Month: November 2018

  • November 6, 2018

    Chronic Back Pain: Can Stem Cells Help?

    Back pain left me with a lot of questions as a kid. How was it possible to “throw out your back”? I thought backs attached pretty firmly to stuff in that general area. And why did this throwing out your back situation lead my parent(s) to crawl around on hands and knees for days at a time?

    As a persnickety 3rd or 4th grader, it seemed like a great way to force me to do all the cooking. Mom just pretended she couldn’t do stuff so that I would pick up the slack. A convenient method of tricking me into child labor so she could take a day or two off. I had her all figured out.

    The Back Pain Struggle Is Real

    In hindsight, I’m pretty sure my mom wasn’t super jazzed about eating nothing but overly sugared cinnamon toast and pancakes. But I couldn’t possibly have understood the crippling nature of back pain at that age. After all, I was an indestructible kid who regularly jumped out of tree forts and somehow never broke an arm. So how could sneezing bring someone to their knees?

    As a former technical trainer for a spine implant company, I now know all too well the realities of back injury and chronic pain. It affects the people I love and probably almost every person reading this – at one point or another. And honestly, we, the scientific and medical community, haven’t done a great job treating it for… oh, let’s say most of history.

    But treatments have improved recently, and you should definitely know about those improvements.

    So, let’s do a quick tour of your spine, how cool it is, what happens when it breaks, classic treatments, and cutting edge options like stem cells and nerve confounding implants.

    I know that last part sounded bad, but I assure you it’s not. It’s actually really fascinating and hope inducing. Kind of like every person who’s ever been on ancient aliens, except with a lot more hope.

    The Spine Is Important

    That’s not the understatement of the century, but it’s definitely in the top 10%. Also up there are “Kanye likes Kanye,” and “the Insane Clown Posse missed a couple of days of science class.”

    Your spine is made of 33 bones interspersed with cartilage discs. and that simple structure carries a lot of responsibility. Pun intended. #DadJokes #NotJustForDads

    Your spine has three main jobs, according to my summary of the thousand things it does:

    1. Provide structural support.
    2. Absorb shock while allowing movement.
    3. Protect nerves.

    That last one gets most of us at some point in our lives. Because we jump off of cliffs and fracture spinal bones (not referencing any person in particular that I definitely know), or throw ourselves from moving cars. And then our shock absorbing spine parts squish out onto our nerves, compressing them. Which causes pain, tingling, numbness, lightning strikes down your leg, and a whole bunch of other unpleasant symptoms.

    Spinal Injury = Pain or worse

    If we make incredibly stupid choices – like jumping off of river-spanning bridges, or if we get into a horrific car accident, the bones in our spine can become unstable. Sometimes they even get knocked out of place. Which causes some really aggressive consequences – chronic pain, loss of sensation, paralysis, loss of muscle control, and others.

    Basically, if your spine malfunctions or gets damaged, your whole body can suffer the consequences. And they are unpleasant in the extreme, ranging from mild discomfort to complete and total paralysis.

    A Lot of Back Pain Fixes Itself

    According to one study, 90% of patients with first time low back pain symptoms will get and stay better with physical therapy and time. But the more times your pain returns, the lower the probability of it improving without surgical intervention. Now, that’s *mostly encouraging*, because the data says most people get better without ever needing surgery. But if you fall into that unlucky minority, you could be stuck with chronic back pain. Unless you know your way around the treatment options. Luckily for you, I already know that stuff!

    Let’s start with the most aggressive treatment option and work our way down to the less invasive, more biologically friendly options.

    Spinal Fusion Is For Serious Back Problems

    Spinal fusion surgery typically helps patients with very serious mechanical problems in their spine. Like the instability and misalignment I mentioned earlier (and also scoliosis). So avoid jumping off of railroad bridges, tangling with the Hulk, and aggressive car accidents if you don’t want to personally learn all about this type of surgery.

    In this procedure, a surgeon removes tissue that squishes nerves, brings bones back into alignment, and places implants that give nerves enough space to breathe while also holding everything in place. At the same time, the surgeon adds graft material in the operated area so that bone will grow there and take the mechanical load off of the metal implants over time. Because, and this may shock you, metal implants don’t hold up near as well as your own bone. That’s right – titanium is no match for the incredible self-maintaining power of human bone!

