“Black box” warnings are issued by the FDA when a drug causes life-threatening complications.
The FDA uses this warning when it’s necessary to “call attention to serious or life-threatening risks.” To a layman, it means these drugs are potentially the most harmful of all drugs issued.
Most drugs are slapped with black box warnings after they are already on the market. There are black box warnings on drugs as common as Xanax and Adderall. These are pills prescribed to millions of Americans every year. And the warnings aren’t innocuous. The black box warning for Adderall, for example, states “increased risk of sudden death and cardiovascular events”.
The risks for black box drugs that aren’t as common can be even more extreme. An anticoagulant drug called Xarelto has been tied to severe internal bleeding incidents, and it doesn’t have an antidote! This means that if an unfortunate patient has an internal bleeding incident while taking the drug (even as prescribed), they will likely bleed to death because there is no counter-drug to reverse the effects.
Whether you’re taking a black box drug or not, you probably want to know the best ways to stay safe from such harmful side effects.
The best way, even though it’s a cliché, is to become your own doctor and advocate. Most doctors in the U.S. have very limited time with each patient, which logically infers that they’re less likely to do extensive research on each individual patient’s needs and issues. You should read through all the documentation that comes with prescriptions you’re written, and come with a list of succinct questions to ask your doctor or pharmacist when you have an appointment. It’s also a good idea to do your own research using free resources like PubMed where you can search clinical trials by condition or by treatment.
If, unfortunately, you do have an adverse reaction from the drug (which is possible even when being fully prepared beforehand), make sure to report it on the FDA Medwatch site. This will help the organization determine whether the drug is still safe for consumers. You also have the option of calling the FDA directly at 1-800-FDA-1088 to report the incident.
There is also the option to stay away entirely from black box drugs as much as possible through diet, exercise and lifestyle changes, and given the risks discussed in this article, that may be the prudent thing to aim for.
The key postural distortions associated with Janda’s upper crossed syndrome (UCS) are forward head and rounded shoulders. If I see this distortion on a static posture analysis, I follow up with ROM and movement assessments. I also perform manual muscle tests, glenohumeral joint stability tests and orthopedic tests for shoulder impingement, and neuro tests for neuropathy and/or radiculopathy. Continue reading
North American marijuana sales grew 30% in 2016 to $6.7 billion as the legal market expands in the United States and Canada. A recent report by A Review Market Research indicates North American sales are projected to top $20.2 billion by 2021!! Like it or not, a growing number of states are becoming more and more accepting of this once illicit practice of growing, selling and consuming. Read more of my article Medical Cannabis Part 1
By Jeffrey Tucker, DC, DACRB
For the past several years, around the same time that the American College of Sports Medicine publishes the results of its annual survey of fitness trends, I’ve discussed what I think are the chiropractic trends for the year ahead. Here are my top chiropractic trends, followed by the top 10 ACSM trends – many of which are… continue reading
If you suffer from the pain and stiffness of hip arthritis, a steroid shot may seem like a miracle. After all, anything that can give you complete relief from that pain (even if just for a short time) is amazing. However, a new study has found that these injections can cause a domino effect that results in even more serious hip problems. And that can happen very quickly.
Before turning to steroids that can damage bones, let’s give this a second thought. Especially since there are some proven safe and effective treatments for hip pain that won’t prove to be bone damaging!
Dr. Connie Chang, a radiologist at Massachusetts General Hospital, examined patients X-rays after hip steroid injection. She kept finding “rapidly” developing changes, namely bone “death and collapse” occurring several months after such injections.
Dr. Chang arranged a study of close to 250 patients with hip arthritis, some of whom received a steroid shot in their hip and some who didn’t. And as soon as three months later, she was finding “new” occurrences of bone death, eventually affecting up to a quarter of the volunteers who had been given a shot.
Along with that, around 17 percent of those who got a steroid shot suffered from bone collapse in the “head” of their femur bone.
Dr. Chang said that joint and bone changes in those with arthritis usually develop “slowly over time.” That’s been my clinical experience over the years. This is why I talk about your age and current pain levels before getting a cortisone shot. If you are young there is a lot of risk. If you are old but plan on living a long time, let’s talk about this.
The fact is that steroids can cause damage to your bones.
The Mayo Clinic warns that steroids are the most “common cause” of “avascular necrosis” (which is basically the death of bone tissue caused by a lack of blood supply, eventually leading to collapse of the bone) that isn’t caused by bone trauma.
The University of Michigan Medical School and the VA Center in Ann Arbor, Michigan, found that you don’t have to be taking steroids for a long time to suffer some serious side effects.
