Initially I thought about writing an article on the "Joys of Needle Bending" for this installment of the newsletter as quasi sequel to the article that I wrote a few years ago on the "Joys of Using Phenol" in a prolotherapy practice. However, more pressing issues have arisen so I'll address bent needles at some future date.
My father was a very wise man, a sage in many respects. I didn’t realize this until after his passing some ten years ago. But one of his mini–proverbs rings true at this time in our organization so I am taking the opportunity to highlight it – "timing was everything". In reflecting upon that adage today, he may have been discussing his golf swing as he was a rabid golfer, but I suspect not.
Certification is a topic that periodically has come to the forefront of our organization’s consciousness and most recently over this past year. Yes, I realize that prior attempts to introduce a certification program may not have succeeded; however, we have reached a point in our development as a professional and educational association that the logical next step is to actively engage in the development of a certification program. Tom Ravin has been pushing and Tommy Bond has been recommending the development of a series of programs from PROL0 101 to Infinity and beyond. Hell, I think that it is a conspiracy of the Toms', but it makes sense. The LAOM wants it, the HKIMM is doing it and our membership has been asking for such a program.
Briefly, a certification program could involve creating a standardized educational curriculum (such as Prolo 101 and 202 with demonstrations), developing an exam to evaluate the knowledge of the core concepts and lastly designing a practicum in which the students demonstrate their competency in taking an H &P and injection techniques for hip, knee, shoulder etc. While it sounds simple in concept, I want to acknowledge the commitment and effort that would be required to undertake this endeavor.
The AAOM is the preeminent organization in Prolotherapy and Regenerative Medicine. I don't think that we can lag behind on this one. The timing is right. I and others feel what I call, "The Universal Tug" pulling at our education strings. The establishment of a certification program would serve as a foundation for our educational programming and promote professional competencies.
I invite you to contact me with your thoughts and ideas regarding certification.
Enough for now, hope to see you soon in Denver.
Lyme disease has been called the "Modern Masquerader" and that doesn’t ring anywhere more true than in Orthopedic Medicine. We tend to see the people who have not gotten better with the usual medical approaches. Some have been misdiagnosed while others have been through the gamut of several other physicians in multiple disciplines and because of their ongoing pain they seek us out for help and hopefully a diagnosis. There is another rarely mentioned characteristic of the doctors who find their way to the AAOM. We are seekers. We have maintained our inherent intellectual curiosity to find the root cause of the pain and dysfunction. We see with more than just our eyes when looking at the whole patient. We recognize patterns putting together symptoms with physical findings. We tend to be more intuitive and kinesthetic in our approach by touching the patient using our “hands-on” diagnostic skills letting the tissue and our educated hunches lead us to the correct diagnosis.
And so it is with recognizing Lyme disease and its three associated co–infections masquerading as everything from tendonitis, fascitis, arthritis, fibromyalgia, chronic fatigue, compartment syndromes, back and neck pain, discitis, radiculitis, temporalmandibular joint dysfunction, headaches, peripheral neuropathy, autoimmune disorders, autonomic neuropathy, vertigo, tinnitus, special sensory auditory and visual overstimulation, anxiety, depression, brain fog, bipolar symptoms, disorientation, dementia, ADD/ADHD/dyslexia/autism, irritable bowel symptoms, food intolerances, chest pain, heart palpitations/arrhythmias, skin rashes, air hunger/shortness of breath, chronic sinusitis, hormone imbalance, hypothyroidism, adrenal insufficiency, night and day sweats. These are mentioning only a few of the 350 symptoms that mimic other diseases and disorders that attributable to Lyme disease.
The patients who come to us with undiagnosed Lyme disease are our "failures" as well. These are the folks who we throw our magic cures at who either don’t respond as we would expect or they respond to a point or even slide back into their original symptom complex after signs that they were improving. And most of them get worse if we expose them to steroids of any kind. Sound familiar? They are already in your practice, just as they were in mine before I put on my LYME colored glasses on and saw them for who they are. I hadn’t lost my skills or talent; I just never considered that what I had seen and treated for years in family medicine, sports medicine, occupational medicine and clinical biomechanics was now being caused by a bacterial and/or parasitic infection.
Lyme disease and it's three common co–infections; Bartonella, Babesia and Ehrlichia/Anaplasma live in the belly of the tick and at the time of the bite are regurgitated back into the host. These three other infective organisms can cause the same symptoms as the usual arthritis, tendonitis or fascitis from old sports injuries or degenerative wear due to biomechanical imbalance. The real difference is that they tend to come and go in different areas of the body and migrate from one place to another. The symptoms from these infections are typically associated with a multisystemic presentation.
