Clinic Wellness Team. A key factor to spine or back pain conditions is staying healthy. Overall wellness involves a balanced diet, appropriate exercise, physical activity, restful sleep, and a healthy lifestyle. The term has been applied in many ways. But overall, the definition is as follows.
It is a conscious, self-directed, and evolving process of achieving full potential. It is multidimensional, bringing together lifestyles both mental/spiritual and the environment in which one lives. It is positive and affirms that what we do is, in fact, correct.
It is an active process where people become aware and make choices towards a more successful lifestyle. This includes how a person contributes to their environment/community. They aim to build healthier living spaces and social networks. It helps in creating a person’s belief systems, values, and a positive world perspective.
Along with this comes the benefits of regular exercise, a healthy diet, personal self-care, and knowing when to seek medical attention. Dr. Jimenez’s message is to work towards being fit, being healthy, and staying aware of our collection of articles, blogs, and videos.
PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and micronutrients for overall health and wellness. Following a proper diet and participating in exercise alone isn’t enough to make sure that the human body is functioning properly, especially in the case of athletes. Fortunately, there are a variety of tests available that can help people determine if they have any nutritional deficiencies that may be affecting their cells and tissues. Vitamin and mineral supplements can also ultimately help improve an individual’s overall health and wellness. While we may not be able to change certain aspects of our genes, Dr. Alex Jimenez and Dr. Marius Ruja discuss that following a proper diet and participating in exercise while taking the proper supplements, can benefit our genes and promote well-being. – Podcast Insight
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Dr. Alex Jimenez RN, DC, MSACP, CCST
PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and micronutrients for overall health and wellness. Following a proper diet and participating in exercise alone isn’t enough to make sure that the human body is functioning properly, especially in the case of athletes. Fortunately, there are a variety of tests available that can help people determine if they have any nutritional deficiencies that may be affecting their cells and tissues. Vitamin and mineral supplements can also ultimately help improve an individual’s overall health and wellness. While we may not be able to change certain aspects of our genes, Dr. Alex Jimenez and Dr. Marius Ruja discuss that following a proper diet and participating in exercise while taking the proper supplements, can benefit our genes and promote well-being. – Podcast Insight
[00:00:00] Welcome, guys. We’re Dr. Marius Ruja and myself. We’re going to be discussing some really important topics for those athletes that want the advantage. We’re going to be discussing real important clinical technologies, as well as information technologies that can really make an athlete or even just the average person a little bit more aware of what’s actually happening in terms of their health. There’s a new word out there, and I just have to kind of give you a little heads up, where we’re calling. We’re actually coming from the PUSH fitness center, it’s this huge monster that actually people are still working out late at night tonight and after going to church. So they’re working out and they’re having a good time. So what we want to do is we want to bring in these topics. And today we’re gonna be talking about personalized medicine. Mario, you know, ever heard of that word, Mario? [00:01:04][63.8]
[00:01:05] Yeah, all the time, Alex. All the time. I dream about it? There you go. Mario. [00:01:13][8.3]
[00:01:14] So we’re going to be talking about is the personalized arena of what we have now. We’ve come to a state where a lot of people tell us, hey, hey, you know what? You should have some more proteins, fats, or they come up with some convoluted idea and you’ll end up with your eyes crossed and most of the time more confused than anything else. And you’re pretty much a lab rat to all these different techniques, whether it’s the Mediterranean, low fat, high fat, all these kind of things. So the question is, is that what is specific to it. And I think one of the frustrations that a lot of us have, Mario, is that we don’t know what to eat, what to take, and what’s good for me doesn’t mean that it’s good for my friend. You know, Mario, it’s different. We come from a whole different kind of genre. We live in a place and we’ve gone through things that are different from 200 years ago. What do people do? Well, we’re going to be able to figure this out nowadays in today’s DNA dynamics, though, we don’t treat with these. It just gives us information and it allows us to relate to the issues that are affecting us. Now, today, we’re gonna be talking about personalized medicine and DNA testing and micronutrient assessments. So we’re gonna see what it is that we. How are our genes, the actual predisposing issues, or they’re the ones that give us the workings of our engine? And then also, if it’s good for that, then we also want to know what our level of nutrients is. Right now, I know, Mario, you had a very dear and near question the other day with one of your I think was your daughter. Oh, yeah. What was she? What was her question? [00:02:51][96.9]
[00:02:51] Yeah. So Mia had an excellent question, you know, she was asking me about, you know, utilizing Keratin, which is very predominant in and, you know, athletes, you know, it’s the buzz word, you know. You know, use creatine to build more muscle and such. So the point that I talk to you about, Alex, is, you know, this is something so serious, so, so important that we cannot let in in terms of the sports environment, performance environment. It’s like taking a Bugatti and you’re going, well, you know what? Hey, what do you think about like just putting, like, you know, synthetic oil in? Well, is it the synthetic oil that is necessary or that Bugatti? Well, it’s good because it’s synthetic. Well, no. There are lots of different forms of synthetic. You know, it’s like five-thirty, five-fifteen, whatever it is, the viscosity level. It has to match. So same thing for athletes and especially for Mia, you know, the generality. Well, let them know who Mia is?� [00:04:06][75.0]
[00:04:07] What does she do? What kind of. Oh, yeah. [00:04:08][1.1]
[00:04:08] Mia, you know, Mia plays tennis. So her passion is tennis. And she’s nationally ranked and she plays internationally on the International Circuit ITF. And she’s right now in Austin with Karen and the rest of The Brady Bunch, as I call them, you know, she’s working hard and through all this COVID, you know, kind of disconnect. Now she’s getting back into, you know, the fitness mode. So she wants to optimize. She wants to really, you know, do her very best to catch up and move forward. And the question about nutrition, a question about what she needed. I needed a specific answer, not just general. Well, I think it’s good. You know, good is good and better is best. And the way that we look at it in that conversation of sports performance and also genetic nutritional conversation, functional medicine conversation. It’s like let’s get really functional. Let’s be on point instead of buckshot. [00:05:20][71.3]
[00:05:21] You know, it’s like you can go in and say, you know, it generalities. But in terms of this, there’s not a lot of information that is out there for athletes. And that’s where the conversation linking the genetic and linking the micronutrients. That is phenomenal because as you mentioned, Alex, when we look at the markers, genetic markers, we see the strengths, the weaknesses, we see what’s at risk and what is not. Is the body adaptive or is the body weak? So then we have to address the micronutrients to support. Remember we…� [00:06:00][39.3]
[00:06:00] Talked about that, to support that weakness in that DNA, that genetic pattern with something that we can strengthen. [00:06:11][10.7]
[00:06:12] I mean, you can’t go and change your genetics, but you surely can increase and be specific with your micronutrients to really change that platform and strengthen it and decrease the risk factors. [00:06:23][11.4]
[00:06:24] It’s fair to say now that the technology is such Mario that we can actually find the… I wouldn’t say weaknesses, but the variables that allow us to improve an athlete. At the genetic level. Now, we can’t alter the genes. That’s not what we’re saying, is that there’s a world of what they call SNP or single nucleic polymorphisms where we can actually figure out there’s a certain set of genes that we can’t change like eye color. We can’t do those. Those are very coded in. Right. But there are genes that we can influence through nutrigenomics and nutrigenetics. So when I say nutrigenomics, this is nutrition, altering and affecting the genome right. To a more adaptive or more opportunistic dynamics. Now, wouldn’t you like to know what genes you have that are vulnerable? Wouldn’t she like to know where her vulnerability is? [00:07:18][53.8]
[00:07:18] What do we all want to know? [00:07:19][0.8]
[00:07:19] Whether you’re a high-level athlete or you’re a high-level CEO or you’re just a high-level mom and dad, that’s running around too, from tournament to tournament. [00:07:30][11.0]
[00:07:31] And you cannot afford to have low energy that, you know, when we talked about the markers, you know, that methylation within the body, we want to know, are we processing or how are we doing in terms of the oxidative pattern within ourselves? Do we need that extra boost? Do we need to, you know, increase that green intake, that detoxified pattern, or are we doing well? And this is where when we look at the patterns of genetic markers, we can see that we are well-prepared or we are not well-prepared. Therefore, we have to look at the micronutrients again, those markers to say, are we meeting our needs? Yes or no or are we just generalizing? And I would say 90 percent of athletes and people out there, they’re generalizing. They’re saying, well, you know, taking vitamin C is good and taking vitamin D is good and selenium, you know, that’s good. But again, are you on point? Are we just guessing, right, Alex? [00:08:36][65.4]
[00:08:36] Exactly. That’s the thing. When we’re in that store and there’s a lot of great nutritional centers, Mario, that are out there. And we’re looking at a wall of a thousand products. Right. Crazy, we don’t know where we have holes. We don’t know where we need them. That, you know, there are certain deficiencies. You got bleeding gums. Most likely you’ve got some sort of scurvy or, you know, some sort of issue there that you’re meeting especially. But let’s assume we look at things like scurvy. Right. Well, we know that gums start bleeding well, and it’s sometimes not that obvious, right. That that we need certain things. There are hundreds and thousands of nutrients out there. One of the things that we call them, we call them cofactors, a CO factor is a thing that allows an enzyme to work. Right. So we are a machine of enzymes. And what codes those enzymes? Well, the DNA structure, right. Because it produces the proteins that code those enzymes. Right. So but those enzymes, they have cofactors like minerals, like magnesium, iron, potassium, selenium, as you mentioned, and all different components. As we look at this, this hole that we’re facing a wall. We would love to know exactly where our holes are because, Bob, you’re my best friend says, you know, you should take protein, take whey protein, you should take iron, you should take this. Maybe so. And we’re hit or miss. Right. So today’s technology is allowing us to see exactly what it is, where we have the holes and this point that you mentioned about the holes. [00:10:03][86.7]
[00:10:04] Again, the majority of the factors are not that extreme, like. Like scurvy, you know, bleeding gums. We’re not. I mean, we live in a society where gosh. I mean, Alex, we have all the food that we need. As a matter of fact, we got too many foods. It’s crazy. I mean, again, the issues that we talk about is overeating, not starving. OK. Or we’re overeating and still starving because the nutritional pattern is very low. So that’s a real factor there. But overall, we are really looking and addressing the component of what. [00:10:35][31.4]
[00:10:37] Subclinical issues. You know, we don’t have the symptoms. We don’t really have those big marker symptoms, you know, but we do have low energy, but we do have a low recovery pattern. But we do have that problem with sleep, that quality of sleep. So those, again, are not things that are huge, but those are subclinical, that erode our health and performance little by little. For example, with athletes, they can not be just good. They need to be tip of the spear top. They need to recover so quickly because, in their performance pattern, they do not have time to guess. [00:11:19][41.9]
[00:11:19] And I see that they don’t. You know, as you mentioned, that I mean, most of these athletes, when they want to assess their bodies. They want to know where every weakness is, they’re like scientists or laboratory rats for themselves. They’re pushing their bodies to the extreme from mental to physical to psychosocial. Everything is affecting them, put it in at full throttle. But they want to know. They want to know where that extra edge is. You know what? If I could make you a little bit better. If there was a little hole. What would that amount to? A two more second drop in over a period of time, a microsecond drop? Well, the point is that the technology is there and we have the ability to do these things for people. And the information is coming faster than we can even imagine. [00:12:04][44.8]
[00:12:05] We have doctors around the world, scientists around the world looking at the human genome, and seeing these issues specifically at SNPs, these single nuclear polymorphisms that can be changed or that can be altered or can be assisted in the dietary ways. [00:12:19][14.5]
[00:12:20] Go ahead. I’ll give you one, the InBody. [00:12:23][2.6]
[00:12:24] How about that? Yeah, that’s a tool right there. That is critical for a conversation with an athlete. The InBody is body composition. Yeah. BMI. Yes. You know, you’re looking at it in terms of your hydration pattern. [00:12:37][13.2]
[00:12:38] You’re looking at in terms of like. Yes. Body fat, that whole conversation, everyone wants to know. You know, I’m overweight, my belly fat. Again, we’re talking about how we had conversations on metabolic syndrome. We had conversations on risk factors, you know, high triglycerides, very low… [00:12:53][15.9]
[00:12:54] HDL. High LDL. I mean, those are risk factors that put you in a pattern in that line towards diabetes and that line towards, you know, cardiovascular disease in that line of dementia. But when you’re talking about an athlete, you’re not worried about diabetes. They’re worried about am I ready for the next tournament? And I want to make the cut. [00:13:15][21.0]
[00:13:15] I’m going to the Olympics. That’s yes. [00:13:16][1.1]
[00:13:17] That’s I mean, they’re not, that’s what they want to do and that InBody and the micronutrient that combination of genome nutrition, that genomic nutrition conversation on point allows them to honor their work. Because I’m telling you, Alex, and, you know this, I mean, everyone’s listening to us, you know, if you again. The conversation I share with people is this. Why are you training like a pro when you don’t want to be one? Why are you trained like a pro when you are not eating and have the data to support that pro-level workout? What you’re doing, if you don’t do that, you are destroying your body. So, again, if you’re working like a pro, that means you’re grinding. I mean, you’re pushing your body to limits, neuromuscular. Again, we’re chiropractors. We deal with inflammatory issues. If you’re doing that, you’re redlining that. But you are not turning around to recover through micro nutrition-specific chiropractic work. Then you’re going to damn it, you’re not going to make it. [00:14:25][68.4]
[00:14:26] We’re going to show that we’ve been able to see in a lot of times cities come together for certain sports, such as wrestling. Right. Wrestling is one of those notorious sports that puts the body through massive, massive emotional and physical stresses. But a lot of times what happens is individuals have to lose weight. You’ve got to have guys hundred sixty pounds. He’s got to drop down 130 pounds. Right. So what the city has done in order to avoid these things is to use specific bodies, specific weight, and they determine actually what’s the molecular weight of the urine. Right. So they can actually tell you are you too concentrated. Right. So what they do is that they have all these kids line up all the way to UTEP. Right. And they do a specific gravity test to determine if they’re able to lose any more weight or what’s the weight that they’re allowed to lose. So someone who’s about 220 says, you know what? You can drop up to about, you know, X, Y, Z pounds. Right. [00:15:19][53.4]
[00:15:20] Based on this test and if you violate this, then you do that. But that’s not good enough. We want to know what’s going to happen because what happens is when the kids in a load and he’s fighting another person that isn’t just as good of an athlete. And he’s pushing his body. That’s when the body. Collapses, the body can handle the load. But maybe the supplementation that the person has had, maybe their calcium has been so depleted that all of a sudden you’ve got this kid who’s 100 injuries, pops say it again, injuries, the elbow snaps he has dislocated. That’s what we see. And we wonder, how did he snap his elbow because his body has been depleted from these supplements. [00:15:58][38.0]
[00:15:59] And, Alex, on the same level, you’re talking about one on one, like that pugilistic, that intense three minutes of your life on the other level when it comes to tennis. That’s a three-hour conversation. Exactly. There are no subs, there is no coaching, no subs. You are in that gladiator arena. I mean, when I see Mia playing, okay. I mean, it is intense. I mean, every ball that’s coming to you, it’s coming to you with power. It’s coming in like, can you take this? It’s like someone like fighting across a net and looking at it. Are you going to quit? Are you going to chase this ball? Are you going to let it go? And that is where that definitive. The factor of…� [00:16:46][46.6]
[00:16:47] Optimal, optimal micronutrition connected with the conversation of what exactly do you need in terms of genomic conversation, will allow someone to scale up with a decrease risk factor of injuries where they know they can push themselves more and they have the confidence. [00:17:09][21.4]
[00:17:09] Alex. Alex, I’m telling you, this is not just nutrition. This is about the conference to know I got what I need and I can redline this thing. And it’s going to hold. [00:17:21][11.2]
[00:17:21] It’s not going to buckle. You know, that said, you know, I got a little Bobby. He wants to wrestle and he wants to be in. And the biggest nightmares, the moms, because you know what? They’re the ones that want Bobby to thump the other Bobby. Right, Bob or Billy. Right. And when their kids are getting thumped on, they want to provide them. And moms are the best cooks. They’re the ones they take care of. Right. They’re the ones that make sure. And you can see it that the pressure on the child is immense when parents are watching. And sometimes it’s just incredible to watch. But what can we give moms? What can we do for the parents to give them a better understanding of what’s going on? I’ve got to tell you, today’s with DNA tests, you know, all you have to do is kind of get the kid in the morning, open his mouth, you know, do a swab, drag that stuff off the side of his cheek, put it in a little done, done within a couple of days. What we actually can tell if Bobby’s got strong ligaments, if Bobby’s micronutrient levels are different in order to provide the parent with a better kind of, um, kind of a roadmap or a dashboard to be able to understand the information that’s affecting Bobby, so to speak. Right. [00:18:26][65.3]
[00:18:27] Because and this is what we’ve come to a long way. This is 2020 guys, 2020. This is not 19. You know, 75. No. [00:18:37][10.2]
[00:18:37] You know where Gatorade. Come on. Let’s talk about that Gatorade. I got my tub. I got my tub. And he’s got a lot of things on the side of it. I’m going to have everything. You look like Buddha. By the time you become diabetic with so much sugar, you’re eating. What is your thinking about this? [00:18:52][14.8]
[00:18:52] We have come to a long way, but we cannot just go in and go, oh, you need to hydrate here, you know, drink these electrolytes, Pedialyte and all that. That’s not good enough. I mean, that’s good. But it’s 2020, baby. You got to scale up and level up and we can’t use old data and old, you know, instrumentation and diagnostics because the kids now they’re starting at three years old, Alex. Yeah. Three years old. And I’m telling you right now at three, it is unbelievable. By the time they’re five and six, I mean. [00:19:29][36.8]