    Spinal Fusion Doesn’t Always Work

    Now, at the end of this procedure, you’ll have a pretty significant recovery period ahead. And depending on which study you read, success rates range from 60% – 90%, leaving a pretty significant fraction of patients with unresolved symptoms. So after all that trouble, having your spine opened up, implants thrown in there, maybe having your personal religious leader pray over it, throwing a penny or two into a fountain, and that lengthy recovery, you could still have the same symptoms your surgery should have treated.

    Please excuse my language, but that’s pretty crappy, y’all. And it’s one of the many reasons people often just don’t want to get this kind of surgery, even if their doctor/insurance provider recommends it.

    Some mechanical problems can’t be fixed without this kind of surgery, but most people with back pain don’t have that level of mechanical issue. Meaning they likely have other options, like this next one.

    Microdiscectomy Restores Your Nerve(s)’ Personal Space

    Remember when I said earlier that the shock absorbing parts of your spine can squish into your nerve space and cause pain? When that happens, the tissue doesn’t just disappear. Especially if it registers as a large chunk of tissue. Instead, it hangs out, crowds your nerves, and generally makes a nuisance of itself. Like if your mom moved into your dorm room with you. No matter how awesome your mom is, she will cramp your college style if she shares your dorm room. And probably not in the hilarious Melissa McCarthy way either.

    Don’t worry though. Unlike the mom in your dorm room situation, a physician can easily just remove the squishy disc material that crowds your nerves. For many patients this means a return to their formerly carefree, more importantly, pain-free lives. And best of all, physicians can do this procedure through a big straw, meaning very short hospital stays, much kinder recoveries, and waaaay less risk.

    For most patients, this type of procedure leads to satisfactory pain and disability improvements, and they don’t need additional surgeries. A small portion of patients may experience recurrent symptoms at the operated level, requiring a repeat microdiscectomy or possibly a spinal fusion. But for the most part, microdiscectomy represents one of the most dependable spinal interventions we have. For appropriate patients, it works like a charm.

    Microdiscectomy In A Nutshell

    In this procedure, a surgeon simply uses surgical instruments to remove the tissue your disc has accidentally allowed to crowd your nerves. That’s the whole thing. Most patients do very well with it, but a few do end up needing further intervention.

    Bonus

    Microdiscectomy doesn’t cause irreversible changes in the same way that a spinal fusion does. With a spinal fusion, a bunch of tissue comes out, and you will never get that cartilage-squishy-shock-absorby tissue back in that spot. Which means that (after spinal fusion) microdiscectomy and the concentrated bone marrow procedure further down this post either won’t help or flat out no longer apply to the situation.

    Microdiscectomy, on the other hand, provides an option that keeps all your other treatment options open.

    Another Option: Concentrated Bone Marrow

    with mesenchymal stem cells. I mentioned this treatment in one of my first posts, because it stands as one of the few legitimate “stem cell” treatments currently available in the United States. It carries a big qualifier with it though. Injection of concentrated bone marrow only helps appropriate patients. That means patients who don’t have mechanical problems requiring spinal fusion or giant chunks of tissue suffocating their nerves. Bone marrow derived cells, stem cells or otherwise, can’t handle that kind of problem.

    What can they handle?

    Well, in this study, 26 patients whose insurance companies approved them for spinal fusion surgery had either one or two injections of their own concentrated bone marrow. That’s right – just an injection. No surgery. These patients had confirmed diagnoses of discogenic back pain, without any of the nerve compression we discussed earlier with spinal fusion. They experienced pain and disability improvements on the order of 70% at one, two, and three years post-procedure. And a couple of patients showed quantifiable improvements in the health of their discs (the squishy shock absorby part of your spine).

    Now, after three years, 6 of the patients had actually chosen to move on to spinal fusion. That probably means their pain and disability scores started climbing sometime after their initial treatment. But. That means 20 people who could have had a very invasive, irreversible surgery, didn’t. That means almost 77% of patients in the study avoided spinal fusion surgery.

    Another bonus

    Disc injection with concentrated bone marrow, just like microdiscectomy, allows you to keep your options open. If it doesn’t work out for you, you can still get literally any other treatment for your back pain.

