Author: adamsewellmd

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Medications that Cause Neuropathy

Patients are often unaware that many common medications can cause neuropathy.  Medications known to cause neuropathy from “toxic effect”:

  • Most chemotherapeutic drugs
  • Antibiotics (eg, dapsone, fluoroquinolones, isoniazid, metronidazole, nitrofurantoin)
  • Antiretrovirals (eg, didanosine, stavudine) 
  • Amiodarone 
  • Colchicine 
  • Disulfiram 
  • Phenytoin 
  • Pyridoxine
  • Tumor necrosis factor inhibitors (eg, infliximab)

There are many ways to treat the toxic buildup that occurs from such medications. The first step is to migrate to a different medication and discontinue the original medication. The next steps vary depending on the medication but typically can involve infusions medications that restore liver function. For heavy metal there are iv infusions that will bind to the heavy metals and help your body eliminate them.

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Adam Sewell MD

How to Win Back Your Health

I have been fortunate to have been able to treat thousands of patients in my career.  Looking back at my experiences of having a front row seat to watch and help so many people overcome their health challenges has been a real blessing.   I found three characteristics that are common among patients that have overcome health challenges.

  1. Positive Attitude (Focusing on Positive)

Probably the first and most misunderstood characteristic: Positive attitude.  This idea is commonly misunderstood to be unrealistic.  This is not the case. This is the most common characteristic I have seen in patients who have overcome almost any illness. The patients will acknowledge negative issues and results but they never dwell on the negative.  There is a large body of research from Carol Dweck, PhD on the importance of a “growth mindset” in the areas of education and learning.  Ms. Dweck set out to find why some children were able to learn faster than their peers.  What she found was that the children that were considered “gifted” and learned faster had one thing in common, they all had a certain set of beliefs.  These beliefs she called the “growth mindset.”  These beliefs were most evident when the children came across obstacles.  For example, when the student failed to solve a problem correctly those students with the growth mindset would almost immediately attempt to solve the problem again.  Often when faced with an incorrect answer they would say statements such as “it’s okay I will love to figure out this problem” and “I love challenges”.  The growth mindset students would also be forward thinking and anticipate success with beliefs such as “ I am going to really love it when I get this problem correct” and “I can figure this out, I love challenges”  This set of beliefs was the only thing that separated the “gifted” students from the average students.  How can you apply the “growth mindset” to your life? How will looking at the world through the growth mindset lens change your thoughts and therefore your actions?

  1. Taking Responsibility.

When we give away responsibility we give away our power.  Nearly all patients that heal and recover completely have always taken their healthcare as their responsibility.  While they consult physicians and other healthcare professionals they take responsibility for getting better.  When recommended a treatment they read about it and prepared themselves.  Often I could tell the success of a treatment prior to the treatment because the patients would often be so focused on getting better.  The patients would often come to a new patient appointment with many informed questions and would take notes.  If there was an obstacle to their care such as an insurance company they would work on their end to handle it.  If there was a problem with scheduling they would figure it out.  What was very interesting is that by taking responsibility it would empower the patient and in many cases this would correlate with a faster rate of recovery.  How often do we accidentally give our power to someone else?  How can we take our power back by taking responsibility?

  1. Willing to Try

The final characteristic common to patients who were able to win back their health was a willingness to try.  All too often, when we face a challenge we can default to blame or a “why me” attitude and give up.  Those patients that overcome a health challenge have a willingness to try different treatments and therapies.  Not all therapies worked and many did not work right away.  It is the ability to persist and keep trying until the correct solution is discovered that makes the difference between failure and success.  What I found most about patients who overcame illness was that by taking initiative and being willing to try new treatments this would produce results.  When these results were analyzed it would provide information that would often lead to a solution.  Without the initial attempt and failure, we would have never had the information to find the solution.  The willingness to try was directly linked to the solution the patient was seeking.  How willing are you to try new things?  How willing are you to think “outside of the box”.  I think this quote by Tobias Wolfe says it well — “We are made to persist .. That’s how we find out who we are”

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Neuropathy

Patient’s Guide to Neuropathy

Pain in the foot of the elderly.Symptoms of peripheral neuropathy. Most symptoms are numbness in the fingertips and foot.

Neuropathy is probably one of the biggest misunderstood areas of medicine. Partially because neuropathy does not fall under one medical speciality and partially because the term neuropathy encompasses many different illnesses.  

