MIM Health - April 2008

Doctor's Corner

Spring brings with it the excitement of all sorts of outdoor fun: summer sports--soccer, fishing, horseback riding, backpacking; gardening; and just enjoying friends and family in the long summer days. Unfortunately, many people cannot take full advantage of the nice weather like they used to. They suffer from chronic pain that inhibits their ability to enjoy friends and family, and to do the activities they love. What most people don't realize is that a possible solution exists. And it's not steroids and just more pain medications. It's Prolotherapy, a non-surgical injection procedure that helps rebuild connective tissue to strengthen joints and eliminate pain. Dr. Neustadt has been providing relief to people for years with this effective technique, that has even been endorsed by former US Surgeon General C. Everett Koop.

This issue also features a monograph on Hawthorne berry, a vibrantly red berry that has been studied for years for its ability to reverse congestive heart failure. And if you love barbecuing this summer, you'll love this Balsamic-Glazed Salmon Fillets recipe.

And if you're ever interested in reading back issues of the newsletter, they're posted on the clinic website, at www.montanaim.com/newsletter.

Wishing you good health,

Dr. Neustadt

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Health Topic: Prolo Your Pain Away
Endorsed by US Surgeon General C. Everett Koop
"I have been a patient who has benefited from Prolotherapy....My intractable pain was not intractable and I was remarkably improved." —Excerpt from the book: Prolo Your Pain Away: Curing Chronic Pain with Prolotherapy Beulah Land Press, 2000 By Ross Hauser, MD and Marion Hauser, MS, RD	Former US Surgeon General
Enjoy an Active Life Again
"Prolotherapy was the right choice for me. My knee joint was painful, hot to the touch, and the knee cap snapped and popped. X-rays showed the joint had deteriorated significantly. After three treatments the ligaments and tendons had regained normal function and flexibility and I was pain free.
"Prolotherapy is a proven technique that has been around since the 1930s and I had read about it in golf magazines. Unlike cortisone, an injection which masks the pain, Prolotherapy restores joint integrity. Prolotherapy costs significantly less than orthopedic surgery and with no downtime. I had not realized that over time I had given up horseback riding, golfing, hiking, snowshoeing, and cross country skiing because it hurt. I no longer use the excuse 'I can't, I have bad knees.' I'm enjoying an active life again thanks to Dr. Neustadt and Prolotherapy."  - Joan, age 54, Bozeman, MT
Prolotherapy, A Safe and Effective Treatment Musculoskeletal pain can be debilitating. Whether it's pain in the knees, low back, neck wrists or ankles, everyone experiences this discomfort at some time in their lives. It's been estimated that over their lifetime, 80% of Americans suffer from low back pain. There are many potential reasons for musculoskeletal pain. It can be from tight muscles, from direct injury from sports or a car accident, and even from food allergies or infections. But the most commonly overlooked cause of musculoskeletal pain is ligament or tendon instability. Ligaments are bands of connective tissue that connect two or more bones. Tendons are bands of connective tissue that connect muscles to bone. Both of these structures--ligaments and tendons--are frequently damaged just by normal wear and tear. There are a lot of nerves at the spots where the ligaments and tendons attach to bones. When the ligaments and tendons are weakened, additional stress can be placed on these attachments and