injecting stem cells, potent signaling cells and growth factors, can be very helpful.

WILL IT WORK FOR ME?

Stem cells, as wonderful as they can be, are sometimes sold with a lot of hype that doesn’t stand up to reality. Whether stem cell therapy will work for you requires a thorough evaluation of both the type of your injury and the severity of your injury.

For mild to moderate injuries, there is a high likelihood that stem cells will work to repair the injury.

Technique is a critical part of the equation . Two physicians could treat the same exact injury with the same degree of severity and get different results because their technique is different, For example, if there is a patient with osteoarthritis of the knee joint, you would want to make sure to assess the tendons and ligaments surrounding the joint to look for instability and weakness. There is a good chance if these structures are not assessed for instability and treated, you will not get good long term results.

Stability of the joint or injured area is often overlooked and is critical to the healing process. It is not enough use stem cells to heal injured tissue, that is only half of the treatment course. To achieve long term success, the treatment needs to address both injured tissue and stability. Instability is not easy to see with an MRI or X ray. These images may show joint deterioration, but not the weakness in the supporting ligaments and tendons. Additionally, when we the X-ray or MRI is performed, our bodies are still. In daily life, we are anything but still and the still imaging techniques do not capture what happens when we are in motion. We want to identify the injuries limiting or causing an imbalance to our functional movement.

Our bodies are an intricate and complex balance of muscle, bone, and tissue. Muscles move our bones. Ligaments attach bone to bone and stabilize the joints. When ligaments become weak, this creates instability. This in turn causes the muscle to tighten (it is trying to act as a ligament) and that is why you lose range of motion and have pain or muscle spasms.

You may have heard from some people who received stem cell therapy for back problems such as degenerative disks or pinched nerves (radiculopathy) that they didn’t get the results they were hoping for. This may be an issue of technique. Many practitioners will do just one or two injections. To see results, you have to inject the surrounding ligaments in the back for stability. Stem cells can only fix so much if the instability is not also given the opportunity to be corrected. This can take more time, be more costly, and yield better results. You do get what you pay for.

Let’s go back to the issue of technique and why it's so important for the surrounding ligaments to be addressed. For example, let's look at someone with severe chronic degenerative arthritis in the knees. Over years, cartilage has been wearing down in the joint. It isn't happening in isolation though. The surrounding ligaments that were supporting the knee joint became weak/or chronically injured first. This is what allowed the joint to move in a way that put that unequal stress on the joint. The person may feel pain, which changes the way they walk and then puts even more stress on the ligaments, tendons, and surrounding muscles. The surrounding muscles, over time, change, even if you are working out or going to physical therapy; If your ligaments are weak, the body is going to use the muscle to protect that joint. There is considerable instability, which then creates friction. If only the joint is treated, pain will initially be less, but the cartilage will have a difficult time healing and you won't be pain-free long-term because you still have instability. On the other hand, if you also inject the ligaments surrounding the knee joint with stem cells or PRP (platelet rich plasma), you can stabilize the joint and then the cartilage will be able to heal because you addressed the whole problem, not just part of it.

Let’s take a moment to compare stem cell therapy for your knees versus surgery. Total knee replacement surgery tends to need to be repeated every 10 years. Surgery is invasive. The use of general anesthesia has been linked to dementia and immune system suppression (3).  If you go straight to knee replacement surgery, you can’t go back to stem cells. This is permanent.

Professional sports injuries, degenerative conditions in knees and hips, lower back pain, athletic hernias, abdominal muscle tears, carpal tunnel, golfer’s elbow, tennis elbow, shoulder injuries, rotator cuff tears, osteoarthritis in joints, ankle sprains, TMJ – these are the conditions to which stem cells would benefit. Stem cell injections have a very low risk of any side effects, and often our patients no longer need to be dependent upon pharmaceutical medications.

BOTTOM LINE

Stem cells maintain, heal, and regenerate tissues throughout our body. Without them, we would die because there would be nothing to replace exhausted cells or damaged tissue.
When stem cells are injected in the area of an injury, regardless of the source, we are injecting signaling cells that direct the body to produce a healing response in the tissue and organs.

For each patient, it comes down to these questions:
  • Are you candidate based on health issues, imaging, pain level, stability issues?
  • What result do you want?
  • What is likely to promote the best healing for you?
  • What is your budget?

Stem cell therapy can:
  • Repair tissue that is too damaged to heal on its own or just doesn’t heal properly: ankle sprains, knee meniscus tears, plantar fasciitis, ACL tears, rotator cuff tears, labral tears, arthritic joints, and more.
  • Regenerate tissue that is missing: cartilage in arthritic joints, cellular re-growth in trauma sites, reinforce muscle and connective tissue that is lost through the aging process.
  • Provide a source of immunomodulation: it balances out the pro- and anti-inflammatory forces in the body
  • Be used in cosmetic procedures to fight aging, such as microdermabrasion, wrinkles, and sunspots. With direct injections under the skin, we see collagen growth.
Covered by insurance? Most of these procedures are not yet covered by insurance.
Stem cell therapy helps you heal from degeneration and injuries, and many people return to a fully functional lifestyle free of medications and constant follow up visits to the doctor.

If you have more questions and would like to find out if you're a candidate for stem cell therapy, call us at 720-270-9559. You can also check out http://form-medical.com/Stem-Cell-Therapy.



1.Ceserani V, Ferri A et al. Angiogenic and anti-inflammatory properties of micro-fragmented fat tissue and its derived mesenchymal stromal cells. Vascular Cell, August 2016. 8(3) 

2.Mark L. Weiss* and Deryl L. Troyer, Stem Cells In The Umbilical Cord.
Stem Cell Rev. 2006 ; 2(2): 155–162. doi:10.1007/s12015-006-0022-y.

3.Lloyd DG, Ma D, Vizcaychipi MP. Cognitive decline after anaesthesia and critical care. Continuing Education in Anaesthesia, Critical Care & Pain. June 2012 

4.Oliver KT, Alexander RW. Combination of Autologous Adipose Derived Tissue Stromal Vascular Fraction Plus High Densiry Platelet Rich Plasma or Bone Marrow Concentrates in Achilles Tendon Tears. J Prolo, 2013; 5: e895-912

5.Omar MMS. Superior Proliferative and Tissue Regeneration Potential of Adipose Tissue-Derived Mesenchymal Stem Cells Compared to Bone Marrow: A Review. Insight In Stem Cells. 2015.