    Note: your local doctor probably doesn’t offer this treatment. But I mentioned several who do in this post.

    Another Option: Spinal Cord Implants

    I promise it sounds a lot worse than it is, like goulash or mole. Just give me a hot minute to explain.

    Sometimes back pain does. not. respond to treatment, even after spinal fusion surgery. And that sucks. Because chronic pain can lead to depression, declining quality of life, and not having enough energy to heckle your siblings in public anymore. None of which are good things.

    Doctors, researchers, and engineers figured out a fairly elegant way to deal with this though. Instead of targeting the source of the pain, they decided to interfere with the road it takes from the source to your brain. If the pain signal can’t reach your brain, or comes through as something else (like very light tingling), then the pain disappears.

    How do they do this?

    Tiny Spaghetti Implants Block Pain Signals

    Your spinal cord basically transports information between every part of your body and your brain through electrical impulses. These spinal implants create electrical fields that change the message as it heads toward your brain. So what started as “CRIPPLING ANGRY BACK PAIN” can end up in your brain as “nothing to see here.” Since you only know the final message in your brain, these implants can literally make chronic pain disappear.

    Another cool thing about this approach: ALL pain signals get to your brain this way. So it applies to a wide variety of chronic pain conditions.

    In one study, 69% of patients receiving spinal cord stimulating implants for back pain after spinal fusion surgery reported “substantially improved or better global perceived effect,” (a measure of pain relief) at six year follow-up. And that study used old school technology. The implants available today blow that old stuff out of the water.

    You Can Try Them On – Just Like Amazon’s Clothes!

    But minus the free shipping and burgeoning shopping addiction.

    Honestly, the fact that you can try on these implants to see if they work – before actually getting a long-term implant – is revolutionary and epic. You basically visit a pain management physician, have them place the spaghetti implant in the most effective spot for your pain, then go home with a smart-phone app that lets you control the level of therapy your trial implant provides. Within a week you know whether or not it works well for you, and then you can make the decision to go ahead and have a long-term implant placed – or not.

    Yes, having a long-term implant does mean living with a small battery somewhere in your body, just like a pacemaker. But they’re so small now, and doctors are so good at implanting them that most people don’t even notice them. And if you do, you can have the whole thing removed. The whole procedure is reversible from start to finish.

    So, just as I mentioned with microdiscectomy and concentrated bone marrow injection, spinal cord stimulating implants keep your other options open. If it doesn’t work, it still doesn’t rule out most other procedures.

    For more info, WebMD has a pretty solid overview of the therapy, and this video shows you exactly where the implants go and how they work.

    Back Pain Is Terrible

    and so are super long blog posts, but look at me still writing!

    We just covered a lot of information, so I want to do a quick, brief recap. This way every reader will wonder why they didn’t just read this section first.

    1. Your spine does really important things, and it causes pain, disability, and/or paralysis when injured.
    2. Spinal fusion surgery can address big mechanical problems and relieve pressure on nerves, but it’s not exactly reversible and does shut down a lot of future treatment options.
    3. Microdiscectomy surgery removes chunks of cartilage that escape from your intervertebral disc(s) and crowd your nerves, and it keeps your future treatment options open.
    4. Intervertebral disc injection with your own concentrated bone marrow addresses discogenic pain without mechanical complications and keeps future treatment options wide open.
    5. Spinal cord stimulation implants can shut down pain signals from a wide variety of pain conditions, can be tried on like shoes or careers, and keeps future treatment options open.

    Phew, ok. I need to call it quits now. Plus it’s election day, and I have to go make sure everyone I know has voted.

    Side note: I didn’t include marijuana or opioids in this post because it’s already way too long, and they could each be their own blog category. So you’ll have to keep reading if you want to find out my opinions on cannabis (it works for some stuff) and vicodin (it’s super addictive).

    So yes, mesenchymal stem cells from your own concentrated bone marrow can help certain kinds of back pain, but we also have several other effective, patient-friendly options that don’t necessarily involve surgery.

    Alright, that’s it. Now, y’all go vote!

    Photo by Jesper Aggergaard on Unsplash

  • November 1, 2018

    Which Supplements Help Manage Stress?

