Ankle Fracture - How to speed bone regrowth and muscle strength

Hiya Gary,

...I enjoyed but was flabbergasted to read the articles about long-term effects of bisphosphonates. Really scary!

(Gary: Google "gary moller fosamax" for these articles)

I have another concern to bring to your attention. I had a silly fall - just a little trip down two small steps - but as a result found myself with one pretty badly broken ankle and both legs with torn ligaments ... ouch painful! I was x-rayed, shown a clear break and a crack in one leg and subsequently placed in a fibreglass cast to help and support during the healing process.

Eight days afterwards I collapsed at home and was rushed to the ER. Apparently a clot had formed at the site of the injury behind the cast and subsequently traveled up through the leg veins and towards my lungs where the clot split and relocated in smaller clusters of clots in both my lungs. I was completely unable to take full, deep breaths and my blood oxygen had fallen to potentially disastrous levels. I had what appeared to be a typical lower leg DVT and subsequent pulmonary oedemas. As an in-patient in the hospital I was started on the routinely given Warfarin anti-coagulant treatment - but I reacted badly immediately - excessive bleeding and weird enzymes produced by my liver (sorry don't know all the clinical names).

I was then put on daily injections of Clexane (enoxaparin sodium) and have been told to self-inject until the year-end and thereafter I shall be told to take 'an aspirin a day for life to be "safe". I am forbidden to fly anywhere for the rest of this year - besides, apparently there isn't an insurance company anywhere which will cover me!

After 7 weeks I returned to the hospital for the removal of my cast. Can you imagine my horror to be shown the fresh x-rays and told that the bone was still broken and therefore I'd need another cast for another 6 weeks! I have done as much reading as I can about Clexane and contra-indications and asked my doctor if the link between Clexane use and a still broken ankle was more than bad luck! Apparently, long term use has been linked with osteoporosis (in my mind the links between bone health/Clexane/osteoporosis all made a kind of logical sense?). Moreover, my elderly mum has spinal osteoporosis and I am very concerned that I do not put myself on a downward path to similar problems in my old age!

Can you believe that the doctor's response here was that..... "aw well, if that kind of news in breaking in the US it will be a while before it is generally acknowledged in this country!" I am torn between the fixed-mind-set of doctors who will not think outside the square, my own peace of mind for my future bone health and a desire to avoid strong drug therapies when there might be safe and healthy alternatives available out there.

Are you able to suggest any healthy alternatives to the regime which has been set before me, can you recommend anything to improve a speedy bone and muscle re-growth/re-condition, and though my sporting son has already charted some suitable physio exercises for me, do you know of any exercise which will help rebuild ankle strength soon so that I can hop back on the bike again? Keep well, and keep up your research and fabulously good reporting work.

Regards 

(Name supplied but withheld)

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Gary Moller replies

I have no doubt that your slow bone healing is associated with the drugs that you are taking. Healing should be well on the way to completion within 6-8 weeks at the most.  I have broken an ankle, aggressively treated it myself, including making my own cast (not recommended!) and been back weight-bearing in less than four weeks .  Most treatments for injuries like fractures and sprains are "one-size-fits-all", taking little account of individual differences in health and healing.

While I have encountered several cases of DVT this year I have not encouraged anybody to stop taking their medication. DVT is one of those conditions that you do not mess with lightly because the consequences can be fatal, as you well know.  Instead, we test a person to determine the underlying causes of the unwanted clotting (can be from medication side effects such as hormone therapy, nutritional imbalances and always a good dollop of stress and exhaustion!).  Once we have an idea of what is going on, we set about systematically correcting any identified imbalances, deficiencies or excesses, de-stressing and so on.  Once this is achieved the person may be able to gradually remove the medication.  This process is best patiently measured in months and even years.

As a generalisation, a doctor is reluctant to stop a medication, even after the health crisis has long passed; even when the drug can be replaced  by healthy nutritional alternatives that do not have any of the side effects you are currently having to deal with. If your doctor was to take you off the medication and place you on a nutritional alternative and, if you were to suffer a stroke, your doctor would be in big trouble for not sticking with "best practice guidelines" for treating DVT.  Best practice for DVT includes includes long term aspirin and other drug use, in some cases for life.  If your doctor does take you off the anti-clotting drugs, it will, as you know be replaced with another drug, such as aspirin which you are expected to take for life (not a good idea because aspirin is far from being a benign drug).