6.Tokiko Nagamura-Inoue, Haiping He. Umbilical cord-derived mesenchymal stem cells: Their advantages and potential clinical utility. World Journal Of Stem Cells. 2014 April 26; 6(2): 195-202
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Top 5 Reasons to Get Prolotherapy


By Jessica Kelner, D.O. - January 7, 2020

What is Prolotherapy? 
Prolotherapy is a medical procedure for musculoskeletal pain. The prefix “prolo” comes from the word “proliferate,” since this treatment stimulates the body’s natural ability to create new connective tissue. Frequently, the underlying cause of musculoskeletal pain is ligaments (connective tissue that connects bones to each other) that have become damaged or weakness at the sites where tendons attach to bones (e.g., rotator cuff injuries). Prolotherapy creates a healing reaction in the body that allows ligaments and tendons to heal themselves. Prolotherapy is also called “regenerative injection technique” because it stimulates cells to regenerate damaged tissues.
If you’re looking for doctors who do this, you may see the words, Prolotherapy, Regenerative Injection Technique, or even Dextrose Prolotherapy (Prolotherapy can utilize dextrose or sugar in the solution).

What can Prolotherapy be used for?
Prolotherapy is an excellent treatment for musculoskeletal pain. The underlying cause of this pain is often a weakened ligament or tendon. Prolotherapy can restore the integrity of the tissue and relieve pain from arthritis, whiplash, sciatica, disk problems, hip pain, low back pain, rotator cuff (shoulder) pain, tennis elbow, old sports injuries, knee pain (osteoarthritis, ACL or PCL injuries), and TMJ (temporomandibular joint) dysfunction.

How does Prolotherapy work?
Prolotherapy works by stimulating the production of new connective tissue. It does this by creating a local, controlled inflammatory reaction, which recruits specific cells in the area (fibroblasts) to strengthen ligaments and tendons. It also increases blood flow and growth factors in the area, which help with healing.

So, now that you know a little bit about what prolotherapy is, what it can be used for, and how it works, you may be thinking well this could be really useful for my _____ pain or injury.
So many people think they have to live with pain, take pain medications, or have surgery for their issue. All three of those choices are not optimal. You don't have to live in pain. 

Here are the Top 5 Reasons to Get Prolotherapy


1. Better Alternative to Surgery
When faced with the very serious prospect of having major surgery, it is good practice to research every option available. Depending on the condition, many people are choosing a more natural way to heal their bodies.

Prolotherapy is less of a commitment than surgery. Surgery can not be undone. Once a patient has had a surgical procedure, they can NEVER go backwards and un-do the surgery. General Anesthesia poses risks for the patient also. Surgery is not a quick fix as some may believe it to be. There is always post-operative recovery time from surgery. For some patients, the road of recovery is long, painful, and not without complications. Some patients are in worse pain after the surgery than they were before it.

Prolotherapy requires no long-term commitment like surgery. All procedures are done in the office and require no general anesthesia, no overnight stays, and no major recovery. Most patients are back to normal daily activities the day of or after treatment.

2. Faster Healing and Recovery Time
I have already mentioned the long recovery time following surgery, however with Prolotherapy, there is virtually no down time. After Prolotherapy treatment, a patient is able to walk out of the office on his/her own. The patient may experience 24 to 72 hours of post-injection soreness (usually not painful enough to warrant pain medication). This is expected and very normal. Patients are also able to go back to work the same or next day. The rehabilitation process can start as early as a few days to one week after the procedure. Patients usually are able to return to their sport or activities within 1-3 weeks. Putting too much stress on the treated area (ie high impact or high weight) may not be advised, depending on the patient and case. Patients can still exercise, walk, work out gently and use the joint as they normally would.
 
3. Physical Tolls
When a patient chooses to replace a joint or alter a joint via surgery, they are often required to complete lengthy sessions with a Physical Therapist. These sessions are necessary for the patient to adapt to the new joint or new joint structure. There is numbness in the incision areas after surgery and it takes time to learn to use the surgically altered body part.

Prolotherapy works with a patient’s existing joint, and simply prompts the immune system to heal itself naturally. Physical therapy following treatment can be helpful, but is used more to increase and optimize the function of the joint rather than the grueling therapy required following a major joint replacement. It is not nearly as involved as learning to walk again after a knee or hip has been replaced through surgery.
 
4. Cost
When a patient has surgery, they often miss weeks, sometimes even months of work due to the recovery process. The cost of surgery is massive already, but most people don't think about the cost of lost earnings from work. Recent health insurance plans have deductibles that are quite high, between $3,000-$8,000/year. On average, most people pay several thousands dollars just for the surgery. Add to this the expenses of co-pays, follow-up visits, physical therapy, and missed work.

Prolotherapy is significantly less costly than surgery. Regenerative Injection Therapies, including Stem Cells, often cost less than the patient’s deductible!
 
5. Low Risk and High Reward
The risk of surgery is very high (as mentioned before). If the surgery doesn’t work and the pain still persists, patients have to live with pain that can be worse than it was before, even after investing a lot of time and money in the treatment. Surgery has the potential to structurally change a joint that becomes weakened, unstable, and causes more injuries to the surrounding ligaments, muscles and bones.

When a patient chooses to do Prolotherapy, they are risking very little. The worst-case scenario for a patient choosing Prolotherapy is that the treatment may not give the patient the relief they are looking for. There is always a small risk of infection with any injection procedure, but assuming all things were done properly during the procedure, that risk is very very low. If the treatment doesn't work for a particular person, for whatever the reason, there is no harm done to the person's body (they will be out a small bit of money).

Prolotherapy can be an incredible treatment for so many patients. A lot of the time, the patient's pain improves quickly after the first treatment, which can bring them tremendous relief. Sometimes, patients have more than one body part involved in an injury and depending on the patient and physician, it's possible to treat more than one area to give the patient maximum strength, pain relief and return of optimal function.

Patients should always do their own homework and research their options before choosing to undergo any procedure, be it injections or surgery. It is clear that there is less risk and more benefits associated with Prolotherapy. Surgery is about as foreign and final as it gets and living in pain shouldn't be something anyone should have to do.

If you have any questions about Prolotherapy or would like to know if this treatment is right for you, you can call FORM Medical at 720-370-9559 or check out http://form-medical.com/Dextrose-Prolotherapy.
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Delayed Onset Muscle Soreness (DOMS) - What it is, how to deal, and how to prevent it


By Jessica Kelner, D.O. - December 9, 2019

The technical term for post-exercise soreness is DOMS, or delayed-onset muscle soreness.

Delayed onset muscle soreness (DOMS) usually peaks 48 to 72 hours after a workout, as your body really goes to work on the process to repair muscle fibers that were torn during exercise. It is a familiar experience for the elite or novice athlete. Although DOMS is considered a mild type of injury, it is one of the most common reasons for compromised sport performance. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS.

