Back in the saddle!

It’s been a couple of months since I’ve updated Ask Dr. P.  You see, I’m one of those individuals who has multiple interests.  We’re living in interesting times, where access to information is becoming easier and easier especially with the arrival of AI, especially ChatGPT, Gemeni, Claude and others.

In fact, I’ve been dabbling with ChatGPT, using it to answer questions about Biology (I teach Biology at the high school level) and I must say, I am very impressed with the results I get.

When the Google search engine came out, it took a couple of years for Google to be universally used.  I believe that with ChatGPT, it’s going to take much less time before everyone is used to it, and starts depending on it.

The more you use it, the better you get at it– you’ll get a hang of how to articulate your questions, and a sense of what it can help you with:

• an email to someone?
• an important letter to a business?
• a business proposal?
• a college admissions essay?
• a recommendation for a European travel itinerary?

and…recommendations on how to heal pain and injury?

The big question on everyone’s mind is, how disruptive will ChatGPT be?  Will it enable people to avoid visiting websites like Ask Dr. P to get the information they are looking for?

I think “yes,” ChatGPT, once people are familiar with using it, will at some point become the world’s most visited website.  Imagine getting accurate (in most cases; still evolving), concise explanations on how to overcome a problem/ challenge.  Will a future version of ChatGPT generate its own videos to accompany its explanations?  I think so.

But until then, I will continue to post content on how people can self-manage pain and injuries.  I believe that most people still trust humans, and/or connect and learn from them better (as long as they are genuine and qualified) than some online software.

Remember, the means to achieve a pain-free life that are available to you, that don’t include visiting a doctor are:

1. Diet and Nutrition
2. Exercise and Stretches
3. Manual Therapies
4. Devices and Supports

I produce videos on my YouTube channel in each of these self-help categories.

If you are experiencing chronic aches and pain affecting your back, neck, joints, muscles and tendons then I can teach you how to effectively eliminate or minimize its impact on your life.   

My next project is to complete my Ask Dr. P Home Page that indexes all the body parts, and how to relieve or eliminate pain in each of those regions, so please stay tuned.

  Imagine waking up one morning, eager to start your day, only to feel a sharp, stabbing pain in the bottom of your heel as soon as your foot touches the floor. It might ease as you move around, but the discomfort often lingers, especially after periods of rest or extended activity. If this sounds familiar, you may be experiencing plantar fasciitis, one of the most common causes of heel pain.

This condition affects millions of people worldwide and can disrupt daily life. In this article, we’ll explore what plantar fasciitis is, its causes, risk factors, treatments, and what to expect on your road to recovery.

 What is Plantar Fasciitis?

 Plantar fasciitis is the inflammation of the plantar fascia, a thick band of connective tissue that runs along the bottom of your foot, from your heel to your toes. The plantar fascia acts like a shock absorber, supporting the arch of your foot and aiding in movement.

When the plantar fascia becomes overstretched or overloaded, tiny tears can develop, leading to inflammation and pain. The hallmark symptom of plantar fasciitis is heel pain, often described as sharp or stabbing. This pain is typically worse in the morning or after periods of inactivity, as the fascia tightens when not in use.

 Anatomical and Physiological Causes

Overloading the Plantar Fascia

Repeated stress or strain can damage the plantar fascia, causing microtears. Over time, these tears can lead to chronic inflammation. Activities like running, jumping, or standing for prolonged periods on hard surfaces often exacerbate this strain.

Biomechanical Issues

Certain foot mechanics, such as high arches, flat feet, or abnormal walking patterns, can increase tension on the plantar fascia, making it more prone to injury.

Tightness in Surrounding Structures

Tight calf muscles or Achilles tendons can reduce ankle flexibility, putting additional strain on the plantar fascia.

Age-Related Degeneration

As we age, the elasticity of the plantar fascia decreases, making it more vulnerable to injury.

Activities That Increase the Risk of Plantar Fasciitis

Certain activities can significantly increase the likelihood of developing plantar fasciitis. These include:

High-impact sports: Running, dancing, or aerobics place repetitive stress on the heel and arch.

Prolonged standing or walking: Occupations that require being on your feet for long periods (e.g., teachers, retail workers, healthcare professionals).

