Cocktail of Popular Drugs May Cloud Brain
By RONI CARYN RABIN

Many people are unaware that dozens of painkillers, c and psychiatric medications — from drugstore staples to popular antidepressants — can adversely affect brain function, mostly in the elderly. Regular use of multiple medications that have this effect has been linked to cognitive impairment and memory loss.

Called anticholinergics, the drugs block the action of the neurotransmitter acetylcholine, sometimes as a direct action, but often as a side effect. Acetylcholine is a chemical messenger with a range of functions in the body, memory production and cognitive function among them.
The difficulty for patients is that the effect of anticholinergic drugs is cumulative. Doctors are not always aware of all of the medications their patients take, and they do not always think to review the anticholinergic properties of the ones they prescribe. It’s a particular problem for older patients, who are more vulnerable to the effects of these drugs and who tend to take more medicines over all.

Now a spate of new research studies has focused on anticholinergic medicines.After following more than 13,000 British men and women 65 or older for two years, researchers found that those taking more than one anticholinergic drug scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68 percent higher.

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That finding, reported last July in The Journal of the American Geriatrics Society, stunned the investigators.
“So far we can’t tell why they are dying, but it wasn’t because they were sicker or older,” said Dr. Malaz A. Boustani, director of the Wishard Healthy Aging Brain Center and a scientist at the Regenstrief Institute, both in Indianapolis, who was one of the paper’s authors. “We adjusted for age, gender, race, other medications they were taking, other diseases and social status. We adjusted for everything we could, and that signal did not go away.”

He added: “These are very, very common drugs. That’s the scary piece.”
Dr. Chris Fox, a senior lecturer at Norwich Medical School at the University of East Anglia in England and the paper’s lead author, said he and his colleagues suspected that anticholinergics take a toll on bodily organs and systems like the cardiovascular system, although there are no studies confirming this.

Anticholinergics have also been implicated in the delirium that intensive-care patients frequently develop in the hospital. “Clinicians don’t think of them nearly as often as they should as a potential cause of cognitive problems,” said Dr. Wesley Ely, a professor of medicine at Vanderbilt University who studies neuropsychological deficits that occur after intensive care hospitalization.

Of the 36 million Americans 65 and older, at least 20 percent take at least one anticholinergic medication. A study by Dr. Boustani of nearly 4,000 older adults in Indianapolis found that those who had been using three or more possibly anticholinergic drugs consistently for 90 days or longer were nearly three times as likely to receive a diagnosis of mild cognitive impairment as those who had not taken anticholinergics.
“If you were taking one of the drugs we know is definitely an anticholinergic for 60 days, you doubled the odds of developing mild cognitive impairment” compared with a patient taking no anticholinergic medicines, Dr. Boustani said.

No association was found between chronic use of anticholinergics and dementia, however, even though mild cognitive impairment often precedes dementia. Dr. Boustani said the reasons for this were not clear.
The aim of studies like these is to evaluate the magnitude of the effects of different drugs, to determine whether there are safe thresholds for their use and to learn whether the effect is transient and reversible. Still, there is already a consensus in the scientific community that anticholinergic compounds should be prescribed with caution, especially for the elderly.

“There’s not much doubt about this,” said Dr. William Thies, chief medical and scientific officer for the Alzheimer’s Association, adding that studies from large clinics that treat people with memory disorders have shown that up to 25 percent of the patients who seek help have reversible disorders, including those caused by polypharmacy — taking a combination of medications, some of which may have anticholinergic activity.

Still, Dr. Thies said, “it would be unfair to suggest that this is the cause of a great deal of cognitive impairment in our society.”
Even so, why do physicians prescribe any medications with anticholinergic activity to elderly people, who may be using them regularly for many years? Not only are doctors often unaware of all the medicines their patients are taking, but the list of drugs with anticholinergic properties is a long one.

The heart drug digoxin, the blood thinner warfarin, the painkiller codeine and prednisone are considered mild anticholinergics. Those with the most severe effects include Paxil, Benadryl, a drug for overactive bladder called oxybutynin, and the schizophrenia drug clozapine.
“People are worried, but we’ve gotten pushback from some physicians who say, ‘Great, thank you, but what do we do? We’ve got to use these pills,’ ” Dr. Fox said.

So what’s a patient to do?
If you or an elderly relative take one or more drugs on a regular basis, ask your primary care physician to evaluate the cumulative anticholinergic burden of all them (as well as other potential interactions and side effects).