I find that the easiest way to explain the types of neuropathy is to group the neuropathies by what is happening to the nerve:

Axonal Nerve Damage (Damage to the wire)

If you have a problem with the long part of the nerve that sends the information, kind of like having a problem with the telephone line it is called axonal neuropathy.  The reason it is called axonal is because the neuropathy is caused by the long part of the nerve known as an axon being damaged.  The best way to think about this is to think of wire where parts of the wire has been damaged.  Kind of like an old cellphone charger where you have to place the cord “just right” for it to charge your phone.  

The following illnesses cause “axonal neuropathy” (wire damage neuropathy)

  • Diabetes
  • Critical illness
  • Longstanding HIV infection
  • End-stage kidney disease (aka “Uremic polyneuropathy”)
  • Amyloidosis
  • Hypothyroidism
  • Vitamin deficiencies
  • Lyme disease
  • Toxic — due to alcohol, chemotherapy exposure, and most heavy metals

Demyelinating Nerve Damage (Damage to the insulation around the wire)

Other illnesses cause “demyelination” the best way to think of this form of nerve damage is like a wire where the insulation surrounding the wire has been damaged:

This type of nerve damage is usually caused by:

  • Autoimmune illnesses (for example Guillain-Barré syndrome*)
  • n-hexane exposure

Environmental (physical damage to the wire due to the environment)

The third type of nerve damage is environmental meaning the nerves were damaged by something in the environment.   Environmental factors can also impact nerve health in many ways. 

Environmental nerve damage has been caused by:

  • Vibration-induced nerve damage 
  • Prolonged cold exposure
  • Low oxygen supply 

Each of these types of neuropathy can be determined with some testing.  Once you determine what type of nerve injury you have there are many ways to go about fixing the problem.

First step is to control the pain — we will often use a small device that can generate an energy field around a nerve or a set of nerves while we treat the nerve.  Chronic pain isn’t a joke as anyone who suffers from it will tell you and getting out of pain is the first step to healing.  There are many reasons why but one of the most important is that if you are in chronic pain the pain causes release of flight or fight chemicals called catecholamines.  These are the chemicals that get released if you are suddenly startled or are in physical danger like before a fight.  These chemicals cause your heart to beat faster and shift blood flow away from organs that don’t need it and towards the muscle to get your body ready to either fight or take flight (run away). Being in this state will likely stop any healing process. 

So what do you do to stop the pain and then heal the nerve?


There is now technology that can turn off pain from nerves.  This technology is call a neural stimulator (not to be confused with tens units or shock like devices).  The neural stimulator generates an energy field around the nerve or group of nerves and can interrupt painful patterns.  It is kind of like a remote control for your pain.  It essentially allows you to turn off your pain and replace it with a pleasant sensation.  For most patients, once the pain is controlled then sleep cycles return to normal blood pressure often will level out and blood pressure medications are often decreased.  Once the body is in the state there are several ways to heal the damaged nerves which we will cover in our next post.

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BACK PAIN

The only condition more common, in the United States, than common headache is back pain (National Institutes of Health, 2011). It is estimated that nearly a quarter of the population is suffers from it. Billions of dollars are spent each year on back pain treatments (Jones et al, 2010; National Institutes of Health, 2011). Both men and women suffer equally from this common annoyance that interferes with functioning, daily activities, work performance and leisure (National Institutes of Health, 2011). It is the leading cause of missed days at work and job-related disability (National Institutes of Health, 2011). Often, back pain will go away on its own, but sometimes it returns and a qualified pain physician needs to be consulted.

Common Causes of Back Pain

Pain that lasts several weeks is acute, or severe, and this is different than chronic back pain which lasts for more than three months progressively (National Institutes of Health, 2011). Back pain can be the result of trauma, disease, spinal stress, muscle strain, car accidents, sports or work related injuries, and herniated or ruptured discs (National Institutes of Health, 2011). Non-traumatic medical issues can include, malignancy, osteoporosis, degeneration, nerve tissue damage, arthritis, viral infections, bone diseases, disc disease, congenital abnormalities, vascular dysfunction, bone infection, or joint or disc irritation (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Symptoms of Back Pain

Any part of the back may experience acute to chronic levels of pain, though the most common form of back pain is found in the lower portion of the spine. Symptoms may present as restricted range of motion, the inability to stand straight, limited flexibility, sharp shooting pains, sudden stabbing pains, stiffness, soreness, tenderness, numbness, tingling and muscle aches (National Institutes of Health, 2011). The pain often radiates to other areas and/or extremities or becomes aggravated with strenuous activity or movement (Jones et al, 2010). Any of symptoms of back pain can cause serious damage if left untreated by a physician (National Institutes of Health, 2011).