Even a low dose, such as 20 mg a day or less, can trigger sepsis… triple your risk of a blood clot… and double the chance of breaking a bone.
While steroids can be lifesavers, say, during a bad asthma attack, the truth is that, given the risks they come along with, they’re given out way too haphazardly.
Before you resort to a shot in the hip, why not first give these alternative treatments a try?
• Laser: This treatment uses light therapy and has been proven to reduce inflammation and decrease pain in numerous conditions, including arthritis.
• Shockwave therapy: This has been a remarkable therapy for my patients. It penetrates deep into the tissues to increase circulation and stimulate the breakup of scar tissue and other pain producing substances.
• Exercises: Having a skilled doctor that can guide you through stretches and exercises can help keep your hips moving smoother.
• Natural anti-inflammatories: Taking a daily supplement of omega fatty acids that contain DHA and EPA made by Metagenics (offered to our patients) is well known to reduce swelling, pain, and inflammation.
“Steroid injections for arthritic hips: More trouble than they’re worth?” Robert Preidt, November 29, 2017, U.S. News & World Report, usnews.com
What I do as a practitioner is provide the kind of care I want for myself and my family. My practice style is interactive, meaning we make decisions together, co-decide treatment options for pain relief, and I will help you achieve new range of motion. If you need weight loss I have very successful practical plans, and if you want to improve your fitness I can help guide you along. I’m formally trained in pain reduction strategies, flexibility and mobility training, weight loss, strength training, cardio and all its many forms, nutritional supplements, diets, and stress reduction. I have studied all of these concepts for 35 years. The things I continue to do and use are methods I know have worked for other people. I have stayed at the top of my game by staying in active practice, I’ve continued learning, I am an instructor to other Doctors around the world, I enjoy writing, sharing, and I continue to learn my craft.
I have been challenged by difficult patients with chronic pain, over-achievers with lots of stress, and patients with crazy character. I’ve learned and tried many different techniques, studied with masters and put together my own processes based on what works. For example if you ask me “What’s a good exercise?” I will say ‘One the patient does’ – I teach the ones I know patients do because I live it every day. As I have gotten older I have become more direct, a no nonsense style, and I have applied ‘healthy aging’ knowledge to myself and my patients. I am more serious about helping people regain lost range of motion in the neck, shoulders and back and then it is up to you to never lose it. That is my ‘healthy aging’ program for patients.
A session with me starts with getting to know you. Then we make a plan or program. Maybe you will need to schedule twice a week, once a week, once every two weeks. I don’t know that answer until we meet. I will teach you what you can do at home on your own. The truth is that what we do in the office is 10-20% of your change, the other 80-90% is what you do at home. Please call my West Los Angeles office 310-444-9393 for an appointment.
Stem cell therapy for osteoarthritis is gaining in popularity by practitioners but are the patients who get these injections seeing the results? My answer based on my patient population is about 50-50. Meaning about 50% of those getting injections note some improvement and the others don’t notice any change in pain relief from the injections. Stem cell injections are expensive and risky. However, I have recommended several patients try stem cell injections, but honestly I am still on the fence regarding these injections. I am ‘all-in’ on the concepts of regenerative medicine and I definitely see this as the future for osteoarthritis.
For years my ‘non-invasive’ approach to the treatment of osteoarthritis is using laser (TheraLase, LightForce), PiezoWave (Acoustic waves therapy), EnPuls (shock wave therapy), LymphaTouch lymphatic therapy, SCENAR (Russian therapy), localized vibration and percussion devices (Deep Muscle Stimulator, Rapid Release Therapy), nutrition, supplements, diet and gentle movement exercise for achieving similar results to the stem cell regenerative medicine concepts.
- Certain supplements, shockwave therapy and exercise have a high chondrogenic capability (the ability to make cartilage) without the risks of injections.
- The non-invasive approach is a safe treatment strategy.
- Laser for treatment of osteoarthritis patients has no side effects.
- Laser by itself, EnPuls by itself, help the cells undergo high rates of proliferation.
- PiezoWave by itself decreases pain and increases circulation.
- LymphaTouch has immunosuppressive actions because it stimulates the lymphatic system.
- All of the above (laser, shockwave, supplements and exercise) modalities can produce anti-inflammatory effects, and pro-regenerative properties.
My take home message to you is that it’s important to pick the right therapy for you and we can discuss the benefits of stem cell injections versus the natural anti-inflammatory and pro-regenerative devices at the same time.