“The patient is critical in triggering that kind of discussion,” Dr. Thies said. “It may not be automatic, but if in fact the patient asks for it, it’s much more likely to be done.”
Remember to tell your physician about drugs prescribed by other specialists, as well as nonprescription or alternative medicines you take. He or she should be able to prescribe substitutes without anticholinergic effects. This review should be done once a year. Do not stop medications on your own without medical supervision.

Even before going to the doctor, do your own research. Use the Anticholinergic Burden scale, developed by scientists from the Regenstrief Institute, to assess your risk. The scale ranks drugs based on the strength of their anticholinergic activity, from zero if there is no effect to 3 for severe effect.

Keep in mind that many over-the-counter drugs, including allergy medications, antihistamines and Tylenol PM, have anticholinergic effects. “Don’t overreact to your cold,” Dr. Boustani advised. “Try Grandma’s remedy for a couple of days before you ramp up to Advil PM or Aleve PM.”

For people with an overactive bladder, he suggested, “try scheduled toileting or bladder exercises before jumping to medicine.”
There may be no adequate substitutes for some essential anticholinergic drugs. In that case, Dr. Fox said, “We’re saying, ‘O.K., but you can’t take one or two others that also have the effect.’ ”

source from http://well.blogs.nytimes.com/2012/02/27/cocktail-of-popular-drugs-may-cloud-brain/

Chronic Inflammation

Do you suffer from aches and pains? Are your joints puffy, bloated or swollen? Do you experience stiffness? If you have any of these symptoms, you could be at risk for chronic inflammation. The good news is, you don’t have to live with the pain. Learn a little about the good and bad sides of inflammation, as well as how to prevent and reduce it through simple nutrition and lifestyle changes.

About Inflammation

A high functioning immune system responds to harmful substances, irritants, infections and injury by becoming inflamed. Inflammation is actually a healthy and normal response that detoxifies and repairs the body. Redness, warmth, swelling, itching and pain are all symptoms that inflammation is doing it’s job by sending antibodies to heal the damaged area and protect the body from further irritation.

Problem

Problems occur when inflammation becomes chronic as a result of being untreated. Most people seek quick relief in pills like Advil, Tylenol or Ibuprofen that mask the pain and prevent healing by disabling the body’s ability to detoxify, repair and protect itself. With additional side effects, these drugs often do more harm than good.
Chronic inflammation not only affects your daily performance, but damages surrounding organs and tissues, contributing to degenerative diseases like arthritis, heart disease, stroke, obesity, cancer, and Alzheimer’s. Chronic inflammation can also result in an increase in LDL (bad) cholesterol. You may be surprised to find out that LDL cholesterol does not increase in response to the number of eggs you eat, but in correlation with the amount of inflammatory foods consumed. Experiment and see for yourself!

Solution

Start healing! Pain is felt for a reason. Don’t ignore it! Get rid of it for good! Get to the root of the problem by making simple nutrition and lifestyle changes! You’ll increase the nutrients in your diet, lower LDL (bad) cholesterol, strengthen immunity, prevent disease and even reduce body fat!

Nutrition

Avoid foods high in refined carbs, and excess omega-6 essential fatty acids, such as refined sugars, grains, grain-fed animal products, legumes, manmade fats, and most alcoholic beverages.
Anti-Inflammatory Foods Green leafy vegetables: kale, collards, spinach, mustard greens, etc. Omega-3 rich wild fish: salmon, mackerel, sardines, tuna, halibut, etc. Herbs and spices: garlic, ginger, curry, chili peppers, rosemary Stinkers: garlic, onions, scallions, leeks, chives, shallots Fermented foods: yogurt, kefir, sauerkraut, etc. Filtered water (helps detoxify the body)
Supplement Support Cod Liver Oil (essential fatty acids) Probiotics (gut health and immunity) Turmeric & Bromelain (joint support)LifestyleAvoid chronic cardio – take long easy walks instead Stress less – chronic stress results in chronic inflammation Sleep more – give your body time to rest, repair and heal itself Get tested – take a C-reactive protein (CRP) test (but don’t get tested if you’ve had a recent injury or illness as the CRP can linger from the acute inflammation)


By Cate Munroe

Isolated Hip Exercise Reduces Anterior Knee Pain

Anterior knee pain is often associated with hip muscle weakness of the abductors, extensors and external rotators. Dr. Vladimir Janda noted these muscles were particularly susceptible to inhibition and weakness. Patellofemoral pain is often associated with muscle imbalance. Hip weakness is particularly prevalent in females with anterior knee pain.

This hip weakness is thought to result in abnormal forces occurring at the knee during stance, allowing the femur to adduct more than normal, possibly leading to excessive force and/or abnormal tracking of the patellofemoral joint.