It is typically caused by eccentric types of exercise (activation of a muscle while it is lengthening under a load) or when you're doing an activity that your body isn't used to. This is compared to concentric exercises that the muscle shortens when it tries to move a load. During eccentric exercise, you're creating tears in the muscle. Although the exact pathophysiological pathway remains unknown, the primary mechanism is considered to be due to structural damage of muscle cells that occurs after excessive eccentric exercise. This leads to protein degradation, apoptosis (cell death) and local inflammatory response. The development of clinical symptoms is typically delayed (peak soreness at 48 - 72 h post-exercise) as a result of complex sequences of local and systemic physiological responses.
There are varying degrees of pain depending on how much damage has been done (and other factors like genetics and how hydrated you are), but regularly experiencing an extreme level of soreness isn't something you should make a habit of.

The research shows that the muscles can actually atrophy [or break down too much] when they get that sore—it's almost like the muscle was overworked, and it can't repair itself adequately. So just because you are more sore, doesn't mean you're getting better results. Also, since you need more time off to recover, it can throw a wrench in your workout plan and make you miss out on additional days of training.

Extreme soreness can happen occasionally, usually after you've done something your muscles aren't used to

DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. In the past few decades, many hypotheses have been developed to explain the etiology of DOMS.  Up to six hypothesized theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories.

DOMS can affect athletic performance by causing a reduction in range of motion, decreased muscle force, and the ability of the body part to absorb shock. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.

The best remedy for soreness is time—but there are a few things you can try that might help ease the pain a bit

Unfortunately, if you're already in the throes of monumental soreness, the only sure-fire remedy is time (generally, DOMS lasts about two to three days after the soreness peaks). There are a few things you can do to hopefully help ease the pain while you wait, and in some cases, maybe even speed the process along.

1. Get in some light movement.

Exercise is the most effective means of alleviating pain during DOMS, however the analgesic (pain reduction) effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover.

Yea, it may suck to move when you are already in pain. The activity increases circulation, improving blood flow throughout the body.
It’s thought that increased blood flow and nutrients to the muscles does, in fact, speed up the repair process, which should reduce DOMS. Blood carries nutrients and oxygen to muscle tissue. In particular, amino acids are brought to the area, which are the “building blocks” of muscle repair. The idea is that the faster these nutrients get to their destination (via blood flow), the faster they can get to work, and the faster you’ll feel better.

Now, this doesn't mean you should go back to your regularly scheduled workout programming. We're talking gentle activity, like going for a walk or hopping on a recumbent bike at the gym. If you can manage it, you can try some very light strength training. But seriously, light means super light, since you don't want to do more damage to the muscle fibers. Perhaps start at 25% of the weight you would normally lift.

2. Hydrate, hydrate, hydrate.

Drink water. There is research that shows a correlation between dehydration and increased muscle soreness and DOMS. While more research needs to be done, if dehydration increases soreness, than hydration can minimize it. Your tissues will have more fluid to fill the cells, which means blood flow will be better able to remove damaged products and cells and bring nutrients in. The main theory here is that water helps flush out waste products. When muscles break down, they release waste products and toxins that need to be filtered out of the body. These waste products are associated with increased soreness. While your kidneys and liver are ultimately responsible for filtering out toxins, (after all, it’s our organs, not anything we eat or drink, that detox our bodies) staying hydrated may help move along this process.

3. Do some light stretching.

Again, the keyword is light. Stretching can be a great way to release tightness and increase your range of motion when you're sore, which can make you feel better, even though it’s not actually healing the tears in your muscles or making them repair any faster. Be careful not to overstretch a muscle that feels really tight. If it's too painful, you may want to skip this step.

4. Make sure you're getting enough protein.

Protein is a critical nutrient for building and maintaining muscle, so it plays a huge role in helping your muscles recover from a tough workout.
While you should be consuming enough protein all the time to prevent recurring or long-lasting soreness from your workouts, it can still be helpful to double check that you're eating enough protein after the damage is done. This doesn't mean excessively high amounts of protein, necessarily. People's needs may vary.

5. Try heat to ease the pain. (and ice if you have to)

Heat can minimize tension and pain signals. It also helps open blood flow to the area which will help remove toxins. You can try a warm bath. The debate between heat therapy and cold therapy is ongoing, but when it comes down to it, it's really just about what feels good to you—for the most part, the effects are temporary. But when you’re super sore, any fleeting relief (as long as it’s safe) is worth it. Ice can help reduce the swelling that sometimes comes along with extreme soreness,

6. Nonsteroidal Anti-Inflammatory (NSAID) Medication

NSAIDs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. I'm not crazy about this option, but if you're that uncomfortable, go for it.

7. Massage and Other Therapies

Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.

In order to avoid DOMS in the future, eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption.

Overall, time will heal all soreness—as long as it's not something more serious.

While you're recovering, it's also important to watch for signs of something more serious. If your pain persists longer than a few days or you notice any other abnormalities with your body, you should seek medical attention. This could be a sign that you are actually injured.

If you need help recovering from an injury or would like to find out more information about how to optimize your exercise plan, contact us at 720-370-9559 or check us out at http://form-medical.com/Sports-Medicine-and-Otrhopedics-Overview.
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The Daily Grind - So Long, Farewell


By Jessica Kelner, D.O. - October 8, 2019

Are you aware that you grind or clench your teeth at night? Maybe you are already using a mouth guard? Is ringing in your ears or a sore jaw an issue for you?

If you grind or clench your teeth, you may experience pain with chewing or hear a cracking noise when opening or closing your mouth. It's possible that you may experience headaches, neck, and shoulder pain along with this.

22-30% of adults experience this. Most people that grind their teeth (aka have bruxism) are unaware that they are even doing it.

What is this all about? When the teeth in the mouth are not met with balanced opposition, the body's reaction is to clench down with the jaw. We can consciously prevent this from happening while we are awake, but unfortunately, while we are asleep, our brain has a mind of its own. There are other factors that may contribute to grinding or clenching such as psychiatric, neurologic, or movement disorders. Clenching and grinding can be exacerbated by stress as well.

Teeth grinding can lead to wear and tear on the enamel and even lead to fractures of the teeth!

More and more dentists are realizing that Cranial Osteopathic Manipulation can be a missing piece to a successful dental treatment.

Cranial Osteopathic Manipulation can be effective for treating hypertonicity (continual tight muscles) in the muscles and soft tissue which directly impacts the position of the temporomandibular joints (TMJ) or malocclusion (misalignment of teeth when jaws are closed).
Cranial Osteopathic Manipulation helps reduce the sympathetic response in the body and helps bring it back to balance with the parasympathetic nervous system. It is also able to assist in releasing muscles that may be holding the jaw in a place that is out of balance.

Cranial Osteopathic Manipulation follows the osteopathic premise that structure and function are interrelated. If the structure is normalized, proper function will follow. The gentle manipulation of the cranial bones help balance the body’s system.