[00:19:30] I mean, I’m telling you the kids that I see they’re already in select teams, six years old and the select team is the thing. You know what, the thing that determines if a child is ready is attention span. Yeah. I got to tell you, you can watch this. You got to see a kid who’s at three years and six months and he ain’t paying attention three years and eight months. All of a sudden, he can focus more in front of the coach. Right. Yes. And you can tell because they wander and they’re not ready. [00:19:57][27.4]
[00:19:57] So we’re bringing the kids and we’re exposing them to loads, experiences. Then what we need to do is to give moms and dads the ability to understand and as well as athletes of NCAA. How can I see what’s actually happening in my bloodstream? Not a CBC, because the CBC is for basic stuff. You basically, you know, basic you know, a red blood cell, a white blood cell. We can do things. Metabolic panel tells us a generic thing, but now we know deeper, deeper information. Mario, we can go into the susceptibility of the gene markers and actually see this on tests. And these reports tell us exactly what it is and how it pertains. [00:20:35][37.5]
[00:20:35] And progression. So this is where I love. This is where I love, everything in the world of performance is pre and post. So, you know, when you’re a sprinter, they time you. [00:20:49][13.7]
[00:20:50] It’s electronic time. When you’re a wrestler, they look at you. You know, what’s your winning ratio? What’s your percentage? Anything. It’s all data. It’s data-driven. As a tennis player, as a soccer player, they will actually track you. Computers will actually track how strong, how fast is your serve? Is it 100 miles an hour? I mean, it is crazy. So now if you have that data. Alex, why is it that we do not have the same data for the most critical component, which is that biochemistry, that micronutritional, the foundation of performance is what happens inside of us, not what happens outside. And this is where people get confused. They think, well, you know, my kid works, you know, four hours a day and he has a private trainer, everything. My question is that is really good. But you’re putting that kid at risk if you are not supplementing on point, just as specifically when it comes to the special needs of that child or of that athlete, because if we don’t do that, Alex, we are not honoring the journey and the battle, that warrior, we’re not, we’re putting them at risk. And then all of a sudden, you know what, two, three months before a tournament, pulled a hamstring. Oh, you know what? You know, they got fatigued or all of a sudden they had to pull out of a tournament. You know, I see tennis players doing all of that. And why? Oh, they’re dehydrated. Well, you should never have that problem. You should already know before you go in exactly where you are, what you’re doing. [00:22:29][99.3]
[00:22:29] And I love the combination and a platform that we have for all of our patients, because within two, three months, we can show pre and post, can’t we? We can show, yes. Lists and body composition to the InBody systems and the systems that we use are incredible. These Dexas, we can actually do a bodyweight fat analysis. We can do a lot of things. But when it comes down to predispositions and what’s unique to individuals, go down to the molecular level. We can go down into the genes level and understand what the susceptibilities are. We can go on once we have the genes. We can also understand what the micronutrient level is on each individual. [00:23:09][39.4]
[00:23:09] So what’s pertaining to me? I may have more magnesium than you and the other child may have totally depleted magnesium or calcium or selenium and/or his proteins or its amino acids are shot. Maybe he’s got a digestive issue. Maybe he’s got lactose intolerance. We need to be able to figure out these things that affect them and we can’t guess. [00:23:29][20.0]
[00:23:30] And we know. The bottom line is there’s no need. [00:23:32][1.6]
[00:23:32] Everyone has that wonderful conversation, Alex, about, oh, you know what? I feel okay. When I hear that I cringe, I go, I feel okay. So you mean to tell me that you are putting your health, the most precious thing you have, and your performance based on a feeling like, wow, that means that your neuroreceptors in terms of pain tolerance are dictating your health. That’s dangerous. That is completely dangerous. And also subclinically, you’re not able to feel your deficiency in terms of vitamin D, your deficiency in terms of selenium, your deficiency in terms of vitamin A, E, I mean, all of these markers, you’re not, you can’t feel it. [00:24:21][49.2]
[00:24:22] You know, we need to start presenting to the people out there the information that’s out there, because what we want to let people know is that we’re going deep. We’re going down to this gene susceptibilities, that gene understanding as it is today. [00:24:34][12.5]
[00:24:35] What we have learned is so powerful that it allows parents to understand a whole lot more of the issues pertaining to an athlete. Not only that, but the parents want to know what are my susceptibility? Do I have a risk of bone arthritis? Do we have issues of oxidative stress? Why do I always inflame all the time? Right. Well, believe it or not, if you’ve got the genes for let’s say you’ve got the gene that makes you eat a lot, well, it’s likely that you’re going to gain weight. You can raise 10000 people’s hands who have that same gene marker and you’re going to notice that they’re BIA’s and BMIs are way out of there because it’s the susceptibility to that. Now, can they change it? Absolutely. That’s what we’re talking about. We’re talking about understanding the ability to adapt and to change our lifestyle for the predispositions that we may have. [00:25:26][50.9]
[00:25:26] Yeah, and this is wonderful. And I see this quite frequently in terms of the conversation about losing weight, you know, and they go, oh, I did this program and it works great. And then you have 20 other people doing the same program and it’s shot. It doesn’t even work. And it’s almost like hit or miss. So people are becoming disillusioned. They’re putting their bodies through this incredible roller coaster ride, which is like the worst thing you could do. You know, they’re doing these extreme things and but they can not sustain it because why? At the end of the day, it’s not who you are. [00:26:02][35.8]
[00:26:02] It wasn’t for, it’s not who you are. You may need a different type of diet. Yes. [00:26:06][3.6]
[00:26:07] And so we. And again, our conversation today is very general. And we’re kind of starting this platform together because we have to educate our community and we have to share the latest in technology and science that addresses the needs. [00:26:26][19.1]
[00:26:28] Personalized health, personalized fitness. We understand that. We don’t have to guess if a diet is better for us, such as a low calorie, a high-fat diet or a Mediterranean style food or a high protein diet. We won’t be able to see that from the information that we’re continuously gathering, these scientists are putting information together and it’s compiled and it’s here and it’s a swab away or blood work away. It’s crazy. You know what? And this information, of course, you need to. And let me be mindful. Before this started, my little disclaimer comes in. This is not for treatment. Do not take anything. We’re taking this for treatment or for diagnosis. You got to talk to your doctors and your doctors have to tell you exactly what’s up there and what’s appropriate for every individual. We integrate. [00:27:17][48.9]
[00:27:18] The point is this. We integrate with all of the health care professionals, all the physicians, we are here to support and champion the functional wellness. Okay. And as you mentioned, we’re not here to treat these diseases. We’re not, we’re here to optimize again when athletes come in and they want to be better. They want to get healthier and help the recovery rate. [00:27:46][27.2]
[00:27:46] You know, the bottom line is the tester there. We can actually see Billy has not been eating well, OK? Billy has not been eating well. I can tell you well, he eats everything no, but he hasn’t had this level of proteins. Look at his protein depletion. So we’re going the present to you some of these studies out here, because it’s information, though, it’s a little complex, but we want to make it really, really simple. And one of the things that we were talking about here is the micronutrient test that we were actually providing here. Now I’m going to present it to you so you can see it a little bit here. And what we are using is some in our office when a person comes in and says, I want to learn about my body. We present this micronutrient assessment where we can actually figure out what’s going on. Now, this was one that was, let’s say, just it was in a sample for me, but it kind of tells you where the individual is. We want to be able to level the antioxidant level. [00:28:33][47.0]
[00:28:34] Now, everyone knows that if that. Well, not everyone. But now we understand that if our genes are optimal and our food is optimal, but we live in an oxidative stress state. Exactly. Our genes will not function. So it’s important to understand what the, it’s rust. [00:28:50][16.3]
[00:28:51] It’s I mean when you’re looking at this and I see two markers, I see the one for oxidative and then the other one is the immune system. Yes. Right. Yeah. So again, they correlate together. But they are different. So the oxidative I talk about it about rusting. Like your system is rusting out. Yes. Yeah. That’s oxidation. You see apples turning brown. You see metals rusting. So inside you want to absolutely be at your best, which is in the green. And that’s 75 to 100 percent exact functional rate. Exactly. That means you can handle the craziness of the world. Mario, you know? Stress. Yes. [00:29:31][40.8]
[00:29:32] So we can yes, we can look at the stress of the human body. Mario, we can see, is actually what’s going on. So as I continue with this kind of presentation here, we can kind of see what this individual is and what is his actual immune function age. So people want to know this stuff. I mean, I want to know where I lie in terms of the dynamics of the body. Right. So when I look at that, I can actually see exactly where I lie. And my age is 52. OK, in this particular situation. OK. Now, as we look down, we want to know at. Hold on. Hold on. Let’s get real. [00:30:03][31.6]
[00:30:04] So you mean to tell me that through this incredible system that we can actually get younger? Is that what you’re telling me? [00:30:14][9.5]
[00:30:14] Well, it tells you if you’re aging quicker. How’s that sound, Mario? So if you can slow down, if you’re in that top 100, the green, you’re going to be looking like a 47-year-old man when you’re 55. Right. So, from the structure, from the immune function, from the oxidative stresses in the body, what’s gonna happen is, is that we’re going to be able to see exactly where we are in terms of our body. [00:30:37][23.4]
[00:30:37] So that is correct. Yes. So we could be, our birth certificate could say 65, but our metabolic functional markers can say you’re 50. [00:30:50][12.4]
[00:30:51] Yes. Let me make it real simple. Yeah. People sometimes understand that oxidative stress is. It is. We hear about antioxidants. Yes. And reactive oxygen species. Let me make it simple. We’re a cell, you and I. We’re having a family meal right, we’re enjoying ourselves. We are normal cells. We’re happen. We’re functioning where everything is properly. All of a sudden, there’s a wild-looking lady got blades and knives and she’s greasy and she’s slimy. And she comes on. She hits the table, boom. And she kind of walks away. You know, it’s gonna unsettle us. Right? It’s going to be… Let’s call her an oxidant. OK. She’s an oxidant. She’s called a reactive oxygen species. Now, if we got two of those walking around the restaurant, we kind of keep an eye on her. Right. All of a sudden, a football player comes and takes her out. Boom. Knocks her out. Right in that situation, this greasy, slimy weapon looking lady. Right. That’s kind of scary. That was an antioxidant. That was a vitamin C. It just wiped her out, right? There’s a balance between oxidants and antioxidants in the body. They have different purposes, right? We have to have antioxidants and we have to have oxidants in order for us to body to function. [00:31:58][67.2]
[00:31:59] But if all of a sudden you got eight hundred of those ladies, walking around like zombies, I can just see that. Zombies man. [00:32:08][8.9]
[00:32:08] You know what you’re going to want. We’re football players. We’re the antioxidants. Right. Take them out. Take them out. Football players come in. But there are just too many of them, right. Anything that you and I do in a conversation, we could be healthy cells. And we’re having this conversation at the dinner table. Right. We’re disrupted totally. We cannot function in an oxidative stress environment. No. [00:32:31][22.9]
[00:32:31] So basically, we may have all the supplements and we may have all the nutrients and we may have the proper genetics. But if we’re in an oxidative state. Right. An elevated level, we are not going to be aged. It is not going to be a comfortable night. And we will not recover. We will be at a higher risk factor for injuries. Exactly. And the other thing is, we also have the risk factor where we will age faster than we should. [00:33:04][32.5]
[00:33:04] That night would be really rough. If there’s like one hundred of those people. [00:33:07][2.8]
[00:33:07] The balance in life, in the antioxidants, we have A, E, C, and all the foods that are antioxidants. We need to know the state. That is what this test does. It actually shows you the level of antioxidants. Hey. [00:33:19][11.8]
[00:33:20] Hey, let me ask you this, Alex. Everyone loves to work out. When you work out. Does that increase or decrease your oxidative stress? [00:33:28][8.8]
[00:33:29] Please tell me. It increases your oxidative stress. You’re right. No, no, no. Stop it. No, it doesn’t. No, because you’re breaking the body down. However, the body responds. And if you are, if we are healthy, Mario, if we are healthy. Right. Our body first has to break down and it has to repair. Okay. In that process, we want to have antioxidants because it helps us go through the process. Part of healing and part of inflammation is oxidative balance. So in essence, when you’re working out too hard or you’re running hard, you can overburn the bar, there you go. And those are the things that you and I have to kind of look at. And when people, and this is the balance. Now, this is a balance that is like the paradox. [00:34:10][41.5]
[00:34:11] Right. You know what? If you overwork, you’re gonna look awesome. But you know what? You’re actually breaking down. And if you don’t work out, there goes your cardio. There goes. I mean, other risk factors. Yeah. Right. So this is where it is so critical that we need to balance and know specifically what each person needs to be at their best. And they. And we can’t guess. No. You can’t take the same supplements as, I can’t take the same supplements as you. We can. [00:34:41][30.1]
[00:34:42] We can. But it may not be. It may be a lot of waste of money. We may just be missing the whole process. Exact. So in this whole dynamics, you’re just losing this test, Mario. Just using it at this particular assessment. We want to be able to see also what our cofactors on. We talked about proteins, we talked about genetics. We talked about things that make these enzymes work, our body functions, and pure enzymes. [00:35:02][20.9]
[00:35:03] In this particular one, you’re actually seeing what the cofactors are and what the metabolites are. Well, you see amino acids. There are levels where they are in your body. If you’re an extreme athlete, you want to know that those things are. [00:35:14][11.0]
[00:35:14] Oh, yeah. I mean, look at that. Those aminos. Those are critical. I mean, you know, I’m sorry, Mario, you think. Yeah. I mean, you know, it’s like every athlete I know, they’re like, hey, I got to take my aminos. My question is, are you taking the right ones at the right level and or do you even know? And they’re guessing, you know, 90 percent of the people are guessing. You’re looking at antioxidants. Look at that. That’s the beast right there, glutathione. That’s like the granddaddy of antioxidants right there. Exactly. And you want to know is that football players, that linebacker gonna, like, crush those zombies, you know? And again, vitamin E, I mean, CoQ10. Everyone talks about CoQ10. What? Heart health. Right. Coenzyme Q10. Yes. Right. Exactly. Yeah. [00:36:02][47.6]
[00:36:02] A lot of people taking cardiac medication specifically to lower the cholesterol. [00:36:07][4.7]
[00:36:08] Well, they’ve pulled the beta-blockers. What does it do to CoQ10?. Don’t get me started. I want to get started, man. As you know what? [00:36:15][7.6]
[00:36:16] Documentation came out early on when they did a lot of these medications. They knew they had to end and put Coenzyme Q in it. They did. They knew. And they patented it because they knew that they had it. Because if you don’t give coenzyme Q Right. What happens is you have them having inflammatory states. People have issues that are just, they’re starting to understand now. That’s why you see all the commercials with the coenzyme. But the point is here is this. We need to know where our present state is at. Right. So when we understand those things, we can take a look at tests as these and we can actually look at the dynamics of it, wouldn’t you like to know which of these antioxidants, it’s so clear? [00:36:52][35.5]
[00:36:52] I love that. Exactly. Look at that. You know what? It’s red. Green, black. I mean, that’s it. I mean, you can see it right away. This is your board. This is your command center. You know, I love the command center. I say everything’s there. [00:37:09][16.7]
[00:37:10] I know. Mario, you know, with those athletes, they want to be at the top level. Yes. It looks like this person’s kind of floating somewhere. [00:37:15][5.7]
[00:37:16] But they want to top in at one 100 percent. Alex, they’re on a bench, they’re on a bench, baby. Yeah. [00:37:23][6.6]
[00:37:24] And when they’re under a lot of stress, who knows what they are. Now, these tests are really simple to do. They’re not complex to go in. Take a lab test, sometimes… [00:37:30][6.3]
[00:37:30] These are urine tests. We can do those in our offices in a matter of minutes. [00:37:35][5.0]
[00:37:36] Exactly. In a matter of minutes. Crazy. That’s crazy. This is why it’s so simple. [00:37:41][4.9]
[00:37:42] It’s like my question is what color is the red bus? [00:37:45][3.5]
[00:37:47] I don’t know. No, it’s a trick question. [00:37:49][2.2]
[00:37:50] Well, going back into what our topic was today was personalized medicine and personalized wellness. Personalized fitness. Doctors around the country are starting to understand that they can not just say, OK, you’re pregnant. Here’s a folic acid bill. OK, here are some nutrients, though every doctor has to be taking care of their own clients. They’re the ones that are doing this. But people have the ability to understand, where are the other holes? [00:38:15][24.8]
[00:38:15] Wouldn’t you want to make sure you have the right selenium before you have symptoms? That’s the thing before. And this is why we are not treating issues, diagnosed issues. We’re not. We’re saying, what are you doing to optimize and decrease your risk factors? [00:38:35][19.3]
[00:38:36] There’s the issue of longevity, too. Because, I mean, the issue of longevity is if you’re providing your body with the right such substrates, the right cofactors, the right nutrition, your body has a chance to make it to a hundred years plus. Plus. Exactly right. And actually function. And if you have a depleted life, well, you’re burning the engine. So the body starts having issues, you know, so as we look at those kind of things. [00:38:59][23.3]
[00:38:59] If you go back, can you go back to our two markers, the immune. [00:39:04][4.4]
[00:39:06] Yeah, antioxidants. Look at that. ImmunoDex. [00:39:10][3.8]
[00:39:11] ImmunoDex. There’s a reason why they stop here at 100, because that’s the whole idea. The whole idea is to get you to live 100, centennial. Right. So we if we can do this, if you’re a person who is, let’s say, 38 years old and you’re in the midst of your life and let’s say you’re a business person and you’re a junkie for business, you’re a junkie for entrepreneurship. Right. You want to throttle, you against the world. You do not want a kind of Nicholas the worm weakness, so to speak, taking you out of your football run in life. Right. Because otherwise, you can trip up on things. And what we want to be able to do is provide people through nutritionists, through registered dietitians to doctors through the information out there to better supplement your lives. And it’s not just about little Bobby. It’s about me. It’s about you. It’s about our patients. It’s about every single one of them who wants to live a better quality of life. Because if there’s a depletion in certain things, it’s not now. But in the future, you may have a susceptibility that will bring out diseases. And that’s where those susceptibilities. We can take it to the next level because we can actually see what’s actually going on in terms of this. I’m going to go ahead and bring this back up here so you can to see what we’re looking at. You can actually see the B complexes. Now, we have a lot of B complexes. [00:40:33][81.2]
[00:40:34] And we basically oh, we got people texting all over the place here. [00:40:38][4.1]
[00:40:38] And I’m getting zapped with messages. Your oxidative stress is going up, Alex. [00:40:44][6.0]