Immediate Attention Required

Some back pain symptoms are indicate an emergency and require immediate attention from a medical professional. These are – fever, pain when coughing, weight loss, numbness or tingling, loss of bladder control, bowel dysfunction, pain that radiates into the legs or progressive weakness in the legs, and increasing pain that lasts more than three months (National Institutes of Health, 2011).

Back Pain Diagnosis

A physician will perform a comprehensive evaluation before back pain treatment can begin. The initial exam should include a thorough patient history, a full neurological workup, and a physical examination. Blood work, scans and imaging, may be ordered, based upon levels of pain and symptoms. Additional tests may reveal broken bones, fractures, injury, disc herniation, bone infections, tumors, ruptured disc, malignancy, spinal stenosis, vertebral damage or degeneration (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Back Pain Treatment

Back pain treatments are meant to alleviate pain and improve daily functioning (Lin, 2009). Within a few weeks of conservative back pain treatments, pain is usually reduced (Jones et al, 2010; National Institutes of Health, 2011). Physicians may prescribe several conservative back pain treatment methods (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011). These may include muscle relaxants, anticonvulsants (to treat nerve pain), antidepressants (relieves pain and aids in sleep) or pain medications (National Institutes of Health, 2011). Physical therapy may be recommended to stretch and relax muscles, strengthen the back and speed recovery (National Institutes of Health, 2011). Reducing risk factors, losing weight, and eliminating strenuous activities that aggravate pain, are all important in aiding back pain relief. Massage, acupuncture, biofeedback, or yoga may be suggested as alternative therapies as well (National Institutes of Health, 2011).

Invasive Back Pain Treatment for Serious Pain Sufferers

Physicians might suggest more aggressive pain management treatments if conservative treatments are not producing adequate results. Pain can be reduced or, even completely eliminated, with interventional therapy using injections that pain signals from getting to already irritated nerves (National Institutes of Health, 2011). These include narcotic, steroid or local anesthetic injections (National Institutes of Health, 2011). For more severe pain, nerve blocks, spinal cord stimulation or drugs administered by catheter into the spinal cord (National Institutes of Health, 2011). Pain management procedures such as spinal fusion, discectomy, foraminotomy, rhizotomy, cordotomy or spinal laminectomy are surgical options used in cases of extreme chronic back pain (National Institutes of Health, 2011).

References

  1. Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from 
  2. Lin, M. (2009). Upper Back Pain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from 
  3. National Institutes of Health 2011. Low Back Pain Fact Sheet. NINDS. Available at  NIH Publication No. 03-5161
  4. Nidus Information Services 2010: Low Back Pain – Chronic. Patient Handouts page. MD Consult Web site, Core Collection. Available at Accessed January 14, 2011
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ARTHRITIS

According to the Centers for Disease Control and Prevention, half of all adults, over the age of 65, are diagnosed with arthritis each year. Arthritis is an inflammation of one or more joints, and it can be crippling in its later stages. There are different forms of arthritis, but osteoarthritis is the most common. There is no cure for arthritis. However, there are medications, procedures, and treatments that can assist with the pain caused by the disease.

Osteoarthritis is a chronic condition that is caused by gradual wear-and-tear on the joints. Obesity is usually a factor in osteoarthritis, as it causes additional stress to weight-bearing joints in the body. The hips and the knees are most effected. Rheumatoid arthritis is not caused by deterioration, rather, it is an auto-immune disorder that causes the body to attack its own tissues, and this results in the deterioration of the joints.

Treatments for arthritis are generally minimally invasive and are conservative in nature. Most arthritis treatments begin with non-steroidal anti-inflammatory medications, otherwise known as NSAIDs, including ibuprofen and naproxen. These medications can help to minimize the chronic inflammation and pain that is associated with arthritis.

Consistent exercise is important in alleviating the pain of arthritis and keeping the joints flexible and more fluid. Walking, yoga, and water aerobics are very helpful, low-impact exercises, for arthritis sufferers. Physical therapy is helpful as well, and a physical therapist can devise an exercise and stretching regimen specific to the patient’s abilities and pain level.

Speaking with an occupational therapist about what kind of accommodations can be made for arthritis in the finger joints can be helpful. He or she can make a recommendation to purchase special grips for pens, doorknobs, or a reacher for grabbing objects out of reach.

Many arthritis patients experience improvement in pain through joint injections. These consist of a corticosteroid that reduces inflammation and pain in the joint. A physician will recommend a series of joint injections that can improve a patient’s range of motion and quality of life.

