Hallux Rigidus and a man with Parkinson's Disease

Gary, I am a 55 yr old man with Parkinson's Disease (PD) (diag. in 2004) who just had knee replacement surgery (left) in Dec. of 08 and have been diagnosed as having Hallux Rigidus in my right great toe by an orthopedic surgeon who is a foot specialist.

I have always been an athlete (college football) , backpacker, golfer for my entire life, but due to the PD (my right side is the affected side). I have had to cut back or cut out a lot of my activities due to complications caused by the PD. My changed gait caused an already arthritic left knee to deteriorate more quickly , thus the need for the replacement. I am doing real well with that, but my right great toe has gotten worse thru the last 6-12 months due to my shuffling gait where I tend to walk on the balls of my right foot. I can still move my toe up and down some, but not much and it is swollen.

I used to take Glucosamine Chondroitin for several yrs and felt it helped but wasn't sure if it was just in my head or if it really helped. Also, due to the cost of the meds for the PD, something had to go, so a couple of yrs ago, I stopped taking it.

I am reluctant about having the toe surgery and was wondering what to look for to find a good massage therapist in order to persue that course of action and what else would you recommend I consider? "M"
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Gary responds:
Additional information - medications:

• Mirapex .75mg for Parkinsons
• Stalevo 75 mg for Parkinsons
• Lisinoprol 20 mg for high blood pressure
• Mobic 15 mg anti imflam.
• Used to take high doses of Q10 for PD

There is a possibility that there are a couple of associations going on between your joint pain, blood pressure and Parkinsons. While it is not advised that you stop any medication, please talk to your doctor about the following suggestions, including questioning the need for taking the blood pressure medication. The priority is managing the PD. Blood pressure medication may be one medicine too many because one can easily lose control of the drug interactions. Most cases of blood presssure can be managed without the need to resort to drugs.

Try to keep the drugs regime as simple as possible - You have a war on your hands: One of the big lessons of the 2nd World War was not to fight on more than one front at a time.

Vitamin D deficiency
There is an association between Parkinsons and vitamin D deficiency. While it may be associated with causation, it does not mean it is a cure. Restoring vitamin D levels to "optimum" may slow its progression; but this is conjecture. Then again, the only side effect of restoring vitamin D is good health, so why not do it! Low vitamin D is also associated with cardiovascular disease (blood pressure) and joint softness, including osteoporosis and arthritis - to name some. You can take 4-6,000,iu of natural vitamin D while going to your doctor and getting a 25 (OH)D blood test (send me the results for interpretation).

Check your homocysteine levels
The medication you are on to treat your Parkinsons is known to increase homcysteine levels. There is also an association between homocysteine and Parkinsons. Homocycsteine indicates oxidative stress which is closely linked to degenerative diseases including joint destruction. If levels are even slightly elevated, take a drink of Nutralife Loadup Fruitful Greens and/or Berry Brights three times daily and take a quality daily B multivitamin like Nutralife Ener B (you can get these off this website.

Check your footwear
With Parkinsons there is a tendency to shuffle. Ensure your shoes are sturdy enough to protect the toes from stubbing and that there is ample space in the toe box. You could try replacing the innersoles with Formthotics Shock Stop which you can get off me. These are heat moulded using a hair dryer to shape your feet.

On this issue of shuffling: take up activities like Tai Chi and social dancing. Rhythmic dancing may be just what you need to keep you out of the shuffle habit. Try marching using music and call "Left-Right-Left!" loudly to keep timing with the beat. Stride out really long. Heel to toe jogging/walking on a rebounder, again using a beat may help. Take car ewith balance. You can obtain additional exercise on a exercycle or rowing machine.

Lift a light weight daily several times from ground to stretch above your head. Breathe deep. It is most important to maintain upper body strength, to stretch open the rib cage and to counter the tendency to slump forwards. Sit up straight.

Mobilising the toe
Once you have addressed all of the above and given them a few weeks to kick in, you may consider the exercise of progressively mobilising the toe. Please do so with the guidance of your doctor. Please read the articles about toe mobiliation that I have written by clicking on the label words at the base of this article. Among other things you will read my advice about finding a suitable therapist in your area, plus more advice about nutrition and supplements for artritic joints.

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Just how effective is glucosamine and chondroitin for repairing joint damage?

"I've just recently learned through a series of tests that i'm suffering in my knee from advanced wear and tear. I'm not exactly sure how to say it, as i'm no expert yet, and i don't remember word for word, but the Doc basically said the results look like the results that may typically come in from a 50yrd, and i'm 27. Arthritis, bones rubbing in the joint, bone expanding due to rubbing... etc. He assured me not to take this out of proportion, and that we'll have a much better picture of what's going on once we have the MRI done, which is coming soon. For starters, i couldn't believe the results! at first, a little shocked and sad, but i'm definately not one to let a negative thing remain negative. I want to turn this around, and make a positive here, and be proactive in REPAIRING and hopefuly, fixing this problem. I came accross Glucosamine, and heard what it does. i became very interested. Essentially, the heart of every arthritis matter is cartiliage wear i guess. So, if this promotes the repair of cartiliage, then this is very intersting..

