In the United States, drugs are king. I’m talking about pharmaceutical drugs that promise to cure everything from the sniffles to cancer. When sick, the first thing we do is seek a medicinal solution from somewhere out there — some product we can swallow or apply to our bodies and wait for the magical chemical ingredient to kick in. We think our bodies cannot function properly unless our medicine chests are bulging with prescriptions. Our doctors have become shamans whose mastery of mixtures and potions we rely on to stay healthy. As a nation, we’re hooked.
But true health begins with choices we make every day in the privacy of our homes. Eating the right foods, making sure we get the essential nutrients and vitamins our bodies need and reducing harmful stress are the most effective ways to stay healthy. When our emphasis is on prevention, our minds and bodies have a better chance of staying healthy.
Skin: First Line of Defense
Those of us prone to pressure sores usually attack the problem too late, after skin has broken down. Our experts — primary care physicians, wound care specialists, surgeons — stand ready with their arsenals of gels, treated dressings, antibacterials, debriding tools and surgical techniques. We forget that our bodies are made to heal on their own. But only if adequate blood supply bathes the wound site with healing elements and carries waste products away. Adequate circulation and micronutrients are absolutely critical to skin health and wound healing.
I’ve had semi-chronic pressure sores on both ankles (malleolus) for almost 40 years. Dozens of doctors and wound care specialists have spent hundreds of thousands of dollars applying just about every dressing, gel, ointment and medicine known to man, from high-cost growth factors like Regranex to saline soaks. But none of these have brought about any lasting beneficial result, especially on my right ankle. Several treatments have reduced the size of the wound, but getting the wound to close and stay closed has been marked by chronic failure.
Never in my 40-year history of relying on state-of-the-art wound care has any doctor, nurse or surgeon addressed my body’s need for proper vitamins and nutrition in any prescribed regimen. Never, that is, until I met Dr. William C. Duncan III, a semi-retired vascular surgeon who works one day a week at Legacy Emanuel Hospital’s Wound Clinic in Portland, Ore.
I was referred to Duncan with the expectation of having peripheral vascular surgery done on one or both legs. My favorite wound care nurse and I had mutually decided to throw in the towel after another unsuccessful round of conventional treatment. As a 61-year-old para, I was ready to admit that my circulation was no longer up to the task of closing a wound the size of a nickel and almost half of an inch deep.
Duncan measured the blood pressure at both ankles and confirmed that I had vascular disease in my lower extremities and significantly impaired circulation. Then came the surprise: “I think we can heal it without surgery,” he said. “We’ll go with a vitamin blitz and collagenase.”
Vitamin blitz? Not only was I skeptical, I was almost angry. Because my wound had refused to heal, I had been sick with five consecutive cellulitis infections in the previous four months. My overall skin health was going downhill fast. But six weeks after beginning the vitamin blitz, the open wound on my right malleolus had healed perfectly, and it has stayed healed for the past eight months — with no further cellulitis infections.
“My mentor at Harvard Medical School was the chief of vascular surgery, Dr. Robert Linton, probably the best known vascular surgeon on the planet back then. The vitamin blitz I use to this day was one that Dr. Linton drew up more than 35 years ago,” says Duncan, who has been practicing general and vascular surgery in Portland since 1971. “I’ve seen and had success with this treatment in hundreds of patients who were having difficulty in wound healing.”
Actually, Duncan has made a couple of tweaks to the original recipe, adding an all-important amino acid — L-Arginine — and boosting the amount of zinc. Here are the ingredients (daily): Vitamin A, 10,000 units; B complex, as available in most multivitamin supplements; C, 500 mg twice/day; D, 500 mg; E, 400 units twice/day; Zinc, 50-250 mg (I took 150 mg); L-Arginine, 2,000 mg.
The first clue I got that this concoction was having a significant effect had to do with my regularity. My normal routine was to have a bowel movement, more or less naturally, every three days or so. I weaned myself from suppositories about 30 years ago and have been trying to control my bowels through diet ever since. During my six weeks of vitamin blitz therapy, I had regular, natural bowel movements every day, almost a minor miracle in itself.