1 Kopka M, Bradley JP. The Use of Biologic Agents in Athletes with Knee Injuries. J Knee Surg. 2016 May 20. [Epub ahead of print]
2 Filardo G, Perdisa F, Roffi A, Marcacci M, Kon E. Stem cells in articular cartilage regeneration. Journal of Orthopaedic Surgery and Research. 2016;11:42. doi:10.1186/s13018-016-0378-x.
3 Yang X, Zhu TY, Wen LC, Cao YP1, Liu C, Cui YP, Meng ZC, Liu H. Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis. Chin Med J (Engl). 2015 20th Sep;128(18):2516-2523. doi: 10.4103/0366-6999.164981.
- Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.Open Access Journal of Sports Medicine. 2016;7:21-32. doi:10.2147/OAJSM.S72332.
5 Shapiro SA, Kazmerchak SE, Heckman MG, Zubair AC, O’Connor MI, A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Am J Sports Med. 2017 Jan;45(1):82-90. doi: 10.1177/0363546516662455. Epub 2016 Sep 30.
6 Burke J, Hunter M, Kolhe R, Isales C, Hamrick M, Fulzele S. Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and Translational Medicine. 2016;5:27. doi:10.1186/s40169-016-0112-7. 2
The answer is pretty simple: oxidize fat. That means lose fat via some combination of an effective diet and exercise. Stay low carb, be consistent and be disciplined. Everyone is talking about the ketogenic diet. Ketones are a byproduct of fat oxidation. Ketones are an effect, NOT a cause. My office uses a protocol, it’s a rational way to eat that’s the ultimate cause of your fat loss. Ketones are an effect of this fat loss—they are merely the evidence along the way that you’re indeed losing body fat. Technically, any diet that produces significant and sustained fat loss is a ketogenic diet.
Our fat lose program is very hands-on, we provide weekly coaching, weight and body composition analysis, advice, products to produce ketones from dietary fat and supplements. This is the most sensible diet approach I have seen for fat loss.
By the way, when people put in the effort required to actually oxidize body fat by means of a sensible diet that accounts for energy in and out, it works! They lose fat.
Warm ups are used prior to training and competition by athletes from all sports. But, can a warm up actually improve performance?
Dr. Jeffrey Tucker, a sports medicine chiropractor in Brentwood, CA teaches his patients that a proper dynamic warm up can increase endurance performance. In one study that pertains to cyclist performances, eight well trained road cyclists were used and they performed time trials after the following warm ups. These warm ups were performed in a random order.
* No warm up (control)
* Easy warm up – This involved a 15 minute warm up, made up of three 5 minute segments at power outputs of 70, 80 and 90% of ventilatory threshold followed by 2 minutes rest.
(Ventilatory threshold is the point during incremental exercise where lactate begins to build up in the bloodstream marked by a rapid increase in breathing rate).
* Hard warm-up – This involved the same three 5 minute segments, plus 3 minutes at the respiratory threshold followed by 6 minutes rest.
(Respiratory threshold is a higher intensity of exercise marked by the onset of hyperventilation).
Oxygen uptake, power output and the contributions of the aerobic and anaerobic energy systems to the 3k time trial effort were measured throughout each test. Key results were as follows:
* 3k time trial performance was improved after both easy (266.8 seconds) and hard (267.3 seconds) warm ups, compared with 274.4 seconds after no warm up.
* The gain in performance after both active warm up conditions was mostly during the first 1,000m, reflecting higher early power outputs than after no warm up.
* Oxygen uptake was significantly greater after the active warm ups than after no warm up;
* There were no differences in anaerobic power output during the trials, but aerobic power output during the first 1,000m was larger after the active warm ups than after no warm up.
The authors concluded that the pre exercise warm up led to a significant performance enhancement of about 2-3%, which seems to be associated with boosted aerobic efficiency especially in the early stages of a race.
Med Sci Sports Exerc 2005; vol 37, no 9, 1608-1614
These are the types of studies we use to help patients make decisions about training and workouts.
Both Active Release Technique and Deep Muscle Stimulator (DMS) are a deep tissue therapeutic technique used to reduce adhesions in soft tissue, thereby reducing pain, increasing range of motion, and significantly decreasing recovery time from athletic injuries. Both have been taught to thousands of providers worldwide, including medical doctors, chiropractors, athletic trainers, and physical therapists. Both are utilized by athletes at the highest level of competition, from the NFL to the NBA and even to the US Olympic Committee. Dr. Tucker prefers DMS treatments for his patients because “We can provide similar results with the DMS at half the cost of an ART session”. Compare them both and then decide for yourself.