[00:40:45] Well, it’s crazy that we’ve been here an hour, so we want to be able to bring information out for you guys as time goes on. I want to go through this and talk about the individual antioxidants. Now, individuals, your football players, man, she was taking those people out right, really making your whole life a lot better. Right. Mario, this is the kind of stuff that we look at. You know, your glutathione and your coenzyme. [00:41:06][21.0]
[00:41:06] Selenium, your vitamin E, carbohydrate metabolism. Look at that. I mean, glucose and insulin interaction that is called energy, baby. [00:41:16][9.6]
[00:41:17] And I know that’s called turbo. Last time I checked, you know. Listen, we got a lot of good doctors. We do. We got like Dr. Castro out there. We got all great doctors out there that really understand. We’re running over.� [00:41:29][12.6]
[00:41:30] I mean, this is like we’re going to get in trouble. Facebook is going to knock us out. [00:41:37][7.6]
[00:41:38] Facebook is going to put a time limit on this. I think it’s actually about an hour. But the bottom line is, we really start to work on, this can’t cover everything this time. Hey, Mario, when I went to school, we were terrorized by this machine called Krebs Cycle. For those of you, how many ATPs, Alex, tell me how many. Thirty-two is it glycolysis or anaerobic. Right. [00:42:06][27.5]
[00:42:06] So when we start looking at that, we start seeing how those coenzymes and those vitamins play a role in our energy metabolism. Right. So in this individual, there were certain depletions. You can see where the yellow comes in. It affects them, the whole metabolic process, the energy production. So the person is always tired. Well, we kind of understand the dynamics of what’s going on. So this is critical information, as you and I kind of look at this. Right. We can say, what is it that we can offer? We can offer information to better, dynamically change the way the body works. Right. So this is a crazy right. So in terms of it, we can go on and on, guys. So what we’re going to be doing is we’re probably going to be coming back because this is just fun. You think so? Yeah, I think we’re going to come back. We’ve got to change the way that all El Paso is and not only for our community but for the people that that those moms, those moms that want to know what is the best for their family members. What can we offer? The technology is not, we’re not going to allow ourselves in El Paso to be ever called the fattest, sweatiest town in the United States. We do have unbelievable talent out here that really can teach us about what’s going on. So I know that you’ve seen that, correct? Yeah, absolutely. [00:43:18][72.2]
[00:43:19] And what I can say is this, Alex. It’s about peak performance and peak ability and also getting the right specific. Customized. Genomic nutrition pattern free for each individual. And that is the game-changer. That’s the game-changer all the way from longevity, all the way to performance and just being happy and living the life that you were meant to live. [00:43:50][31.0]
[00:43:51] Mario, I can just say that when we look at this stuff, we get really excited about, as you can tell. But it affects all our patients. People come in all depleted, tired, in pain, inflamed, and sometimes we just, you know, we need to go find out what it is. And we in our scope, we are mandated to be responsible and to figure out where this lies in our patient’s problems, because what we’re doing, if we help their structure, the musculoskeletal neurological system, their mind system through a proper diet and through understanding, through exercise, we can change people’s lives. And they want to be able to fulfill their lives and enjoy their lives the way it should be. So there’s a lot to be said. So we’re gonna come back in probably sometime next week or this week, and we’re gonna continue this topic on personalized medicine and personalized wellness and personalized fitness because working with many doctors through integrative wellness and integrative medicine allows us to be a part of a team. Well, we have G.I. doctors, you know, cardiologists. There’s a reason we work as teams together because we all bring a different level of science. There’s you know, no team is complete without a nephrologist. And that dude is gonna figure out exactly the implications of all the things we do. So that cat is very important in the dynamics of integrative wellness. So in order for us to be able to be the best kind of providers, we have to expose and tell people about what’s out there, because a lot of people don’t know. And what we need to do is we need to bring it to them and let the cards lie and teach them that they have to tell their doctors, hey, doc, I need you to talk to me about my health and sit down, explain to me my labs. And if they don’t, well, you know what? Say you need to do that. And if you don’t, well, time to find a new doctor. OK. It’s that simple because today’s information technology is such that our doctors can not neglect nutrition. They can not neglect wellness. They can not neglect the integration of all the sciences putting together to make people healthy. This is one of the most important things that we got to do. It’s a mandate. It’s our responsibility. And we’re going to do it. And we’re gonna knock it off the ballpark. So, Mario, it’s been a blessing today and we’ll continue to do this in the next couple of days and we’ll keep on hammering and given people the insights as to what they can do in terms of their science. This is a health voice 360 channel. So we’re going to talk about a lot of different things and bring a lot of different talents. Thanks, guys. And you got anything else, Mario? [00:46:10][138.8]
[00:46:11] I’m all in. All right, brother. Talk to you soon. Love you, man. Bye. [00:46:11][0.0]
PODCAST: Ryan Welage and Alexander Jimenez, both medical students at the National University of Health Sciences, discuss the several new approaches that they developed in order to help people continue to engage and participate in exercise from the comfort of their own homes. Using their advanced understanding of functional medicine, biomechanics, and nutrition, they undertake explaining simple methods and techniques for complex movement protocols. Moreover, Alexander Jimenez and Ryan Welage discuss how diet can be an essential element in overall health and wellness. Dr. Alex Jimenez offers additional guidelines with the Functional Fitness Fellas, among further advice. – Podcast Insight
[00:00:11] So we are live, so at this point right now, we’re discussing exactly how we’re gonna go with the approach. Guys, can you hear me OK? Yeah. Yep. OK. Hey, Ryan. Alex, how are you guys doing? [00:00:23][11.5]
[00:00:24] Pretty good, not too bad. [00:00:25][0.8]
[00:00:26] Hey, listen. Very well, hey, well, today we’re gonna discuss a little bit about what you’re doing. Specifically, we’re gonna be talking about functional fitness. And the idea is that these two young men have been performing. Now, Ryan Welage and Alexander Jimenez are medical students out there at the National University of Health. And we are going to talk about specifically functional fitness and the things that they’re doing out there. So we’re bringing us to the community and we’re going to broadcast and we’re gonna see how it’s actually going live. So right now, I do see that we’re on Facebook live and it is propagating to quite a few people. So a little bit about what functional fitness is and what you guys decided to do now. Functional means that we find the proper way of movements and dynamics. But I’d like to know a little bit about what you guys did when you guys developed this new organization called the Functional Fitness Fellows. What are the functional fitness fellows? Either one of you guys can answer so. Hey, Alex, why don’t you go ahead, knock it out and tell us what you’ve done. [00:01:30][64.0]
[00:01:32] So when we first decided to do the idea, it was more out of necessity. We came up with the idea. So during this whole epidemic in a quarantine situation, we kind of were forced to find new ways to work out. And Ryan and I came to the realization that. You know, bodyweight stuff usually wasn’t going to cut it. So what can we do to really start implementing some sort of resistance and him and I started taking a look at…� [00:01:59][27.2]
[00:02:00] Kind of weight sets and where to order them and they were overly priced, kind of supply and demand took hold and weights, they were weights that are normally 200 dollars were now a thousand dollars and vise versa. It started to get way too expensive for someone who is either in college or are on a limited budget to be able to afford it. [00:02:21][20.2]
[00:02:21] Plus, we had to lug these weights from the second floor out into the parking lot every day, which is gonna be a hassle. So we looked into the second-best option and it turned out to be resistance bands. And I had already started using resistance bands either in the gym or in the CrossFit stuff as I was growing up, but I never really implemented a way to really focus exercising and hitting each muscle group, and I kind of just hit Ryan up and I told him, hey man, why don’t we try these resistance bands and try to see how they work and we ended up really, really liking them. And then we started coming up with a protocol and then that’s where the idea flourished that we could provide the public with this information on how to do these exercises from anywhere. I mean, from the playground to a door to an anchor that’s stable in the house or outside, you can really just implement these. [00:03:07][46.3]
[00:03:08] And that’s kind of where it sprung to life from. The types of exercise you came up with. They’re really amazing. I got to see what you and Ryan were doing. Tell me a little bit before we go into that, Ryan, what is your background and tell us a little bit about? Because I did introduce you guys early on, but I didn’t tell them your background. And I know that Alex and Ryan have an NC double A background history where they are champions in their own right. Ryan, you’ve done a lot of, you know, national championship in basketball. Tell us a little bit about what you’ve done in terms of your fitness and in the sports you’ve been involved with. [00:03:45][37.9]
[00:03:46] Yeah. So I grew up, I was an athlete from a very young age. [00:03:51][4.1]
[00:03:52] I’ve been a lifelong basketball player. And in high school, I got to be a part of a really good high school team. I actually won back to back state championships. I had finished my high school career with a record that’s about one hundred and seven. I think I’m like second all-time in state history in school and in percentage I own the record for our school, most points in a season in our school history. So I got the opportunity to go play Division one basketball. And so I did three years at San Jose State University, which is in a very good conference in the Mountain West. And I had a good career there. My junior year. I started all three years. In my junior year, I averaged over eighteen points a game, shot really well from the field. I was a very efficient player. And so I actually graduated in three years with a bachelor’s degree in kinesiology, which I think is really served me well with what Alex and I are doing. And with chiropractic, you know, I took a lot of biomechanics classes, a lot of anatomy and so on. But sport wise, I graduated in three years with that. And then I got to kind of transfer up and do my senior year Xavier, which is a nationally renowned basketball school, very good school. And so I got to play my senior year there and pursue my master’s degree. And so after my senior year, I actually had some options to play professionally but I ended up turning that down just because even though I loved basketball and athletics, it’s always been a big part of my life. I ended up turning a couple of overseas offers and a couple of the NBA Developmental League offers down to go to the National University of Health Sciences and pursue my dual chiropractic-naturopathic doctorate degrees like Alex’s. You know, with that kind of background…� [00:05:42][110.4]
[00:05:44] You probably experienced a lot of exercise protocols that you learned in kinesiology and that probably came into effect while you were actually doing this particular protocol with Alex. Alex, tell us a little about you and what you’ve done in the past in terms of your fitness experiences and your dynamic sports. [00:06:02][18.3]
[00:06:03] So when I was younger, it was mainly football, which we kind of got introduced into wrestling. And as I wrestled throughout the years, I mean, we went to a bunch of national tournaments, did it pretty decently, won a state tournament in high school, got offered and wrestled at St. Cloud State University for a little bit. And really, I mean, we were exposed to a lot. I mean, I got to work with Danny, who pretty much invented the ideas of CrossFit before CrossFit was CrossFit. And a lot of it was a lot of resistance training and a lot of weird dynamic movements that he was preparing me for, whether it was hand-eye coordination, neurological stimulation, or other kinds of forward-thinking methods that he applied in our training methods. [00:06:47][44.0]
[00:06:48] And so I got the CrossFit background and did a lot of martial arts growing up, and wrestling. So between the flexibility and agility and strength training with bodybuilding and kind of getting the whole dynamic movement through the connective tissue and development with CrossFit, kind of got the ability to hit all these angles from different points and not only training but understanding the physiological effects on the body with different training methods. So with either wrestling and stuff like that, we got exposed, not only myself, Ryan as well, to a bunch of different training methods that not a lot of people have seen or have only done one type of those methods. [00:07:27][38.9]
[00:07:28] You know, when you look at both of you guys, you can see that there’s an enormous amount of experience and a lot of life experiences that made a big difference in terms of your fitness awareness and dynamics. [00:07:38][9.9]
[00:07:40] How’d you guys meet and what did you guys do in terms of forging this new relationship with the functional fitness fellow? How did the genesis of that begin? [00:07:49][9.3]
[00:07:51] Well, I guess in terms of our meeting, it was kind of our buddy, Pete. We just sat in the front and we had this really talkative dude that wouldn’t shut up the first day of classes and we’ve come to love him. But it was really funny because actually Pete brought us together and we kind of just ended up studying and we always sat in the front row. And Ryan was always really good with the muscles and anatomy. And I was always good with the biochemistry. I always geek out in the front. And Ryan knows I love biochemistry, huh? [00:08:21][29.8]
[00:08:22] So you guys have some biochemistry experience, right? Yeah. [00:08:24][2.3]
[00:08:25] Oh, yeah. Oh, yeah. [00:08:26][1.1]
[00:08:28] Alex is a big help in biochemistry classes. He’s helped me learn so much. [00:08:32][4.1]
[00:08:33] Well, I got to tell you. You know, one of the things that you guys bring together, you bring together a new world of awareness in terms of biochemistry, biomechanics, and putting it all together. [00:08:42][9.2]
[00:08:43] You guys are the new wave of understanding. I’d like you guys to tell me a little bit about and you guys can, because I’m learning about what you guys are up to. Tell me a little bit about what you guys do in functional fitness. What is it you guys do and how is it teach you guys, progress the process and go through the protocols? Because I know you got some videos because people want to know what this is about and understand what they can do in this new world order of being know enclosed. And they want to have ideas as to what they could do that actually bring about great fitness. So why don’t you go out and take it from there, guys? [00:09:15][32.2]
[00:09:18] Ryan, I know you like to talk about…exactly what the purposes of functional fitness and the guys. [00:09:24][6.2]
[00:09:25] Well, so we know there’s a lot of well-meaning fitness influencers out there, but we really wanted to bring a more scientific approach to it, a more evidence-based approach, because we felt that there really was a lack of solid movements, a solid exercise out there, especially the social media sphere. I mean, I know a lot of the stuff that, you know, we might even take for granted would really be revolutionary if, you know, the average personal social media was to hear it. So we really just wanted to bring our knowledge. And we both have really unique backgrounds. We’ve seen a lot, we’re well educated in the sciences and anatomy biomechanics as well as we’ve both gotten to work with a lot of really elite strength and conditioning coaches. So we really just wanted to bring that knowledge as well as our own unique touch to it and share it with people because we really think we have a lot to offer. [00:10:18][53.4]
[00:10:20] That is awesome. Let me ask you this. The rubber band idea. How did that meet? How did you guys begin with using rubber bands and dynamic movement poles? This new apparatus that really doesn’t cost much money, you can actually, could, you know, from what I’m seeing here, what I’ve been able to understand. You can actually convert your whole house into a fitness center with minimal expense. [00:10:39][19.9]
[00:10:40] Is that correct? Oh, yeah. I mean, the way they kind of blossomed was really…� [00:10:45][5.0]
[00:10:48] I just spent maybe about eight or nine hours sitting through YouTube videos, and it really dawned on me what Ryan and I could provide the public with. [00:10:57][8.9]
[00:10:57] When I sent him the video of this guy who has 10 million subscribers and he looks at the camera and says, the hamstrings originate at the iliac crest and then goes back to explain why we should be doing deadlifts because it originates at the iliac crest for those of you who don’t…� [00:11:15][17.9]
[00:11:15] It originates at the iliac tuberosity and I’m sorry, the ischial tuberosity. [00:11:21][5.3]
[00:11:21] And that’s like a totally different ballgame of the mechanics and movement. To those of you who understand anatomy, to those who don’t. It’s about like 10, 15 inches away from the right spot. So I looked at him and I was like dude, we could honestly take this to a whole different ballgame. I mean, this guy’s not even a licensed therapist and he’s providing millions and millions of people with the wrong information, not only of where things attach and function, but as well as the movement of certain things. I mean, I got blessed to have a father who at 40 years of bodybuilding experience. I mean, I got to work with coaches who had 30, 40 years even more if you compound the knowledge that they have for wrestling. I got to work with trainers who worked in the functional movement since the 70s and 80s when this resistance band was a thing. And I was like, you know what? Let’s give it a try. You know what? I’m the type of person that will try everything at least once. You know, if I don’t have any experience, that I’ll give it a shot. And when I got these bands and Ryan and I started working out, it was more of a, we had like a two week period where we’re like, OK, this works, this doesn’t work. This is complete B.S. This is legit. And then all of a sudden we started making up our own movements that were extremely similar to those in the gym and no one had come up with those types of movements. It was just different angles of application. And all of a sudden we started getting better and better at it. I always have my own 48-hour rule that once you spend 48 hours in something, you start getting comfortable with it. And I think that’s after around 20 or 30 workouts, we started getting really comfortable, Ryan and I, with these movements and we had solidified a set of movements that we really liked. I mean, Ryan knows, I mean, every day we’d come up with a new movement and we’d say, OK, this is what we should be doing. [00:13:10][108.5]
[00:13:10] OK, this work, this works perfectly. This doesn’t work at all. Let’s skip that. [00:13:14][3.4]
[00:13:14] So, you know, when we look at this, this is very revolutionary. And the dynamics of it, coming from people, individuals that have done high-performance training. Has this type of fitness actually kept up the part and actually made you…� [00:13:29][14.9]
[00:13:31] Is it as intense as like training, let’s say basketball or even wrestling, is it? Does it do that kind of, does it get you as hyped up and energy expending as those other exercises would do? [00:13:45][13.5]
[00:13:46] You know, I was telling Alex, I think I’m actually in better shape and I’m actually getting a little stronger now that we’ve actually been in quarantine. And it’s really interesting. And Alex actually found a few studies that were done by some physical therapists that strength training with bands, actually recruits more muscle fibers because it’s active by activating the stabilizers. And so you can feel it. I mean, me and Alex actually kind of went through a learning curve. I think anybody that goes with bands that’s only been lifting with dumbbells or barbells especially, you’re going to feel it’s going to work it a little differently. [00:14:23][37.3]
[00:14:24] It’s going to, you’re going to feel a little differently and you’re really gonna have to actively stabilize. [00:14:28][3.4]