There was no doubt that my digestive tract had speeded up. But the real proof was in the quality and consistency of healing. On the wound site itself, Duncan used a gauze pad taped over collagenase, an enzyme in dry form that reacts with drainage fluid to debride dead tissue naturally. His whole approach was to boost my natural tendency to heal by augmenting my body’s nutrient flow and cleansing process.
“The arginine is a protein building block for new tissue, but it also has some action to dilate blood vessels and maximize microcirculation [capillaries and small arterials],” says Duncan. “The vitamins are a kind of micronutrient, and the vasodilation brings the micronutrients and the macronutrients.” In addition to vitamin therapy, Duncan recommends an increase in dietary protein. “We tell our patients to include more meat and fish and dairy products to help build new tissue to heal the wound.”
Duncan says he has used the vitamin blitz therapy successfully on wounds in all the usual places — gluteal, hip, heel, toes, ankles — wherever pressure is a problem. He also insists on managing skin cracks between toes, an oft-neglected area that can be an entry point for cellulitis infection. After washing and drying thoroughly between toes, apply an antifungal cream such as Lotrimin. To get rid of dead tissue on feet and legs (bacteria is attracted to dead tissue), Duncan advises applying a non-medicated skin moisturizer like Eucerin or a natural fat like Crisco. Don’t laugh, it works. Today I pamper my legs like a Dallas Cowboys cheerleader.
Bladder and Bowels: Do’s and Don’t's
“Water is my best friend,” says Bob Vogel, who needs no introduction [see his latest story on catheter usage in NM, December 2006]. “It’s very easy for me to not pay attention and get dehydrated, and dehydration alone will set me up for feeling that a bladder infection is coming on. Forget the juices and everything. When I feel it coming on, I’ll go straight for the water.” You’ve heard it before, but nothing works better than water as a preventative.
Besides drinking plenty of water, preventing UTIs is often about what you cut out of your diet. Gary Karp, a T11 para and speaker/author who travels frequently, has learned to go light on caffeine and alcohol. “They’re dehydrating,” he says, “so they raise the risk of UTI, which is especially important to pay attention to when you’re traveling.”
Karp also suggests vitamin C as a way to acidify urine (acidic urine discourages bacteria growth) and promote cell health. “Vitamin C is known to enhance the membranes around our cells. Takes high doses to do it, like 4,000 mg/day. But you can’t take too much vitamin C — it never gets toxic,” he says.
Recently Karp has learned a new twist in preventative bladder care. “There’s an herbal supplement that I’m told helps enhance the bacterial resistance of the bladder. It’s called Uva Ursi, a leaf that also thickens the mucous layer of the digestive tract and adds more resistance against harmful bacteria. But water is still the main thing.”
Ian Jaquiss is another busy para whose responsibilities demand that he stay healthy. At 40, he heads up a disability sports organization and is father to four active healthy boys. He was a Paralympian swimmer in college, but by the time he reached 25, he had gained over 60 pounds. He attributes his unhealthy weight gain to being addicted to sodas and sugared drinks and eating junk food. The extra weight and poor nutrition took its toll. “Between 25 and 35 I had a ton of bladder infections,” he says, “and the extra weight sped up the degeneration of my shoulders.”
Now, five years after kicking his bad habits, he is down to within 10 pounds of his competitive swimming weight. “And I’ve had only one infection in the last five years,” he says. Instead of sugary carbonated drinks, Jaquiss now blends smoothies at home. He uses a cup of low-fat yogurt, a cup of frozen mixed berries, and tosses in a banana, a tablespoon of honey and a tablespoon of flaxseed oil, and for protein, one tablespoon of tofu. For bowel regularity he adds one tablespoon each of wheat bran, oat bran, wheat germ and flaxseed meal.
Karp also pays strict attention to his balance of bulk and fluids. “Your diet offers tremendous control for staying regular. I eat whole grains and make sure I get greens and salads.” He recommends making shakes (smoothies) with psyllium husk. “Even Metamucil isn’t so horrible in a shake,” he says. Plus he adds another good reason to avoid carbonated soft drinks: “They’re constipating.”