With regards to your poor bone healing I do recommend the use of calcium phosphate monobasic.  This is the form of calcium that is found in abundance at the site of all healing, particularly bone.  It is a special form of calcium that is water soluble.  Other forms of calcium are calcium phosphate dibasic and calcium phosphate tribasic.  These are the hard, insoluble forms of calcium such as found in formed bone and teeth.  You need monobasic for healing and I can tell you that it works with results that are delightful.  I have it here if you want it and it can be taken right away without interference with the medication you are taking.  Unfortunately you are between a rock and a hard place for now: You must continue to take your anti-clotting medication which means bone healing may be slow going.  For now anyway.

Yes, there are effective alternatives to long term use of anti-clotting drugs but I am not going to list these in an article, or explain how to use them, because their long term use and the process of safely switching over must be done under the supervision of an experienced health professional.  I can help with the cooperation of your doctor.

With regards to exercise, the cast presents a problem; but there is no limitation on the rest of your body, including the upper leg that is in the cast.  I suggest that you get into a gym three times a week and work out every bone and muscle, other than those that are in the cast.  But take care not to overly exert yourself or risk bumps and falls because of the bleeding risk.  Exercise that invigorates the body (not exhausting exercise please while on the medication please!) stimulates systemic bodily processes of healing that are beneficial for the immobile ankle.  Please exercise under the guidance of a trained exercise professional and make sure you book in several weeks of physiotherapy once the cast comes off for good.  Sorry, I can't be of more help with the exercise for now.

I wish you a fast and complete recovery.

Related articles:

http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html

http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html

http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html

http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html

http://blog.garymoller.com/2015/02/my-ankle-fracture-dislocation-week.html

http://blog.garymoller.com/2015/01/ankle-fracture-how-to-speed-bone.html

http://blog.garymoller.com/2008/09/do-natural-health-therapies-work.html

Bleeding is the major risk associated with all antithrombotics

What the following notice to medical practitioners does not mention is the over-prescribing of these drugs for many conditions that may be extremely well managed by nutritional interventions, stress management and  other measures such as stopping smoking.  It just seems that it is so much easier to write the patient a script and shove them out the door!

Less than 10% of all adverse reactions get reported and this may be as low as 1%, so the figures below for New Zealand are alarming.  So, what's the true level of harm?

It is interesting to note the disastrous effects of combination therapies, particularly with anti-inflammatories and depression pills, both of which are prescribed with gay abandon in this country.

What statistics do not tell us is the misery that many of the affected individuals and their families suffer as a consequence.  The consequences include disabling brain damage and some deaths.

While the prescribing of anti-clotting drugs may be necessary during acute occasions and following certain surgical procedures, there are few cases, in my opinion, that require this medication for life.

If you, or a loved one, are on these drugs, keep going back to your doctor and ask "when am I going to be able to stop?"  Has your doctor got a proper treatment plan for your ill-health, or not?  If there is no light at the tunnel, then seek a second opinion.  If you are still feeling uneasy, keep looking for healthy long-term solutions.  They are out there.

Notice below.

Gary
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Anticoagulants and antiplatelet agents (antithrombotics) are widely used to treat a number of conditions, with recent guidance on their use being issued by the Best Practice Advocacy Centre (BPAC)¹.

Bleeding is the major risk associated with all antithrombotics. The Centre for Adverse Reaction Monitoring (CARM) continues to receive reports of serious bleeds experienced by patients taking these medicines.

An overview of 12 months of reporting to CARM is shown in Table 1. The main sites of serious bleeding were most often gastrointestinal or intracranial in origin.

Only a small fraction of suspected adverse reactions are reported to CARM, nevertheless these reports show that serious bleeds do occur with antithrombotics and that some bleeds may have been preventable. For example, although combination therapy is recommended for some conditions, adverse reaction data continues to indicate a major risk factor for bleeding is the concomitant use of more than one antithrombotic medicine.