Sudden increases in activity levels: Abruptly increasing workout intensity or mileage without adequate preparation.

Wearing improper footwear: Shoes with poor arch support or cushioning can fail to absorb shock effectively.

Who is at High Risk for Plantar Fasciitis?

Some individuals are predisposed to plantar fasciitis due to certain risk factors:

Age: It is most common between the ages of 40 and 60.

Obesity: Excess body weight increases the load on the plantar fascia.

Occupation: Jobs that involve standing or walking for long hours increase risk.

Foot Mechanics: People with flat feet, high arches, or abnormal walking patterns are more susceptible.

Athletes: Runners and dancers are particularly vulnerable due to the repetitive impact on their feet.

Medical Treatment Options

If you suspect plantar fasciitis, it’s crucial to consult a healthcare provider for an accurate diagnosis. Treatment typically begins with conservative measures and progresses to more advanced options if necessary. Common treatments include:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and inflammation.

Physical Therapy

A physical therapist may guide you through stretches and strengthening exercises to relieve tension in the plantar fascia and improve foot mechanics.

Orthotics

Custom-made shoe inserts or over-the-counter arch supports can help distribute pressure evenly across your foot.

Night Splints

Wearing a splint at night keeps the plantar fascia stretched while you sleep, reducing morning stiffness.

Corticosteroid Injections

In severe cases, a doctor may recommend a steroid injection to reduce inflammation.

Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) involves sending sound waves to stimulate healing in the plantar fascia. It’s often used for chronic cases.

Surgery

Rarely, surgical intervention is required to release the plantar fascia if all other treatments fail.

Home Therapy and Exercises

Many individuals find relief from plantar fasciitis with consistent home care. Key strategies include:

Personal shockwave – as stated earlier, this technology breaks dows scar tissue and improves microcirculation to the injury/pain site, resulting in faster and higher quality healing.  Like red light and pemf below, this device is available for direct purchase by consumers; you don’t need to be a doctor to own one, because they are generally very safe to use with minimal to no side effects.

Red Light Therapy – these devices accelerate healing of soft tissue sprains, strains and cuts by ramping up metabolism of the injured tissues speeding up the process.

Pulsed EMF – these devices strengthen the membrane potential of cells, which improves transportation of nutrients and oxygen into cells, and removal of waste products which helps reduce pain and speed up healing

Stretching Exercises

Calf Stretch: Stand facing a wall, place your hands on it, and stretch one leg back, keeping the heel on the floor. Hold for 30 seconds.

Plantar Fascia Stretch: Sit down, cross one leg over the other, and pull your toes back toward your shin to stretch the arch. Hold for 30 seconds.

Strengthening Exercises

Towel Scrunches: Place a towel on the floor and use your toes to scrunch it up.

Marble Pickup: Pick up small objects with your toes to strengthen foot muscles.

Icing

Roll a frozen water bottle under your foot for 15 minutes, 2-3 times a day to reduce inflammation.

Footwear Adjustments

Wear supportive shoes with proper cushioning and arch support. Avoid walking barefoot on hard surfaces.

Rest and Activity Modification

Temporarily reduce activities that exacerbate symptoms. Opt for low-impact exercises like swimming or cycling.

Prognosis and Recovery Timeline

The good news is that most cases of plantar fasciitis improve with conservative treatment. However, recovery requires patience and consistency.

Short-Term Recovery: With appropriate care, symptoms typically improve within 6-8 weeks.

Chronic Cases: For those with severe or long-standing plantar fasciitis, full recovery may take 6-12 months or longer.

Recurrent Issues: Without addressing the underlying causes (e.g., poor footwear, tight muscles), the condition can return.

Conclusion

Plantar fasciitis can be a painful and frustrating condition, but with the right approach, it’s manageable. Early recognition of symptoms and commitment to treatment—both professional and at home—are key to recovery.

By addressing risk factors like poor footwear, tight muscles, or high-impact activities, you can reduce the strain on your plantar fascia and prevent future flare-ups. If you’re dealing with persistent heel pain, don’t hesitate to seek help from a healthcare provider. With time and care, you can regain your mobility and get back to doing the things you love, pain-free.