Temporomandibular Joint Disorder (TMJ Disorder) may be secondary to orthodontic work, improper positioning of the TMJ disc, ligamentous injury around the joint, arthritis, and other causes. A person may experience similar symptoms to what I mentioned earlier with bruxism and teeth clenching or they may have a greater difficulty chewing and/or be in more pain. TMJ Disorder can be present alone, or along with bruxism and teeth clenching. The discomfort may be the starting point to other medical and emotional issues someone is experiencing. There is a lot more to say about TMJ Disorder, which I will save for a future blog.

Cranial Osteopathic Manipulation is a very effective hands on treatment that supports the body’s own healing resources to release physical imbalances and restrictions, as well as residual emotional trauma that has been stored in the body’s membranes and connective tissue. By releasing the restrictions, the central nervous system is able to perform optimally, allowing patients to experience pain relief, improved immune function and an overall enhanced sense of well-being.

If your experiencing teeth clenching or grinding or you would like to learn more about Cranial Osteopathic Manipulation, you can check out http://form-medical.com/Osteopathic-Manipulative-Treatment or give us a call today 720-370-9559.
 
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Do You Want to Take Your Workout to the Next Level? These Tips May Help!


By Jessica Kelner, D.O. - September 17, 2019

 

Are you thinking about upgrading your workout program or starting a new one? A successful fitness regimen requires thoughtful pre-workout planning so you can get the most out of your workouts and ultimately reach your goals. 

Here are some tips from a functional medicine perspective on how to achieve those goals and insight on other health factors that may hinder your progress.

Energy and motivation are fundamental to achieving exercise goals and maintaining endurance.

If fatigue and a lack of motivation is preventing you from starting a new fitness program or increasing the goals of your present one, that may be a sign of a hormonal imbalance, nutritional deficiency or other health issue brimming beneath the surface.

Thyroid balance, respiratory health, heart health, adrenal balance, hormone balance, and being free of allergies and inflammation affect your motivation and energy levels. If there is an imbalance of any of these, exercising can be very challenging or leave you feeling even more depleted so perhaps you don't want to work out again.

For example:
  • Low testosterone for both men and women may lead to low motivation, poor focus, lack of endurance, and poor workout recovery. Testosterone is an anabolic hormone that affects mental clarity, drive, and tissue regeneration/growth.
  • Adrenal Dysfunction/Imbalance leads to unbalanced stress hormones (like cortisol) that may make you feel too tired to work out and leave you exhausted afterward.
  • Heart health is vital to exercising safely and having enough blood flow to vital organs and muscles during it. Your heart is essentially the motor that pushes blood around your body (carrying nutrients and oxygen). If your heart is not healthy, symptoms could be exacerbated with a new work out if not diagnosed and dealt with by your physician.
  • Optimal Respiratory health is necessary for being able to get oxygen into your body during exercise. When you exercise, the body demands more oxygen and more efficient exchanging of oxygen in the lungs. If you happen to have an underlying lung disease, this may make your workouts difficult to get through. This can be affected by inflammation in the body (often in the gut).
  • Abnormal thyroid function may make you feel too fatigued to get to the gym.

What is Functional Medicine anyway?

Functional medicine involves evaluating the core systems in the body, then applying targeted interventions to correct and optimize areas that are indicating a dysfunction. Once those areas are addressed, your body will have restored function with the energy and drive needed to achieve your fitness goals.

Are you too inflamed to work out?

There are some people that have inflammation in the joints, ligaments, sinuses, and other areas of the body. They may feel physically incapable of working out. These types of inflammation can be diagnosed and then decreased or eliminated to better support a healthy exercise regimen. 

There are many different approaches to decreasing inflammation in the body depending on the source or cause of it, like dietary modification (removing foods that create inflammation in the gut), acupuncture, decreasing stress with meditation, IV therapy, low dose immunotherapy, removing other toxic environmental triggers, and/or other nutritional supplementation.

Is your diet energizing and supporting you or depleting and inflaming you?

"Let food be thy medicine and medicine be thy food" - Hippocrates


Food should nourish and energize you. With the pre-packaged food, mass production of food, and over farmed lands, so much of the "food" that is available to us may be inflaming us rather than supporting our bodies. Most people are unaware that this is even happening. If the food we eat is inflaming our bodies, this leaves us feeling potentially bloated, more fatigued and often less motivated to work out.

Food sensitivities or allergies can create more inflammation than providing nourishment. For example, if you're eating chicken every day, but your immune system is constantly reacting to the chicken, your body may not be able to break this down properly (due to inflammation), absorb the nutrients from this as well as from other foods. Sometimes even the "healthy foods" people are eating are inflaming their bodies causing joint pain, digestive tract inflammation, sinus inflammation and more.

Determining if you have any nutrient deficiencies can be very helpful to achieve optimal wellness, vitality, energy, and support your exercise efforts.

Leveraging the benefits of exercise: Knowing which type of exercises best suit your body, goals, and individual healthy.

There are many different types of workouts and exercises. Picking the right one or combination of exercise types for your unique health, body and goals is critical to keep your brain motivated and see the results you desire.

For example, if you have adrenal fatigue, HIIT (High-Intensity Interval Training) will likely leave you feeling worse after than did before. If you run long distances often, this may not help you lean-out based on your particular wellness picture. A functional medicine evaluation will shed some light on these issues, so a personalized exercise plan can be created for you.

Make sure your workout routine is actually helping energize and motivate you and not leaving you feeling depleted. 

If you are ready to challenge your present exercise program or start a new exercise regimen, a comprehensive Functional Medicine evaluation is a great place to start. During the evaluation, areas that can be optimized to best support your workout efforts will be assessed to determine the type activity that may be most supportive of you and your goals, and an individualized treatment plan will help you optimize your overall health and wellness.

FORM Medical can help you with your Functional Medicine evaluation. If you'd like to learn more, check out http://form-medical.com/Functional-Medicine-Overview or call 720-370-9559. 
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The Perfect Triad of Fitness - Are you fit?


By Jessica Kelner, D.O. - August 12, 2019

People will often tell me that they feel they are in shape because they exercise a few times a week.  Is this true?  Does just the simple fact that you make an attempt to exercise qualify as being "in shape"? 

It really depends on what kind of exercising the person is doing.  If all the person does is lift weights, they may have a rockin' 6 pack, but they are most likely not "in shape".   When this person is asked to bend over to touch their toes or to run a 5k, they may not be able to do that.  

To be truly "fit" or "in shape", one must have a balance of strength, flexibility, and endurance.  Imagine an equilateral triangle with each one of these components sitting at each pointed end of the triangle.  One needs to have as much endurance as they do strength as well as be just as flexible as they are strong.  This is what I would call the perfect triad of fitness. 