Medial branch blocks have shown much success for those who are suffering pain from back and neck arthritis. Facet joint arthritis is one of the leading causes of low back pain in adults in the United States. A medial branch block can reduce inflammation and irritation in the joints of the spine. Often, relief from this kind of pain is immediate. Medial branch blocks may be performed several times in order to reach optimum pain relief.

Sometimes, the only remedy for severe arthritis is complete joint replacement. By replacing the damaged joint with a plastic and/or metal prosthesis, the patient successfully returns to a pain free lifestyle, and they may be able to resume the activities that arthritis has robbed them of for years. Knee and hip replacements are the most common, but medical technology has advanced to include shoulder joint replacements, elbow joint replacements and finger joint replacements as well. Replacement surgery may alleviate arthritis associated pain, but recovery time post-surgery is often long and it can have complications that are not a risk with non-invasive treatments.

According to the Centers for Disease Control and Prevention, half of all adults, over the age of 65, are diagnosed with arthritis each year. Arthritis is an inflammation of one or more joints, and it can be crippling in its later stages. There are different forms of arthritis, but osteoarthritis is the most common. There is no cure for arthritis. However, there are medications, procedures, and treatments that can assist with the pain caused by the disease.

Osteoarthritis is a chronic condition that is caused by gradual wear-and-tear on the joints. Obesity is usually a factor in osteoarthritis, as it causes additional stress to weight-bearing joints in the body. The hips and the knees are most effected. Rheumatoid arthritis is not caused by deterioration, rather, it is an auto-immune disorder that causes the body to attack its own tissues, and this results in the deterioration of the joints.

Treatments for arthritis are generally minimally invasive and are conservative in nature. Most arthritis treatments begin with non-steroidal anti-inflammatory medications, otherwise known as NSAIDs, including ibuprofen and naproxen. These medications can help to minimize the chronic inflammation and pain that is associated with arthritis.

Consistent exercise is important in alleviating the pain of arthritis and keeping the joints flexible and more fluid. Walking, yoga, and water aerobics are very helpful, low-impact exercises, for arthritis sufferers. Physical therapy is helpful as well, and a physical therapist can devise an exercise and stretching regimen specific to the patient’s abilities and pain level.

Speaking with an occupational therapist about what kind of accommodations can be made for arthritis in the finger joints can be helpful. He or she can make a recommendation to purchase special grips for pens, doorknobs, or a reacher for grabbing objects out of reach.

Many arthritis patients experience improvement in pain through joint injections. These consist of a corticosteroid that reduces inflammation and pain in the joint. A physician will recommend a series of joint injections that can improve a patient’s range of motion and quality of life.

Medial branch blocks have shown much success for those who are suffering pain from back and neck arthritis. Facet joint arthritis is one of the leading causes of low back pain in adults in the United States. A medial branch block can reduce inflammation and irritation in the joints of the spine. Often, relief from this kind of pain is immediate. Medial branch blocks may be performed several times in order to reach optimum pain relief.

Sometimes, the only remedy for severe arthritis is complete joint replacement. By replacing the damaged joint with a plastic and/or metal prosthesis, the patient successfully returns to a pain free lifestyle, and they may be able to resume the activities that arthritis has robbed them of for years. Knee and hip replacements are the most common, but medical technology has advanced to include shoulder joint replacements, elbow joint replacements and finger joint replacements as well. Replacement surgery may alleviate arthritis associated pain, but recovery time post-surgery is often long and it can have complications that are not a risk with non-invasive treatments.

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Collagen: What You Need To Know

What Is Collagen? 

Your body makes its own collagen, which is kind of like a protein “glue” that holds your tissues and joints together. 

Nearly all of the collagen in your body consists of types I, II, and III. 

Here’s what each type of Collagen does:

Type 1: This Collagen is located mainly in your bones, skin, ligaments, Tendon, teeth, and extracellular matrix (the space between your cells)

Type II: This type of Collagen is located in your joint cartilage (like your knees, hips, shoulder) and your eyes

Type III: This type of collagen is in your muscle, blood vessels, and also in your skin 

When your body makes plenty of collagen, you look and feel young and strong. Your skin is smooth and joints are healthy, you are able to walk and run pain-free, you will also notice that your fingernails are strong, and your hair full and abundant. 

Unfortunately, if you’re older than 21, you’re already starting to become collagen-deficient—and this deficiency is aging you fast. 

Do You Need Extra Collagen? 

Unfortunately as you get older, your body makes less and less collagen. In fact, after the age of 21, you lose one percent of your collagen each year. Over time, this lack of collagen replacement leads to wear and tear on your body and often shows up as signs of aging.