Introduction:

Sciatica is an often debilitating condition that typically appears after age 60 in those affected, characterized by dysthesias:  abnormal sensations that can include shooting pain, numbness and tingling radiating (traveling) along the path of the sciatic nerve, the largest diameter nerve in the body, which runs from the lower back, between the deep hip rotator muscles, and down the back of each leg. This condition can significantly impair one’s quality of life, affecting mobility, work, and daily activities. In this post, I’ll delve into the main details of sciatica, exploring its causes, pathology, treatment options ranging from conservative approaches to surgical interventions, and the prognosis associated with each.

Understanding the Pathology of Sciatica:

Sciatica typically arises from compression or irritation of the sciatic nerve roots, also called the cauda equina, most commonly at the lumbar spine level. The sciatic nerve is composed of nerve roots originating from the lumbar and sacral spine (L4-S3). When these nerve roots are compressed or inflamed, they can give rise to the characteristic symptoms of sciatica, including pain, numbness, tingling, and weakness along the nerve’s distribution.  The sciatic nerve is comprised of both motor and sensory fibers, but since the sensory fibers are larger in diameter they are more susceptible to mechanical pressure; hence, irritation of the nerves results in mostly sensory dysfunction and less of motor function (leg muscle strength and coordination).

Common Causes of Sciatica

1. Herniated Disc: One of the leading causes of sciatica is a herniated disc, also known as a slipped or ruptured disc. Intervertebral discs act as cushions between the vertebrae of the spine, providing support and flexibility. When a disc herniates, its inner gel-like material protrudes through the tough outer layer, exerting pressure on nearby nerve roots, including those of the sciatic nerve.
2. Spinal Stenosis: Spinal stenosis refers to the narrowing of the spinal canal:  the passageway formed from the stacking of the spinal vertebrae, which are solid in the front and have a ringed rear portion that when stacked form the canal in which the spinal cord resides.  Narrowing can occur due to age-related degenerative changes, such as the formation of bone spurs and thickening of ligaments.  The bone spurs and buckled ligaments encroach the canal, narrowing it.  This narrowing can compress the spinal cord and nerve roots, or cause them to rub against them during movements especially back extension, leading to sciatic symptoms.
3. Piriformis Syndrome: The piriformis muscle, located in the buttocks region, plays a crucial role in hip rotation. In some individuals, the sciatic nerve may pass through or under the piriformis muscle, making it susceptible to compression or irritation. This condition, known as piriformis syndrome, can mimic the symptoms of sciatica.  The muscles scissor the nerve if they get spasmed, which can produce sciatica symptoms.
4. Spondylolisthesis: Spondylolisthesis occurs when a vertebra slips out of alignment anteriorly, often due to degenerative changes or trauma (fractured pars). This misalignment offsets the foramen at that level, usually at L4’L5 effectively scissoring the nerve roots and producing sciatica symptoms.
5. Degenerative Disc Disease: With age, the intervertebral discs undergo wear and tear, leading to degenerative changes such as disc dehydration, loss of disc height, and the formation of bone spurs. These changes can contribute to nerve root compression and the development of sciatica.

Treatment Options for Sciatica:

The management of sciatica aims to alleviate pain, reduce inflammation, improve mobility, and address the underlying cause of the condition. Treatment options may vary depending on the severity of symptoms, the underlying pathology, and individual patient factors.

