I would like to try manipulation for a stiff toe problem

Gary

I would like to try manipulation for a stiff toe problem. However, I am concerned that this may just cause further damage to the cartilage/joint and/or speed up the arthritis. I have read that rest is the best thing. What do you think?

I damaged my toe about 8 years ago which set off this problem and have periodic bouts of pain, which last a week or so and then can clear up for a couple of months. My doctor says the range of movement is good enough that it would not classify for surgery on the NHS in the UK (I could go private but I am not keen on surgery in any event). I am 57 and pretty active e.g. running, walking.

Back pain, surgery, glucosamine and triathlons

Hello Gary, I have just come across your website and I must say its bloody fantastic.

I am an age group triathlete (41year female) who last year had diskectomy surgery on my lower back and am now suffering from painful degeneration that has caused me to cut my running right down (replacing with crazy fast walking) and I am finding the swimming painful too. I have just started taking Glucosamine tablets and am trying hard to not take as many panadol as I am sure it cant be good for me.

My goal is to NOT go and have fusion surgery but to still be able to race and train comfortably for as long as I can.

I was interested in your u tube piece on the various joint supplements but am now a bit confused as to what I should be taking can you help. I have also been reading many online articles about it and some say its not been proven to work and some say its fantastic, what is your opinion?

I really look forward to hearing from you. "L"

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Gary Moller responds:

"L"

Glucosamine works more often than not when taken in ample quantities, consistently and for several months. It can be beneficial for back pain because the spine is a complex series of semi-mobile joints, so the same principles of joint nutrition apply.

Read my book on back pain carefully. More or less, leave the spine alone and concentrate on mobilising the hips which may be very tight as a result of all the repetitive running, cycling and swimming you have been doing over the years. Doing so may relieve stress on the low back, especially when you walk and run.

Get a trained massage therapist to massage your low back and backside muscles, locating and focussing on painful "trigger points". You will require from 6-8 sessions every 4 or so days for relief.

Try a warm Epsom Salts compress on the low back and soak in a hot bath with a cup or two of Epsom Salts. The magensium and sulphur soak through the skin into the body and aid relaxation of muscles and nerves and with tissue healing.

All of the products mentioned in this article are available from http://www.myotec.co.nz/

Given your age and sporting background it is possible that you have burned your body of B vitamins and minerals, principally magnesium. If you are like 100% of everyone I have so far had tested you will be low in vitamin D. Deficiency in any, or a combination of these, will be significant factors in ongoing joint and muscle pain and failure to get better, such as you are suffering. If such deficiencies exist, then no amount of exercise, physio, manipulation, drugs, surgery or rest are going to provide lasting benefit. You must get the chemistry within the body right first for there to be a restoration of vitality and healing to the max.

Further surgery is your final option. Surgery of the type that results in loss of mobility of any joint, including in your lumbar spine, may cause additional stress on the joints located immediately above and below and they may eventually fail.

"L": Give the conservative measures of Mother Nature and Father Time a chance to work their magic. Relax! Put your feet up; your body is telling you that it needs a rest. Be lazy for a few months. Go on a South Seas winter holiday in Rarotonga and lie on the beach and eat good food for as long as you can. Find ways to pamper yourself (triathlons are punishment and you need counterbalances). Body and mind will tell you when you are ready to recommence training. Being in a fresh state, you may find that you have lost little and are very soon doing personal bests.

It is often the case in sport that more is less. Less can mean less punishment on the body and better quality of training and comnpetition. This can equate to injury resistance and higher end performances.

If you are in Wellington I am available for consultation.

Stomach surgery 'needed for teens'

"Surgeons are calling for children to be offered publicly funded stomach-stapling operations in a bid to treat soaring rates of extreme obesity.

New Zealand hospitals have been reluctant to consider weight-loss operations in young adolescents because of the risks of major surgery, and the potential for long-term complications such as nutrient deficiency.

However, growing numbers of teenagers are so overweight they are suffering diseases previously seen almost exclusively in adults.

These include type-2 diabetes, sleep apnoea, high blood pressure and gall bladder disease.
Some are at risk of heart attacks and strokes in their 20s.

Paediatric surgeons are saying it is time to make stomach-stapling surgery more readily available with the complicated health needs of morbidly obese adolescents now impacting on the care of other children.... The surgery can cost between $12,000 and $20,000 and about 400 a year were done, most on adults and only a handful publicly funded. "

To read the full article, click on the title above.
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Gary Moller comments:This kind of surgery produces a very uncomfortable feeling in my gut. The reason why is that stomach stapling surgery is an over-priced solution that, at best, only indirectly targets the cause which is the lifestyle of the positionally challenged. It is symptomatic of irresponsible, neglectful parenting, poor food choices and a societal bureaucracy that engenders a fear of all things natural, including the outdoors, sunshine and water.