Bartonella is associated with slightly different symptoms than Lyme disease alone. It causes cognitive disorder that shows up as dementia, dyslexia, ADD, ADHD, autism, short and long–term memory loss, mental processing slowness, brain fog, dropped thoughts in the middle of a sentence, or dropping the thought all together, mood changes such as depression, anxiety, panic attacks and rages. Physically it causes tendonitis, plantar fascitis, lymph nodes that come and go, skin rashes or cherry angiomas and stretch marks, long bone pain and knife–like stabbing headaches behind the eyes or temporal regions. Bartonella requires different antibiotics or treatments than Lyme disease.
Babesia is a falciprum parasite that is a cousin to malaria. It is an arthropod–looking parasite that lives in the red blood cell. It can cause high fevers at the onset of the infection, soaking night sweats well after its onset, chest wall pain, cardiac arrhythmias, intermittent shortness of breath, air hunger or yawning, dry cough, anemia, upper abdominal pain, headaches across the top of the head from ear–to–ear, severe joint pain and dark urine. Babesia requires completely different anti–malarial drugs or herbs than Lyme disease.
Ehrlichia is a bacteria that is really only important to recognize if after exposure to the organism, usually through a tick bite the patient develops profound shock symptoms. It can have a sudden onset of high fever, hypotension, elevated liver enzymes and low platelets. Some of these patients end up in the ICU circling the drain and no one recognizes the causative organism. They end up on multiple pressers, fluids and empiric antibiotics. It leaves the ID doctors scratching their head when the usual culprits come back negative on the blood cultures and sensitivities. If the patient’s presentation is more placid, the long–term symptoms of Ehrichia are indistinguishable from Lyme disease symptoms. It responds to the same therapies as Lyme.
In the outpatient setting, we will meet those who are in pain that is most always associated with profound fatigue. It will not be until you sit down with the patient and take a thorough history that you will discover all the other systems symptoms spilling over into their pain complaints. They may not mention their cardiac, GI, psychiatric, cognitive, neurologic, GU, insomnia, pulmonary and dermatologic symptoms. They are there to discuss their joint pain (sometimes with swelling/synovitis), neck pain, back pain, shoulder or elbow tendonitis, knee pain, plantar fascitis, shin pain and muscle weakness.
When you take a thorough history you will discover that the pain seems to be debilitating in one area of their body and unresponsive to NSAID or acetaminophen for a few days, then magically disappear and show up in a completely new area of their body. When you let the patient describe what is happening to them it sounds like a bad horror film where someone has their Voodoo doll and is having a party.
What Is It?
What this actually represents is the organism, a corkscrew bacteria called a spirochete (Borrelia Burgdorferi = Bb) feeding on their connective tissue. Bb will swarm in one area and feed for a few days, then pop through the endothelium of the blood vessels and travel through the vascular system’s superhighway to a completely different area of the body and bore through a different area for a few days. They are feeding machines. On one end of the spirochete is a mouth that chisels through collagen consuming it and leaving inflammatory neurotoxins in it's wake and the other end is a whip–like tale that is antigenically similar to the Schwann cells in our brain and peripheral nervous system. This is one of the mechanisms that cause the autoimmune response as our immune system gets confused and starts attacking self. This looks and acts like multiple sclerosis (MS), which can be seen as plaques in the white matter of the brain and spinal cord on MRI imaging. It also looks and acts like lupus, Alzheimer’s, Parkinson’s disease, Sjogrens syndrome, dementia and rheumatoid arthritis. Even if well meaning doctors think of Lyme disease in their differential and sends off a Lyme disease test to the lab, a negative result must be met with some suspicion.
Nothing in medicine is always or never. When looking through your LYME colored glasses this tenant is an indisputable fact when it comes to this disease. The testing for and around Lyme disease cannot ever be trusted unless it is positive. We don’t see "false positive" lab tests. We most commonly see "false negative" ones. This bacteria has numerous ways to avoid the immune systems defenses. It is a smart bug. So smart many leading scientist believe it cannot be a naturally occurring organism. We will save that topic for another installment.