Early treatment of bleeds is desirable and patients and/or carers should be advised to monitor for early signs of bleeding.

Table 1: Antithrombotic CARM reports associated with bleeding from 1 Oct 2010 to 30 Sept 2011.

Medicine	Total number of reports	Number of reports of bleeding (%)	Number of cases reported to be exposed to another anticoagulant or antiplatelet agent (%)	Number of bleeding cases reported to also be exposed to a NSAID or SSRI (%)
Aspirin	28	68	53	42
Clopidogrel	9	67	100	16
Dabigatran*	212	42	59	3
Dipyridamole	3	67	100	50
Enoxaparin	14	50	57	0
Rivaroxaban	3	0	N/A	N/A
Warfarin	32	56	50	11

* Dabigatran has been recently introduced with rapid uptake

Key Messages

• A major risk factor for bleeds is the use of more than one antithrombotic medicine.
• Patients and/or carers should be advised to monitor for the early signs of bleeding.

References

1. A New Zealand Consensus Forum. 2011. The use of antithrombotic medicines in general practice: a consensus statement. Best Practice Journal, 39: 10-21

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About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Pradaxa Bleeding Events: Four Major Factors Which Contributed To These Serious Side Effects

Warfarin: A
popular rat
poison

New Zealand is in the international spotlight.... For the wrong reasons.

If you live in New Zealand and your doctor has switched your anti-coagulation medication recently from Warfarin, the chances are you have been given a drug called "Pradaxa".  Please go here to learn more about this drug here in New Zealand.

Pradaxa has been associated with a rash of "bleeding" incidents in New Zealand and, I understand, a number of deaths.  This does not mean to say that Warfarin, which it replaces is any safer - it is far from "safe".  By the way, there are safe, natural alternatives that most people on blood thinners may wish to consider; but the switching from the likes of Warfarin to these needs to be carefully exercised with the assistance of a suitably trained health practitioner.

Please go here for some articles about Warfarin.

While the number of incidents seem to be relatively low, please bear in mind that less than 10% of adverse reactions ever get onto official databases.  Some cynics believe the real figure is less than 1%.  I go with the latter.

I have reproduced below a letter from Tom Lamb of Drug Injury Watch.  If you feel you have been harmed by this drug, or similar ones, please drop him a line.  While his main interests are within the USA, I am sure he will be happy to hear from you.

One point of note is the lack of an effective reversal agent.  Which means if you suffer an adverse event, things could go from bad to worse because there is no antidote to effectively neutralise the action of the drug.

Gary
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Pradaxa Bleeding Events: Four Major Factors Which Contributed To These Serious Side Effects

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Search Drug Injury Watch

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Pradaxa Bleeding Events: Four Major Factors Which Contributed To These Serious Side Effects

Prescriber Error, Impaired Renal Function, Patient Age, And Lack Of An Effective Reversal Agent Are Cited
(Posted by Tom Lamb at DrugInjuryWatch.com)

Medsafe issues a further warning: Warfarin – Reports of serious adverse reactions continue

Prescriber Update 2010;31(2):16

"The risk of major bleeding events in patients prescribed a combination of warfarin and aspirin was highlighted in Prescriber Update in August 2009.1 Despite this ACC continues to receive reports of serious injury in patients receiving warfarin, including cerebrovascular accidents that have resulted in severe disability.

The ACC reports include cases of warfarin being prescribed concomitantly with aspirin, and of warfarin being prescribed with other medicines known to increase the risk of bleeding.

Healthcare professionals are reminded to regularly monitor INRs in patients prescribed

Deep vein thrombosis (DVT): Can I take vitamin C while on Warfarin?

"I usually take 500 mg Vit C.

I stopped taking C just before skin op. I devoped DVT straight after the op. and a just beginning the Warfarin treatment after a week of INR to find therapeutic dose. I wonder if I can start taking Vit C again and if it is o.k. to take with warfarin."
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Gary:

A course of warfarin to help clear the blood clot (DVT) may be necessary and be guided by the advice of your Dr as to how long this is to continue.