1. Conservative Management: Conservative approaches are often the first line of treatment for sciatica and may include:
• Pain Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and analgesics can help alleviate pain and reduce inflammation.
• Physical Therapy: Targeted exercises, stretches, and manual techniques can improve spinal flexibility, strengthen supporting muscles, and alleviate pressure on the sciatic nerve.
• Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation.
• Epidural Steroid Injections: Corticosteroids injected into the epidural space can provide temporary relief by reducing inflammation around the affected nerve roots.
2. Surgical Intervention: If conservative measures fail to provide adequate relief or if there is evidence of progressive neurological deficit, surgical intervention may be considered. Surgical options for sciatica include:
• Discectomy: In cases of herniated discs causing nerve compression, a discectomy may be performed to remove the protruding disc material and relieve pressure on the affected nerve roots.
• Laminectomy: This procedure involves removing a portion of the vertebral bone (lamina) to alleviate pressure on the spinal cord and nerve roots, particularly in cases of spinal stenosis.
• Spinal Fusion: Spinal fusion surgery may be recommended to stabilize the spine and prevent further slippage of vertebrae in cases of spondylolisthesis or severe degenerative disc disease.
3. Alternative Therapies: Some individuals may find relief from sciatica symptoms through alternative therapies, although evidence supporting their efficacy may vary. These may include:
• Acupuncture: The insertion of fine needles into specific points on the body may help reduce pain and improve nerve function.
• Chiropractic Care: Spinal manipulation techniques performed by trained chiropractors may help alleviate pressure on the sciatic nerve and improve spinal alignment.  Combining chiropractic with a stretching and exercise routine is even better.
• Mechanical Traction:  Some chiropractic and physical therapy clinics have special tables that can stretch the spine using an electric motor.  This may increase space between the vertebrae, retract buckled ligaments and provide temporary relief.
• Yoga and Pilates: These forms of exercise focus on strengthening core muscles, improving flexibility, and promoting relaxation, which can be beneficial for individuals with sciatica.
• Low Level Laser (LLLT):  Lasering the area of the sciatic nerve may alleviate symptoms.  LLLT, also known as cold laser (non-thermal) helps by providing deep penetrating light to the nerve tissue.  Photons from laser light enter the sciatic nerve and can modulate pain producing biochemical pathways.

Prognosis:

The prognosis for sciatica depends on various factors, including the underlying cause, the severity of symptoms, and the effectiveness of treatment. In many cases, sciatica resolves with conservative measures within a few weeks to months. However, some individuals may experience chronic or recurrent symptoms that require ongoing management.  Over time, the neurons in the irritated nerve roots lose some of their ability to conduct sensory signals, and the symptoms tend to be less acute.

Surgical intervention can provide significant relief for those with severe or persistent symptoms, but it also carries risks and requires careful consideration of potential benefits versus potential complications. With advances in surgical techniques and rehabilitation protocols, the outcomes of surgical treatment for sciatica have improved, with many patients experiencing long-term symptom relief and improved function.

Ultimately, the prognosis for sciatica is influenced by factors such as the individual’s overall health, adherence to treatment recommendations, and the presence of any underlying medical conditions. Early intervention, comprehensive management strategies, and a multidisciplinary approach involving healthcare providers from various specialties can optimize outcomes and improve the quality of life for individuals affected by sciatica.

Conclusion:

Sciatica is a complex condition with diverse causes, ranging from herniated discs to spinal stenosis and piriformis syndrome. Understanding the underlying pathology is crucial for guiding appropriate treatment interventions, which may include conservative measures, surgical intervention, and alternative therapies. With timely and comprehensive management, the prognosis for sciatica can be favorable, enabling individuals to regain function and resume their daily activities with minimal pain and discomfort.

In recent years, a concerning trend has emerged in the world of cancer care: more and more individuals under the age of 50 are being diagnosed with various forms of cancer.   At the time of this writing, Kate Middleton, the Princess of Wales (age 42) recently announced that she has cancer.   She had abdominal surgery in January of this year that was at first thought to be non-cancerous, but later diagnosed as cancerous (no details on the type of cancer have been released at this point). This phenomenon challenges the long-held belief that cancer primarily affects older adults, shedding light on a complex issue that demands attention and action.

Recent studies have revealed startling statistics, indicating a significant rise in early-onset cancer cases globally. From 1990 to 2019, the incidence of early-onset cancer increased by a staggering 79.1%, with a 27.7% rise in early-onset cancer deaths. This trend is particularly evident in the United States, where breast cancer tops the list of diagnoses among younger populations, closely followed by gastrointestinal cancers, including colon cancer which are increasing at an alarming rate.  Amazingly, the statistics show that someone born in 1990 has over twice the risk of getting colon cancer than someone born in 1950.  In other words, today’s 34 year olds are twice as likely to get colon cancer than today’s 74 year olds!