[00:14:29] And so I think and like Alex is saying, you can really do almost everything that you would normally do in the weight room just with bands. And so you can increase and decrease the tension, but you’re adding in that stabilizer effect. And I know the word core and activating your core is kind of, gets thrown around a lot out there. But using bands really does make you stabilize your core even more. [00:14:55][26.8]
[00:14:56] And so I absolutely believe I’m in just as good a shape, if not even better, I actually just weighed myself a few days ago. And Alex has a scale at school that we were able to weigh in, I’ve actually gained I’ve actually gained a couple of pounds since quarantine. So I think so. I absolutely think that it’s not just something that you can use to just maintain. You can use it to get better. [00:15:17][20.9]
[00:15:17] And we actually, you know, get better during quarantine, just stronger. [00:15:20][2.8]
[00:15:21] You know what? One of the things I did notice when I started watching these exercises is that YouTube has totally juxtaposed body shapes, you’re an ectomorph, which is a really tall individual, tall for even tall people. How tall are you? 6′ 9″, OK. And Alex, you’re about what? How tall are you? I’m 5’8. So we got about a foot difference. And we’re gonna be watching the videos and we’re gonna see how the dynamics work on that. I don’t know, which one of you guys has the videos cued up. [00:15:49][28.4]
[00:15:50] I am right here. I can screen share those really quickly. [00:15:52][1.8]
[00:15:53] Do me a favor. Go ahead and screen share those. And talk to me as you’re doing this stuff, because I really want to understand exactly what type of procedures you’re actually doing. As you can see that you got Ryan there. I see Ryan. I see Alex in the background. You’re going to fuzz it in. But now we’re gonna go ahead and get those. Tell us a little bit about what’s actually going on. You take it from there. [00:16:12][19.2]
[00:16:12] But so here, let me download that. So kind of what’s going on here? And we’re doing just some regular rows here and we have Ryan kind of working out. [00:16:19][6.7]
[00:16:21] And we can see that we have kind of like an anchor. This was originally intended to be a dog anchor, but we use it on our own little method here. So as you can see, he’s doing the regular types of rows that he would be doing in the gym instead of a linear movement. He’s actually stabilizing not only his core or he’s using his quads to stabilize. He’s making sure that his erectors are keeping him propped up and proper so that way he can work those rhomboids in the upper parts of the trap and the posterior dealt correctly. [00:16:51][30.0]
[00:16:53] And it’s just a whole stabilization mechanism. I mean. They always say that the king of lifting is a squat and the squat is the king of lifting because it forces you to stabilize not only your legs but your core as well as your upper body. And with these banded exercises, you’re getting the same effect and stabilization in all points of movement, not only just in the muscles being worked as well as the accessory muscles. [00:17:18][24.1]
[00:17:19] Ryan, you were doing this particular exercise and you’ve done, obviously, you know, back rows. How is this different in terms of what you’re doing? Because you look like you’re locked in space and you’re holding a whole lot of muscles engaged that typically you would never even think of using when you would be doing the regular, let’s say, a pulley row. What’s going on here? Tell me a little about what you were feeling. [00:17:39][20.6]
[00:17:41] Absolutely. That this exercise is a full-body exercise. I mean, as Alex said, you can see my thighs and hamstrings are absolutely engaged. [00:17:50][9.7]
[00:17:51] And your core has to be engaged. I mean, you have to be able to stabilize and hold yourself in place. As an aside from that, the bands, they provide so much tension on the way back down that again, it forces you to recruit all the stabilizers and then also to recruit your legs, to actually support you, to keep you from being drawn back in. So that exercise right there, aside from obviously just being a regular row on which, you know, you could get on a rowing machine. But the difference is this is truly a full-body exercise. And so it really is more functional in that way. That’s a full-body exercise. It’s a natural range of motion. So this is actually one of my favorite exercises that we were able to come up with. [00:18:32][41.0]
[00:18:32] Two things I’ve noticed here. You know, when you, when we work on fitness and we require people to do a certain exercise, we always tell them that you’ve got to start from the core. It looks and it appears that you got your core engaged in this entire movement through all ranges of motion. Is that what you’re feeling? [00:18:47][14.7]
[00:18:48] Absolutely. Yeah. I mean, if you let go for a second. I mean, I would fall forward. You absolutely have to be clearly engaged. Again. Yeah. That’s something that there probably will be a learning curve for people that have just been barbell training. They probably haven’t been used to actually having to keep their core engaged with a whole range of movement. [00:19:10][21.7]
[00:19:10] But I think that they are training and even this particular exercise especially can really help them with the…You know, the level of neuromuscular reeducation. [00:19:19][8.3]
[00:19:19] I mean, that’s occurring in the body. It’s adapting, many of us when we started lifting weights for the first time. We ran into a, the first time we had neuromuscular reeducation on the squat. When you pull the squat bar off the very first time, if people can remember when they do squats, they were all over the place. It took about three or four days of learning how to grab a barbell and actually bringing both your legs together. [00:19:42][22.8]
[00:19:43] It’s the same thing that’s happening here because you’re actually training the brain to engage the entire body at the same time. Alex, what is it you’re doing here on this particular one? [00:19:52][9.0]
[00:19:53] So here we have just a different variation of shoulder press. The cool part that I really liked about these is that not only are you forcing the concentric reaction, which would be all the way up, but the eccentric has to be controlled. [00:20:08][15.1]
[00:20:09] And not only did I realize that my delts were working a lot harder, but it was really interesting because on the eccentric, on the way down my lats were actually having to engage a lot more. So I was not only working in those, but I was also having to work my lower back to keep me forward to stabilize my core towards the front that way I wouldn’t fall forward and I had to really stabilize almost every part of my body, become almost like a contraction, just to be able to do the exercise there. [00:20:33][24.1]
[00:20:34] You know what I’ve noticed, too, as you’re doing this, it seems like the rubber bands are giving a forgiving range of motion. In other words, it allows the joint to follow its normal glide. In other words, it’s not going to force you in a position that is abnormal for the joint because it appears that it gives. Is that what it’s given here, too? [00:20:55][20.9]
[00:20:56] Oh, yeah. The cool part about these is that I mean, on the bottom here, it felt maybe like. Hundred pounds or shoulder press and towards the top with all-around one eighty-five. So it’s following the natural strength curve of not only the joint but as well as the muscle. So as you go up higher, it gets heavier. As you come down lower, it gets lighter. So allowing there to be less stress on the joint and more focus on the muscle. [00:21:22][25.6]
[00:21:23] This is absolutely an amazing experience when you see this. This is not a normal range of motion. This is actually a normal rep. It is amazing, it’s progressively changing as the distance changes and it seems logical. But if you can notice, there’s only one rubber band here. Is that correct or is that two? [00:21:40][17.5]
[00:21:41] That’s what well, the cool part about this is that this is a 40-pound rubber band. So in a linear-pull, the rubber band pulls 40, but if you bend that rubber band in half, you’re actually getting 40 on each side. This is a total of 80 pounds here. [00:21:56][15.0]
[00:21:57] Wow, and by the time it was in the top, you felt the load. [00:22:00][2.1]
[00:22:00] And yeah, so around here it’s around 80 pounds. Let’s say here, felt around one hundred. This is just an obscure measuring method and we need to solidify these numbers. But it did feel around one eighty-five toward the top there. [00:22:10][9.9]
[00:22:11] Now we’ll take a look at someone, let’s say, with different body mechanics. Let me see. Here we go. [00:22:16][5.8]
[00:22:19] And we can download this. Is that, by the way, just out of curiosity, was that the same cable? Was that the same rubber band? [00:22:24][5.4]
[00:22:25] This is a 30-pound rubber band. So we could see that Ryan is a lot taller. So the farther he is away from that point of contact, the more it’s going to cause a higher load there. [00:22:36][11.0]
[00:22:37] Ryan. How did you feel about this one? Tell me a little bit about what you were experiencing on this one. [00:22:39][3.0]
[00:22:40] Yeah. So like Alex was saying, it does fall natural strength because, at the top of the movement, which is where you’re strongest, it’s actually heaviest. But where you’re weakest, which is a lot of people, you know, they get caught as they go down. They can’t get back up. But it falls a natural strength curve and actually allows you to do more weight where you’re strongest, which is something that you can’t do, obviously, with a bar bill. So as for this specific movement. Alex and I were really working on kind of the incline bench, which I think a lot of people would think of. You know that the weight room is closed like there’s no way I can do an incline bench with this, but all you need is something that you can put in the ground. And Alex and I had this thing at school here. But we also, Alex and I looked into something that we can actually buy to help tell people what to put in the ground. And so we actually found a shed tool that we can talk about at some point that we were able to link into the ground that has a hook like that so that we can hook it in the ground and then put that cable through and be able to do this exercise. [00:23:45][64.8]
[00:23:46] Now, I notice that you’re doing this outside and you used it. You show different areas. Now, I do notice that on some of these times when you do have some videos, I have some videos here of you doing things like show, actually, Ryan. [00:24:00][13.9]
[00:24:00] I have a video here. I’m going to go ahead and show my screen just a second here. [00:24:03][2.7]
[00:24:04] And what we have is Ryan doing a specific type of procedure. Show us your screen, here it goes. We’re gonna go in there and there we go. We’re going to share and we’re going to share right now. Now, this particular one, you can actually see that you’re doing this in an area that’s just any anchor. Is that correct? [00:24:24][19.4]
[00:24:25] Yeah, yeah. And the cool thing about that is that that jungle gym had a lot of different anchors. But again, we found a way that you can do this inside your home if you just have any door that you can actually put a slip through. [00:24:39][14.1]
[00:24:40] It’s got a little ball on the other side. Keep it in place. And so you can actually young hook the bands to that. And so any door you can do this. So we’ve really found a way to just do this anywhere. [00:24:49][9.6]
[00:24:50] But obviously, we wanted to train outside when we could. In this particular one right here, I actually have Alex and you’re showing and you’re talking about the bulb actually holds around the door, correct? Alex? [00:25:01][11.1]
[00:25:01] Yep. What is it, what’s going on here? [00:25:04][2.2]
[00:25:04] What are you doing here? So we’re doing pullovers, the same thing that you would do to get that serratus anterior to prevent any scapular protraction. A lot of problems with that is that some people really don’t work that serratus anterior. So they have problems with those scapulars protruding outwards and it causes a little bit of an effect to be able to be put in a range of motion that is not stable and causing scapular whinging. So by strengthening those? You can prevent that. [00:25:31][27.3]
[00:25:32] Ryan, you were doing some other exercise. I’m gonna take you to this one, this particular one. I’ve noticed that when I’ve always lifted weights, I’ve always known that there’s always the best exercise for a motion. And one of the most common ones is the incline bicep bilateral curl. When you lean back and you actually do curls. This looks very similar to it, though. You’re leaning forward. You’re actually getting a good pull on the bicep. What is it you’re doing here in terms of this one? This is not a bicep exercise. This is a what is this one? [00:26:03][30.5]
[00:26:04] So we were hitting lower. We were in the lower pecs with this exercise. So we were yeah, we were actually keeping our arms straight and got it. Makes sense. Yeah. So we weren’t hitting the bicep. We had a lower pec there. [00:26:16][12.5]
[00:26:17] So the lower pec on this one is the one that you’re doing this not for biceps I can tell you didn’t curl the arm that much. So straight. So how did that feel? [00:26:24][7.1]
[00:26:26] I mean, again, that is a great hit on the lower pectoral muscle. Yeah, I mean, those again, that’s something I never really felt before I hit bands actually isolating that lower pectorals muscle cells. Yeah, that was another great exercise. [00:26:41][15.6]
[00:26:42] This particular one I’ve noticed here. Alex, tell me a little bit about what you were doing out here. [00:26:46][3.2]
[00:26:46] Let me, if you want. Let me share my screen. Go ahead. You got it. [00:26:50][4.0]
[00:26:55] These are amazing exercises. Guys, you guys are really up to something really amazing here. [00:26:58][3.4]
[00:27:00] Here we have kind of just more of a regular chest press. So the cool part about this is that my upper torso probably weighs, let’s say, around 100 pounds roughly. And this band right here is actually a one hundred and fifty-pound resistance band. So on the bottom part, it’s around one hundred pounds and towards the top, it’s around a three hundred pound chest press. So kind of going into the movement. It actually feels like a pretty heavy. Push up. Really? And let’s say that you’re stronger than this, right? Just add another band. If you’re still stronger, just add another band. And I don’t think anyone’s gonna be doing a 500-pound push jump anytime soon. So you’re getting a pretty good amount of resistance in the proper mechanics of it all towards the top. It is heavier and towards the bottom, it is lighter. Allowing your pec to get that full range of motion while preventing possible areas of injury. [00:27:53][53.8]
[00:27:56] Wow. All right, so you got some cool. What other stuff do you got in there that you were looking at? I saw that you had a lot of others. Oh, yeah, we got tons of videos here and let me see because I think everybody wants to see what’s going on here. I’m really interested in this. And if you could tell me a little bit what you’re doing now in terms of that one. Amazing. Look at that. [00:28:16][20.1]
[00:28:19] So here we’re doing a kind of an almost like a squat press here. And we’re kind of just playing around with the ideas. But it turned out to be a really good mechanism. I mean, before Ryan had gone home, we were doing resistance bands, squats, and we’re getting around the same. I mean, probably had about 10, 15 bands on this thing while we’re doing squats, but it was still around a three to four hundred pound squat while you’re doing it right. [00:28:42][22.9]
[00:28:43] What are you feeling here? What do you feel like? That’s just amazing. I’ve never, I’ve worked out for years, I’ve come from the 80s and I have never done a squat where you’re actually doing a shoulder press. The only thing that would become close to this is a snatch or a cleaning jerk. And those kinds of things would actually bring. This is an Olympic lift. [00:28:58][15.9]
[00:29:00] Yeah, yeah. There’s another great one we came up with. [00:29:02][2.5]
[00:29:03] So we were able to load the squat more in later sessions or for this one it was a little light. It’s a little light on the squat part, but it really loads the press over the shoulders heavy because again at the top is where you get the most tension. So it’s really a great overhead shoulder exercise. And again, just the way that the band moves, it’s so much safer for the shoulders. I told Alex that my joints are actually because I was using mainly dumbbells with some barbells as well before. And so my joints actually, they really feel better than they have in a long time from using these bands just because they allow such a natural range of motion. [00:29:44][40.5]
[00:29:46] Look at this man. You guys went out there and it looks like it’s a little bit cold out there, too, huh? [00:29:50][3.8]
[00:29:52] Little bit. Brian says it’s a beauty day outside. It’s 30 degrees outside. [00:29:56][4.5]
[00:29:58] I did like to train outside. [00:29:59][0.8]
[00:30:00] You know what? That’s the beautiful thing about it. You got, this is just, it’s amazing. [00:30:03][3.4]
[00:30:04] What’s going on here? We have a variety of wrist curls to strengthen the flexors of the forms. [00:30:09][5.4]
[00:30:11] And actually, it’s pretty heavy there. I mean, even though it’s a 40-pound band, we’ve kind of not only bent the band in half but bent it almost into three different quadrants. So by the time you bring it up to the proper stabilization, it’s definitely around 50, 60 pounds of a wrist curl. [00:30:24][13.6]
[00:30:26] That is amazing. [00:30:26][0.3]
[00:30:30] And again, yes, there’s no way to do this without engaging the core. There’s no way. [00:30:34][4.0]
[00:30:37] What’s going on here with these tricep pushes, right? Yep, so tricep extensions here. Here’s another variation of it. [00:30:43][6.3]
[00:30:58] Ryan, you’re going to have another career in photography. [00:31:00][1.9]
[00:31:00] I can tell you now. Alex taught me quite a bit about photography. He had a camera but yeah I was just trying to get a good angle. [00:31:12][11.7]
[00:31:12] And we spent a lot of time filming each other, you know, trying to make these videos for people. I think I really improved. Oh, my goodness. Going to show. Alex. [00:31:23][10.3]
[00:31:23] What are you feeling here in terms of the triceps? Because you can see the angle pull changes dramatically as your body’s putting it in the, what is it? [00:31:31][7.6]
[00:31:31] So if we pause it here and take the triceps out for the movement. Let’s talk about what needs to be stabilized in order to be able to even do the movements. So not only do we have the core stabilization, the rectus abdominus from stopping you for being pulled up, but you will also have the serratus anterior and the posterior muscles preventing you from coming up, as well as preventing any movement in the shoulder area. So by locking in the shoulder, you’re forcing all these muscles in the upper body to stabilize as well as the… [00:32:03][32.0]
[00:32:06] The lateral side of the pec. I’m sorry, but be able just to do a tricep extension so you can see as I’m getting tired here. [00:32:12][6.7]
[00:32:13] You see, I’m kind of starting to come up a little bit more than I was originally keeping that stabilization form there. [00:32:18][5.6]
[00:32:23] What kind of pumps do you guys get? You know do you guys feel the same swole, I guess that you would feel if you’re lifting weights, or is it something that’s a little bit different? What do you feel like after? You’re mentioning, Ryan, that you felt really, really sore? How did you feel when you were doing these things? How does the muscle feel different? [00:32:40][16.9]
[00:32:43] Yeah, I mean, again, I feel just as good as a pump from using bands as I had ever felt from using barbells. I mean, I think it’s… [00:32:51][8.5]
[00:32:52] The way we’ve been able to assess some of these exercises up and down, again, you’re talking about recruiting the stabilizers, you’re actually recruiting more muscle fibers which need more blood flow. So you’re gonna get a great pump using bands. There’s no doubt about that. [00:33:07][14.3]
[00:33:08] Alex, you mentioned to me after you started doing this kind of workout, you noticed your body changing in a different way. What did you notice? [00:33:13][4.9]
[00:33:14] I noticed that I had more stability. That’s a good word as well as I had less body fat built onto me, too. I usually aim for about 15 to 20 reps on every exercise that we do here. The important part of these is to explode on the way down, but control on the way up. [00:33:33][18.8]
[00:33:35] And forcing that eccentric stabilization is a big key factor in a lot of these exercises. I’d say it is not in most of these exercises and you really get more of a burn with these type of things too. I noticed it, the main way that I noticed it was, let me see if…�[00:33:50][15.5]
[00:33:51] I can find the video here. Ryan, in this particular one that you’re doing, the tricep. [00:33:56][5.0]
[00:33:56] Does the lockout happen when you lockout, is there a lockout or is it under a constant load that prevents the lockout or is the lockout real difficult to attain in terms of the extension of the arm? [00:34:06][9.9]