Sorry for drawing this out, but basically, what i wanted to know from you is how effective this stuff is in rebuilding and repairing joint problems? If i keep on this stuff, and i've already noticed a difference (i'm taking this nutri-flex fluid formula that contains the MSM and glucos) can i repair and/or prevent further damage?
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Gary Moller comments:
I have now had about 15 years experience with people using these glucosamine and chondroitin products and I have no doubt whatsoever that they work - in most cases; but not all. This view is more or less supported by the growing body of research on these natural nutrition products.

It just makes sense that a nutritional approach to managing arthritis would work best if utilised early in the development and while the person is young. While this may be the case there is evidence that these can also be beneficial for old joints and are even effective for pain relief in advanced joint wear.

I am curious as to why you have running and so much wear at such a young age? If there is joint damage such as a lax or ruptured knee ligament, then this should be repaired by a specialist knee surgeon now - while you are young. Do not leave it too late. Sort out the underlying causes of the wear and get it fixed asap.

In your case, the best joint food preparation is probably Balance Joint Food for Athletes. This is formulated for young joints that have been injured. Take the maximum recommended dose for at least three months and continue indefinitely at lower doses and certainly for as long as there is any sign of joint pain, tenderness or swelling. You must do all you can to care for your joints. Your knees have many, many years of hard work ahead of them.

Body PH (acidity) and health

Degenerative diseases, including cancer, heart disease, osteoporosis, arthritis, kidney and gall stones, and even tooth decay are associated with excess acidity in the body.

Acidity in the body can result from several factors coming together to overwhelm the body's natural mechanisms to maintain a slightly alkaline environment of about PH 7.4. These include physical and emotional stress, poor circulation through muscles, limbs and organs, various medications and a poor diet.

So, if you are in a stressful job, unhappy at home, competing hard in sport and eating a diet that is high in acid producing foods you may be setting yourself up for ill health or injury.

The body has a mechanism which maintains a constant pH 7.4 in the blood, this works by depositing and withdrawing acid and alkaline minerals from other locations including the bones, soft tissues, body fluids and saliva. Therefore, the pH of these other tissues can fluctuate greatly. The pH of saliva offers us a window through which we can see the overall pH balance in our bodies.

Some minerals are highly acidic in nature, forming acids like hydrochloric acid, phosphoric acid and sulphuric acid. Others are alkaline, forming base solutions such as calcium, magnesium and sodium hydroxide. These counter the acid forming minerals.

The ideal PH for the human body is in the 7.5-7.1 range.

The range from 6.5 (weakly acidic) to 4.5 (strongly acidic) represents states from mildly deficient to strongly deficient, respectively. Most children are pH 7.5. Over half of adults are pH 6.5 or lower, reflecting the gradual rundown that happens with a stressful life, inadequate diet and the accumulating effects of injury and illness. Cancer patients may have a very low pH of 4.5. Cancer cells thrive in a acid environment.

While I would never go so far as to suggest that an acid environment causes disease, it certainly is associated with ill health, including sore muscles, sore bones, stress and generally feeling tired and unwell. It becomes a "chicken or the egg" question. But who cares? Who cares when the solutions to an acid body are so simple and a person invariably feels damn good when body PH is restored to about 7.5.

A low PH is very common in sports people who are over-trained, eat poorly and who have tight and tense muscles.

The first step is to get your body PH tested. I can do this for you if you are in Wellington using a simple saliva PH Litmus test. Once we know what we are dealing with, we can then set about correcting matters. This usually consists of:

• Eliminating or reducing acid foods from the diet
• Eating more alkaline foods in the diet
• Taking an alkaline supplement from the Floradix range of tonics
• Rest
• Massage

The massage is a fascinating one. Tense muscles store acidic metabolic wastes that slowly leak into the rest of the body, poisoning it. If I test body PH before massaging a stressed and toxic body, PH is generally lower than 7.4. Immediately following a massage, the PH can drop several more points, indicating that the body has been flooded with acidic metabolic toxins. This helps explain why a person may feel a little ill for a couple of days after a massage. It also explains why they end up feeling great if they stick to the plan and do several massage sessions on the trot. They feel great because their body has been steadily squeegied of metabolic toxins.