The Testing Sucks and Here’s Why:
The CDC along with the Infectious Disease Society of America (IDSA) has devised a two–tiered diagnostic paradigm in order to diagnose this disease, the ELISA and Western Blot. The ELISA is a combined antibody test looking for antibodies for Bb, both IgM and IgG. If found to be > 0.90, it simply means the patient has been exposed to this organism in the past and has mounted an immune response strong enough to buy them a western blot. These test were developed by the CDC for surveillance purposes in populations only. Not to diagnoses individual cases. It clearly states that on their website. However, if the patient does not have positive labs, we are being told by the IDSA they do not have this disease. Oh, and by the way, chronic or persistent Lyme disease does not exist according to the IDSA –because we cannot find evidence of the bacteria– using this mode of testing.
There is a litany of inherent flaws with the test, the most glaring being that in North America we have 100 strains of Bb that cause the symptoms of Lyme disease. Our regular trusted lab testing facilites such as LabCorp, Quest and others don't keep on hand multiple strains of the organism and don’t keep their strains/antigens fresh, so the likelihood of getting past the ELISA on your way to a Western Blot is dismal. It can miss up to 81% of true positive cases, calling them falsely negative (NIH study in 1993).
Even if the patient has a western blot performed the strictly adhered to guidelines set forth by the IDSA and CDC qualifying for the diagnosis is tremendous. Of the 25 possible bands, 10 specific bands are considered reportable and the IgG western blot must include at least 5 of them. The included bands are the 18, 21, 28, 30, 39, 41, 45, 58, 66, and 93 kDa. An IgM western blot must have two or more of the following three bands: 23, 39, and 41. Conspicuously absent are the most important bands 22, 23, 25, 31 and 34. It specifically excludes two of the most sensitive and specific bands the 31 and 34 kDa bands, which are the most specific to identify Bb and were used to create a vaccine for Lyme disease back in the middle 1990’s. The vaccine was inadvertently given to people who had been previously exposed to Bb, providing another jolt of antigen to their immune system. Many began developing migratory joint pain that resulted in full-blown Lyme disease. This was a huge debokal that resulted in a class action lawsuit and the recall of the vaccine. The CDC decided to exclude these two bands from the commercially available diagnostic kit that the "regular" labs use. The cover story for this was to avoid re–diagnosing patients who had received the vaccine? This now left the test watered down by 40% for the IgG and 60% for the IgM. I am not making this stuff up.
IGene–X laboratory in Palo Alto California does nothing but Lyme testing and reports a 98% sensitivity and sensitivity rate with their form of testing. That means that 98% of the time they will find what they are looking for and you can trust their results. They have included the 31 and 34 kDa bands back in their western blot and keep several different fresh strains as reagents as well as performing several different tests in which to find evidence of the infection including a polymerase chain reaction (PCR). PCR testing looks for DNA of Bb and then magnifies it, to identify the evidence of the actual organism in the serum. I explain to patients it is like going fishing in a lake that you know is stocked. If you get a bite and land a fish you have proof positive evidence that the lake contains fish. But what if you go fishing in the same lake and didn’t hook a fish? Does it mean that the fish and game department lied to you? The same is true for PCR testing. You can only rely on it if it is positive. If your sample did not contain DNA from Bb, it doesn’t necessarily mean it isn’t there. Remember, the spirochetes are only in the blood when they are jetting around searching for new greener pastures in which to feed upon. Positive or not, the CDC does not currently include a positive PCR test for Lyme as part of their diagnostic criteria. The patient would still be considered sero–negative for Lyme unless their ELISA and Western blot qualified.
Back Door Method Testing:
"We have the technology to make you better." It is called the CD57. This is the killer T–Cell line that is assigned to fight Lyme disease and the co–infections and big numbers in this game are good. Nothing but Lyme disease and its co–infections can lower this number. LabCorp is the only lab that will give you an actual number rather than a percentage. So if you order it, make sure your lab sends it to LabCorp or send the patient directly to a LabCorp drawing station. It will only be revealing in chronics. Those people are defined as having had the disease longer than six months. The longer they have it, the more time this organism has to breakdown and confuse their bodies defenses and gain entrance to do havoc in their system. Again, big numbers are reassuring. The normal range is 60 to 360. If the patient’s number is less than 60 it is proof positive the person has Lyme and/or co–infections. Even if it is less than 100, and above 60 they can still have it, it just shows their system is still up and fighting, protecting their beachhead from this invader. Low CD57 are another reason why the typical ELISA and Western Blots tests can be read as negative. It is the killer T–Cell line that sends messages back to the macrophages and B–Cells to make a specific antibody against Lyme. If you don’t have enough infantrymen doing hand–to–hand combat, they don't have the firepower to send messages back calling for more help and heavier artillery to be sent to the front lines.