cause pain. George Hackett, MD, one of the founders of the modern techniques and education in prolotherapy in the U.S. concluded that up to 90% of people have degenerative changes in their weight bearing joints (low back, hips, knees, etc.) by the age of 40. There are many causes for pain, and an integrative pain specialist will conduct a thorough interview with the patient and a detailed physical exam. Many pain treatments just suppress the symptoms with anti-inflammatories (eg, Aleve, Ibuprofen, Tylenol) and steroids. However, if the underlying cause is ligament or tendon instability, then in most cases it can be corrected with prolotherapy. The pain is relieved and function is restored. Prolotherapy is a simple, natural technique. It has been used and studied for more than 70 years. Usually all that's injected is a simple solution contain dextrose, glucosamine, some vitamin B12 and a local anesthetic. The underlying cause of musculoskeletal pain is often a weakened ligament. Prolotherapy can restore joint integrity and relieve pain from: arthritis whiplash sciatica disk problems low back pain rotator cuff (shoulder) pain tennis elbow old sports injuries that are now acting up knee pain (osteoarthritis, ACL or PCL injuries) TMJ (temporomandibular joint) dysfunction. Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body's healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which "turns on" the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after Prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases! The concept of strengthening ligaments goes back to the time of Hippocrates. Reports of shoulder joint instability and its many repair methods date back to Hippocrates' treatise, "On Joints." Hippocrates described the practice of using cautery to cause the capsule to scar and thus tighten around the joint. While his technique is no longer used, the underlying concept is similar to Prolotherapy—strengthen the ligaments. In the 1930s many case reports emerged in France and the United States of musculoskeletal disorders, such as TMJ, knee pain, and sacroiliac joint (SI joint, which holds your pelvis to your lower back), being successfully treated with Prolotherapy. In 1956, George Hackett, MD, a surgeon, published the first edition of the textbook Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hackett reported a 12-year success rate of 82% in the treatment of 1,800 patients with back pain using Prolotherapy. Then, in 1983, microscopic examination of rabbit tendons after Prolotherapy treatment confirmed the that Prolotherapy stimulates connective tissue repair. This study was published in the journal, Connective Tissue Research (Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. 1983;11[2-3]:95-102). Another landmark study was published in 1987 in the prestigious journal Lancet by Dr. Thomas Dorman. The study demonstrated the effectiveness of using Prolotherapy to treat back pain (Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LF. A new approach to treatment of chronic low back pain. 1987;2:143-146). Interestingly, Dr. Dorman was Dr. Neustadt's mentor. Dr. Neustadt spent more than 300 hours studying directly with Dr. Dorman at Dr. Dorman's private clinic, the Paracelsus Clinic in Kent, WA (www.paracelsusclinic.com). More recently, in 2005, the Mayo Clinic featured Prolotherapy in its Health Letter publication, which stated that Prolotherapy stimulates tissue growth and is used for tendon and ligament pain (Alternative Treatments. Dealing with Chronic Pain. Mayo Clinic Health Letter. 2005 Apr;23(4):1-3). Numerous clinical trials have proven Prolotherapy to be helpful in the treatment of musculoskeletal pain.  * * *