Daily life is busy.  It is hard to manage the adult responsibilities that we have to do every day.  People get busy with work, kids, other life stressors and they may not make time for exercising at all (which is no excuse).  Those that do exercise, may exercise in a more habitual way (I am guilty of this), where they may gravitate toward one type of exercise or activity because that is easy for them to do, easy to access, or they really like the feeling of it. 

Let's use the weight lifting guy again as an example (I just made the person a guy for ease of discussion); He may really dislike endurance training because he has trained his muscles for so long to perform at weight lifting activities. He probably is a heavier guy with larger muscles, which makes cardio activity a bit more challenging. Subsequently, this person may shy away from endurance training for that very reason. He may also believe that if he does endurance training, he will lose his muscles and become "too skinny". This is not exactly true.  We aren't talking about completely shifting his exercise to only endurance training.   Then, there is the flexibility component. The weight lifter will be less able to bend and move in certain directions due to his sheer muscle size alone. Without proper stretching and flexibility training the large muscles can become a limitation to the movement of the body, which doesn't lead to being "fit". 

How does one achieve "fitness" or be "in shape"? 

Cross Training! 
Cross training is when you utilize multiple different sports or exercises to train.  I wrote more about cross training in this blog called " Active Recovery vs Rest Days".  You want to maintain balance between your strength training, endurance training, and flexibility. There are many ways to achieve this and for each person, their training schedule may be different based on their interest, body type, health, and goals.  One way to achieve this is to choose different exercise activities like yoga, rock climbing, swimming, and basketball. You will get your endurance from basketball and swimming, strength training from rock climbing, and flexibility from rock climbing and yoga. 

What is endurance training? 
Endurance training is a type of training that utilizes the aerobic system to make energy.  This means  your body is utilizing  oxygen to make energy for your muscles. This is what people like to think of as "cardio". 

Anaerobic Exercise 
Cardiovascular or endurance training is different, in contrast to anaerobic exercise which  is a form of exercise that is intense, short (<2 min) and causes lactate to form in the muscle.  Cardiovascular exercise works on steady state, long term activity, while anaerobic exercise is focused on short term strength/energy bursts. Lactate is an acid that forms in an energy demanding environment in the body that doesn't have enough oxygen. An example of this is weight lifting. 

It is important to train utilizing both aerobic and anaerobic training.

Why does any of this being "in shape" or being "fit" matter when it comes to my health? 
1. Cardiovascular activity is actually protective for your heart. 1 day of cardio activity protects you from having a heart attack for 9 days after!
2. Having balanced muscle tone and strength in your body will prevent injuries and pain.   For example, having core strength will balance out your back muscles and prevent you from lower back injury and back pain. Another good example is the shoulder. If the shoulder is balanced, you're less likely to have shoulders that are rolled forward and less likely to tear a rotator cuff muscle when you try to lift that dog food out of the car. 
3. Being flexible and maintaining that flexibility will also prevent you from injuring or tearing things.  Imagine if you have a really tight tissue that you then go to use, it is more likely to tear, like a frozen rubber band will snap. 
4. Flexibility will also allow you to perform at activities that you may not otherwise be able to do.  For example, with rock climbing, while you have to be strong, you also have to be flexible enough to flex your hips and legs to climb higher. 
5. Flexibility allows for the rest of your body to have the ability to utilize proper biomechanics.  Your body is a machine that has to be allowed to freely move.  If parts of the machine are tight and restricted, it can cause a kink or a blockage in the machine.  You may develop abnormal or compensatory movements, which can cause further injuries. 
6. Endurance allows you to do physical things, like hike a mountain (or hill), clean your house (or pool), walk for long periods of time. Imagine going on a trip to NYC and not being able to walk around all day long to do sight seeing because you physically can't do it. 

At FORM Medical, we can perform a biomechanics analysis, guide you in correcting your imbalances, treat any injuries you may have developed and help you achieve your goals of getting in shape. 
 
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IV Vitamin Therapy - Medical Treatment, Health Fad or Both?


By Jessica Kelner, D.O. - June 21, 2019

What is IV Vitamin Therapy? Why has it become so popular? 

IV Therapy Treatments aren't a new medical therapy. 

These IV treatments aren’t exactly new — they’ve traditionally been used in hospitals to help patients rehydrate or restore nutritional deficiencies. They have become increasingly popular now because they’re more of "a quick fix" that’s been made more accessible to the public. There are functional medicine doctors using IV Therapy as a medical treatment:  to replace depleated nutrients and treat heavy metal toxicity in their patients.  On the other hand, there are companies that have set up brick-and-mortar clinics in many cities all over the country and others  that offer concierge-style services where they bring needles and infusions straight to a client’s home or office. The difference being the brick-and-mortar clinics/concierge services for the most part are not intending on treating a specific medical condition.

IV therapy is a medical treatment in which fluids, nutrients, and medications can be administered directly into a patient's blood stream without having to go through the stomach or the skin.  While some people may be squeamish with needles, others prefer this method of delivery. 

IV Fluids in their most basic form are either salt water, salt water + electrolytes, salt water + sugar, or sugar water.  These fluids are used to maintain the body's homeostasis when the patient may be dehydrated from vomiting for example, or when they are not allowed to eat due to a medical condition or upcoming surgery. Maintaining the body's homeostasis is very important because without the proper balance of fluids and electrolytes in the body, fluid can leak out of the blood stream into places where it isn't supposed to be, tissues may have pressure in them (that shouldn't have) and then the blood stream will have less fluid to circulate oxygen in. You can see why this may be an issue.  In a hospital setting, doctors are very careful to make sure their patients have adequate fluid intake and when necessary, doctors will give patients IV fluids. 

IV fluids have grown to become super fancy. We now have the ability to deliver vital nutrients right into the blood stream that are custom tailored for specific medical conditions. With American's nutritional deficiencies growing over the years, this has become more and more vital as a  treatment option. 

Intravenous Vitamin Therapy (IVT) is the most efficient way to deliver the nutrients your cells need directly into your bloodstream. The vitamin-rich fluid cocktails contain a myriad of required nutrients to encourage improvement in health, reduce fatigue, and super charge the immune system to help fight against chronic illnesses. IV Vitamin Therapy is among the most effective and quickest ways to penetrate the cells in the body for revitalization in higher quantities than oral doses can provide.

 IV Vitamin Therapy has a long history of providing relief for a variety of illnesses.  IV Vitamin Therapy was founded back in the 1930s and after experiments, a physician named Dr. Klenner developed a megadose of intravenous Vitamin C treatment in the 1940s.  This was followed by William Kaufman who published articles that verified the idea of IV Vitamin Therapy with his treatment of arthritis using frequent megadoses of niacinamide (also known as Vitamin B3/niacin, which is shown to improve cholesterol and lower cardiovascular risks as well).  The research and publication of studies continued throughout the 1950s and 1960s with individualized vitamins and nutrients being studied. Results of studies of niacin (aka B3/niacinamide) improving cholesterol was confirmed in 1986.