So what if your ELISA and Western Blot are negative and your CD57 is less than 60 and they have been to every other specialist who did all of their specialty testing that in Lyme is usually negative? That's why they are in your office looking for you for answers. At this point, the likelihood that the person has chronic Lyme disease is very high. What I do now is a treatment trial. I start them on a course of therapy, whether it is antibiotics to treat all the compartments of Lyme (at least two separate drugs), or one of two very well studied (randomized controlled trial proven) herbal protocols, along with the specific other meds for the co–infection I sense is on lead for six weeks. I also stress the importance of supplementing high quality probiotics and whole–body detoxification methods.
We are looking for one of two responses. Either their symptoms improve or they get worse for a 2–4 day period. That is called a Herxheimer reaction. It is a massive die–off of the bugs, which showers their system with bacterial body parts and neurotoxins that cause inflammation until the body can get rid of this debris. A Herxheimer reaction is proof positive that we are treating what we think we are treating. It is the best functional test we have. We go six weeks because the organism changes it external protein coat every 28 days. It is much more susceptible to the treatment during that time.
So why not ship them off to your local infectious disease colleague and be done with it? Well unfortunately unless the ID doc is what is called "Lyme Literate" they will tell your patient their party’s line. "Chronic Lyme disease doesn't exist because we cannot find evidence of the organism," these people are depressed somatoform disorders who need to get off the couch, get back involved in life, exercise more and be started on antidepressants. The interaction will leave you and your patient with the common dilemma we share here at the AAOM. We see the world just a little bit skewed from the rest of medicine. We actually see with our hearts and minds and know other possibilities do exist beyond the ones we were fed in medical school for complex pain disorders. It is a lonely business out here.
If there is interest, I can outline the treatment protocols in the next installment.
Adherence To Mediterranean Diet Linked To Regression Of Carotid Vessel–Wall Volume.
Medscape (6/4, O'Riordan) reports that "an analysis of the primary–prevention PREDIMED study provides some evidence as to why a Mediterranean diet is able to reduce the risk of cardiovascular disease."
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Fasting Triggers Stem Cell Regeneration of Damaged, Old Immune System
In the first evidence of a natural intervention triggering stem cell–based regeneration of an organ or system, a study shows that cycles of prolonged fasting not only protect against immune system damage — a major side effect of chemotherapy — but also induce immune system regeneration, shifting stem cells from a dormant state to a state of self–renewal.
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Group Releases Imaging Recommendations for Sports–Related Injuries
Aunt Minnie (6/2, Forrest) reports that as part of the Choosing Wisely campaign, the American Medical Society for Sports Medicine "recently released a list of recommendations" for the use of imaging in sports–related injuries.
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Incidental MRI Findings Not Generally Linked To Development Of Chronic
Low Back Pain, Radicular Symptoms
Medwire News (6/3, Cowen) reports that research published in BMC Musculoskeletal Disorders suggests that "incidental magnetic resonance imaging (MRI) findings are not generally associated with the development of chronic low back pain or radicular symptoms."
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Left Side of Brain at Increased Radiation Exposure Risk during Cardiac
Medscape (6/3, Wood) reports that according to a poster presentation given at the Society for Cardiovascular Angiography and Intervention 2014 Scientific Sessions last week, "increasing reports of left–sided malignancies among interventional cardiologists has prompted researchers in California to test whether the left side of the head does indeed receive more radiation than the right and whether a nonleaded protective cap can help guard against exposure." The study's findings provided "some of the first real evidence that the left side of the brain is likely at increased exposure risk and that a lightweight cap may help." The "barium sulfate and bismuth oxide cap (BioXR)" worn during the study is approved by the FDA.
Many treatments popularized before adequate testing
In a 2,250–word piece called "Heralded Medical Treatments Often Fail to Live Up to Their Promise," McClatchy (5/23, Bavley, Canon, Subscription Publication) reports that the "combination of industry marketing, overly eager doctors, demanding patients and news media ready to cheer on anything that sounds like a breakthrough is popularizing many drugs, surgeries and other treatments long before they’re adequately tested." What sometimes happens is that "they're ultimately proved ineffective, no better than older, cheaper therapies, or even hazardous." The piece quotes nephrologist Josephine Briggs, MD, director of the National Center for Complementary and Alternative Medicine, who explained how the fact that people get better on their own sometimes "can skew...perception of a treatment." McClatchy also mentions how results from the National Institutes of Health's Women's Health Initiative revealed that the combination of estrogen and progestin was no better than placebo at staving off chronic diseases in women past menopause.