Some Signs that you are collagen deficient:

  • Aching joints
  • Wrinkles
  • Increased Cellulite appearance
  • Weak, easy-to-break nails
  • Thinning hair

If you fail to reverse this loss, before you know it, you’ll see these signs appear in your life.  

Luckily, there’s a simple solution: Give your body the collagen it needs by supplementing your diet with it every single day.  This is not difficult.  

How to Increase your collagen levels

If you want to increase your collagen levels, it is fairly easy.  Here is what I recommend and I follow:

Drink bone broth. Bone broth contains large amounts of gelatin, which is cooked collagen — so every time you drink a bowl of bone broth, you’re giving your body the building blocks of collagen. Also, gelatin heals and soothes your intestines, lowering inflammation and helping you lose weight.  I personally drink bone broth every morning. It tastes good and is easy to make.  

Another benefit, bone broth is incredibly filling — and it’s low in calories and almost carbohydrate-free. By drinking it every morning it will keep you full and decrease your appetite during the day.  This will help you lose weight. In fact, I will often sip on it all day long and it stops my cravings for food during the day.  

The benefits of collagen and gelatin

Research has shown that supplementing your diet with collagen, or the gelatin found in bone broth has remarkable benefits. 

Some of the findings:

In two double-blind, placebo-controlled studies, researchers found that eight weeks of collagen peptide supplementation led to a 12% increase in skin moisture, a 9% increase in collagen density, and a 31.2% reduction in collagen fragmentation compared to a placebo.

Researchers conducted two experiments to see if gelatin affected hair. The researchers reported, “The most dramatic effect of supplementing the normal diet with 14 grams of gelatin daily was an increase in hair diameter averaging 9.3% in the first study and 11.3% in the second study. Approximately 70% percent of the subjects in both studies showed increases in hair diameter ranging from 5% to 45%.”

In a later study, women who took collagen peptides for 4 weeks showed a 12% increase in nail growth and a 42% decrease in nail breakage and damage. Additionally, 80% of the study participants also reported an improvement in the appearance of their nails.

How to boost your body’s own collagen production

In addition to drinking bone broth, you can provide your body additional nutrients that support your own collagen production. 

Below are the most powerful natural collagen boosters:

Vitamin C: This vitamin combines with two amino acids to form procollagen (the Mother to collagen). Vitamin C is so important in collagen production the collagen production line actually shuts down without it. Have you ever heard people of British origin being referred to as limeys? The reason that expression exists is that british sailors in the old days would eat limes to prevent a terrible disease called scurvy? Scurvy is actually a severe collagen deficiency caused by not enough vitamin C being present. 

Green Vegetables: Spinach and kale are full of antioxidants that protect you against collagen-damaging free radicals.

Red Colored Vegetables: Beets, tomatoes, and red peppers contain high amounts of lycopene, which boosts collagen and protects your skin from UV light damage from the sun.

Orange colored Vegetables: Carrots, sweet potatoes, and pumpkins are full of vitamin A, which restores collagen that’s been damaged.

Sulfur containing vegetables: Sulfur is an important player in collagen production. Eggs, broccoli, cauliflower, bok choy, onions, shallots, leeks, and cabbage all are rich in sulfur.

Copper: This mineral plays an important role in collagen production. It’s also an antioxidant that helps protect our collagen when it forms. Some foods to add to your diet that contain large amounts of copper are: nuts, shellfish, and grass-fed red meat.

Most Berries: Blueberries, strawberries, blackberries, and raspberries contain large amounts of antioxidants that fight free radicals and boost your collagen level.

Garlic: This powerful superfood contains taurine and lipoic acid, which rebuilds collagen — and Garlic also has high amounts of sulfur.  I find the best way to use Garlic is by supplementation with gel caps.

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Headache

Headache Secrets

Dr. Sewell discusses headache secrets that you should know.

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Neck Pain

Proven ways to live WITHOUT Neck Pain & Avoid Surgery

In this video Dr. Sewell discusses proven ways to live WITHOUT Neck pain and avoid surgery.
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Knee Pain

How to Stop & Even Reverse Knee Pain & Arthritis

In this video Adam Sewell M.D. discusses how to stop and even reverse knee pain and arthritis.

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What is Glutathione and How Can it Help?

Glutathione has been shown to decrease inflammation in the body rapidly, increase cell metabolism, and improve nerve and mental function. Glutathione infusions significantly improve pain and healing in many patients when combined with other IV treatments.

Dr. Sewell discusses Glutathione and how to can improve health rapidly