    Confession: I have a drawer full of supplements, and I actually take them every day. Because, for real, I want to live to see people on Mars. Or Europa. Or whichever non-earth terrestrial body we finally colonize – I want to see that, y’all. Which is one of the many reasons I’ve done research into which over-the-counter supplements manage stress. Or help manage stress at least.

    The first time I did this little research run, my life didn’t look exactly how I’d pictured my mid-twenties. I didn’t have any adorable children *or* a husband who seemed delighted (not annoyed) by my hilarious and endless supply of sarcasm. #ThankYouVeronicaMars I did have borderline high blood pressure and a newly diagnosed arrhythmia though. After blindly taking a beta blocker for a few months, I decided to get to the bottom of the issue instead of treating the symptom. Because science.

    Despite a careful examination of my dysfunctional family, high stress work environment, and type A personality, I still couldn’t peg a likely cause. #MustBeCellPhones, right?

    But, I clearly had all the signs of what I’m gonna call constant, aggressive cortisol levels – aka serious consequences of chronic psychological and physiological stress. So I decided to make like a pharmaceutical company, give up on addressing the cause, and focus on the symptoms.

    Before I tell you what I found, let’s take a look at the biological consequences of stress and what happens if we don’t address them. Spoiler Alert: it’s basically an extended Snicker’s hungry commercial. Two parts entertainment, one part terrifyingly accurate truth and consequences.

    Stress Affects Your Whole Body

    Most of the systems in your body devote themselves to one critical job: maintaining the status quo. Processes continually provide push and pull, hopefully completely balanced with each other. When something out of the ordinary happens to us or around us – Coca Cola announces they’re discontinuing your favorite drink, or your new boss holds a lot of scream meetings because “they really get people moving” – our bodies see that as a threat to maintaining normal operations. We get stressed.

    In response to that stress, your body produces cortisol to give you the energy you need to either fight or run like The Leprechaun is after you. [I don’t care what anyone says, that dude still creeps me out.] In a perfect world, this provides glucose and insulin to all your muscles. But in the real world, where Russian bots popularize conspiracy theories about bears replacing all the teachers in Idaho, that cortisol doesn’t always help.

    It slows down bone formation, leading to osteoporosis, and decreases collagen synthesis. Yes, y’all. That means stress can actually cause wrinkles. So you *can* blame your boss for aging you. But only if you have a terrible boss. If you have a good one, congratulations, and hang onto them!

    Stress Affects Your Heart, Brain, & Metabolism

    I know cortisol already seems pretty bad, but the most insidious effects of stress come in the form of cardiovascular, metabolic, and brain related changes. Our heart rate and blood pressure immediately skyrocket when stressed, but when the stressor hangs out for a while, things get worse. We end up developing chronic high blood pressure, insulin resistance (we get fat), and cognitive impairment (i.e. cotton candy for brains).

    And. And, and, and. Stress rewires our brains to make us eat more, even though it knows it already made us fat! I suppose you could argue that response is really just attempting to prepare us for a long, hard winter. But come on y’all. Whether you believe in climate change or not, none of us really needs to pack on that winter finish anymore.

    Long-term, all this stuff adds up and kills us much faster than all the other stuff that’s killing us. Like eating the whole bag of candy corn despite promising yourself you absolutely wouldn’t do it this year. Or going ahead and jumping off that cliff because those idiot college freshmen did it, and they survived, right? #GradStudentsAreTheWorst #BecauseIDidThatInGradSchool

    Some Supplements Help Curb The Symptoms

    Today’s post isn’t all doom and gloom though. Whole Foods, Amazon, and a slew of other retailers carry a few supplements that are clinically proven to combat some of the downstream effects of chronic stress, like high blood pressure. And not in the “4 out of 5 dentists recommend Trident” kind of way. More like the “statistically significant decrease in systolic blood pressure” kind of way. Which, as you all know, is the right way.

    Side Note

    Is it just me, or did I take a Joey Tribbiani having and giving and loving and sharing the love that we have and give kind of detour just now? Well if not, I definitely have now!