Medication–Assisted Therapies — Tackling the Opioid–
The rate of death from overdoses of prescription opioids in the United States more than quadrupled between 1999 and 2010.
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Platelet rich plasma in tendinopathies: how to explain the failure
Tendinopathies are very common in athletes and in people practicing sport activities.
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PREDIMED: Mediterranean Diet Costs
More than Standard Diet
ROME, ITALY — New data from the much ballyhooed PREDIMED diet study are confirming what many nutritionists and researchers have been warning for years: the Mediterranean diet may be best for the heart but may also be harder on the pocketbook.
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Potentially Unnecessary Radiation from CT Scans After Suspected Sports–Related Injury
Preliminary results of a study by researchers at the University of Utah suggest that new state concussion laws may increase unnecessary exposure to radiation from CT scans among student athletes. Utah is one of 48 states that have passed laws related to concussions in youth sports. Utah's law requires that young athletes believed to have suffered concussions or other head trauma must be removed from play and evaluated and cleared by a qualified medical professional before they return to play. Researchers examined the records of Intermountain Healthcare's emergency department database for 19 hospitals in Utah between September 2009 and September 2012 to identify the number of children and teenagers admitted with suspected sports–related head injuries, how many received CT scans, and what those scans revealed. Researchers found that the number of children and teenagers admitted with suspected sports–related head injuries increased by 43 percent in the year following the passage of the state concussion law, and the total number of CT scans increased by 17 percent. Fifty–four percent of the scans made after the law passed came back negative. The study is ongoing, and researchers are not ready to say what the overall impact of the law has been, but they note that it has increased unnecessary radiation exposure and the costs of defensive medicine. The study was presented at the Pediatric Academic Societies conference.
Self–referral prompts unnecessary knee MRI exams
Knee MRI exams are more likely to be negative if ordered by physicians who have a financial interest in the imaging equipment being used, researchers concluded in a study published online September 17 in Radiology.
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Study Finds Epidural Steroid Shots
Ineffective for Back Pain
Epidural steroid shots do little to relieve back pain caused by sciatica and should only be considered as a last resort, according to a new study in the Annals of Internal Medicine.
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The Top 10 Over–used Tests and What Should be Done Instead
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Thyroid Cancer: An Epidemic of Disease...Or Over
Put the word cancer after anything–brain cancer...pancreatic cancer...lung cancer–and it raises everyone's level of alert, especially when a particular cancer appears to be on the rise. But the new alert that's sounding now, which centers around thyroid cancer, isn't really about an epidemic of the disease itself. Instead, what has many experts worried is a possible epidemic of overdiagnosis and overtreatment.
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It is July and like many Americans you may be getting ready to fire up the Barbie to prepare a sumptuous 4th of July celebration feast. By now you have most certainly heard that research has confirmed that charring meat over an open flame produces carcinogens, heterocyclic amines (HCAs) and polycyclic hydrocarbons (PAHs). The charred area at the edges of grilled meat contains HCAs in their purist form. HCAs, also found in cigarette smoke and car exhaust, have been shown to cause stomach, colon, rectal, liver and skin cancer. The good news is that research from the University of Porto, Portugal just revealed that beer marinade may reduce levels of PAH’s in grilled meat. The researchers grilled samples of pork marinated for four hours in Pilsner beer, non–alcoholic Pilsner beer or Black beer ale, until well done on a charcoal grill. The greatest effect was with the Black beer which reduced the levels of 8 major PAHs by more than half when compared to unmarinated pork. The inhibitory effect for the beer tested measured, Black beer= 53%, followed by nonalcoholic Pilsner= 25%, and Pilsner beer= 13%. After reviewing their findings the researchers stated, "The intake of Black beer marinated meat can be a suitable mitigation strategy". (1)