[00:34:07] Yeah, it is very difficult to obtain because, yeah, as you said with the bands, there is constant tension and there’s a constant need to stabilize. It forces you to stabilize at all times. So we were a little all over the place when we first started using bands. And I think a lot of people when they first do it, too. They’ll kind of be a little all over the place while almost shaking a little bit faster than they do something exercise. But again, it’s amazing how fast you can adapt. And it really teaches you to contract in a new way. [00:34:38][31.0]
[00:34:39] Alex, this particular, this is the one I thought Ryan was going to do the other time. How did this feel in your biceps? [00:34:44][4.6]
[00:34:45] I felt really, really good. It’s honestly probably biceps have benefited the most from these types of workouts because it’s under a constant load and it gets heavier as it comes sorts of the top. You and I, we used to train. We always used to force a negative on everything. This is just negative in itself with everything you’re doing. It’s getting heavier on the way up and getting lighter on the way down to really allow that muscle to work in different mechanisms. [00:35:09][24.2]
[00:35:10] There really is the ability to go into the muscle and to really benefit from the concentric and the eccentric in a way that has never been done. It’s always been known. And when you lift weights, the concentric was the idea. [00:35:22][12.2]
[00:35:23] But as fitness became much more science, they found so much in the eccentric motion that was part of the training that actually developed the muscle that this is actually pulling. And this is maintaining the load on the absolutely eccentric and being kind to it on the way down, which is typically where most people get hurt on the eccentric, not on the concentric. They get hurt on the eccentric on the extension or the opening of the muscle. This actually it actually prevents a load that would reach maximal pull and actually may hurt the tissue. So this is really, really amazing in terms of its structure when you actually study it. What are you doing here? [00:36:03][40.5]
[00:36:03] You’re going to concentrations or something similar? Concentration curls here. And it’s actually really, really good for the bicep there. As you know, I tore part of my bicep when I dislocated my right arm and to be able to work in such a manner and actually break up that scar tissue and work through it. It’s really, really good. [00:36:22][19.1]
[00:36:23] Truly great. You guys, you’re offering a huge amount of diversity in this presentation just because you’re dealing with different body types and you’re watching the body adapt to it. Which ones are you doing here? These ones are flies or these are? [00:36:35][11.8]
[00:36:35] Yep. These should be flies here. [00:36:37][1.2]
[00:36:44] Nice stabilization, you’re forced to stabilize really nicely, right? [00:36:47][2.9]
[00:36:48] Yep. And you can almost see I kind of wobble a little bit at first because it caught me off guard again. It really takes a bit of getting used to because you’ve really never been forced to stabilize like that. I mean, if you just go to a machine, the you know, the cable machine at your local gym. They’re not going to force you to stabilize in the same way that these bands are going to the way we’re doing it. So is it ever really a completely different feel. And when people get a chance to do this, they’re going to be able to tell what we’re talking about. [00:37:20][31.7]
[00:37:22] What else you got in there, Alex. Some cool stuff, you know. Yeah, let me close this here and let me see. [00:37:28][5.6]
[00:37:38] I say this is probably a good one here. [00:37:40][2.5]
[00:37:41] Ryan hates these, but they’re good. Yeah, wrist extensions. [00:37:44][2.9]
[00:37:47] So I started looking into, the reason I started trying to do a lot of wrist work was I got lateral epicondylitis, otherwise known as tennis elbow. And it’s actually a weakness in the extensor carpi radialis brevis. And by being able to strengthen these you actually allow the forearm to get a really good pump. And not only that, but it pretty much works really well. The abductor pollicis longest as well as the brevis to some extent. But yeah, these are really great for wrist extensions. I really love these, I’ve fallen in love with them and I probably won’t go a day without doing some sort of wrist exercise. [00:38:22][35.1]
[00:38:23] Oh, guys, I got to tell you, this has been a very much of a learning experience for myself watching what you guys are doing from a physiological state, just from what we do with patients here at our office. [00:38:35][11.9]
[00:38:36] We’ve done a lot of exercises and rubber bands it’s really a new addition over the last I’d say last decade or so, but it’s gone from just a simple level of exercise work to very complex science. And I think that you guys are forging this new, fundamental physiology motion or kinesiology motion. And we’re learning a lot here. What do you guys take from this? And I like to hear from both of you guys because I want to understand what it is you guys are doing and what we have to look forward to with the functional fitness fellas and what you guys are going to do with this new protocol and program in the future. [00:39:16][40.1]
[00:39:18] We’re gonna do a lot of different things, I mean, Ryan has an extensive background in how to be an NC double A athlete while being vegan. I personally don’t do well with carbs, just my genetic genotype, but whether it’s from diet to exercise to, let’s say, a book of the week to discuss different contents. Gonna be going into different things. And the cool part about these bands is that I’m sure, you know, it was learning about the X and Y access as well as the Z-axis in terms of rotation and anatomy. And the cool part about these bands is that it forces muscles on every plane to be working to stabilize the movement of that one isometric contraction of that muscle. So we’re getting a lot of different movements and a lot of different implementations, a lot of different ideologies that are being worked. And once the weight room opens up again, we’re gonna be doing videos on how to use bands in the weight room, how to implement them on free weights. There are different mechanisms, different ways to tie the hands up and not only from them, but the world’s best powerlifters use resistance bands to get those heavier weights. If you can do a three hundred and fifty pound squat with two bands that equate to 250 pounds in each of them, you’re gonna be able to squat 800 pounds like it’s almost nothing. [00:40:30][71.2]
[00:40:31] Ryan I was watching some videos where you were actually doing some, you know, kind of like a hack squad. [00:40:35][4.7]
[00:40:36] I think it was a hack squad or some sort of leg press where rubber bands were attached to the machine. So this is like a hybridization process where you not only are you using standard machinery, but you’re amping it up with rubber bands and getting the double the benefit because now you get the rubber band constant eccentric load along with the concentric blast of a machine. What is it you guys were doing there in the gym? Because I don’t have that particular video, but I do remember I got that video. Let me share that to you. [00:41:04][28.3]
[00:41:06] Yeah. So we had hooked up a band on to each side. [00:41:11][4.9]
[00:41:11] And again, I think that’s part of what we can do once we come back to the gym is we’re actually going to integrate the bands with, you know, some of the barbell and dumbbell machine and some of the other stuff. But again, I really like how it tests you where you’re strongest, but it allows you to do more reps because with more weight, according to your natural strength or because it’s heaviest when it’s at the top. But it’s lightest at the bottom, which is where you’re the weakest. So that’s one of the things I really love about bands I think a lot of people can take advantage of. [00:41:46][34.2]
[00:41:46] You don’t even have to change the weights that much you actually just keep the same weight on if you want to go if you want to do more you can do more. But this is amazing how much that load increases during that period of time. Wow. Well, I’ll tell you what, I look forward to hearing from you guys and seeing exactly what’s going on, learning about the nutritional components and the things that you’re gonna do with the diverse presentations that you guys are going to have. So let me ask you this. What are we looking forward to in the next one? Because I know we’ve got one scheduled, I think, within a week. I look forward to it and we’ll go and start broadcasting that one. But I want to be able to learn different concepts and ideas from this. And I can see that the people that are watching this, they’re obviously gonna see that, you know, with a bag, with a bunch of rubber bands in it. Is it expensive to get into this? A hundred bucks. [00:42:29][42.6]
[00:42:30] Everything we bought. A hundred bucks and you just basically amped up your gym, huh? Exactly. I mean, the problem with right now is that everyone bought resistance bands so they’re a little bit out of stock for a lot of these and a lot of people are charging absurd prices. So what we’ll do is we’ll try to find you guys some credible sources to buy these resistance that we’re also gonna be putting and launching on our website within the next week or two, putting all the videos up, their description in each of these videos, a little bit about us, background and everything. Ryan is gonna be taking the vegan supplemental thing to a whole new level. I’ve learned a lot of things from him in terms of types of foods that would favor your microbiome as well as help your gut function better through him. We’ll be doing shakes, we’ll be doing books. We’re gonna hit it all. So there is no single topic, we’re gonna hit it all from a functional perspective. That’s why we are the functional fitness fellows and we’re going to be kicking ass and taking names showing you what works and what doesn’t. [00:43:25][55.0]
[00:43:26] The biochemistry, because you guys are really I mean, I’ve seen the work you guys have done in the biochemistry. Ryan, I was looking at your website. You got some good biochemical reactions and studies that are on your website. So I look forward to understanding a lot about the vegan mechanisms as a way to deal with your diet and along with your workouts. It just in a short just a little synopsis of that. What kind of things do you do, particularly what is your philosophy in terms of vegan approaches with little level of athleticism? Because it really is rare to have this level of diet. And I’m not too sure you met many people in your sport that were vegan. But tell me a little bit about your awareness of vegan and how it began. [00:44:11][44.5]
[00:44:12] Yeah. So you’re right. There are not too many high-level athletes that are vegan, although it is a growing movement. But so I really. Let me quickly tell the story of how I went into it. So my junior year of college, while I was at San Jose State, you know, I was playing almost the whole game, every game. So I had a high workload. But so I had really bad shin splints. And I obviously I was in the kinesiology program, I was researching information and all this stuff and I was looking into the biomechanics and I thought my biomechanics were pretty sound. So I’m like, OK, that’s not it. And I’m looking at the nutrition and what I was finding that some of these animal products, especially the ones that aren’t grass-fed, you know, they have a lot of hormones. All this stuff and dairy particularly, they have the potential to be more inflammatory, as I can’t talk about on my website. Part of the reason is that because they have a higher omega 6 to omega 3 ratio, and so that omega 6s, they become arachidonic…� [00:45:12][60.4]
[00:45:13] Acid on the biochemical pathway and then they become this molecule called p.g 2, which is 100 times more inflammatory than the p.g 3, which is the byproduct of omega 3s. So these omega 6s are causing a lot of inflammation. And so once I actually went to a fully plant-based diet, I found that I was having terrible shin splints and I kid you not that my shins completely went away in three or four days. It was really, it was profound. There was a profound difference. [00:45:43][30.4]
[00:45:44] And I kind of went on to learn that I wasn’t the only one that had had this type of experience and a lot of people had benefited from a plant-based diet. And I was obviously interested in nutrition and continue to study it. But that was kind of how I started, I personally tested it and I had amazing results. And, you know, I’ve found that it speeded up my recovery actually I wear a trackable one. I found that my resting heart rate actually dropped by three beats per minute when I made the switch, which I thought was pretty incredible. My heart rate variability went up. So I saw some profound physiological changes. So I just never went back. [00:46:20][36.2]
[00:46:21] I got to tell you, this is what I want to hear about that. Maybe we can do that on the next one that we talk about, specifically the vegan approach to your training. And this is an amazing thing because I know, Alex, you were doing something you were sharing with me about the days you eat, the higher proteins and eliminate the proteins or the high meats or those chickens or just the animal-based proteins. And on days that you don’t train as hard, you changed your diet plan. So I want to learn a lot about this because I think that it’s so important that people understand what you guys who are actually on the front lines of learning medicine today are doing. So I look forward to having you guys. I want to thank you guys today for taking this time. And it’s been a little bit intense, but it really has given people an insight as to what’s going on. And I hope that the individuals watching this really have learned something and can take it to another level. This is a really amazing time. It’s a time where we’ve been quarantined, so to speak, and we’ve come up with some creative ideas. Any words or thoughts from you guys before we leave guys? [00:47:24][63.2]
[00:47:27] We’re ready�for the information. [00:47:27][0.5]
[00:47:29] I appreciate you for having me on. Oh, no. We’re gonna be doing this. So you guys are scheduled for the next, it’s already broadcasted. I think it’s next week and I’ll hook up with you guys and it was a blessing. [00:47:38][9.3]
[00:47:38] I’ll have the recordings out to you guys. You guys have a great night. And thank you for sharing your time. I really appreciate you, Ryan. Alex, for taking the time to teach us these things because I want to know and I know every one of my patients want to know what’s going on here. So thank you for bringing it to us, guys. I appreciate it. Hey, have a good one, guys. Blessings, okay? Bye Bye. [00:47:38][0.0]
The Neurotransmitter Assessment Form (NTAF) shown above can be filled out and presented to Dr. Alex Jimenez. The next symptoms that are listed on this form are not intended to be utilized as a diagnosis of any type of condition, disease, or syndrome, as well as any other type of health issue and complication.
Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a �disease� per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.
Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.
Anatomy of Related Structures
Anatomy of the Spine
The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.
The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)
Anatomy of the Intervertebral Disc
Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.
Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)
The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)
Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6? in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)
Blood Supply
The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (�Intervertebral Disc � Spine � Orthobullets.Com�)
Nerve Supply
Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don�t extend beyond the superficial fibers.
Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)
The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)
Pathophysiology of Degenerative Disc Disease
Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.
The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ��degenerative cascade��. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.
Stage 1 (Degeneration Phase)
This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)
The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.
Stage 2 (Phase of Instability)
The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.
The symptoms seen in this phase are similar to those seen in the dysfunction phase such as �giving way� of the back, pain when standing for prolonged periods, and a �catch� in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)
Stage 3 (Re-Stabilization Phase)
In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.
Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)
All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.
Etiology of the Risk Factors of Degenerative Disc Disease
Aging and Degeneration
It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.
There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.
The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.� (Roberts, S. et al.)
When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.
All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)
Genetics and Degeneration
The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.
Nutrition and Degeneration
Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)
Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.
Environment and Degeneration
Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Batti�, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTI�, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662�70�)
Pain in Disc Degeneration (Discogenic Pain)
Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJ� T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.
Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.
Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)
The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient�s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)
Clinical Presentation of Degenerative Disc Disease
Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.
Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This �flare-up� is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.� (Jason M. Highsmith, MD)
The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.
The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)
Diagnostic Approach
Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.
Through the patient�s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)
Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.
Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)
Investigations
Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.
Imaging Studies
The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (�Degenerative Disc Disease � Physiopedia�)
Plain Radiography
This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.
Magnetic Resonance Imaging (MRI)
MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)
Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.
There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)
Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)
Computed Tomography (CT)
When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.
CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.
Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.
Lumbar Discography
This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.
The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)
Imaging Modality Combination
In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.
CT Discography
After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.
CT Myelography
This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.
When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)
Electro Myographic Studies
Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (�Journal Of Electromyography & Kinesiology Calendar�)
Laboratory Studies
Laboratory tests are usually done to exclude other differential diagnoses.
As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.
Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.
Treatment
There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.
Conservative Treatment
This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.
Exercise-Based Therapy with Behavioral Interventions
Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)
Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.
Physical Modalities
This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.
In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)
Back School
This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.
Patient Education
In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.
Bio-Psychosocial Approach to Multidisciplinary Back Therapy
Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called �behavioral� and �bio-psychosocial� strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient�s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.
Massage Therapy
For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)
Spinal Manipulation
This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.
Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)
Lumbar Supports
Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.
Lumbar Traction
This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)
Medical Treatment
Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.
Muscle Relaxants
Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.