Traditionally, anterior knee pain was thought to result from quadriceps weakness, particularly from the vastus medialis muscle. Recent biomechanical and epidemiological data suggest however, that hip weakness may play a more important role in the etiology of patellofemoral pain.

Dr. Khalil Khayambashi and colleagues performed a randomized controlled trial of hip exercise on females with patellofemoral pain. The experimental exercise group performed hip strengthening exercises 3 times a day for 8 weeks. Hip extension and external rotation exercises were performed on both legs using Thera-Band® elastic tubing.

The control group did not exercise. Both groups were tested before and after the program for hip strength, pain, and self-report WOMAC scores. There were 14 participants in each group, and no significant differences at baseline between groups.

After the 8 week intervention, the hip exercise group significantly decreased in knee pain and significantly improved their health status, whereas the control group did not improve. In addition, the exercise group improved in hip strength significantly more than the control group, between 32 and 56%. These improvements were maintained at the 6 month follow-up as well.

While these results are impressive given the simplicity of the exercise program, the study had a few limitations. Subjects were not categorized as having hip weakness before the program; it would be interesting to know if their knee pain was actually associated with hip weakness. The researchers didn’t evaluate kinematics in subjects; therefore, it’s not clear if the strengthening program had a biomechanical effect. Finally, the relatively small sample size limits the generalizability of the findings.

In summary, a simple 8 week Thera-Band exercise program with only 2 hip exercises significantly reduces pain in females with anterior knee pain.

REFERENCE: Khayambashi K, et al.The Effects of Isolated Hip Abductor and External Rotator Muscle Strengthening on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain.J Orthop Sports Phys Ther. 2012. 42(1):22-29.

The Misunderstood QL

On January 19, 2012, in Abdominal Training, Examination, General, by Craig Liebenson
Thanks to Chad Waterbury for filming & posting Videos of the assessment & training for the lateral stabilizers of the torso & pelvis. Here is an introduction to the function of the QL & lateral stabilizers.


I will be showing

Assessment

Side Plank Endurance (lateral chain)
Importance of Asymmetry

Basic Training

Side Plank
: Key Points – couple Lats w/ QL by packing shoulder down

Plank Roll
: Key Points – maintain core stability by rolling not twisting; pack shoulder down throughout

Side Bridge
: Key Points – pack shoulder down; use hip hinge pattern to achieve plank form knees to occiput

Functional Progressions

The Kettlebell Carry
- Suitcase
- Rack & Bottoms Up w/ elbow tucked in
Key Point – elbow tucks in to reactively facilitate core; Bottoms Up also facilitate core

- Waiter (overhead) Rack & Bottoms Up
Key Points – Use weight that allows for ideal gait pattern; observe for motor control errors such as pelvic or shoulder unleveling

Developmental Exercise

The Baby Get-Up

- Note: This is essentially the movement achieved by an ideal 7.5 month baby. It is “hard-wired”
- Goal: Achieve side plank on knee & feel lateral chain w/out feeling shoulder/neck region
- Key Point – Push off wall w/ balls of foot on bottom leg



Check out the Basic, Functional & Developmental Series of Training Exercises for the Lateral Stabilizers of the Trunk I would like to credit 2 great inspirations – Pr Stuart McGill & Dr Pavel Kolar PT





References:
Endurance times for low back stabilization exercises- clinical targets for testing and training from a normal database

Functional training with the kettlebell. J Bodywork Movement Ther. 2011 Oct;15(4):542-4.The Baby Get-Up J Bodywork Movement Therapy 2012 Jan; 16(1):124-6

Sources from "craigliebenson.com"

Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention

On Aug. 18, 2008, just a couple of weeks beforethe start of the NFL season, a 45-year-old NFL official was referred to us with a diagnosis of right Achilles tendinosis with specific orders from our medical director to check his orthotics and to startthe Graston Technique® as part of his treatment.

History

Three years before this bout of right Achilles pain/tendinosis, this patient had a diagnosis of bilateral achilles tendinitis and right plantar fasciitis. At that time,the patient presented with tight gastroc/soleus and had pain with running on his tread mill, which is what heused to get into shape for the upcoming season. He had been trying to stretch, was strengthening, and was taping his ankles for the support he thought he needed. As this was prior to use of Graston Technique,® his treatment consisted of: iontophoresis; XFM to each Achilles tendon and the right plantar fascia; stretched the gastroc andsoleus; strengthened the lower legs, and ordered orthotics. The patient had nine treatments, was discharged with only mild stiffness in the morningsfor 15 minutes until warmed up and had instructions to continue home exercises.