Foods that are acid and alkaline:

• Strongly Acid foods include: meat, fish, soft drinks
• Mildly Acid: grains, legumes, nuts
• Mildly Alkaline: fruits, vegetables, berries, dairy
• Strongly Alkaline: green leafy vegetables, cabbage, brocolli, spinach, sprouts and cucumber

About PH
"Some problems that can indicate acidosis include: bladder and kidney conditions, immune deficiency, diabetes, weak brittle bones and lactic acid build up. PH is behind the body's electrical system, intracellular activity and the way our bodies utilise enzymes, and minerals, and vitamins. That is why pH is one of the first things to be looked at if you are experiencing an imbalance in your body. Decades ago Dr. Otto Warburg, the only physician to ever win two Nobel prizes, proved that cancer can not exist in an alkaline/high pH environment.

We can eat more alkalinic foods which include brocoli, carrots, dried figs, celery, grains and many fruits. On the other hand, the active ingredient in the soft drink Coke is phosphoric acid. Its pH is 2.8 and it will dissolve a nail in about four days. The phosphates in soft drinks bind to calcium and we can't absorb it. The typical Western diet is largely composed of acidic or acidifying elements (proteins, cereals, sugars). Alkaline foods such as vegetables are eaten in much smaller quantities; their alkaline content is insufficient to neutralize surplus acids.

Stimulants like tobacco, coffee, tea, and alcohol are also extremely acidifying. When we get angry or stressed we are also making the body ph more acidic. Our ph changes not just from the foods we eat, but due to our emotional states". Source: Your Body's ph And It's Relation To Your Health

Does gelatin reduce joint arthritis and joint pain?

Dear Gary,
I have a friend with a background in food technology. He has had some severe arthritic problems with his knees and began taking doses of gelatine. After several months of taking this he maintains that he has had considerable improvement both in his mobility and a big reduction in pain.

Have you heard of this as a treatment of arthritic problems?
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Gary Moller comments:

Athol,
Your friend is definitely on the right track. It depends on how refined the gelatine is. I would assume that there are quantities of chondroitin, one of the constituents of joint cartilage in the gelatine. Of course, there are other constituents of cartilage that may be in the gelatine from the rendering process. The less refined it is the better. Home made is best. Read on!

The best way for people to get these and many other valuable nutrients for joint and general health is via bone broths such as those that Grandma swore by. Get a kilo of beef, lamb or free range chicken bones from the butcher and simmer for a few days to render them down, boiling out all of their goodness into a rich broth of proteins and minerals – and gelatine. Here is the recipe.

Gelatine has several health benefits, including aiding digestion and soothing the gut. It holds water in the digestive tract and helps soothe and keep the intestinal wall in good health. It aids the absorption of nutrients from the digestive tract. Gelatine is a constituent of collagen which is the material that holds us together at the cellular level! As we age, we sag. We need more gelatine in our diets as we get old.

In addition to the gelatinous broths, I would not hesitate to add a commercial glucosamine and chondroitin formula to the mix. These preparations are concentrated sources of the nutritional substrate that makes up healthy joint tissue: glucosamine, chondroitin and nutrients such as trace minerals and vitamin C

Wishing you good health

Knee Pain

Mike wrote:
"This product (Nutra-Life Joint Factors 4500 - Ed) has been brilliant. The problem I have is with my left leg, which was twisted in a skiing accident when I was 15. While it always made its presence felt, it only threatened to become incapacitating when I reached about 55. The joint factors has allowed me to keep on exercising as I always have done. I am running up to 50 minutes about twice a week at the moment.

Another thing I have appreciated since your talks at last year at our company is the advice on diet. In particular, the change I made to breakfast (now muesli, fruit and tea only, (except for now and then!)) and stopping taking sugar in coffee and tea, have been very beneficial."
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Gary Moller comments:
Knees, knees, knees - I get so many inquiries about painful knees nowadays! Is it because of the tsunami of active Baby-Boomers now hitting that age when injuries of old are starting to fester their way to the surface? Is it because keyhole ops for niggly knees are flavour of the month? Is it because commonly prescribed medicines for knee pain only deal with symptoms and not the cause? Is it because contract health providers are mostly focussed on outputs rather than outcomes? Or is it all of the above?
The answer is "YES" to the lot!

So, your knee(s) hurt for some reason? If you go to a surgeon, you will be operated on. If you go to a rheumatologist, you will be prescribed a powerful medicine. If you go to a physio, you will be given utra-sound and strange exercises. If you go to an osteopath, you will be massaged and manipulated. If you go to a podiatrist, you will be given $500 orthotics, if you go to a personal trainer, you will do lots of funny exercises and go on a diet. Sounds uncomfortably like a lottery to me, I reckon! Currently, in NZ, if you have a knee problem, you will probably be sent to the surgeon. Heaps and heaps of knee ops are happening.