What factors are contributing to this concerning uptick in early-onset cancer? While genetics play a role, it appears that environmental and lifestyle factors are paramount. Changes in nutrition and lifestyle habits over the past few decades have created a perfect storm, with ultraprocessed foods, sugary drinks, smoking, alcohol consumption, obesity, and physical inactivity identified as potential culprits. These factors can disrupt the body’s internal processes, leading to inflammation and metabolic disturbances that increase cancer risk.

Moreover, emerging research suggests a link between changes in the gut microbiome—a community of microbes residing in our bodies—and cancer vulnerability. Poor dietary choices, excessive antibiotic use, and certain medications can disrupt this delicate balance, potentially facilitating cancer development.

As a long time advocate of using scientific thinking in everyday life, I think of the major environmental changes in society that coincided with the birth of millennials, born between 1981 and 1996, for this generation is getting hit the hardest with this uptick in cancer.   What new thing did this generation absorb, starting in their early prepubescent years? 

The one that comes to mind is cell phone use.  Cell phones started to become mainstream in the late 1990s.  Ten years later, about 80% of adults had one.  Of course, cell phones needed cell phone towers that carried the signals using radiofrequency waves, and today’s 5G networks have a frequency of about 25-52GHz.  Could this be a factor?  Yes, everyone who lives in modern society gets exposed to these frequencies, but maybe they do their damage when the body is still developing?  This may explain why people born in the 50s and before have about the same rates of cancer over the past decades.

Cancer is also associated with genetics.  Certain mutations can be the catalyst for cancer development, and maybe these new cell phone frequencies are able to affect DNA, which is passed onto the offspring?

Another possibility for the rising rates of cancer in young adults is the introduction of new industrial chemicals and food additives in consumer products and the food supply.  Chemicals are used for many different purposes, such as fire retardants, fabric manufacturing, materials engineering such as hardwood flooring, agriculture, and more.  Sometimes the use of these chemicals in consumer products are rushed for government approval and there hasn’t been enough time to conduct experiments on their toxicity to humans.  Ultra processed food have preservatives that help big food corporations produce more food that has longer shelf life and have addictive effects on consumers to encourage repeat buying.

Of course, many of these chemicals can find their way into the water supply and atmosphere, where they continue to be ingested, daily.  This is why I encourage everyone to invest in a home water filter and air purifier, like the AirDog.  You must be mindful of what goes into your body at all times.

Despite ongoing efforts to understand the root causes of early-onset cancer, many questions remain unanswered. While obesity and lifestyle factors explain some cases, there are instances where seemingly healthy individuals are diagnosed, highlighting the complexity of this issue. Additionally, underdiagnosis of early-onset cancers remains prevalent, emphasizing the need for improved awareness among primary care physicians and proactive advocacy by patients.

The consequences of early-onset cancer extend beyond diagnosis and treatment. Younger patients face unique challenges, including concerns about fertility, long-term side effects of treatment, and the impact on daily responsibilities such as work and education. Addressing these challenges requires a holistic approach that encompasses not only medical treatment but also psychological support and long-term care planning.

As we grapple with the implications of this unsettling trend, there is a pressing need for collective action. This includes increased funding for research, education campaigns to raise awareness among both healthcare professionals and the general public, and revisions to screening guidelines to ensure early detection and intervention. Recent recommendations to lower the age for colorectal cancer screening reflect a step in the right direction, but more must be done to address the multifaceted nature of early-onset cancer.

In conclusion, the rise in early-onset cancer cases serves as a sobering reminder of the complexities of this disease and the importance of proactive measures to combat it. By working together to understand the underlying causes, improve detection and diagnosis, and support affected individuals, we can strive towards a future where cancer is no longer a threat to individuals of any age.

The singer Celine Dion, whose glorious singing career spanned the last four decades, was recently diagnosed with a condition called Stiff Person Syndrome.  Unfortunately, the condition is prevening her from performing, due to its debilitating effect on muscle control, including the vocal cord muscles.

Stiff Person Syndrome (SPS) is a rare, progressive neurological disorder characterized by significant muscle rigidity and spasms, often leading to debilitating physical and psychological symptoms. This article provides an overview of SPS, delving into its causes, symptoms, diagnosis, and current treatment options, as informed by medical research and trusted medical resources.