Warfarin is a toxic chemical that is used as rat poison and longterm use can have serious side effects such as osteonecrosis from micro bleeding into the bone. The same happens to other organs including the brain.

Vitamin C, Vitamin E, garlic, fish oil and Ginkgo may augment the actions of blood thinners such as Warfarin. This being the case, I would definitely discuss the taking of any of these with your doctor before doing so.

This could be combined by a diet such as followed by the Centenarians of Okinawa (Refer image right)

If your doctor says you should not take more than a certain amount of a vitamin, then ask:

"If I change my diet and take a combination of, say, vitamin E, vitamin C, fish oil and garlic oil, then do I need to have the Warfarin? Or, can I reduce the Warfarin dose to compensate for the benefits of these nutrients?"

It may be that once you are over the initial threat of the DVT that you can go onto a regime that includes nutrient supplementation with lowering doses of Warfarin.

Having said this, my experience is that most Drs will not support this. If a Dr departs from best practice guidelines and something goes wrong, he/she may be in trouble with peers and authorities and the possibility of insurance problems.

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Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Will prolotherapy cure my arthritic thumb?

Hi Gary: I have either tendonitis or mild osteoarthritis in my thumb joint at the base of my right hand where it joints the wrist. Thanks to your website, I did some further research on cortisone shots and concluded NO WAY! Now that I've dodged that bullet, I'm investigating alternative therapies. I've started a course of supplementation consisting of vitamin D3, flax seed oil, liquid glucosamine/chondroitin with MSM (also suggested by your website), and vitamin C.

I ran across some information on prolotherapy (injecting an irritant such as dextrose into the joint to stimulate healing). It's considered an alternative treatment here in the USA and isn't covered by insurance, but the Mayo Clinic (which I have nothing but praise for) has started offering it. Here's some website info if you'd like to look into it:

http://www.mayoclinic.com/health/prolotherapy/AN01330
http://en.wikipedia.org/wiki/Prolotherapy
http://jointrehab.com/prolotherapy_medical_rationale.htm

I'm an active 49-year-old female who unfortunately has to take warfarin due to a blood clot in my femoral artery last year. Otherwise no meds.

Thanks again--you have a great website, and I love your beautiful, progressive country (visited in '94, hope to return soon).

Loretta USA
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Gary Moller comments:
Who am I to argue with the Mayo Clinic! I'll have a go anyway...

I have no doubt that prolotherapy has some merits and it will tend to gather favour with the quick fix brigade which is modern sports medicine and rehabilitation. You know - the clinics that limit clinician time to 15 minutes and, in some cases, just five minutes. When time is of the essence therapies like injecting, heating, suctioning, electrifying, quick-clunk manipulations and prescribing a pill all take precedence over the more time consuming therapies like massage and exercise. Not to mention the importance of nutrition for longterm recovery. I do not like quick fix solutions.

My strong prference is several 20-40 minute sessions of massaging your arthritic hand while working on nutrition and also tidying up your medications. But in the absence of a suitable massage therapist, why not try the prolotherapy which does exactly the same as the massage (though less effectively over the longterm, I would argue).

With regards to your taking Warfarin, I would ask that you exercise caution with various supplements that might augment the blood thinning actions of this drug which is also used as rat poison. Warfarin may cause breakdown in hard-working bone like the jaw due to microscopic bleeding into the bone and this may cause disintegration of the bone over many years of use. This shocking condition is called osteonecrosis.

My advice to you is to discuss with your Doctor the potential for any interactions between the drugs you are on and any nutritional supplements that you are taking or planning to take. Of course, you should also discuss gradually replacing the Warfarin with natural nutritonals that have benefits on blood flow and clotting without the risks of these drugs. With each year, your need to take Warfarin decreases.

Please let us know how you get on Loretta

Do you have a question?

Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Warfarin linked with brain bleeds

"Warfarin is often prescribed to prevent blood clotting and help combat the most common type of stroke, known as ischemic stroke. However, warfarin itself has been linked to intracerebral brain hemorrhage, another type of stroke caused by ruptured blood vessels and subsequent bleeding in the brain." (Click on the title for the full article).
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Gary Moller comments:
As with most medicines, the full extent of adverse side effects goes largely unnoticed. This is because there is usually no direct link between taking a drug and the adversity.