Not only has IV Vitamin Therapy existed since the 1930s, but it has gained traction and popularity as a component of the functional and integrative medical practice. Following the work of Dr. Klenner, Dr. John Myers, MD, a Baltimore physician, further developed and popularized the use of IV Vitamin Therapy as a medical treatment for various medical conditions. Since the 1980s, IV Vitamin Therapy has helped people with chronic medical conditions, such as fatigue, depression, fibromyalgia, asthma and more. 
 

Fun Fact:
Although you may see only nurses administering IVs today, only doctors were allowed to administer IVs until the 1940s. Delegating this task to nurses occurred during WW1 and WW2 to expedite care to soldiers. 

Dr. Myers developed a special formulation of nutrients that is now called the “Myers’ Cocktail”. This is a cocktail designed with specific selected vitamins necessary to improve health and vitality. 

What Medical Conditions Can IV Vitamin Therapy BENEFIT?
Some of the many common problems that IV Vitamin Therapy can address include:
  • Chronic Fatigue
  • Asthma
  • Anxiety
  • Headaches
  • Resistant Infections
  • Immune Deficiency
  • Stress
  • Brain Fog
  • Sleep Disorders
  • Fibromyalgia 
  • Sports Proficiency and Exercise Stamina
  • Atherosclerosis (plaques in arteries)
  • Anti-Aging

Benefits of the Vitamins in the Myers' Cocktail?

Each of the vitamins in the Myers' Cocktail were chosen for their known benefits of improving specific acute and chronic illnesses (ie. short and long term). These nutrients are given in a much higher dose via the blood stream than can be absorbed by mouth and the gastrointestinal tract. 

Magnesium:  Magnesium is a crucial nutrient the body needs that is involved in energy production, muscle contraction, and DNA synthesis. It also contributes to the structural development of bone.

Calcium:  Our body uses calcium to make our teeth and bones, while adequate quantities are
required to maintain the strength of bone and teeth. 

Vitamin B12:  Vitamin B12 is necessary for neurotransmitter formation, cholesterol synthesis, energy production and much more.  Optimal levels of B12 assist in reducing depression, anxiety, fatigue, stress, and mental clarity. 

Vitamin B6:  Vitamin B6 assists with neurotransmitter formation, helps maintain adrenal function, and functions in metabolic processes. 

Vitamin B5:  Vitamin B5, also called Pantothenic Acid, is a highly effective treatment for various medical conditions.  It has a role in energy production, nervous system function, has anti-inflammatory role in treating allergies, asthma, wound healing and acne. 

B-Complex:  B-Complex Vitamins such as Niacin, Riboflavin, and Thiamin benefit cholesterol, cardiovascular health, neurotransmitter production, energy production, and many other cellular processes.  

Vitamin C: We all know vitamin C is available in great quantities in oranges, but our food sources of Vitamin C are unable to provide us with the amount of Vitamin C orally with what an IV can provide. Megadoses of Vitamin C have been shown in lab studies to have anti-inflammatory abilities.  These Megadoses of Vitamin C can have the oxidative ability to help the body attack viruses and bacteria.  In cancer patients, it has been shown to reduce side effects and improve overall quality of life.   

The Meyers' Cocktail is only one formulation of vitamins that can be given IV, there are many other custom tailored nutrient "cocktails" that can be given to help with medical conditions such as asthma, muscle fatigue, chronic fatigue, heavy metal toxicity, and many more. 

All of these vitamins mentioned are essential to the body's normal daily function,  however many people are not getting adequate nutrition through their food intake alone. 

Why is this the case? 
The food of the American diet is more processed than ever before; specifically, the packaged products: bars, cereals, breads, frozen food, esentially everything in the middle isles of the grocery store. Additionally, the fruits and vegetables we grow in America do not have the nutrients in them they used to 100 years ago due to our present farming methods.  So, a multivitamin should just fix this right? With daily consumption of your typical over the counter oral multi-vitamin, the digestive system may still not be able to absorb all of the necessary nutrients and the multivitamin may not have everything that your body needs in it.  Getting IV Vitamin Therapy every week or every few weeks can benefit the entire body with improved vitality and health.

Are there any risks with receiving IV Nutrient Therapy? 
You want to make sure you go to a reputable IV Therapy Center. 
What makes a center reputable you ask? Here are some questions you may want to consider asking:
Do they have well trained staff? Is the facility clean? Are they particular about where they obtain their supplies and nutrients? Do they have a health care professional such as a Physician, Nurse Practioner or Physicians Assistant available for an emergency? If there is an emergency, do they maintain records, know your emergency contact, have a protocal they follow? Do they obtain adequate information about your health and history prior to giving the IV? Was thought put into the formulations of their IVs?  Are they claiming to treat specific medical conditions? If they are, there should be a qualified health care professional there to guide you through the process. 

If a person is looking for IV Nutrient Therapy as a treatment for a medical condition, it would be best to see a physician first to be evaluated for the specific treatment that will work best for the condition.   These are just some questions and things to consider prior to starting IV Vitamin Therapy. 

Other things to consider: Make sure to tell the staff if you have any allergies. People with allergies may have reactions to some of the nutrients in the IV.  Certain people may also have difficulty processing some of the nutrients and it is important that proper blood tests be performed before receiving high doses of nutrients, particularly Vitamin C.  It's always a good idea to discuss starting an IV Vitamin Program with your physician before starting.

There is always a small risk of infection anytime a needle passes through the skin, but with proper technique in administration, these risks are small. 

Most people tolerate IV Nutrient Therapy well and enjoy the benefits of it. 

Last Tips on IV Vitamin Therapy
One IV Nutrient treatment may make you feel great, but again if you have any medical conditions or nutrient deficiencies you are trying to address, you most likely will need more than one treatment and may benefit from an IV Therapy Treatment program. 

Some people have a defective enzyme called MTHFR (methylenetetrahydrofolate reductase) that methylates (puts a carbon atom bonded to 3 hydrogen atoms) onto folate and B-12. If a patient has a defect in the MTHFR enzyme, then that patient may need different formulations of vitamins for their body. If you aren't sure if you have this, you may want to get screened for this first.  It is a simple DNA test that can be done though a cheek swab or blood test.  People that may have this defective MTHFR enzyme may be suffering from chronic fatigue, depression, anxiety, mental fogginess, paresthesias, and other non specific symptoms.  