There is an alternative to stomach stapling: I used to run rehabilitation programmes for long term Accident Compensation clients: people who had been seriously injured, incompletely rehabilitated following surgery, consequently losing their jobs and becoming unemployable due to ongoing health problems, loss of work skills, confidence and poor personal habits.

Rehabilitation focussed on gradually replacing old unhealthy habits with healthy ones. This was a challenging process that took 12 weeks to be successful. Successful it was, and almost without exception - and for a cost of from $3-$6,000. What was a constant frustration were the constant demands by the health and funding agencies to cut back on the cost of these programmes, the preference being to spend their money on high technology surgical solutions at quadruple the cost or more. These intervention programme were progressively reduced to about 5 weeks for several hundred dollars - effectively rendering them a complete waste of time.

The same model of gradual behavioural change can and should be applied in cases of extreme childhood and teen obesity and they need to involve the entire family. Costing probably no more than $6,000 and lasting 12 weeks, the outcome will be fit, strong and healthy families that play together.

This is a far better prospect than surgically turning out thinner teens who then face uncertain lives that are still a constant daily preoccupation with food and at serious risk of malnutrition-related ailments and shortened lives.

Note: The Google Adsense ads to the right of this article can interesting to peruse. You will see that there is quite an industry, involving drugs and surgery, surrounding obesity. It is no conicidence that the call by surgeons for public funding of this kind of surgery for teens comes at the time of year of greatest over-indulgence and just in time to capitalise on all the New Year's resolutions for weight loss. Am I just being too cynical?)

Herniated Disk Improves With Either Surgical or Nonsurgical Treatment

"Patients with herniated disks had improved outcomes during 2 years whether treated surgically or nonsurgically, according to the results of a randomized trial with an accompanying observational cohort reported in the November 22/29 issue of JAMA.

"these findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference. For the patient with emotional, family, and economic resources to handle mild or moderate sciatica, surgery may have little to offer."

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Gary Moller comments:

The terrible suffering and restriction on that severe back pain causes can probably never fully appreciated by others more fortunate.

With modern imaging techniques, detailed pictures can be obtained showing herniated discs and other mechanical abnormalities. Modern keyhole microsurgery makes the surgical solution increasingly attractive. But is it really that more effective than a decent physical therapy programme and the progress made by Mother Nature herself over time? This study, and many others over many years, show little extra benefit in most cases of going down the surgical track.

In most cases surgery must still be supported by months of progressive exercise to regain as close to full strength and mobility. This is more or less the same path as the non-surgical treatment approach anyway. Over the long term, there is little to separate the two paths in terms of final destination. I know that from experience of working in back rehabiliation for about 15 years.

If you are suffering back pain; unless you are losing sensation and function, then my advice is to take your time with deciding whether or not to take the surgical path to recovery.

Get the imaging done by MRI or ultrasound (DO NOT allow your internal organs to be irradiated by a cancer producing CT Scan). Discuss the results and the need for surgery with your specialist. Before making a final decision, if surgeryt is recommended, take the results of the imaging away with you and consult a range of back experts who have been in practice for at least 10 years - a physiotherapist, chiropractor, osteopath, various doctors and don't forget the Chinese therapist with the incomprehensible qualifications. If you undergo any treatment with any of them, do not allow any procedure to continue if you feel uncomfortable - tell the therapist to stop and discuss your concerns. Sometimes a regime as simple as a proper exercise programme, massage, stretching and a few key nutritional supplements can give gradual and lasting relief.

All surgery involves an element of risk. The outcome is never assured. The big worry nowadays is hospital based infections. Ask your Dr what the post-operation infection rate is in the hospital you are being referred to. If he/she does not know, you should insist on finding out. Hospitals prefer to keep this kind of information quiet for obvious reasons. Your Dr should know and so should you.

If you have back pain or a friend or relative who is suffering, a good present for the Xmas stocking is my book on Back Pain. You are always welcome to write in with your questions and concerns.

Having surgery - which doctor is best?

Any surgery, no matter how minor, carries a degree of risk. In fact, the most appalling medical balls-up I have ever encountered happened during an operation to remove a small mole from the cheek of a fit young man. After spending a year or so in an old people's nursing home as a near vegetable, he finally died the most agonising of deaths.