    And Now Back to Those Supplements

    First on deck are Rhodiola Rosea and Ashwagandha, both of which I buy from Amazon on Subscribe & Save, because savings. Rhodiola Rosea research shows it relaxes blood vessels and helps curb the brain fogging effects of stress in real live people.

    Ashwagandha on the other hand has achieved blood sugar control comparable to a prescription diabetes medicine. And, patients who took an Ashwagandha supplement for a period of 60 days had statistically significant decreases in cortisol levels and stress assessment values as compared to placebo.

    i could have really used this stuff in undergrad when I earned my first grey hairs by spending weeks running on less than 6 hours of sleep (per week). According to a lot of research, that’s the level of sleep deprivation where you start hallucinating, which may explain my repeated waking nightmares about showing up late to an organic chemistry test, proctored by a shark, without ever studying.

    Fish Oil Rocks

    We don’t eat a lot of fish in this country, or at least we don’t over here in Central Texas. I think the first time I saw fish it was in stick form, and that inspired me to avoid seafood for decades. Which was a mistake, y’all! Fish provide a lot of really beneficial nutrition, as evidenced by a bunch of clinical studies. In this one, people who took a fish oil supplement had 20 – 26% lower risk of cardiac related death. In a meta-analysis (a study of studies), these Mayo Clinic authors concluded that fish oil supplementation likely reduces a person’s risk of coronary heart disease.

    Now, I can’t live with myself if I don’t mention that not all studies have come to the same conclusions about fish oil. Some researchers have analyzed their own or other people’s research and concluded that fish oil doesn’t provide benefit. Right now that says the jury is still out. In another ten years, our information will have improved. And I bet we’ll have learned that our doses weren’t standardized in previous studies, which explains the seemingly equivocal conclusions.

    Kind of like if you did two studies on the efficacy of food to alleviate hunger in college students. In one study you provide 200 grams of meatloaf, and in the other one you provide 200 grams of spring salad. They both study food and hunger, but I bet the salad one fails where the meatloaf succeeds. And you can’t really conclude that food doesn’t alleviate hunger if the studies you’re using don’t standardize their food.

    So.

    For now, I personally find the evidence strong enough that I take fish oil every single day. I use this one, but you can take any high quality one. You just want to make sure that whatever version you’re taking, it’s been certified to have very small or zero levels of mercury in it. Because fish carry a lot of mercury these days. And you don’t want to be the first person to gain super powers from excessive mercury exposure. Right? Unless you do, in which case, by all means source your fish oil from a discount pharmacy in Russia.

    My Stress Supplements

    Because I’m a crazy person who likes to fill their tiny kitchen with bottles of supplements, this is what you’ll find me taking every day:

    1. Rhodiola Rosea
      relaxes blood vessels & decreases the brain slowing effects of stress.

      1. AM: 2 capsules
      2. PM: 2 capsules
    2. Ashwaganhda
      helps with blood sugar control and decreases cortisol levels.

      1. AM: 3 capsules
    3. Fish Oil
      decreases the risk of cardiac related death.

      1. AM: 2 Gelcaps
      2. PM: 2 Gelcaps

    Now, certainly other stress symptom-controlling supplements exist. These just happen to be the ones I’ve researched most extensively and used personally for many years now. And to be fair, I no longer take beta blockers. My blood pressure is perfect, and I barely have any arrhythmias anymore. So I guess addressing the symptoms (blood pressure, cortisol) instead of the cause (stress) gets the job done every once in a while. Not bragging, just saying… science works, y’all.

    Oh, also – the fish oil I mentioned is lemon flavored. So if you happen to wash your pills down with a morning Coke, you won’t end up burping fish coke. Which we can all admit is revolting. #ThatsNasty

    And for those wondering if I really take these every single day, I do. Even when I travel. Every. Single. Day. Because I decided years ago that I wanted to see people on Mars, and I will. NOT. let a silly thing like stress or cardiovascular disease get in my way. Not as long as I can help it.

    Alright folks, that’s it for today’s episode of “my pantry already looks like I’m in a Colonial Penn commercial.”

    Wondering how I got this crazy? Or trying to figure out if that fish Coke comment was from personal experience? Ask me in the comments, or drop a line directly in my inbox!

    Photo by Matthew Henry on Unsplash