This history was noted when he presented in August of 2008 with mainly right Achilles pain at the medial M-Tjunction, stiffness in the calf with running that progressed to bothering him when walking, and tingling inthe plantar aspect of both feet during running. The patient said he thought he had been stretching correctly,was taping his gastroc and ankles with no relief of the pain and stiffness, and that he also felt his orthotics rocking in his shoes. The physician had given him Don Joy Air heels and they did afford some relief. This patient was fairly active in his off-season playing golf and tennis. I was asked to assist with this case because I was the clinician on our staff who was certified in GT and because I had the most experience doing gait evaluations and orthotics.

Exam Findings

Tenderness and tissue restriction at the right med MT junction, hypertonicity of the gastroc, soleus, hamstrings, and plantar fascia bil, decreased flexibility of the great toes in flexion bilaterally with excessive “grit”felt in the extensor tendon of the right > left great toes as well as in all of theafore mentioned areas bilaterally,decreased dorsiflexion with knee flexed on the right only, weakness in inversion and eversion > plantar flexion, decreased balance on the right LE, good hip/pelvis alignment, over pronation in gait with moderate RF varus deformity, moderate FF varus deformity,slight tibial varum bil, the metatarsal arches had collapsed bil, typical over pronation calluses noted on themedial aspect of the great toes and over the second and third met heads, and the posting on the orthotics he had from 2005 had compressed in the rear foot.

Treatment

Because of the bilateral findings, the physician sent aprescription to treat both lower extremities. We rushed his orthotics in for refurbishing asking for RF postingof 6 degrees, FF posting of 2 degrees, an extension of ¾ length to full length with 1/8” PPT padding and CASE REPORT
Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention By Terri Angelo, MA, ATC, Summa Health System, Akron, OHT his article was published in the Fall 2010 issue of THE EDGE, a quarterly publication by Graston Technique® 2 leather covers added along with PPT teardrop metpads added that I made and sent with the order. The patient warmed up with walking before each treatment; on day 1, GT2 was used first, brushing over the hamstrings, the calf and plantar fascia, and the knobs were used on the sides of the Achilles. GT4 was used more aggressively over the hams and calf during active knee flex and plantar flexion, followed by GT3 used in multi-direction over the med gastro-Achilles MT junction, the Achilles tendons, and the insertion and middle portion of the plantar fascia. The single beveled edge of GT6 was used on the great toe extensor tendons and over the Achilles tendons,working with the single beveled tip on the under side of the Achilles during active PF. This was followed by stretching of the gastrocs and soleus, hams and hip flexors, light strengthening using the Pilates Reformer doing a leg press with heel dip motion, BAPS work,seated calf raises, and eccentric gastroc ex with Pre-Mod e-stim on sub-acute, sweep to light contraction with ice after the session on each calf. GT was progressed aggressively over the next four treatments to using GT4 over the calves and Achilles while thepatient was doing resistive toe raises and while doing the BAPS rotations on each leg. The Achilles tendonswere taped with elastoplast for running.

Outcome

The patient felt some pain relief after the first GT treatment, and by the fifth and final treatment over 18 days, he had no more plantar fascial pain; he could run with no pain in either Achilles; there was minimal to moderate ecchymosis fading, and he felt good with the new orthotics, which also relieved the tingling inthe feet. At the patient’s request, his ankles were taped prior to each game. The patient was so impressed with how GT saved his season that he has referred family members to us and has sent colleagues to other cities to receive it.

By Terri Angelo, MA, ATC, Summa Health System, Akron, OH

Hip weakness again associated with anterior knee pain

Anterior knee pain, also known as patellofemoral pain syndrome, is characterized by knee pain around the patella and patella tendon. It’s quite common in females, and has been associated with muscle imbalances at the hip. Recently, researchers found inadequate control of weight-bearing activities, reporting increased femoral adduction and internal rotation, which may affect patellar movement (Magalhaes et al. 2010). Brazilian researchers examined 50 sedentary females with patellofemoral pain syndrome and compared their hip strength to 50 control subjects without knee pain. They used a handheld dynamometer (Nicholas, Lafayette Instrument Co) to quantify the strength of 6 major hip muscles on both the right and left sides. Their results were published in the Journal of Orthopedic and Sports Physical Therapy.

They found that sedentary females with unilateral anterior knee pain had 15 to 20% less strength in hip extension, external rotation, abduction and flexion, compared to a control group. Females with bilateral pain had weakness in all 6 hip muscles, ranging from 12 to 30% deficits. Subjects with anterior knee pain had 20% less hip abduction strength compared to the uninjured side. This was the first study to demonstrate weakness in sedentary females; most other studies have been completed on female athletes.