Lungs: Breathing Easy; Beating Fatigue
Of course, disabilities do require some conventional treatment to ensure good health. New Mobility associate editor Roxanne Furlong, who has muscular dystrophy, discovered recently that she also has asthma. “I do have to have medicine for my asthma,” she says. “I have to take pills, an allergy pill, an inhaler, and other stuff. Part of it is the asthma, part of it is the MD effect. The type of MD that I have affects the skeletal muscles, and that has to do with your breathing.”
Furlong stresses that cold can be an enemy of healthy lung function. “I can’t comfortably eat ice cream,” she says. “It’s just too cold, and living in Minnesota I have to be very careful. Like this last week I didn’t even go out. Cold triggers my asthma. I really bundle up when I do go out in the cold and I keep a scarf in front of my mouth and try to breathe through my nose and not my mouth.”
Furlong also tries to avoid caffeine. Like cold, it can dry her out and put her at risk for throat or lung infection. “My pulmonologist suggested a humidifier because I’ve been having problems lately. The phlegm just comes out of nowhere, and then I’ll start clearing my throat constantly, and I can’t cough up the phlegm because of muscle weakness.” Her pulmonologist also taught her the “quad cough” for clearing her lungs. “My husband pushes on my diaphragm when I’m clearing my throat and it pushes it up.”
The key to keeping lung problems and asthma at bay is to keep hydrated and use a humidifier, says Furlong. But like Karp, she has also found an herbal remedy that is helpful. “I met someone from San Diego who gave me this herb called Yerba Santa. She gave me just a little piece of a plant in Saran Wrap, and I swear to God it’s the clearest I’ve ever breathed in years. So now I have her send me some every once in a while. It clears you right up. You can also get it in pill form and it works the same.”
Yerba Santa grows naturally all over the mountains near San Diego, she says. “I take a little bit of leaf, no more than an inch of it, and just suck on it and bite on it a couple of times. It tastes like licorice. You can make a tincture or steep it as a tea, but I just throw a piece in my mouth and suck on it.”
Josie Byzek, NM’s managing editor, has a number of strategies for dealing with major symptoms of multiple sclerosis, but she doesn’t always play by the book. “MS is known for lung problems, but at my stage I don’t have that problem. For fatigue, I do what you’re not supposed to do,” she admits. “I drink lots of coffee and I drink energy drinks. It takes the edge off of fatigue. I follow my cravings.”
Lately Byzek has been craving veggies, spinach and eggs. “After I wrote about nutrition a few years ago, I decided the reason I craved eggs is because of the protein, the potassium, the vitamin E. And spinach has a lot of iron, and I think vitamin B, so I consciously try to eat as much B as I can.” There is method to her madness. She has learned to trust her cravings but educates herself about what her body needs.
“I’m a meat eater,” she says. “I think my craving protein has to do with my MS, which a lot of doctors think means your body is constantly somewhere fighting something. I know that I have some muscle groups that are weaker than others, and some more spastic than others, so I just assume that I’m craving it because I’m needing it.”
Byzek and her partner, Ginny Rogers, who has fibromyalgia, both have problems with fatigue, so they have learned to plan ahead. “We eat a lot of chicken,” says Byzek. “We buy boneless, skinless chicken breasts that come frozen in a bag. You can just throw a couple in a baking pan with some spices or throw them on the broiling rack with some spices. They’re low fat, high protein, healthy.
“It’s too easy to order in a pizza, so we get a lot of frozen vegetables. I prefer fresh, but frozen veggies you can throw in the microwave. Spinach, green beans, peas. I love corn. We try to keep healthy foods ready to cook with no hassle,” she says.
Stress Reduction: Prayer, Meditation, Laughter
There’s a widespread misconception that prayer is what we do when all else fails, a last-ditch whisper for help when pills or surgery don’t fix us. But contemplative prayer and meditation techniques have in common the ability to reduce stress, which has been shown to be beneficial for prevention of illness as well as healing. And studies have also validated the saying, “laughter is the best medicine,” as having a scientific basis. Prayer, meditation and humor are all inexpensive, self-directed and easy to access. Most importantly, they provide us with effective ways to reduce stress and stay healthy.