If you are interested in IV Vitamin Therapy and would like to learn more information on it, you can check out form-medical.com/IV-Therapy.  If you would like to discuss the details of IV Vitamin Therapy and how it can help improve your health, you're welcome to come into FORM Medical for a consultation. Call us today at 720-370-9559. 
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Headache, Migraine, Sinus Headache: Everything You Wanted to Know About What Is Causing Your Head Pain


By Jessica Kelner, D.O. - May 21, 2019

What is a Headache?
headache is pain in the head or upper neck (or a pain in the butt, kidding).  It may feel like a dull ache, a sharp pain, or a throbbing sensation. Headaches can be located in one specific area of the head or be present on both sides of the head.  Experiencing a headache is a very common thing for most people. However, "most" people do not experience headaches often.  

Is Sinus Pressure a Headache?
A headache is different from sinus pressure or discomfort in the face.  People often will call this sensation a "sinus headache", but this is not a true headache as it has a different cause.  Specifically, the paranasal sinuses are hollow air cavities in our face that allow for voice resonance, moisturizing the air we breathe as well as filtering the air we breathe.   The tissue lining the sinus cavities can become inflamed as well as the air flow tract may get blocked flowing in or out of the sinus cavities.  When this happens, pressure and discomfort may result.  This is different than a headache.  You may have a headache and sinus pressure at the same time.

Types of Headaches
The two major types of headaches are:

1. Primary Headaches, which are not associated with a medical condition or disease.
2. Secondary Headaches, which are caused by an injury or underlying illness, such as a concussion, bleeding in the brain, an infection or a brain tumor.

Primary Headaches include tension headaches, migraine headaches and cluster headaches.

Tension Headaches: Symptoms of a tension headache include pressure and a band-like tightness that begins in the back of the head and upper neck, and gradually encircles the head. These occur due to tight muscles, stress, dehydration, poor posture, bio-mechanical imbalances, nutritional deficiencies, glasses that are too tight, vision that is not properly corrected by glasses, or a mixture of these. 

Cluster Headaches: are headaches that occur in groups, or clusters, over a period of several weeks or months separated by headache-free periods of months or years. During the headache period, the cluster headache sufferer experiences several episodes of pain during the day, each of which lasts 30 to 90 minutes. These attacks, which often occur at the same time of day, include sharp, penetrating pain around or behind one eye, watering of the eye and a stuffy nose.

A Migraine isn't just a Headaches and a Headaches isn't necessarily a Migraine
Migraines are a specific type of episodic headache that is severe in nature. Migraines progress through a cascade of events that may last for hours or days.   It is generally associated with nausea, light and/or sound sensitivity.  Migraines affect only 12% of the population. They are more common between the ages of 30-39 and 3 times as more common in women than men. 

Migraines have a classic course consisting of 4 phases:  Prodrome, Aura, Migraine Headache, and Postdrome. 

4 Phases of Migraine Headaches
1. Prodrome: May occur up to 24 to 48 hours before the onset of the headache. It consists of  increased yawning, euphoria (happy feeling), depression, feeling irritable, food cravings, and neck discomfort. 

2. Aura:  This phase may overlap with the headache phase.  Auras develop gradually, over longer than 5 minutes, but no longer than over one hour, and have a mix of positive and negative symptoms.  Positive symptoms are symptoms that are added to what is "normal". They can be visual (bright lines, shapes, wavy lines, ect), auditory (tinnitus, ringing in the ears), paraesthesia (or burning pain), or motor (jerky movements) symptoms.  Negative symptoms are the loss of function, such as vision (blind spots), hearing, body movement (decreased).  Some patients actually experience an aura without a headache.

3. Migraine Headache: Often unilateral and tends to feel like a throbbing or pulsating sensation.  This feeling can increase over 1 to a few hours.  Patients report sensitivity to light and sound.  Patients also often feel nausea and sometimes experience vomiting during this phase. 

4. Postdrome: After the throbbing subsides, the person may have pain in the location where the headache was with sudden head movement.  They may feel drained or exhausted. 

Migraine Triggers
Migraine suffers may have triggers associated with specific foods or environmental changes such as:  hormonal changes/fluctuations, wine, aspartame, nitrates (found in deli meat), visual stimuli, stress, not eating, alcohol, smoke, and sleep disturbances.

Headaches Can Be A Warning Sign

If you experience a headache that falls into any of these categories, you should seek immediate medical attention.
  • The headache is severe. If you believe it is your "worst headache ever," seek emergency medical care.
  • The headache is different from your usual headaches in terms of its location, severity or accompanying symptoms, such as numbness or vision loss.
  • The headache starts suddenly, or is aggravated by exertion.
  • The headache causes pain significant enough to wake you from sleep.
  • The headache does not respond to treatment and instead worsens over time.
  • The headache reoccurs frequently.
  • The headache is accompanied by any of the following:
  • A head injury that involves a loss of consciousness, even for a few seconds
  • Seizures or convulsions
  • Recurrent vomiting
  • Dizziness and impaired balance
  • Fever or stiff neck
  • Changes in speech, vision or behavior.

Most headaches are benign in nature and can be resolved by figuring out the cause of the headaches. Traditional headaches should not re-occur on a regular basis. If they do, you should seek medical care.  Migraine Headaches are a special kind of headache that has 4 phases. Only 12% of the population experiences migraines and they are more common in women than men. Migraines can be treated with medication or through natural treatments.  Even migraines have a root cause. 

At FORM Medical, we try to get to the root cause of the issue, to get rid of the pain or injury naturally, without medications.  If you would like to learn more about the types of treatments that we offer at FORM Medical, you can check out form-medical.com. If you would like to schedule an appointment to find out how we can help get rid of your headaches, call 720-370-9559. 
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Low Dose Naltrexone: An Effective Treatment for Chronic Pain and Fatigue


By Jessica Kelner, D.O. - May 8, 2019

Low-dose naltrexone (LDN) is often confused with naltrexone, which is a pharmaceutical medication that is typically used in higher doses of 50 mg or more to treat conditions such as alcohol and narcotic medication addiction as well as other opiate abuse. Naltrexone is an opiod antagonist. This means it is meant to bind to opioid receptors in the body and traditionally would block medications or drugs that bind to the receptor. 

Low-dose
 naltrexone (LDN) is a much lower dose than the traditional naltrexone dose.  LDN is  compounded by a reliable pharmacist specifically for each patient to make the doses very low. The dose of LDN starts between 1.0 to 4.5 mg of naltrexone/dose.  The lower dose of naltrexone helps the body combat chronic illness states.

LDN works by reducing inflammation in the brain caused by over-active microglia. Microglia are a type of glial cell of the Central Nervous System (CNS) (brain and spinal cord) and an important line of defense. When there is an assault on the CNS, the microglia are activated and release inflammatory substances (called cytokines) to destroy the foreign invaders. When the assault is over, the microglia go back to their normal resting state. However, when they react too often from repeated injury, infection, toxins, traumas, or emotional blows, they can  remain hyperactive, keeping the brain in a chronic state of inflammation.  