This study had a few minor limitations. The examiner was not blinded to the control or experimental group. This study was also retrospective, leaving us unable to determine cause-and-effect. More studies are needed to determine if hip weakness is a cause or result of patellofemoral pain syndrome. Furthermore, this study did not investigate the effects of a strengthening program.

This study supports Dr. Janda’s classification of muscle weakness, noting decreased strength of phasic extension, abduction, and external rotation. It also noted weakness of hip flexors and remaining muscles in females with bilateral knee pain. Janda noted that flexion, internal rotation, and adduction were tonic motions, prone to tightness. This study did not assess muscle length; however, it’s possible that the muscle weakness may be related to short muscle length-tension. Exercises including hip extension may be effective at improving anterior knee pain in females.

REFERENCE: Magalhães E, Fukuda TY, Sacramento SN, Forgas A, Cohen M, Abdalla RJ. A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome.J Orthop Sports Phys Ther. 2010 Oct;40(10):641-7.

by Dr. Phil on January 24, 2011

Fall Prevention Facts

Introduction

Falls can be catastrophic. The 2 year mortality rate for 75+ year old individuals who fall and break a hip is greater than for heart disease or even cancer! Yet, falls can be prevented. It doesn’t take any surgery or medication, just simple, safe, regular strength and balance balance exercises such as in a Tai Chi class.
A fall can deprive an older person of their ability to lead an active, independent life. Each year tens of thousands of older men and women are disabled, sometimes permanently, by falls that result in broken hips and other bones. Besides strength and balance exercise, simple changes at homes and in daily routines can prevent such falls.

When should I see a doctor?
Any person over 65 years of age should have their balance tested. Diabetes, arthritis, and poor vision can each contribute to diminishing agility, coordination and reflexes. Certain medications may also have side effects such as dizziness or light-headedness.
Osteoporosis is a particular risk factor for a fracture due to a fall. Bone density declines in women after menopause and in older people in general. For someone with severe osteoporosis, even a minor fall may cause fractures to occur. Thus preventing falls is very important for all older persons.


What can I do for myself?

Falls and accidents don’t “just happen.” There are steps that can be taken to reduced our chances of falling. Here are some things you can do to prevent falls and fractures.

Check with your pharmacist if dizziness or light-headedness is a side effect of any of your medication

Be evaluated for diabetes

Have your vision and hearing tested.

Wear a properly fitted hearing aid and eyeglasses if recommended by your doctor.

Don’t drink too much alcohol

Avoid become overheated or dehydrated

Don’t get up too quickly after sitting or lying down. Low blood pressure may cause dizziness at these times.

If your walking is unsteady or if you sometimes feel dizzy, use a cane, walking stick, or walker.

Be particularly careful when walking outdoors on wet or icy sidewalks.

Don’t wear just socks on stairs or waxed floors where you could easily slip.

If you are carrying something when going up or down a stairway, keep one hand on a handrail.
Ways to increase your activity.

Keep up a regular program of exercise.

Join a Tai Chi or similar type exercise class

A simple self-test for balance involves testing if you stand in a doorway on 1 leg for 10 seconds

If you can, try it with your eyes closed

If you can’t do it for more than a second or two then try standing with 1 foot in front the other.

Always reach out to the doorjam for support if needed

Here are some other examples of ways to modify your activity:

How to Make Your Home Safe Checklist:

Stairways & hallways should have:

good lighting and be free of clutter

secure handrails of all stairs

light switches at the top and bottom of stairs.

Bathrooms should have:
grab bars placed in the bath tub or shower and if necessary near toilets
nonskid mats, traction strips, or carpet on all surfaces that may get wet
nightlights.

Bedrooms should have:
night lights or light switches within reach of bed(s)
area rugs should be removed or firmly attached to the floor
telephones that are easy to reach, near your bed.

Living areas should have:
couches and chairs with arm rests and at proper height to get into and out of easily.
Loose cords should not be present in any walkways


Rehabilitation

When you see a functionally oriented health care provider they will give you a comprehensive functional assessment. This will include a battery of tests to assess your balance, agility, coordination, strength, and flexibility. One of the most important treatments will involve balance training.

Your health care provider will identify balance exercises which you can do for a few seconds, but are not too easy.


For More Information

The U.S. Consumer Product Safety Commission can send you a free copy of the booklet Home Safety Checklist for Older Consumers.
U.S. Consumer Product Safety CommissionWashington, DC 20207800-638-2772800-638-8270

(TTY)Website: http://www.cpsc.gov/CPSCPUB/PUBS/701.html

Source from "clinicalrehabspecialists.com"