Choose your surgeon carefully - you can't trade in your body if something goes wrong!

• Choose a Dr who is at the peak of his/her professional powers: between 35 and 60 years of age is a good rule of thumb. Stay away from the brilliant young ones and the doddery old ones who are long past retirement.
• Be wary of the foreign trained Dr. I recall a Dr friend telling me of his concern when he noticed a foreign trained colleague taking a quick look through a text book prior to undertaking a potentially risky procedure!
• Get a specialist surgeon and not a general one. If it is a knee op, then get a surgeon that specialises in these; if it is a back op, then go to a back specialist
• Be wary of the latest technique: if the surgeon has not done at least 50 of these "new" procedures, don't volunteer to be a Training Dummy.
• Be wary of having it done in a training hospital: the specialist might be tempted to go on an ego trip in front of the students while poking about your insides; worse still, one of the students might be allowed to "have a go" on you.
• Private is not necessarily the best. The same surgeons that operate in the public system often work privately. Private hospitals may not be properly equipped for emergencies, relying on emergency transfer to the better equipped public hospital. This is what happened to the man with the mole, with the subsequent delays causing irreparable harm.

Find out the following:

• Is there a problem with antibiotic resistant drugs in the hospital at which the surgery is planned? These awful bugs are a growing problem in hospitals, despite attempts to keep this quiet. Choose a hospital that is certified free of these bugs.
• Who is the surgeon with the lowest failure rate? Ask people who have had the procedure. Speak to therapists like physiotherapists, occupational therapists, osteopaths and chiropractors about who they think is best for a particular procedure. If you can get it out of them; ask who to avoid.

Take your time. Take your time!
Is the operation really necessary? Are you being recruited as un-witting high profit contract padding? Here is NZ much orthopaedic surgery is unnecessary; but happens because of the Government contract purchasing of millions and millions of dollars worth of surgery for hips, knees etc. These production line contracts are made all the more profitable when the more costly "necessary" ones are padded out by the many operations that need never happen and which would be better managed by non-surgical methods.
If the answer is that it can wait, then why not wait? Procedures improve, new ones are developed and, surprise - surprise! Things often get better of their own accord. Especially if you have been following my exercise, nutrition and lifestyle advice.

Hospital Dumps 1,800 Patients off Waiting Lists

The Hawke's Bay District Health Board has unanimously approved a move that would see 1,800 people cut from its waiting lists. They will have to go back to their GPs with no hope of surgery in the foreseeable future. Board CEO Chris Clarke says the hospital cannot keep up with the rising demand for its services. 12/04/2006NewstalkZB

Gary Moller comments:
This news is hardly a surprise and something we are all going to have to get used to as our populations age and the positionally challenged youthful generations begin to get old and suffer diseases of old age, such as diabetes, osteoporosis and CHD, in their 30's and 40's. The current medical model simply can not cope with the tsunami of ill health.

When I was doing my studies in rehabiliation through the Otago School of Medicine, our lecturers frequently referred to the "dreaded specialist appointment". This appointment was dreaded by rehabilitation health professionals because it signaled that nothing would, or could, happen with a patient while waiting to see a specialist. Of course, this appointment would be several months out and it usually would take more than a few further appointments before anything of substance would happen.

A typical interaction between a therapist and a patient goes a bit like this:

Therapist: "I would like to start you with a gentle exercise programme to begin strengthening your lower back"
Patient: "I am not allowed to do anything like that until I have seen my orthopaedic specialist about my suspected prolapsed disc".

Nothing happens and any opportunity for early and active intervention is lost because a lesser expert cannot pre-empt the specialist that is yet to be consulted. This is very frustrating.

What we know is people on waiting lists do not get better; the rule of thumb is that they deteriorate. Adding to the problem; if a person is unable to work, due to a health problem, the chances of getting them back into productive employment plummets with each week they are laid up. After about 3 months, the odds of getting this person back into employment are looking pretty grim.

I have written about this growing problem many times and published a substantial discussion paper that offers one piece to the jigsaw, as far as solutions are concerned. You can read it here.

Resorting to dumping people off waiting lists is not the solution; although it might help a little over the short term by enabling some kind of intervention to begin, instead of having the patient sit around doing nothing and getting worse. Sadly, general practitioners, who are now being asked to deal with these dumped patients, are poorly equipped to offer lasting solutions to ailments that are mostly the result of ageing, combined with the effects of poor lifestyle and nutrition choices.