Opioid Medications
This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (�Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction�)
Anti-Depressants
Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.
Injection Therapy
Epidural Steroid Injections
Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.
During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn�t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (�A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain�)
There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.
Facet Injections
These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)
SI Joint Injections
This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.)�
Intradiscal Non-Operative Therapies for Discogenic Pain
As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.
Surgical Treatment
Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Bj�rn L.)
Lumbar Spine Procedures
Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)
Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)
Lumbar spinal posterolateral guttur fusion
This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.
Posterior lumbar interbody fusion
In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.
Anterior lumbar interbody fusion
This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.
Transforaminal lumbar interbody fusion
This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.
Total Disc Arthroplasty
This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.
Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)
Lumbar discectomy
The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 � 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.
Lumbar laminectomy
This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.
Cervical Spine Procedures
Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)
Cell-Based Therapy
Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)
Gene Therapy
Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)
Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
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Infections can happen to any individual given specific circumstances, however, infections occurring in HIV/AIDS patients are more commonly referred to opportunistic infections or OIs.
HIV/AIDS severely dampens the immune system of the patient, making it less able to fight off infections. It wipes out the white blood cells that eliminate an infection. Specific types of bacteria, viruses, fungi, and other organisms, which do not commonly result in infections in individuals who are healthy can make those with weak immune system sick. This exposes them to the dangers of suffering from opportunistic infections (OIs). OIs are severe infections that affect an individual due to his or her weak immune system.
The strength of an individual�s immune system with HIV can be estimated through the T cell count, which is also referred to as the CD4 count. When the T cell count is under 200�cells per microL,�it means that the individual condition has deteriorated to AIDS and, thus, he or she faces the risk of suffering from opportunistic infections. Nevertheless, a lot of opportunistic infections can be inhibited when the individual is placed on specific antibiotics and anti-fungal medications. HIV medications can also enhance the T cell count and reduce the risk of the individual suffering from opportunistic infection. This can normally be minimized when the individual is given continual therapy. Opportunistic infections are generally less widespread and less severe in healthy people.
What is an Opportunistic Infection (OI)?
Opportunistic infections (OIs) are the types of infection that commonly develop in individuals with weakened immune systems than in people with healthy immune systems. Individuals with weak immune systems are mostly HIV patients and patients receiving chemotherapy treatments.
OIs are normally caused by a lot of germs which include viruses, bacteria, fungi, and parasites. Germs that cause OIs can be transmitted through various ways including the air, the saliva, semen, blood, urine, poop of an infected person or through contaminated food and water.
Individuals who are more at risk of suffering from OIs are those with their CD4 count below 200, but you can contract some OIs when your CD4 count is less than 500.
OIs are not as widespread now the way they were when HIV and AIDS first originated, due to the fact that a better treatment is now available which minimizes the quantity of HIV in an individual�s body and this increases the immune system. Nevertheless, a number of people with HIV still develop OIs due to the fact that they were unaware that they were infected with the HIV virus for a good number of years after their infection. Individuals who know that they have HIV, but who are not receiving the antiretroviral treatment (ART), will still be infected by OIs. Individuals who have AIDS, but who are not taking medication for the prevention of OIs, can also suffer from OIs.
The best way to stay clear of opportunistic infections is to stay in care and get your�lab tests�carried out. This will help your doctor and other medical teams know when you may be facing the risk of OIs and ensure that they are prevented. Most opportunistic infections can be prevented by taking additional medications.
There are different types of OIs. This includes the following amongst others:
Bacterial infections like�tuberculosis�and similar disease,�Mycobacterium avium complex�(MAC)
Viral infections like�cytomegalovirus�(CMV) and�hepatitis C
Fungal infections such as yeast infections, cryptococcal meningitis,�pneumocystis carinii pneumonia(PCP) and�histoplasmosis
Parasitic infections like crypto (cryptosporidiosis) and toxo (toxoplasmosis)
Having HIV/AIDS and complications from common illnesses like flu.
Salmonella�infection
Herpes simplex virus 1 (HSV-1) infection. This is a viral infection that can result in a sore mouth and face
Salmonella�infection a bacterial infection that affects the gut.
Candidiasis (or thrush). This is a fungal infection of the mouth, esophagus, or vagina
Toxoplasmosis (TB). This is a parasitic infection that can have a harmful effect on the brain.
You can avoid being infected by taking medication for your HIV/AIDS. Taking HIV medications prevents HIV from injuring and weakening your immune system. Due to the fact that HIV medicines are now extensively used in the United States, the number of people who develop OIs has drastically reduced. You can also limit your exposure to causative factors by engaging in safe sex, washing your hands thoroughly and frequently, and cooking your foods properly.
Why Do HIV/AIDS Patients Get OIs?
As soon as an individual is infected with HIV, the virus starts to multiply and begins to injure the individual�s immune system and immune function. A weak immune system makes it difficult for an individual�s body to ward off HIV-related OIs.
HIV medication inhibits the capacity of HIV to cause damage to the immune system. However, if the individual does not take the medication, HIV will gradually be destroyed by the immune system. Most OIs, for instance, the ones that contain specific forms of pneumonia and tuberculosis (TB), are taken as AIDS-defining conditions. AIDS-defining conditions are infections and cancers that are life-threatening in individuals suffering from HIV.
Prevalence of OIs in People with HIV/AIDS
OIs were formally the leading cause of death among individuals with HIV before the advent of medications used in the treatment of HIV infection. Now that HIV medicines are very widespread in the US, the occurrence of OIs among aids patients has been reduced. HIV medications reduce the ability of HIV to damage the immune system and by so doing, it impedes the occurrence of OIs.
Prevention of Opportunistic Infections
The best ways to prevent yourself from becoming infected with an OI are to start medical care and to take HIV medications according to the doctor�s prescription. Sometimes, your doctor will also recommend drugs specifically for the prevention of specific types of OIs. When you take your HIV drug, you can reduce the amount of HIV in your body and this would, in turn, increase your immune health and prevent you from being infected by OIs.
It is particularly significant that you go through standard check-ups. While you go, remember to go with all your medications and take the drugs according to the recommended dosage and time. You may have to take HIV medications for the length of your life. Other things you can also do to improve your immune function and minimize opportunistic infections include the following:
Use condoms every time you have sex and in the correct manner to limit your exposure to sexually transmitted infections.
Don�t share tools for drug injection with anyone. Blood infected with hepatitis C can stay in syringes and needles after they are used and the infection can be transferred from one user to another user.
You need to get vaccinated with a suitable vaccine. Your medical teams will advise you on the best vaccine to take.
Limit your contact with germs that cause OIs. For instance, germs that cause tuberculosis are found in the poops, saliva, or on the skin of animals.
Be cautious with things you eat and drink. Avoid eating undercooked eggs, unpasteurized (raw) milk and cheeses, unpasteurized fruit juices, or raw seed sprouts. Avoid drinking water that is not treated, like water from lakes or rivers. Depending on your country, tap water is also not safe for drinking. Make use of bottled water or water filters.
If you are visiting abroad ensure that the food and water you eat and drink will not make you sick.
Find out from your doctor other safety precautions you need to take at work, at home, and while on a holiday trip to ensure you stay safe.
Treatment of Opportunistic Infections
There are various medications to treat HIV-related OIs. These include antiviral,�antibiotic, and�anti-fungal�medication. The type of drug you will need to take depends on the particular OI.
As soon as the OI is effectively treated, an individual may continue to use the same medication or extra medication to inhibit the reoccurrence of OIs. An OI can be a severe medical condition that may be difficult to treat. The development of an OI possibly implies you have a weak immune system and that you are not putting your HIV properly in check. This is why it is essential to take your medication according to the prescription and book appointments with your doctor for routine checks to minimize the spread of the virus. This also ensures that you keep your immune system healthy.
Understanding Common Opportunistic Infections
HIV and Rheumatic Disease
Rheumatic diseases that are linked with HIV affect individuals of all age groups. However, they are more common among individuals between twenty to forty years of age. An individual may contract HIV-related rheumatic diseases before being infected with HIV. The signs and symptoms of rheumatic diseases, their treatment, and HIV infection can all have common characteristics. The majority of people with HIV-related rheumatic diseases get better after several HIV treatments.
Several older medications for HIV and AIDS can cause joint and soft tissue ache and muscle weakness. Others are associated with metabolic bone disease. Many people with HIV experience musculoskeletal issues with pain affecting the joints, muscles, and bones. HIV infection can result in rheumatic (joint and muscle) which can include joint pain, arthritis, muscle pain, weak spot, and exhaustion.
However, it is not every muscle, bone, and joint complaint experienced by people who have HIV come from HIV. Some of them occur due to other reasons. It can also come with supplementary articular symptoms, like uveitis or eye inflammation, which may also exist in individuals with HIV who are suffering from arthritis. Occasionally, the individual starts to experience these symptoms before observing the HIV signs.
HIV-associated rheumatic diseases are diseases of the joints and muscles that affect an individual with HIV infection. It can result in aching and inflammation. Pain in the joints, soft tissues, adjoining joints, and muscles are frequently the foremost symptoms experienced by 5% of HIV positive patients.
Less widespread rheumatic diseases that can be experienced by individuals suffering from HIV are:
Infection of the joints also known as septic arthritis, muscles infections known as myositis and infection of the bones known as osteomyelitis.
Psoriatic arthritis
Reactive arthritis
Polymyositis or irritation of muscles
Fibromyalgia
Vasculitis or swelling of blood vessels
Individuals with HIV may experience joint, soft tissue, muscle, or bone issues from the medication they are taking for the management of HIV. These include things like gouty arthritis, tenosynovitis, inflammatory myopathy or muscle disease, osteonecrosis, osteoporosis, and lipodystrophy or atypical fat circulation. Nearly all the issues are connected with taking drugs that are no longer prescribed as the first set of treatments by experts. It is progressively more uncommon to experience these types of side effects with the drugs that are presently prescribed by the US Department of Health and Human Services.
Even when the proper medication is used, the individual may experience Immune reconstitution inflammatory syndrome. As the CD4 T cells start to recuperate their number and function, individuals infected with HIV may experience overpowering systemic inflammatory reactions together with fever, malaise, and deterioration of formerly affected organ systems.
Causes of HIV-Associated Rheumatic Diseases
HIV-related rheumatic illnesses can be experienced by both males and females, irrespective of their ages and their ethnic background. Widespread risk factors of HIV infection include unprotected sex and the administration of IV intravenous medication with shared needles. There are many reasons why individuals with HIV experience rheumatic disease. The infection can be due to direct cause, while some can also be caused by other viruses or bacteria.
Diagnosis and Treatment of HIV-Related Rheumatic Diseases
HIV-related rheumatic diseases can be treated with the use of antiretroviral drugs. The combination antiretroviral therapy (cART) use started in the mid-1990s. cART is frequently referred to as the �cocktail� of HIV medications due to the fact that it is the unification of up to three HIV medications. This treatment has tremendously increased the symptoms of HIV, in addition to the ones that affect the joints and the muscles.
the cART has minimized the number of HIV patients that suffer from a rheumatic disease. And when they do get one, it is much easier to treat. The majorities of HIV patients respond very well to regular treatments. This is a combination of pain relief medications and anti-inflammatory medicines given to reduce inflammation, aching, and fever.
Individuals who respond poorly are prescribed medications that repress their immune system. They may also require physical therapy to alleviate symptoms, avoid deforming their joints, and improve their function.
How to Prevent HIV-Related Rheumatic Diseases
Most factors that increase your risk of suffering from HIV also increase your risk for HIV-related rheumatic disease. To minimize your risk of suffering from the two diseases, you should engage in safe sexual practices. If you are HIV infected, you need to take your medication as the doctor prescribed. Again, the Centers for Disease Control and Prevention recommend that individuals with HIV go for HIV routine screening in all healthcare settings for individuals between the age of thirteen and sixty-four years old. Specific groups ought to be more concentrated upon such as seniors with an active sex life together, pregnant women that are mostly less than 24 years, and men who engage in sexual activities with fellow men.
How to Manage HIV & Rheumatic Diseases
Individuals with HIV who have money to pay for cART and whose body can tolerate them commonly live longer. Nevertheless, HIV-related rheumatic disease can result in uneasiness, weakness of the muscle, and impaired function. To stay healthy as an HIV patient apart from taking your medication as prescribed, you must also eat a balanced diet and engage in proper exercise. If you experience weak joints or pain or weakness of the muscles while you take HIV drugs, take the medication to your doctor, and have a thorough review of the medications you are taking. Find out if any of the symptoms you are experiencing is a result of the medication you are taking.
Toxoplasmosis in HIV-Infected Patients
Toxoplasmosis is an infection that is experienced by people all over the world. It is usually caused by a Toxoplasma parasite that infests the individual without resulting in any serious symptoms. Nevertheless, the parasite sticks with the individual�s body and can result in a severe brain infection among people suffering from HIV/AIDS.
Individuals that are diagnosed with HIV are usually recommended to go for a blood test to check if they have been infected by the Toxoplasma parasite before that time.
Toxoplasmosis is the most widespread central nervous system infection experienced by people diagnosed with the acquired immunodeficiency syndrome (AIDS), especially those of them that are not being given suitable prophylaxis. The Toxoplasmosis infection is spread all over the globe and transmitted by the intracellular protozoan parasite known as�Toxoplasma gondii. Individuals with a healthy immune system that are suffering from standard toxoplasmosis are normally asymptomatic and dormant infection can stick with the individual all through his or her life. However, in individuals with a weak immune system, particularly people suffering from AIDS, the parasite can become activated again and result in disease, especially when his or her CD4 count measures lower than 100�cells per microL.
Epidemiology
If the T count of a patient with AIDS is below 100�cells per microL, the individual is recommended to take preventive treatment. There are some antibiotics used to prevent PCP. These antibiotics can also be used to prevent Toxoplasma. The likelihood of reactivated toxoplasmosis emerging among AIDS patients who have a CD4 count less than 100�cells per microL, who are toxoplasma seropositive and are not being given efficient prophylaxis or antiretroviral therapy is as large as 30%. This reactivation normally takes place in the central nervous system (CNS).�
Transmission
Human beings normally get the infection by eating infectious oocysts, normally from soil or cat litter infected with catlike poops, or non-properly cooked meat from an animal that is infected. If an individual swallows�T. gondii oocysts, the parasite raids the intestinal epithelium and circulate all through the body. Afterward, they encyst into any form of composite cell and remain inactive inside the tissues of the individual all through the person�s life.
How Common is the Infection?
The spread of the infection caused by�T. gondii differs greatly across different countries of the world and the range differs roughly by 11% in the United States to over 80% in some European, Latin American, and African nations. Generally, the seroprevalence of antibodies to�T. gondii�amongst HIV-infected individuals is similar to the rate of seropositivity in the general population and is not related to possessing a cat. Nevertheless, the prevalence may be associated with age. For instance, a research study with HIV-infected women in the United States found that individuals 50 years old or younger are probably going to be more seropositive compared to younger women.
Blood Test and Prevention
If the result of the blood test indicates that the individual has not previously contracted the toxoplasmosis infection, it is very essential for the individual to stay away from such environment that would expose him or her to the infection.
Causes and Sources
The widespread sources of the parasite are raw or uncommon meats like lamb, beef, pork, or venison meats; cat stool, and soil.
Prevention
The preventive methods an individual infected with HIV, who have not been exposed to Toxoplasma in the past, include the following:
Avoid eating raw or uncommon lamb, beef, pork, or venison. Meat that is pink in color shows that it is not properly cooked. The interior temperature of the meat must be up to 165�F and above.
Do not change your cats litter by yourself. If no one is around to assist you, make use of hand gloves and wash your hands properly afterward to ensure that they don�t touch your hands. Also, try to avoid touching wandering cats.
Wash hands after farming.
Always wash your hands and cooking worktops after preparing raw meat or poultry.
Always wash your fruits and vegetables thoroughly if you want to eat them raw.
HIV and Hepatitis B
Hepatitis B is a liver disease that is caused by a virus known as Hepatitis B virus (HBV). When an individual is infected with both HIV and HBV, it is referred to as HIV/HBV coinfection. Individuals with HIV/HBV coinfection ought to be treated for the two-health condition. The abbreviation HBV can be used to represent the virus or the disease itself.
HBV can either be a quick-fix or acute condition or a long-term illness which can be chronic.
Acute HBV condition can exist for less than six months after an individual is exposed to HBV. Acute HBV can deteriorate to chronic HBV, although this is not always the case.
Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure. HBV is a contagious disease that can spread from person to person.
Transmission of HBV
HBV is transmitted through contact with the blood, semen, or other body fluid of an individual who has HBV. In the US, HBV is most commonly dispersed through sexual activities.
HBV can also be dispersed through the following methods:
By using the needle or other tools used for drug injection which has been used for an individual with HBV
By using razors, toothbrushes, or related materials that has been used by an infected person.
From an unintended puncture or cut from an HBV-infected needle or other pointed materials
Congenitally through a mother to her baby during childbirth
Connection Between HIV and HBV
HIV and HBV both can be dispersed through the following ways: semen, blood, or other body fluids of an infected person. Thus, the key risk factors for HIV and HBV are equivalent: having unprotected sex and medical treatments that involve the use injection medicines.
It was found by the�Center for Disease Control and Prevention (CDC) that roughly 10% of individuals with HIV in the United States also suffer from HBV. Infection with both HIV and HBV is known as HIV/HBV coinfection. Chronic HBV worsens faster and easily deteriorates to cirrhosis, which is the final stage of liver disease and liver cancer in individuals suffering from a combination of HIV and HBV coinfection. However, chronic HBV doesn�t seem to cause HIV to increase faster in individuals with HIV/HBV coinfection.