With the focus on surgical outputs (ie: number of ops performed this year as compared to last year) patients are being recorded as successes whether pain-free post-op or not. There is generally no followup at all once the stitches are out and no way the patient can provide useful feedback to the surgeon and funding agenices - like Mike (above) has provided me several months down the track. This is an extremely unsatisfactory state of affairs: My impression is that there are legions of people out there who are not fully recovered from their knee ops and some are, in fact worse off! But, by all accounts, they are recorded as "successes" of a system that is working well. No proper feedback loop = bad service and much waste.

Body heal thyself
During my training years ago, we were told that joint cartilage is incapable of healing itself. The standard procedure with a cartilage injury was to cut the whole thing out. This was a terrible action, in retrospect, condemning many to plastic joints about now.



What we do know nowadays is that cartilage, even in old age, is capable of self repair. Even in the case of tears (so long as they are small) healing can happen - so long as the joint is protected from further injury and given the right nutrition and exercise to help the healing processes.

Cartilage in mature adults does not have a direct blood supply so it heals poorly when damaged, be that from overuse or direct trauma like twisting the joint while under pressure. But it still is living tissue that is constantly being replaced by new tissue. It will heal with time and the right care. This process of repair relies on the supply of oxygen and nutrients to the cartilage cells and the removal of wastes via the fluid inside the joint called "synovial fluid". This exchange and tissue repair is enhanced by:

• Rhythmic movement of the joint through its full range of movement
• Oscilating compression and decompression of the cartilage
• Keeping the joint warm
• A diet that is rich in the ingredients that build healthy cartilage tissue
• A diet that is rich in anti-oxidants to soak up free radicals before they can harm the healthy cartilage cells
• Avoiding medicines, including anti-inflammatories and aspirin, that inhibit cartilage cell activity

So, you will gather that dealing with knee pain is not via a single one off solution like surgery or drugs. It is a multi-factorial and long term project.

Repair has to exceed wear

This is the name of the game - the game of life, in fact: even several hours after you die, tiny cartilage cells are still beavering away building new tissue to replace the stuff that you have damaged through sport and normal activities of life. While you still breathe, you must do everything to assist these busy little fellas with their job of keeping you mobile and upright. This consists of:

• Minimising harm by avoiding excess wear and injury
• Giving sufficient time for repair and healing before the next assault
• Ensuring optimum nutrition and circulation for joint health
• Doing full range joint movement to spread the synovial fluid, thus aiding nutrient exchange

So, here is a list of what you can do for joint health:

• If you statically stand or sit for long periods at work, break these up at every opportunity by striding about, lying down, sitting, pulling knees to chest, jogging and squatting. Wear shock absorbing shoes, fit quality inner soles. If surfaces are hard, get soft non-slip matting fitted
• Take the joints frequently through their full range of motion. For the knees; try repeatedly pulling the knee to the chest, then extending fully, tensing the thigh hard. This can be done sitting, standing or lying on one's back
• Keep the knees warm in cold weather by heating the room and wearing warm leggings when exercising. A long hot bath does wonders for aching joints
• If you do a really punishing thing like running a marathon, rest 5-10 days after and do not repeat this kind of abuse for at least another 3-6 months. Read our Guide to Running a Marathon
• Do aqua-jogging once or twice a week the way recommended here
• Add a machine-based Pilates session once or twice a week to your exercise programme. This will strengthen the muscles that support your joints as well as taking them through their full range of motion
• If you are over the age of 35 or have ever had surgery on a knee, consider taking a quality formulation of glucosamine and chondroitin (joint food). This supplies the nutritional substrate for healthy joint tissue. Take the maximum recommended dose for at least 3 months before easing off regardless of whether or not any benefit is noticed
• Take a multi vitamin, anti-oxidant and multi-mineral with the joint food, including vitamin C (A quality joint food formulation will also contain some of these essential vitamins and minerals)
• Take fish oil, flax seed oil and cook using a quality olive oil. These improve circulation, are essential for healthy joint collagen and have a mild anti-inflammatory effect. They might even help lubricate the joints
• If you are carrying excess body weight, gradually lose it over several months through exercise and healthy eating
• If you get knee pain from activities like cycling and running, your style or setup might be faulty. Get it checked by an expert.
• Feet are a common cause of knee pain. Read this e-Pub about the subject
• If you are diabetic, ensure the condition is absolutely optimally managed
• Only take anti-inflammatories, including aspirin if absolutely necessary (I'll write about this matter including non-drugs pain management measures in a future article)
• Do not have cortisone injections into joints. Read this article about this subject

On the question of joint surgery: If you are earmarked for an op or have been advised to have one, you are welcome to give me a call to discuss this and possible options. While I do recommend the surgical option now and then, there are many cases where this option has been prematurely exercised. Surgery does not always work out over the long run and may compromise the benefits of more conservative measures like nutrition and exercise.