Perhaps the most exciting area of research in our lifetime is stem cell research. We are on the brink of a new frontier of medically accepted stem cell based treatments for a multitude of diseases from macular degeneration, joint disease, to heart attack and stroke. A new study was just presented at the Society of Nuclear Medicine and Molecular Imaging’s 2014 meeting in St. Louis revealing how a protein encourages the production of stem cells that regenerate damaged tissues of the heart following an acute myocardial infarction. Japanese researchers found that if granulocyte colony–stimulating factor (G–CSF) is given following a heart attack, the G–CSF mobilizes bone marrow stem cells that down regulate the collateral damage of cell death that occurs after acute MI. In this study, 40 patients with acute MI were given either G–CSF therapy or saline IV starting at the time of cardiac intervention (PCI) and continuing for 5 days. The patients were followed for one year with nuclear medicine stress (SPECT) tests. Their findings revealed that earlier initiation of G–CSF therapy after MI improves cardiac function, fatty acid metabolism and blood flow. According to researchers this therapy could potentially prevent dangerous cardiac tissue damage. They further assert that the therapy has a better chance of working if provided early in treatment. (2)
According to a new study released in the June addition of Circulation:Heart Failure, consumption of processed red meat was linked to a higher risk of heart failure and death in men. The Swedish study found that men who consumed the most processed red meat (75 gr/day or more) such as ham, salami and sausage, had a 28% higher risk of heart failure compared to men who ate the least amount(25gr/day or less). For each 50 grams of processed red meat eaten per day, which amounts to 1–2 slices of ham, the risk of heart failure increased by 8% and the risk of death from heart failure increased by 38%. Results of the study were consistent with findings from the Physicians Health Study, in which men who ate the most red meat had a 24% higher risk of heart failure (3)
As sophisticated and advanced state-of–the–art research reveals new findings, it is imperative for our own health, our family’s health and our patient’s health that we keep abreast of this new information. We must make changes to our lifestyles and the recommendations we make to our patients in order to live a longer, healthier and more fulfilling life. Over 40 years ago, Dr. Robert Atkins introduced the "Atkins Diet Revolution." Hopeful participants followed the Atkins Diet, gleefully eating bacon, burgers and sausage without guilt. Today, even the Atkins Diet has changed due to the abundance of research detailing the detrimental effects of a high fat and meat based diet being reported on prime time news shows. Now, there is the New Atkins Diet and their website states, "The new Atkins Diet puts to rest the anti–veggie bias by supporting vegetable consumption from day one. "That statement is actually humorous if it were not so ludicrous. In light of the evidence pointing to the harmful effects of the original diet, the illustration below portrays the fears and uncertainty of the masses.
Green Tea's Impact on Cognitive Function Now Visible
Green tea appears to boost memory by enhancing functional brain connectivity, a new imaging study suggests.
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High–Fiber Diet May Aid Heart Attack Survivors
TUESDAY, April 29, 2014 (HealthDay News) — Heart attack survivors who get the recommended amount of fiber in their diets may live longer, a new study suggests.
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Dirty Money: A Microbial Jungle Thrives In Your Wallet
April 24, 2014 – You may have heard that dollar bills harbor trace amounts of drugs. But those greenbacks in your wallet are hiding far more than cocaine and the flu. They're teeming with life.
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Low Growth Hormone Predicts Longevity in Some Nonagenarians
In healthy individuals in their late 90s, diminished — rather than enhanced — levels of insulinlike growth factor–1 (IGF–1), a product of growth hormone, were linked with improved survival, in a new study published online March 12 in Aging Cell.
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Mother's Diet Modifies Child's DNA
A mother's diet before conception can permanently affect how her child's genes function, according to a study published in Nature Communications.
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Regenerative Orthopaedic Medicine
"Why it Works – How it Works – When it Works"
Treatment of the Lumbo-Sacral Spine and Lower Extremities
SERI (Scientific, Education, Research Institute)
9005 Grant Street, Thornton, CO 80229
August 8 & 9, 2014
Register Now at www.aaomed.orgThe AAOM continues to raise the bar in training in Regenerative Orthopaedic Medicine:
The AAOM Annual Workshop; "Regenerative Orthopaedic Medicine" —The Works&mdashl "Why it Works – How it Works – When it Works" Treatment of the Lumbo–Sacral Spine and Lower Extremities is always "standing room only" so sign up now. The AAOM Annual Workshop is not only about Regenerative Orthopaedic Medicine, it is about understanding the comprehensive curriculum of Regenerative Orthopaedic Medicine, teaching you how to incorporate it into your offices, and giving you the tools to achieve successful patient outcomes in your practice.
This course is for Physiatrists, Sports Medicine Physicians, Orthopedists, Rheumatologists, and more who are ready to add cutting–edge regenerative medicine techniques to their care for patients.
The AAOM is a dynamic and extremely unique medical organization that brings together various specialties and elements within the medical profession. This allows us to give you the overall training that is not available elsewhere. If you see patients with undiagnosed pain of probable musculoskeletal origin, then you need to be a member.The annual membership:
Why wait? Join today, fill out our Membership Application online.