Both meditation and contemplative prayer begin with closing your eyes and concentrating on a word or phrase (mantra), or a sacred verse or deity, and letting the frustrating worries of the day fall away. While traditional meditation techniques have been around for millennia, transcendental meditation was popularized in the ’60s after the Beatles’ George Harrison “discovered” Maharishi Mahesh Yogi, the giggling guru immortalized in Paul McCartney’s ironic classic, “The Fool on the Hill.”
Like many of my generation, in 1968 I paid $50 to receive my “magic” mantra. I meditated for the first time, alone, in a small, incense-filled room off busy Westwood Boulevard near the UCLA campus. It truly was a magical experience. I envisioned descending slowly to the bottom of a calm lake, while outside a small window the footfalls of busy pedestrians and beeping traffic slowly faded. Meanwhile, my inner world grew increasingly comfy and insular, powered by my circular mantra, which gradually became synchronized with my heartbeat.
I emerged from the depths of my maiden voyage 20 minutes later, refreshed, worry-free. On the freeway back to the rented house I shared with a friend, I chose the slow lane. Everyone else, charging ahead in their 9-to-5-mobiles, seemed frantic. I couldn’t help but laugh, which I did for the better part of that afternoon. My roommate thought I was unhinged.
I meditated for a couple of years, but for me, it didn’t last. Others who began meditating with the first wave of converts are still doing it, many of them with impressive results. Studies have shown that regular transcendental meditation can reduce blood pressure and heart rate, and many practitioners swear it’s a great way to manage worry and anxiety.
Today I rely on contemplative prayer, another proven ancient technique, for stress reduction. I will memorize a verse from the Book of Psalms, for instance, and repeat it over and over with eyes closed, much like a mantra, only my focus is on a positive theme like love, forgiveness, redemption, or on giving thanks for a specific blessing that I attribute to God. When I emerge from prayer, I feel grateful and hopeful, and stress has been neutralized.
Byzek also spends time in prayer. “I was raised Catholic,” she says, “so when my mind’s just too busy and I can’t slow down, I find the rosary helps. You pray one bead at a time the way it’s intended and it just shuts your mind down. It’s a good deep meditation technique. And the prayers remind you that there is someone else in control, and you can rest.”
Surprisingly, John Callahan, whose irreverent cartoons often lampoon religion, and especially nuns, has experienced similar calming results with prayer. A Jan. 10 article in his hometown (Portland, Ore.) alternative newspaper, Willamette Week, reports Callahan’s “anger and resentment toward women, especially strong women, simply dissolved one summer afternoon” when he paused and said a prayer before passing a statue of the Virgin Mary. “It sounds so goofy,” Callahan is quoted as saying, “but I had almost a spiritual experience.”
Callahan’s cartoons are better known than his prayers for reducing stress. Whether you consider them sick, dark, or inspired social satire, his cartoons are often good for a belly laugh. Researchers are now saying that laughter changes brain chemistry and boosts the immune system. A 2005 University of Maryland Medical Center study also found that watching stress-inducing war films reduced blood flow, while videos that provoke laughter resulted in vasodilation of the brachial artery and increased blood flow. Could laughter be medicine for the heart?
If so, playwright and NM satirist Mike Ervin is on safe cardiovascular ground. Besides writing columns that make us laugh, he tries not to miss a two-hour Chicago TV program of The Three Stooges’ classic films every Saturday night. “If you need a fix,” he says, “you can just turn it on.” He also gets a laugh out of the Marx Brothers and Monty Python and tries to hang out with people who like to laugh. “It’s not like I test people before I hang out with them,” he quips. “We’re just drawn to each other.”
Mutual attraction based on a shared sense of humor is also important in overcoming marital stress. My wife and I have been known to argue and bicker until we’re blue in the face, but when she morphs into her wounded velociraptor imitation, it cracks me up. She’s a gifted physical shtick mime who surprises me with a Charlie Chaplin walk or a purposely bad ballet move when I least expect it. And she’s always ready to play. Recently we spent almost an entire week communicating in duck talk. Believe me, it’s impossible to argue when you can’t understand a word your spouse is quacking.