Natural Tip: Hawthorne for Congestive Heart Failure

Hawthorn (Crataegus oxyacantha, formerly C. laevigata), family Rosacea, is a cardiotonic made from the leaves, flowers and berries of the Hawthorn tree. Hawthorn contains many constituents, including large amounts of antioxidant flavonoids, particularly anthocyanidins and oligomeric proanthocyanidins (OPC), including epicatechin, which is also found in tea (Camellia sinensis), chlorogenic acid, rutin and isoquercetin.

Hawthorn berry, effective for Congestive Heart Failure

Hawthorn has long been used for digestive ailments, dyspnea (shortness of breath), and kidney stones. Heart Failure Hawthorn’s major contemporary use is for congestive heart failure (CHF), a hallmark symptom of which is shortness of breath. CHF occurs when the heart cannot pump enough blood. There are different causes of CHF, but some of the most common include clogged arteries, damaged heart muscle from previous heart attacks, high blood pressure and heart valve disease. CHF is categorized based on symptoms on a scale called the New York Heart Association (NYHA) Heart Failure Symptom Classification System. There are four classes of heart failure defined by NYHA. People with Class I (NYHA I) show no symptom limitation with ordinary physical activity. In NYHA II ordinary physical activity is somewhat limited by shortness of breath, such as long distance walking or climbing a couple flights of stairs. In NYHA III shortness of breath occurs with mild work loads such as short-distance walking and climbing one flight of stairs. In NYHA IV people experience shortness of breath while at rest or with very little exertion. At least 13 clinical trials have investigated Hawthorn’s effects on heart failure, and it has been shown effective in decreasing symptoms in people with NYHA I, II and III.  Degenring and Suter et al performed a placebo controlled, randomized, parallel group, multicenter trial on 143 volunteers with diagnosed NYHA class II cardiac failure. Patients were received 30 drops three times daily of a standardized extract of Hawthorn (Crataegisan®, Bioforce) or placebo for 8 weeks. Bicycle exercise testing showed an in exercise tolerance and of 8.3 watts from baseline in the treatment group versus placebo. Dyspnea and fatigue did not occur until a significantly higher wattage during the exercise testing of volunteers taking Hawthorn. In a study of more advanced cardiac failure, Tauchert conducted a 16-week randomized, placebo controlled clinical trial of Hawthorn extract WS 1442 versus placebo with 209 NYHA class III heart failure volunteers. WS 1442 is an alcohol extract from the dried hawthorn leaves and flowers, with an extract concentration of 4-6.6:1. It is standardized to 18.75% oligomeric procyanidins. Volunteers received either 1,800 mg WS 1442, 900 mg WS 1442 or placebo. Therapy with 1,800 mg of WS 1442 significantly increased maximum tolerated workload during bicycle exercise compared to placebo (p=0.013). Additionally, self-rated heart failure symptoms were reduced by a significantly greater extent by Hawthorn than placebo (p=0.03). Adverse events were mild and included dizziness and vertigo, which stopped after discontinuation of the hawthorn extract. Zapfe jun conducted a randomized, placebo-controlled, double-blind trial with Hawthorn extract WS 1442. Forty volunteers suffering from congestive heart failure NYHA class II participated in this 12 week study. The treatment group was given 80 mg three times a day (240 mg/d) of WS 1442. Each capsule in the treatment group contained dry extract from hawthorn leaves with flowers (5:1), adjusted to 15 mg oligomeric procyanidins. No adverse effects were experienced by volunteers in the treatment group, and all laboratory parameters were all within normal range or did not differ in a clinically significant manner during therapy. Exercise tolerance in the treatment group increased by 10% while it decreased by over 15% in the placebo group. A meta-analysis by Pittler and Schmidt et al of eight randomized, placebo conrolled clinical trials involving 632 NYHA class I to III cardiac failure patients found beneficial effect on heart failure parameters of Hawthorn supplementation. Seven of the eight trials used Hawthorn special extract WS 1442, and dosages in all trials ranged from 160 to 1800 mg/d. Hawthorn was superior to placebo for exercise tolerance (p<0.01). Shortness of breath and fatigue also improve. Herb-Drug Interactions No herb-drug interactions have been documented in people, and a clinical trial concluded that taking 0.25 mg/d of digoxin and 450 mg twice daily Hawthorn special extract WS 1442 did not cause any interactions. If you are taking any medications, consult a licensed healthcare professional who is knowledgeable in botanical medicine and pharmacology. Dosage Crataegisan 30 drops three times daily WS 1442 240–1,800 mg/d

References

Degenring FH, Suter A, Weber M, Saller R. A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine. 2003;10(5):363-369.

Ozcan M, Haciseferogullari H, Marakoglu T, Arslan D. Hawthorn (Crataegus spp.) fruit: some physical and chemical properties. Journal of Food Engineering. 2005;69(4):409-413.

Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114(8):665-674.

Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. Mar 1 2002;59(5):417-422.

Sokol-Letowska A, Oszmianski J, Wojdylo A. Antioxidant activity of the phenolic compounds of hawthorn, pine and skullcap. Food Chemistry.In Press, Corrected Proof.

Tankanow R, Tamer HR, Streetman DS, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol. Jun 2003;43(6):637-642.

Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. May 2002;143(5):910-915.

Zapfe jun G. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine. Jul 2001;8(4):262-266.

Zhang Z, Chang Q, Zhu M, Huang Y, Ho WK, Chen Z. Characterization of antioxidants present in hawthorn fruits. J Nutr Biochem. Mar 2001;12(3):144-152.

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Recipe: Balsamic-Glazed Salmon Fillets
(Have a recipe you want to share? Email it to us and it may appear in a future issue of MIM Health.)

Salmon is a phenomenal source of healthy protein and omega-3 fatty acids. Remember, though: only purchase and cook wild, line caught salmon. It is healthier than farm-raised salmon. Farmed salmon does not have as much of the heart-healthy fats that wild salmon does.

To view this month's recipe, click here.

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Montana Integrative Medicine
1087 Stoneridge Drive, Suite 1, Bozeman, MT 59718, tel. 406-582-0034