Prevention of HBV Infection
The best prevention method for HBV infection is through the�hepatitis B vaccine.
CDC recommends that individuals with HIV, and those at risk for HIV, get the HBV vaccine or the combination of the two hepatitis A virus [HAV]/HBV vaccine. The housemates and sexual partners of individuals living with HBV need to also be vaccinated. HIV patients can also prevent infection from HBV through the following:
Make use of condoms during sex to lesson HBV infection risk and risk with other sexually transmitted diseases like�gonorrhea�and�syphilis.
Avoid using injections. However, if you must, avoid sharing needles, syringes, or other tools use in injecting medications.
Don�t share toothbrushes, razors, or other personal materials that may be infected by the blood of the person suffering from HB.
If you are getting a tattoo or body piercing, ensure the instruments you are using are sterile.
Why People with HIV Must be Tested for HBV
All people infected with HIV ought to be tested for HBV. Testing for HIV can discover HBV infection even when an individual has no symptoms of the disease.
There are many forms of blood tests that can be conducted for HBV. The outcome of the different tests has a different significance. For instance, a positive hepatitis B surface antigen (HBsAg) test outcome is used to indicate that an individual has acute or chronic HBV and can transfer the virus to others.
Why HBV Therapy is Essential for HBV/HIV Coinfected Patients
Liver disease may deteriorate faster in individuals co-infected with HBV/HIV and could result in severe liver disease impediments like cirrhosis and liver cancer at early ages.
Once HIV patients co-infected with HBV start to take antiretroviral therapy their risk of developing hepatotoxicity is increased more than in individuals who only have HIV alone.
Hepatitis B in HIV-infected patients has a close link with a lower CD4 T-cell count than HIV-monoinfected individuals.
It has not yet been discovered scientifically whether hepatitis B results in an increase of the HIV disease or if hepatitis B changes the response of HIV patients to antiretroviral therapy (ART). Nonetheless, when the individual starts the ART therapy, he or she could face the risk associated with a higher risk of liver inflammation in coinfected individuals, which usually results in ALT (Alanine Aminotransferase) flickers or an increase in liver enzymes. This may reproduce both an immune response against hepatitis B and/or drug toxicity.
Symptoms of HBV Infection
Many people with acute HBV don�t experience symptoms of infection. A number of people can exhibit symptoms of HBV immediately after they have been infected. Mild to serious symptoms of acute HBV are listed below:
Appetite loss
Weariness
Nausea
Fever
Stomach ache
Dark urine
Clay-colored poop
Joint and tummy pain
Jaundice or yellow color of the skin and whitening of the eyes.
A number of people with chronic HBV don�t exhibit symptoms for a number of years. Abnormal�liver function tests�may be the first indication of chronic HBV infection.
Treatment for HBV
Commonly, HBV is treated with antiviral drugs. The medication helps to slow down or inhibit HBV from injuring the liver. People with HIV/HBV coinfection ought to be treated for the two infections. A number of HIV medications are effective for the treatment of both HIV�and�HBV.
The choices of medications to treat HIV/HBV coinfection vary depending on the individual. For instance, a number of people may take just medications that are also efficient against HBV. Other individuals may take HIV drugs and an HBV antiviral medicine. If you have HIV/HBV coinfection, speak with your health care provider to discover which medication is the best for you.
HIV and Hepatitis C Infection
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV is a communicable disease that can be transferred from one individual and another. HCV is mainly dispersed from one individual to the other through contact with infected blood. The majority of people with HCV get the infection by sharing needles or other tools for injecting drugs. The abbreviation HCV can be used for representing the virus or the disease that results from it. HCV can be acute type which lasts short-term or a long-term or chronic illness:
Acute HCV manifests within six months after an individual contracts HCV. In most people, acute HCV becomes chronic HCV.
Chronic HCV can last for a long time. If the individual does not receive treatment, the chronic HCV can result to liver cancer or serious liver damage that can result to liver failure.
Mode of Transmission
HCV can be transferred from one individual to the other, mainly through blood contact of an individual who is infected with HCV. In the United States, HCV is mostly dispersed by sharing needles or other injection drug equipment with an individual who has been infected by HCV.
Connection Between HIV and HCV
HIV and HCV infection can both be dispersed through the blood. Two of them also have as their risk factor the use of injection drugs. Sharing needles or other drug-injection equipment increase the risk of contracting HIV or HCV from any blood that has been previously infected. The Centers for Disease Control and Prevention (CDC) data specified that roughly 25% of individuals with HIV in the United States also suffer from HCV. It also states that roughly 50 � 90% of individuals who make use of injections suffer from HCV. When an individual is infected with both conditions, it is referred to as HIV/HCV coinfection.
In individuals with HIV/HCV coinfection, HIV may make severe HCV to progress quicker. It is not yet known if HCV increases the worsening effects of HIV.
Prevention of HCV
The most appropriate way to protect an individual against HCV is not through drug injections. If you are injecting drugs, it is better to make use of fresh and sterile needles. Avoid making use of needles previously used or sharing needles, syringes, or other equipment for injecting drugs.
Other things individuals with HIV can do to protect themself from HCV infection are:
Avoid sharing toothbrushes, razors, or other personal items that may be infected by the blood of a sufferer.
If you have a tattoo or body piercing, ensure the instruments used are germ-free.
During sex, make use of condoms. Although it can be contacted through sexual contacts, the risk of HCV through this form is usually minimal. However, the risk increases if an individual is HIV positive.
Condoms also minimize the risk of�HIV transmission�and infection with other sexually transmitted diseases like�gonorrhea and�syphilis.
People with HIV and Test for HCV
All individuals with HIV need to undergo tests for HCV. Normally, an individual goes through an HCV antibody test as the first line of treatment. This test is carried out to examine if the antibodies of HCV are present in the blood. HCV antibodies are disease-fighting proteins that the body produces in response to HCV infection. If an individual shows a positive result on an HCV antibody test, it implies that the individual has been uncovered to HCV at a point in their life.
When the result of the test reads positive, it must be confirmed by a second test. The second test is carried out to verify if HCV is present in the blood of the individual. If the result is positive, it means the individual is suffering from HCV.
Symptoms of HCV infection
Many people who have acute HCV don�t experience symptoms. But a number of people can have signs of HCV shortly after becoming infected. Gentle to a more serious symptom of acute HCV can include the following:
Fever
Exhaustion
Loss of appetite
Feeling sick
Vomiting
Stomach ache
Dark-colored urine
Clay-colored bowel movements
Joint pain
Jaundice or yellowish skin or whitening of the eyes
The majority of patients suffering from chronic HCV have no visible signs. Chronic HCV is frequently discovered by conducting a standard�test for liver function.
Treatment for HCV
HCV is treated with antiviral medications. The drug is very effective for slowing down or stopping HCV from injuring the liver. A number of recent medications for the treatment of hepatitis C are more efficient. They come with fewer side effects than older medications. The newer HCV medicines may get rid of HCV from the body of the individual entirely.
Individuals with HIV and HCV coinfection are treated for the infections concurrently. The commencement of the treatment and the medication to use depend on the individual. This is essential because a number of HIV and HCV medications may affect the health if used together. It is better to speak with your doctor for advice if you have HIV/HCV coinfection.
Taking HIV and HCV drugs concurrently may increase the risk of drug-drug interactions and side effects. Health care providers recommend HIV and HCV medicines cautiously to avoid�drug-drug interactions�and strongly monitor those receiving the medications for any side effects.
�
Histoplasmosis
Histoplasmosis is a disease caused by a fungus or mold known as Histoplasma. The infection is transmitted to an individual when he or she breathes the fungal spores. It cannot be transferred from an individual to individual through physical contact.
The fungus usually grows in soil and places that are contaminated with bat or bird droppings. It is frequently seen in places like Mississippi, Ohio, and St. Lawrence River valleys, the Caribbean, southern Mexico, and some parts of Central and South America, Africa, and Asia. It can result in pneumonia in individuals who are diagnosed with HIV, especially those with a low T cell count, and who resides in places with a high risk of infection.
Individuals who are visiting or living in these places must avoid engaging in activities that place them on a high risk of suffering from the condition like digging up of soil under bird roosting sites, knocking down of old buildings or investigating caves.
An anti-fungal treatment may be prescribed for individuals that have a low T cell count usually less than 150�cells per microL�who are at high risk of being infected; this includes individual living in the locations where the infections are frequently found.
Histoplasmosis is not commonly serious and doesn�t come with symptoms. If you ever get sick, it normally affects your lungs. Symptoms of Histoplasmosis are nausea, feverishness, chest aches, and a dry cough. In serious instances, histoplasmosis can disperse to other organs of the body. When this happens, it is referred to as disseminated disease. This frequently occurs in newborns, young children, seniors, and individuals who have problems with their immune system and immune function.
Your doctor may conduct a lot of tests to make the diagnosis. These are chest x-rays, CT scan of the lungs, or examination of blood, urine, or tissues for symptoms of the fungus. Mild instances of the infection are usually reduced after sometimes without any form of treatment. However, chronic or more serious cases are managed with the use of anti-fungal medications.
Test and Diagnoses
Fungal tests are normally used to diagnose a fungal infection for proper guidance on the treatment of the condition and to examine how effective the medications used are. A number of less serious skin and yeast infections would require a clinical examination of the body parts that are affected. This can suitably be carried out through a microscopic examination of the sample. It is sufficient to discover the presence of fungus and not a specific type of fungus. The medical team can make use of a number of topical and oral anti-fungal drugs and medications.
To get persistent, deeper, or�systemic�infections, a lot of tests may be carried out. To discover the type of fungus that is present, fungal cultures are normally utilized.
Most fungi grow slowly. Tests, thus, usually take weeks to produce results. Susceptibility testing�is normally carried out on fungi isolated from a culture. This can be used to determine the anti-fungal drug, which can work best from the treatment of the condition.
Tests for fungal�antigens and�antibodies�may be prescribed to check if an individual has, or recently had, a particular type of fungal infection. They are faster than fungal cultures. However, they are used to test for particular species of specific fungus. Therefore, your medical team must be aware of the type of fungus to test for.
Most people who have the infection also suffered from fungal antibodies in the past from a previous exposure to the organism, thus one antibody test may not be sufficient to verify if the infection is present in the present situation. Often times, blood samples are taken two to three weeks difference for acute�and�convalescent results. The test is usually conducted to show if antibody levels (titers) are altering. The evaluation of these results may take quite a few weeks.
Molecular tests can also be used to determine the fungi that have grown in culture. It can occasionally be used to discover particular fungus present in the sample immediately.
Who is at Risk for Histoplasmosis?
Histoplasmosis can be contracted by any individual who lives in a high-risk zone or an area where Histoplasma�lives in the environment. Histoplasmosis is frequently connected with activities that upset soil, especially soil that is made up of bird or bat droppings. Specific groups of individuals face a greater risk of developing more serious types of Histoplasma. This includes individuals with weak immune systems like people who:
Have HIV/AIDS
Did organ transplanting
Are on medications like corticosteroids or TNF-inhibitors
Are Infant
Are Seniors 55 years old and more
Prevention of Histoplasmosis
Because the disease is transferred through inhalation of the causative organism, it is very difficult for the individual to avoid contracting the disease if one is living in locations that are highly exposed to these factors.
If you are living in areas that have a greater risk to the infection, you must try to avoid engaging in activities that are linked with the spread of the condition like cleaning chicken coops and similar activities. You should get professional cleaners who specialize in the removal of dangerous waste to help you clean huge amounts of bird or bat droppings.
Treatment for Histoplasmosis
Most infected people would require anti-fungal treatment for histoplasmosis.
Your doctor may conduct a lot of tests to make the diagnosis. These are chest x-ray, CT scan of the lungs, or examination of blood, urine, or tissues for symptoms of the fungus. Mild instances of the infection are usually reduced, sometimes without any form of treatment. However, chronic or more serious cases are managed with the use of anti-fungal medications.
Cytomegalovirus (CMV)
Cytomegalovirus (CMV) is a widespread virus that infects a lot of people no matter their age. Roughly one in three children in the US are already infected with CMV before they are five years old. More than half of the adults who are forty years old have already contracted CMV infection. As soon as CMV is found on the body of an individual, it stays there all throughout their life and can reactivate it. An individual can also be re-infected with another type of virus or strain. Commonly, a number of adults with CMV are usually diagnosed by the time they get to forty years of age. Cytomegalovirus (CMV) is a virus that mostly infects people all over the world. CMV can result in a calm illness with fever and body aches, but sometimes, those infected may not experience any symptom.
CMV can stay in the body of AIDS patient and cause sickness in the eyes, digestive system, brain, and spinal cord. The most widespread CMV infection is eye or retina infection. It can create a blurring effect and lead to increasing loss of vision in patients with AIDS. If the blood test of a person with HIV has a sign of previous infection, you need to do a routine eye examination of your retina if your T cell counts are less than 250�cells per microL,�whether or not they have any eye symptoms.
CMV, apart from causing problems for people with weak immune systems, can also cause problems for a child in the womb if the mother is infected with the virus when she is pregnant. The majority of people infected by the viral condition do not have any visible signs. This is due to the fact that the healthy immune system normally prevents the carrier of the virus from making him or her sick. Nevertheless, CMV infection can result in severe health issues in individuals who have weakened immune systems. It also severely affects kids infected while they were in the womb.
Signs and Symptoms
Many people who are infected with CMV have no symptoms and aren�t aware that they have been infected. In some instances, healthy people who are infected may suffer from mild illness which can include:
Fever
Painful throat
Exhaustion
Inflamed glands.
Swollen lymph�nodes
Headache
Exhaustion
Lethargy
Muscle pains
Appetite loss
Babies born with CMV in the womb are usually born very sick at the delivery time. Some of the symptoms shown by babies when they are born are:
Jaundice or yellow skin color
Low birth weight
Seizures
Inflamed spleen
Inflamed liver
Pneumonia, pneumonitis or the swelling of the respiratory tract
Individuals that are receiving immunosuppressant medicines for conditions, such as human immunodeficiency virus (HIV) or from an�organ�transplant, may experience serious symptoms. Immunosuppressant medicines reduce or restrain the immune system. Symptoms of serious CMV are:
Blindness
Swelling of the respiratory tract
Diarrhea
Esophagus�or intestines bleeding�ulcers
Seizures
On rare occasions, CMV can result in mononucleosis, hepatitis or liver issues in healthy individuals. However, people with weak immune systems who are infected with CMV can experience more serious symptoms affecting their eyes, lungs, liver, esophagus, stomach, and intestines. Babies born with CMV can have brain, liver, spleen, lung, and growth issues. Children born with congenital CMV infection commonly have hearing issues. Some are discovered immediately, while others are not discovered until late into their childhood.
Transmission and Prevention
The body fluids of individuals with CMV may contain CMV virus. It can be found in their body fluids like urine, saliva, blood, tears, semen, and breast milk. You can get CMV from an individual who is infected through the following manners:
Through direct contact with the urine or saliva of the infected individual, especially when it is from babies and young children
Through sexual contact
Through the breast milk
From organs infected by the virus. It can also be contacted through infected blood during blood transfusions
It can be transferred from mother to child during pregnancy (congenital CMV)
Standard hand washing, especially after changing diapers, is highly essential to ensure you minimize the dissemination of the infection, and may lessen exposures to CMV.
Diagnosis of CMV
CMV infections are normally diagnosed via blood tests
How CMV is Treated
Healthy individuals who caught CMV infections normally do not need any medical treatment. Medications can treat CMV infection in individuals with weak immune systems and in infants with�congenital CMV infection. Regular antibiotics cannot treat CMV. It is usually managed with antiviral drugs. Antiviral drugs slow down the virus activities but do not cure it.
Treatment to prevent infection with CMV is not generally recommended as it doesn�t help survival. Nevertheless, an individual with early symptoms of CMV retinitis like blurry vision, blind spots, flashing lights, or floaters must contact their healthcare provider as soon as possible because this treatment is efficient if treated as soon as they manifest.
What Causes Cytomegalovirus?
The virus that causes cytomegalovirus is related to the viruses that cause chickenpox and mononucleosis. The germs find their way into body fluids, like saliva, blood, urine, semen, and breast milk. An individual can transfer the virus to others when it is active in his or her system. It is normally transmitted from one person to the other through sexual contact or contact with the blood and other fluids in the body. CMV can seldom be transferred through the processes of blood transfusion or organ transplantation.
An infection of CMV in a pregnant woman can cause a miscarriage, giving birth to a dead child or death of the newborn. Newborns who survive are at an increased risk for hearing loss and mental disability. However, only a small percentage of newborns infected with CMV during pregnancy experience problems from the virus. Most are born healthy or with only mild CMV symptoms.
If you are pregnant and your baby has CMV, your doctor will likely check your baby for any health problems once he or she is born so they can be treated early. Treatable symptoms in newborns include pneumonia, hearing loss, and�inflammation�of the eye.
Mycobacterium Avium Complex (MAC)
Mycobacterium Avium Complex (MAC) is a severe sickness caused by common bacteria. MAC is also referred to as MAI (Mycobacterium Avium Intracellulare). MAC infection can be situated only on a single part of your body or scattered all over the body during, which it is occasionally referred to as DMAC. MAC infection frequently happens in the lungs, intestines, bone marrow, liver, and spleen.