If you’re single and don’t have someone around to make you laugh, try singing in an exaggerated operatic voice in the shower. Not funny? Pretend you’re an Italian chicken, then sing. A tip: Elderly hens are funnier than roosters. Buk buuuuuk. And remember Bobby McFerrin: Don’t worry, be happy.
Osteoporosis: Hidden but Preventable
By Teal Shearer
Eleven years ago, at 14, I became an L2 para from a car accident. My doctors not only saved me, they did many things to improve my quality of life. They performed eight successful surgeries and took great care of me whenever I visited their offices. They gave me good advice and I put my trust in them. Unfortunately, I recently discovered that something terrible happened to me because of something my doctors neglected to do. What’s worse, others with SCI are also at risk.
Several months ago I had an operation to repair two lumbar vertebrae, a complicated procedure, but my doctor was confident I would get through it safely. Unfortunately, halfway through the operation, he discovered that the bones in my lower spine were porous and brittle. When he tried to remove bone from my sacral area to use in a fusion, it literally crumbled in his hands. My bones then began to bleed. I had such massive blood loss that my heart went into arrhythmia and I almost died.
Thankfully, my doctors were able to control the bleeding and transfuse enough new blood into me to stop my irregular heart beat. They told me that I survived because I was young and in good shape.
After a long recovery, I was referred to a rheumatologist who gave me a bone density test. The results were shocking: I had severe osteoporosis. I couldn’t believe it. Osteoporosis, a disease that makes bones thin, weak and easy to fracture, usually affects older individuals — in particular, post-menopausal women. I was only 25.
I thought I was doing everything right. I used a motorized leg bike to exercise my legs. In addition, I used an arm bike, lifted weights, ate a healthy diet and stood in a standing frame. Unfortunately, being young and in good shape wasn’t enough. I had the bones of a woman three times my age.
What disturbed me most was my rheumatologist wasn’t surprised. He said that because I had a spinal cord injury, osteoporosis was bound to happen. Why didn’t I know this? Why hadn’t my doctors warned me?
The worst part is that it could have easily been prevented. A simple bone density test, in which a special x-ray is used to measure the amount of calcium and other minerals in the bones, would have shown that I was at risk for osteoporosis. Then, with proper medication and supplements, I could’ve stopped the disease in plenty of time.
Unfortunately, there are no symptoms associated with osteoporosis. Most people have no idea they have it until it is too late — usually when they break a bone. I recently met two people who had this happen.
Amanda is 26 and has a C7 injury. One day she lost her balance, fell out of bed and broke one of her legs. When Amanda went to see her doctor, he discovered she had severe osteoporosis.
Jerry is 44 and has a T5 injury. Jerry also broke his leg. But unlike Amanda, he has no idea how he did it. This is not uncommon for people who have osteoporosis. In some cases, bones can become so brittle that something minor and unmemorable can cause a break. Some people with osteoporosis have fractured ribs from simply coughing.
Jerry and Amanda are not alone. I have spoken to over a dozen people with SCI at various well-known rehab centers who had no idea that osteoporosis is common, and preventable.
While searching on the Internet, I learned about Rick, a C6 quad in his 30s. He had always been very active and in good health. One morning while sliding on his pants, he heard a SNAP. Just like that — a broken hip. After-the-break diagnosis: osteoporosis.
There is no cure for osteoporosis, but thankfully there are helpful treatments. I am taking Forteo, the first and only approved drug that strengthens bones by building new ones. To increase its effectiveness, I take it with a calcium and vitamin D supplement. I have blood work and a urinalysis done every six weeks to track my progress.
I recently had my first follow-up appointment and my bone density is already showing improvement. I feel positive about the future, but that does not change the fact that my ordeal could have been prevented. People with spinal cord injuries are at a high risk for developing osteoporosis. It only makes sense that doctors should make sure that we have periodic bone density tests.