LDN also causes an adaptive increase in endorphin and enkephalin production (chemicals in the body that make you feel less pain). Endorphin and Enkephalin molecules work on opioid receptors to produce analgesia (pain relief).  The increase in endorphins also helps to normalizes immune response.  Additionally, it increases Met (5) aka Opioid Growth Factor which regulates cell division in normal and abnormal cells.  This may be why LDN is helpful in cancer. 

The inflammatory cytokines created by an assault to the CNS can increase pain sensitivity and fatigue and trigger other inflammation cascades in the body. Although doctors and scientists can't say what specifically causes fibromyalgia, it’s suspected that chronic glial cell activation is involved. This may explain why a 2010 study of LDN treatment in women with fibromyalgia found a 30% reduction in symptom severity. An even stronger response in symptom reduction has been found in studies on patients with Crohn’s Disease; Up to 80% saw significant improvement.

The effect that LDN has on chronic pain caused by autoimmune conditions like psoriatic arthritis works similarly, suppressing glial cells and therefore reducing inflammation. In addition, as mentioned before, there’s some evidence that LDN retains some of its regular dosing activity and blocks opioid receptors, which causes the body to release more endorphins, thus reducing pain.

Research on LDN suggests that it’s able to suppress the inflammatory response of the microglia.  Some of the inflammatory conditions that have shown to benefit from LDN include fibromyalgiamultiple sclerosisCrohn’s diseasecomplex regional pain syndrome and cancer.
Other conditions LDN may treat are: Autoimmune conditions such as: Multiple Sclerosis, Hashimoto’s Thyroiditis, Rheumatoid Arthritis, Lupus, Celiac, Ulcerative Colitis, Crohn's,  as well as IBS/IBD, Eczema, Psoriasis, and Chronic Fatigue. 

Because low-dose naltrexone blocks opioid receptors,  you cannot continue taking narcotic pain medication with LDN.  Otherwise, LDN has virtually no side effects and is well tolerated by most patients. Most people notice an increase in dreaming and some people notice a bit of sleep disruption during the initial few days of treatment but this improves over time.

You can read more about low-dose naltrexone for auto-immune disorders, and other illnesses at www.lowdosenaltrexone.org.

If you have questions about Low Dose Naltrexone or would like to know if this is the right treatment for you, please contact FORM Medical today 720-370-9559. 
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Steroid Joint Injections - Friend or Foe?


By Jessica Kelner, D.O. - April 24, 2019

What are "steroids"? 

When you are talking about joint pain or an upper respiratory infection and you hear someone say they were treated with "steroids", this means they were given a drug that stoped the body's immune system from reacting to their injury or illness.  

"Steroid" or cortisone injections have been used by the traditional medicine world for a long time to help relieve pain that people have from "arthritis".  These steroid shots are not solving the problem, but simply just putting a bandaid on the issue.  The steroids may help temporarily, but a few weeks later, the pain will be back.  There are many patients that end up with a multitude of steroid injections for the same issue and subsequently, end up with pain that seems to get worse over time.  Even their injury can get worse.  They may loose more cartilage and be in worse shape.  What many don't realize is their joint is actually deteriorating at a faster pace because of these injections. 
 

What Steroid Injections Really Do:

Most  people have heard about steroid injections, but have never heard about Platelet Rich Plasma (PRP) or prolotherapy as an alternative to treat many of the same issues.  It has been known for a long time that steroids are damaging on the body, but patients often agree to these injections with hopes that the steroid injection will benefit them more than it will harm them.  Maybe people aren't aware  of how bad these injections really are for you?  If patients were only told about the long term side effects and the alternative options out there, would they still choose to have the steroid injection?

Cartilage and Bone Loss
Traditionally, in medicine doctors may continue to use a drug or perform a surgery that doesn't have great odds at resolving an issue until there is enough evidence to say that it is not helping, but may be even harming the patient.  When it comes to steroids for joint injections, there have been countless studies  reporting that steroids cause cartilage loss and do not provide a significant difference in pain relief when compared to saline (salt water). 

Doctors are injecting steroids into tendons for their "anti- inflammatory" properties.  However, research has shown us that  steroids can actually impair tendon healing and lead to tendon rupture.   It is also well known that long term steroid use, either by mouth or injection causes bone loss and bone necrosis, therefore putting the patient at a higher risk for bone fractures.   

Damage Stem Cells 
The body has an incredibly ability to repair itself.  When you're in pain from an injury, that is your body's way of telling you not to use the area and allow it to heal itself.  If you go to a traditional doctor with shoulder pain for example, they may offer you a steroid injection, while this may help you in the short term, studies have shown that not only do steroids damage the cartilage that protects the bones, but steroids also  impair your natural stem cells that are trying to heal your body.  Stem cells are pre-cursor cells that are able to help you regrow new tissue. Even as adults, we do have some stem cells that can help re-build and repair. 

Adrenal Insufficiency 
Steroids are esentially artificial cortisol. Cortisol is the body's natural stress hormone made in the adrenal glands that your body needs to function. Cortisol is produced in high amounts with stress and it naturally suppresses your immune system to get through the challenging time. If you give the body artificial cortisol, this will suppress the body's own natural cortisol production and have long term consequences.  A study looked at patients that had either received steroid knee injections or hyaluronic acid knee injections.  60% of the steroid knee injection participants end up with secondary adrenal insufficiency vs 15% of the hyaluronic acid group. 

 

What Regenerative Medicine Injections Do:

Regenerative Medicine injections like Platelet Rich Plasma (PRP) or Prolotherapy are essentially the polar opposite of steroids. They harness your body's natural immune system and repair mechanisms by recruiting them to come heal the area.  When you cut yourself, do you notice how you stop bleeding in a minute or so and eventually the cut will heal and be sealed up? It is your body's platelets that start that repair process. They are the first to the scene when you have a new injury. They bring with them a patch for the repair and an army of signaling molecules to tell your body what is needed to get the job done.  Platelet Rich Plasma is a type of prolotherapy ("prolo" means to proliferate or regrow) treatment where  platelets are isolated from your blood and then injected back into the injured area. PRP and prolotherapy can be used to treat many conditions like muscle, ligament,  tendon injuries, arthritis, and much more.  

There have been many studies published more recently showing that PRP has long lasting healing benefits, while steroids may help in the short term, they do not provide a long term benefit to the patient.  So, the next time you have an issue and are offered a steroid injection, consider regenerative medicine instead.  While steroids may be covered by insurance and Regenerative Medicine may not be, the damage from steroids may be detrimental and cause you more pain in the long run.  The short term out of pocket cost will give you a long term benefit and pain relief. 
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