The bacteria that cause MAC are extremely widespread. They are located in water, soil, dust, and food. It is roughly prevalent in the body of every individual. The body of an individual with a healthy immune system will fight against MAC. However, individuals who have a weak immune system can easily suffer from MAC disease. Roughly half of the individuals who have AIDS are likely to suffer from MAC, particularly if their�CD4 cell count�is not up to 50 per microL. MAC nearly never results in sickness in individuals with over 100 CD4 cells.
Mycobacterium avium complex (MAC) can make the individual start to experience high fevers, abdominal pain, and weight loss. Mycobacterium avium can be found all through the environment; you can hardly protect yourself from being infected by taking personal protective measures. Nevertheless, an antibiotic can be given to the individual to help prevent infection from the virus. HIV patients with the T cell count less than 50 cells per microL are commonly recommended to take the antibiotics. They�d continue the treatment until their T cell count goes higher than 100 cells per microL within a span of at least three months.
Mycobacterium avium�complex (MAC) infection can be caused by one of two nontuberculous mycobacterial species which can be�M. aviumor�M. intracellulare. These organisms can infect individuals suffering from HIV infection or an individual who is not HIV positive. The two major forms of MAC infection in individuals with HIV are disseminated disease and focal lymphadenitis. As opposed to these rare pulmonary infection is commonly witnessed in immune-competent patients.
Among people infected with HIV, MAC infection is most commonly witnessed in individuals with a CD4 count less than 50 cells per microL. It was found that there is a remarkable reduction in the number of new cases of MAC infection due to the treatment with the use of prophylaxis to treat MAC infection than when the epidemic originally appeared. This is even additionally reduced with the introduction of efficient antiretroviral therapy and broad use.
Dramatic declines in the rate of new MAC cases accompanied the use of prophylaxis against MAC infection early in the epidemic and more recently, the widespread use of effective antiretroviral therapy.
How MAC is Transmitted
The method of infection for�Mycobacterium avium�complex (MAC) is through breathing or ingestion. MAC causative organisms are everywhere in the environment. They can also be found in the water and soil.
There is no requirement for individuals hospitalized with MAC infection to be isolated given that individual-to-individual or common source spread of the disease is uncommon. In one study that involves 32 individuals with AIDS and MAC from a daycare center in France that lasted for more than a thirteen-month period, the strains of organisms were varied by pulsed-field gel electrophoresis. The second series of 130 isolates from children, both infected with HIV and those not infected, also did not exhibit a clonal origin for the strains, even though HIV-infected children were frequently infected more than the controls.
Diagnoses of MAC
MAC symptoms include high fevers, colds,�diarrhea, weight reduction, tummy ache, fatigue, and�anemia. When MAC spreads in the body, it can result in blood infections, hepatitis, pneumonia, and other severe health issues.
Most opportunistic infections can result in these symptoms. Thus, your health care provider will likely check your blood, urine, or saliva to examine if they are infected by bacteria that result in MAC. The sample will be tested to check the type of bacteria it contains. This is usually carried out through a process referred to as culture. This can last for many weeks. Even when you are infected with MAC, discovering MAC bacteria is difficult.
If your CD4 cell count is not up to fifty, your health care provider may treat you for MAC, even without a specific diagnosis. This is done because this infection, widespread among HIV patients, can hardly be diagnosed.
Treatment of MAC Infection
The bacteria that cause MAC can mutate and build up resistance to a number of the drugs that are utilized to treat it. Mac can be treated by your doctor with the use of antibacterial drugs or antibiotics. The two medications that are commonly utilized are azithromycin or clarithromycin together with three other medications. MAC treatment needs to be given throughout the entire life of the individual. If the individual ceases to use it, the condition will be reversed.
People respond in a different way to anti-MAC drugs. Your doctor would work together with you to discover the particular medication that is most efficient for you.
The MAC drugs that are and their side effects are:
Amikacin (Amkin): Amikin can result in kidney and ear problems; taken as an injection.
Azithromycin or Zithromax: This can result in side effects like vomiting, headaches, sickness, and diarrhea. It is normally taken as capsules or given as an intravenous drug.
Ciprofloxacin (Cipro or Ciloxan): This can cause nausea, vomiting, and diarrhea; taken as tablets or intravenously.
Clarithromycin (Biaxin): This can result in an unsettled stomach, headaches, nausea, and watery poop. It is taken as capsules or intravenously. You must not take a maximum dose of 500 milligrams every day. You are required to take share this maximum dosage two times every day.
Ethambutol as well-referred to as Myambutol can cause nausea, vomiting, vision problems.
Rifabutin, also known as Mycobutin, can result in rashes, nausea, and anemia. Many drug interactions.
Rifampin as well-referred to as Rifampicin, Rifadin and Rimactane can cause fever, chills, muscle, or bone pain. This medication can make your pee, sweat, and saliva to change into red-orange color and this could stain contact lenses. It can interfere with birth control pills and other medications.
Progressive Multifocal Leukoencephalopathy
Progressive multifocal leukoencephalopathy (PML) is a disease that affects the white matter of the brain. It is caused by a virus infection that affects the cells that produce myelin. Myelin is the substance that insulates nerve cells known as neurons. �Polyomavirus JC, which is frequently known as the JC virus, is carried by most people and it doesn�t cause any harm. However, when this virus is present in individuals with low immune systems, like individuals suffering from HIV, it could deteriorate into serious conditions. The sickness is not common but it is frequently found among individuals receiving persistent corticosteroid or immunosuppressive therapy for an organ transplant. It can also manifest in patients suffering from cancers like Hodgkin�s disease or lymphoma.
People who have autoimmune issues like multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus, a few of them treated with biological therapies that permit JC virus reactivation, also have a higher risk of suffering from PML. PML is mainly experienced by people with HIV-1 infection / acquired immune deficiency syndrome (AIDS).
Studies
It was found by studies that before effective antiretroviral therapy, individuals, about 5%, who are positive with HIV-1 ultimately develop PML, which is an AIDS-defining sickness. Nevertheless, the present management procedures for HIV with the use of antiretroviral drugs (ART), which efficiently boost the immune function makes it possible for individuals as much as half of all HIV-PML patients to live. Irrespective of this, they could occasionally suffer from inflammatory reaction in the parts of the brain affected by PML.��
Symptoms of PML
There are many symptoms of PML and they can cause substantial amounts of damage in the brain and may develop within a few weeks to some months. The most significant symptoms are awkwardness, progressive tiredness, and visual, speech, and personality impairments. The increase of the defects results in severe disability and often death of the individual.
Diagnosis of PML
The diagnosis of PML can be carried out through brain biopsy or through a combination of examination of the deteriorating condition of the disease or constant white matter�s lesions. This can be seen through the use of a magnetic resonance imaging (MRI) scan and the discovery of the JC virus in spinal fluid.
Diagnosis
PML generally result to 39 � 50% within the first few months it was diagnosed. However, it varies according to the seriousness of the core disease and treatment received. Individuals who survive PML can be left with serious neurological incapacitations.
Treatment of PML
Presently, the greatest accessible treatment is by reversing the immune-deficient condition, given that there are no efficient medications that obstruct the individual from being infected by the virus that are not harmful and poisonous to the individual. The medications that can be used have serious damaging effects to the individual.
The immune-deficient condition can be reversed with the use of plasma exchange to increase the elimination of the restorative agents that exposes the individual to the risk of suffering from PML. For HIV-connected PML, starting anti-retroviral therapy straight away would be beneficial to the majority of people. Many fresh drugs that were found by laboratory tests to be efficient against infection are being utilized in PML patients with particular authorization of the FDA. Studies are currently being conducted on the use of Hexadecyloxypropyl-Cidofovir (CMX001) to treat JVC due to the fact that it is able to repress JVC by restraining the reproduction of viral DNA.
Tuberculosis and HIV
Tuberculosis (TB) is an�infectious disease�that can be transferred from one person to the other. TB is caused by�bacteria�known as�Mycobacterium tuberculosis. The TB bacteria usually spreads through the air, thus it is an air-borne disease. Individuals infected with HIV frequently suffer from tuberculosis (TB). This is due to the fact that HIV makes their immune system weak. This makes it difficult for their body to fight TB causing bacteria. TB commonly affects the lung of the individual, but it can sometimes affect other parts of the body like the brain, the kidneys, or the spine as well. TB can result in the death of the individual if not properly managed.
How the TB Disease Spreads
TB bacteria pass from an individual to the other through the air. TB germs are transferred to the air when an individual suffering from TB coughs, sneezes, laughs, or sings. Individuals that are close to him or her may inhale the germs and get infection. TB doesn�t spread by sharing cutleries or cups or sharing saliva during kisses.
Not all the people that have TB infection get sick. Some people infected have the germs in their lung in a latent or dormant form. Individuals who have latent infections don�t show TB symptoms. They don�t also transfer it to others. Nevertheless, they can suffer from TB disease eventually, particularly if they are HIV positive. To stop the infection from escalating into TB disease, individuals with latent TB infection are placed on medication.
On the other hand, individuals with TB disease have many active TB germs in their body. They commonly experience the symptoms of TB disease which can include extreme tiredness, weight loss, fever, and night sweats. It can also include cough, chest pain, and they may cough up blood. They may experience a few more symptoms, depending on which part of their body is infected.
Why it is Essential to Test for TB and HIV
It is essential for individuals with HIV to test for TB infection because HIV makes their immune system weak, which could expose them to TB risk.
A weak immune system could make a latent TB germ develop into TB disease very fast. This is why it is very essential as an individual with HIV, which is associated with a weak immune system. Also, if you have either latent TB infection or TB disease and do not know your HIV status, you need to also get tested for HIV to assist your doctor in knowing the best way to treat your TB and HIV infections.
TB Tests
TB test can be conducted either through blood test or through the skin test. For a TB skin test, the medical team makes use of a tiny needle to put the fluid, known as tuberculin, immediately under your skin. This is normally carried out on the lower inner part of your arm. After the test is done, you need to return within two to three days to check if you reacted to the test. If there is a reaction, the amount of the reaction is estimated to find out if you are positive for the TB germs.
For the TB blood test, a sample of your blood is drawn to conduct the test. Your health care provider would inform you how you can get the result of your test.
If Your TB Test is Positive
If you are positive of TB, either through the blood test or through the skin test, what it means is that you are infected with the TB germs. It doesn�t imply you have a TB disease. To confirm if you have TB disease or not, you�d usually be required to take a chest x-ray or sputum (phlegm) sample test.
What Happens�if the Test Result Shows You Have Latent TB Infection or TB Disease?
Both latent TB infection and TB disease can be managed with medication even in people living with HIV. If you have latent TB infection and HIV, your risk for developing the disease is greater. You�d require fast treatment for latent TB infection to prevent TB disease. If you have TB disease, you have to take drugs that treat TB disease. If it is not treated, your health may deteriorate and you�ll die eventually.
Prevalence of HIV/TB Coinfection
TB disease is one of the most common causes of death among individuals with HIV. In the United States, due to wise availability of HIV medications, the number of individual with HIV who contracts TB as well is significantly lower than what is obtained in other countries where the medication use is not as widespread. However, TB patients, particularly those born outside US, frequently still suffer from TB.
Symptoms of TB
Individuals with latent TB don�t experience any disease symptoms. However, if latent TB develops to TB disease, there will normally be signs of the disease.
Regular symptoms of TB disease are:
A constant cough which may result in coughing out blood or sputum
exhaustion
weight loss
Fever
Night sweats
Other symptoms of TB disease may vary depending on the parts of the body affected. For instance, signs of TB infection of the kidneys may contain blood in the urine, and symptoms of TB infection of the spine may contain back pain.
What is the Treatment for TB?
TB treatment in HIV patients is commonly the same as the medication used for individuals who are not HIV positive. TB drugs are used for the prevention of latent TB from developing into TB disease and for the treatment of TB disease. The medicine chosen together with TB medication and the duration of treatment depends on whether an individual has latent TB or TB disease.
Pneumocystis Infections
Pneumocystis jirovecii pneumonia was originally referred to as Pneumocystis carinii pneumonia or PCP. It is an opportunistic infection of the lungs. It is the most common cause of pneumonia and death in AIDS patients. PCP can frequently be prevented with the use of antibiotics.
Pneumocystis jirovecii is a small fungus that lives in the lungs of a number of people. When an individual has a strong immune system it will control the fungus, but if an individual has a weak immune system, the fungus can make the individual very sick. However, it can now be treated. The treatment is most effective if the individual starts it early.
In the US, individuals with HIV/AIDS can hardly contract PCP today than what it used to be in the past, prior to the introduction of antiretroviral therapy (ART). Nevertheless, PCP is still a significant problem against public health and safety. Pneumocystis carinii pneumonia (PCP) is a lung infection caused by a fungus. PCP exists in individuals who have weak immune systems together with individuals with HIV. The initial signs of this infection are breathing difficulty, high fever, and dry cough.
Preventive treatment is extremely efficient for preventing this kind of pneumonia and it is a good idea for all individuals who have low T cell count (normally less than 200�cells per microL),�previous sufferers of PCP pneumonia, or a mouth yeast infection known as thrush.
People who start to receive antiretroviral therapy for HIV may stop taking their PCP preventive therapy when their T cell count is above 200�cells per microL�for at least three months.
Nevertheless, long-term preventive treatment may be essential if an individual develops PCP when the T cell count was higher than 200�cells per microL. Previously, the causative organism of PCP (Pneumocystis jirovecii) is classified by scientists as Protozoan but currently, it is classified as a fungus.
Causes
In individuals with a weak immune system, the cause of this pneumonia may be the same causative factor that causes it in healthy individuals, but the cause of this type of pneumonia is more frequently uncommon causative factors. Frequently,�P. jirovecii�pneumonia is the first symptom that an individual with�human immunodeficiency virus�(HIV) is already infected by AIDS.
Other fungi like Aspergillus and Candida; bacteria like Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae, and viruses like cytomegalovirus and herpes simplex virus are also causative factors of pneumonia in individuals who have a weak immune system.
The bacteria that cause Pneumonia may include bacteria�Streptococcus�pneumoniae, also referred to as Pneumococcus.
How Does Pneumocystis Transmit?
PCP is a communicable disease. It is transferred from one individual to the other through the air. Pneumocystis fungus can stay in the lungs of healthy individuals, as well as in some individuals with a weakened immune system without exhibiting any symptoms. A number of individuals are exposed to the fungus in their childhood, but they probably don�t get sick because they have a strong immune system. PCP is transmitted to a person who is exposed to the sufferer of PCP or a person who carries the fungus in the lungs but without a visible sign.
Symptoms of PCP
The symptoms are usually a fever, breathing difficulty, and a dry cough. These symptoms can come fast or a bit slower in some instances. It may limit the supply of enough oxygen to the blood, which can result in serious breathing difficulty. The individual may also experience chest pain, chills, and exhaustion. Get in touch with your doctor if you suspect your symptoms are connected to PCP.
Who is at Risk of Suffering from PCP?
PCP can hardly affect healthy individuals. They could carry the fungus infection in their lungs without causing any symptoms. At any particular time, roughly 20% of people can carry the fungus. They�d normally be destroyed by a strong immune system after many months.
PCP is common in individuals with weak immune systems because of their body�s inability to fight against the disease. Roughly 40% of people with PCP have HIV/AIDS. The rest of the individuals who suffer from the condition are under medical treatment that lowers their immune system like:
Organ transplanting
Cancer of the blood
Inflammatory diseases or autoimmune diseases like lupus or rheumatoid arthritis
Stem cell transplanting
Prevention of PCP
No vaccine prevents PCP. However, prescription medication like trimethoprim/sulfamethoxazole (TMP/SMX), also known as co-trimoxazole, can be used to prevent the occurrence. The medication is also known through the following brand names; Bactrim, Septra, and Cotrim. There are alternative medications for individuals who cannot manage TMP/SMX like dapsone, atovaquone, and pentamidine, which are aerosol taken by inhalation into the lung.
Individuals suffering from HIV, stem cell transplant patients, and people for a solid organ transplant have usually prescribed the medication for PCP.
Test and Diagnosis
PCP can be diagnosed through the following methods:
Chest x-ray
PCP can be diagnosed with Polymerase chain reaction (PCR)
A blood test to detect ?-D-glucan
Microscopic examination of a sputum (thick or dirty mucus) sample obtained from the lung of the individual. It can either be coughed out or obtained through a bronchoalveolar lavage.
Treatment
The most common types of treatment given for PCP are:
Antibiotics, antiviral, or antifungal drugs
Management of the immune system issue of the individual
The treatment given usually depends on the
Particular immune system issue
Seriousness of the condition
The causative organism
The first treatment is usually a broad-spectrum antibiotic. Viral or fungal medication may be added if the condition does not improve.
Infections can frequently happen to any person depending on several circumstances, however, in people with HIV/AIDS, infections can happen much more frequently and these can be much more severe. These are commonly referred to as opportunistic infections or OIs. As previously mentioned in the article above, HIV/AIDS tremendously affects a person’s immune system, making it less capable of fighting off infections. Several types of bacteria, viruses, fungi, and other organisms that don’t commonly cause infections in healthy people can ultimately make people with weakened immune systems sick, including people with HIV/AIDS. Here, we summarize a variety of the most common opportunistic infections or OIs that can affect people with HIV/AIDS. It’s essential to seek immediate medical attention from a qualified healthcare professional if you experience any symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
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