For example (A real one), a dentist may be conducting a routine tooth extraction to be horrified to find that a chunk of dead jaw bone comes out with the tooth! Of course this means the patient is in real trouble. The condition is called osteonecrosis for which there is no effective treatment. Tests are completed, specialists are consulted and there is no reason for this happening in a 50'ish patient. The only suspiscion the dentist has is that the patient has been taking Warfarin (rat poison) for a decade for a heart condition; but the association is dismissed by the experts.

Here is my take on what is happening: The Warfarin is causing micro-bleeding into the bone of the jaw. Why it shows mostly in the jaw is because the jaw is constantly stressed by the action of chewing on the teeth, thus causing the micro bleeds. Bone is very sensitive to bleeding - the delicate bone cells die off similar to what happens when taking biphosphenates that cause "Fossy Jaw".

My experience is that the majority of people I come across who have been placed on Warfarin need not be on it and non drugs strategies should first have been explored and exhausted.

If for example a patient has atrial fibrilations that may increase risk of a clot that might settle in the brain, how about a course of:

• Fish oil plus vitamin E to stabilise the heart electrical activity and condition the blood to reduce clotting risk
• A multi mineral with magnesium and calcium that relax the heart, nerves and stabilise blood pressure
• A course to learn to breathe properly using the diaphragm and thus stabilise body PH - over-breathing is known to cause heart irregularities that can be so severe as to be mistaken for a heart attack
• Sunbathing to increase vitmamin D levels to at least 120 nmol - low vit D is associated with heart disease (Have you had a blood test for your own vitamin D yet?)

Should these fail to brig about a resolution after about 21 days then the option of medication can be considered.

Warning about serious side effects of Warfarin

The US label for warfarin has been strengthened to include a black-box warning about the risk for major or fatal bleeding.SIDE EFFECTS: The two most serious side effects are bleeding and necrosis (gangrene) of the skin. Bleeding can occur in any organ or tissue. Bleeding around the brain can cause severe headache and paralysis. Bleeding in the joints can cause joint pain and swelling. Bleeding in the stomach or intestines can cause weakness, fainting spells, black tarry stools, vomiting of blood, or coffee ground material. Bleeding in the kidneys can cause back pain and blood in urine. Other side effects include purple, painful toes, rash, hair loss, bloating, diarrhea, and jaundice (yellowing of eyes and skin). Signs of overdose include bleeding gums, bruising, nosebleeds, heavy menstrual bleeding, and prolonged bleeding from cuts.
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Gary Moller comments:
I have referred to this widely prescribed cardio medication in the past as "rat poison" and we are now seeing plenty of evidence why it should never be given to humans.

Only a fraction of the complications resulting from prescription medications ever get to be reported, so when the authorities start requesting special warnings be placed on the packaging of a pharmaceutical, we should take heed. The problem/threat is probably much larger than it appears.

Most complications are so subtle and take so long to manifest that the association may never be noticed, let alone proven. While the big side effects may be fatal, it is the subtle ones that are the most prevalent and often they go un-noticed and are never recorded. If you take careful note of the list of complications above from taking Warfarin (especially the section that I have highlighted for you), you will not be surprised to learn what I am about to tell you:

The osteoporosis drug, Fosamax is associated with "Fossy Jaw" or death of the bone of the jaw, a horrific disease for which there is no effective treatment. Well, it may not be just Fosamax: I can tell you that Warfarin may be producing similar cases of bone death, possibly the result of chronic micro-bleeding into the bone. I am aware of one case where this appears to be happening with the result that this unfortunate person is steadily losing his jaw bones; but these matters are difficult to prove, as I mentioned earlier. What is most astonishing about this horrific case is he is still being prescribed the Warfarin! This stuff is what horror movies are made out of.

If you want effective alternatives to rat poison to reduce cardiovascular risk, try a daily Kiwi Fruit, fish oil, vitamin E, the B Group of vitamins, magnesium, vitamin C, plus your usual fruit and veges.

Oh! I almost forgot - and exercise.