What is Stiff Person Syndrome?

SPS is an autoimmune neurological disorder primarily causing muscle stiffness and painful spasms. These spasms can worsen over time and vary in symptoms, including an unsteady gait, double vision, or slurred speech, depending on the SPS type. The condition can be severely disabling, often leading to hunched over postures and frequent falls due to impaired reflexes​​​​.

Causes of Stiff Person Syndrome

While the exact cause of SPS is unknown, it is believed to be an autoimmune reaction where the immune system attacks glutamic acid decarboxylase (GAD) in the brain and spinal cord. GAD is crucial for producing gamma-aminobutyric acid (GABA), a neurotransmitter controlling muscle movement.  Neurotransmitters are protein molecules released from the ends of neurons, which then attach to other neurons causing them to continue the nerve impulse until it reaches the muscle.  Disruption in GABA production can lead to continuous neuron firing, contributing to muscle rigidity and spasms seen in SPS. Low GABA levels are also associated with anxiety and depression. Interestingly, SPS often occurs alongside other autoimmune diseases like type-I diabetes, thyroiditis, vitiligo, and pernicious anemia​​​​.

Symptoms of Stiff Person Syndrome

The primary symptoms of SPS include progressive muscle rigidity and painful spasms, often triggered by stimuli such as noise, touch, and emotional distress. Initial symptoms typically manifest between the ages of 30 and 60 and can vary in severity and progression. Common initial signs include muscle stiffness and pain, especially in the lower back and legs, potentially leading to difficulty in walking and performing daily activities. Severe cases may require wheelchair use, and there’s an increased risk of anxiety and depression​​​​.

Diagnosis of Stiff Person Syndrome

Diagnosing SPS is challenging due to its rarity and symptom overlap with other conditions like Parkinson’s disease, multiple sclerosis, and fibromyalgia. A definitive diagnosis is often made via a blood test measuring GAD antibodies. Most people with SPS show elevated GAD antibody levels. Electromyography (EMG) tests can also be employed to measure muscle electrical activity and assist in diagnosis and monitoring treatment response​​​​.

Treatment Options for Stiff Person Syndrome

While there is no cure for SPS, symptoms can be managed through personalized treatment plans focusing on pain management, muscle relaxation, and immune response suppression. Common medications include pain relievers, muscle relaxants, anti-seizure and anti-anxiety drugs, sedatives, and steroids. Non-medication treatments like physical therapy, heat therapy, red light therapy, and pulsed EMF are also beneficial. In cases where medications are ineffective, treatments like Botox, intravenous immunoglobulin (IVIg), and stem cell therapy have shown promise in symptom improvement​​​​.

Additionally, a narrative review of available medication treatments for SPS suggests starting with benzodiazepines as a first-line treatment, adding medications like levetiracetam or pregabalin if symptoms persist. For second-line therapy, oral baclofen is preferred over rituximab and tacrolimus. In cases of refractory symptoms, treatments like intrathecal baclofen, IVIG, or plasmapheresis can be effective, with intrathecal baclofen and IVIG being more effective than plasmapheresis​​.

Conclusion

Stiff Person Syndrome presents a complex clinical challenge due to its rarity, varied symptomatology, and the intricate interplay of autoimmune responses. Understanding its underlying causes, symptom patterns, and current treatment modalities is crucial for effective management. Ongoing research continues to shed light on this condition, offering hope for more effective treatments in the future. For individuals diagnosed with SPS, a collaborative approach involving neurologists, rheumatologists, and physical therapists, alongside personalized treatment strategies, is key to managing this condition and improving quality of life.

And lastly, when your body is struggling with disease, give it assistance by providing it with nutrients, water, sunlight and mild exercise when possible.  Mind-body approaches including meditation, flotation therapy, biofeedback, yoga, tai-chi, deep breathing and so on, may provide some relief as well.

Sources:

Johns Hopkins Online

https://www.hopkinsmedicine.org/

National Institute of Neuromuscular Disorders and Stroke

https://www.ninds.nih.gov/

American Brain Foundation

https://www.americanbrainfoundation.org/