Prolotherapy is a safe and simple, yet elegant method to stimulate the body’s natural healing processes. By injecting a substance (most commonly dextrose, i.e. sugar) onto a ligament or tendon, a local inflammatory process is created.
This is actually a good inflammatory process and triggers the growth and proliferation of new cells of collagen. This good inflammation can result in healing and thickening of damaged or frayed tendons and ligaments. It cannot work for torn tendons, though there is a recent report of prolotherapy healing a torn anterior cruciate ligament of the knee.
Over time and as we age damage occurs at ligament bone junctions. This causes loosening of the ligaments, which then results in pain or subsequent arthritis as the body tries to compensate for the loose ligaments by laying down calcium to stabilize the joint.
We all know how a very bad sprain may cause more future pain and arthritis than a well-healed fracture. The pain we feel from arthritis when the weather changes is due to baroreceptors, however, these baroreceptors are located in the ligaments, not the joints.
What does prolotherapy work for? Prolotherapy works for neck pain, headaches, tempromandibular joint pain, and all types of back pain including some types of sciatica. It can be used successfully for rib, hip, knee, shoulder, ankle, elbow, wrist, and finger pain. One should consider trying prolotherapy before submitting oneself to certain types of joint surgery as prolotheray can increase collagen and relieve pain. Prolotherapy does not work for severe herniated discs or for torn tendons. Prolotherapy will not work if a person is taking an NSAID (non steroidal anti-inflamatory drug such as naproxen, ibuprofen or aspirin). NSAIDs interfere with the good inflammatory process that prolotherapy is trying to create. Interestingly, cortisone does not interfere with prolotherapy’s inflammatory process.
How is prolotherapy performed? After a general examination, the anatomy of the affected area is drawn with an eyeliner. (This prevents the formation of any tattoos.) The affected area is then palpated and each tender area is marked. Each tender spot will be given a local lidocaine injection and then each is then given a prolotherapy injection of 15% dextrose mixed with saline and lidocaine. Depending on the area, there can be multiple injections. While not pleasant, multiple injections are tolerable. One must refrain from any NSAIDs for 6 weeks to allow for healing. We usually perform a repeat treatment in 6 weeks but shorter intervals are possible. If there is no relief by the third treatment, it is unlikely that prolotherapy will be helpful. Many times, one treatment can be adequate for sustained pain relief. Retreatment may be necessary but may not be needed for months.
Dr. Wingert has been to Honduras three times with the Hackett-Hemwall Foundation working in prolotherapy clinics. These free clinics have been in operation for over 40 years and draw physicians from all over the world. We perform prolotherapy on people eight hours each day and they often travel hours to come to the yearly clinics. We have seen many patients who tell us about the relief they received the year before and now would like a different joint treated. The Hackett-Hemwall Foundation also has yearly clinics in Mexico and the Phillipines.
Adrenal fatigue is a common, underdiagnosed problem that may affect up to 80% of us at one time or another during our lifetimes. It is caused by excessive stresses, be they physical, emotional, psychological, environmental, infectious, or any combination of these.
Our adrenal glands respond to any type of stress (be it good or bad) by secreting cortisol, adrenaline (epinephrine) and noradrenalin (norepinephrine). The adrenals are also responsible for secreting aldosterone (which regulates salt balance) and sex hormones, most notably DHEA (dihydroepiandrosterone) which is the mother hormone of testosterone and estradiol. Cortisol, however is the hormone that helps us to recover from the stress.
Life stresses can be traumatic such as death of a loved one, divorce, life-threatening medical illness or accident. However, stresses can be smaller and cumulative such as workplace stress, unhappy relationships, environmental toxins such as alcohol, mercury or pesticides, a poor diet high in sugar and refined carbohydrates, too much or too little exercise, an abscessed tooth, chronic allergies or sinus infections, to name a few. Each time as stress occurs it taxes the adrenal glands. If the amount of stress is too great for the body to compensate for due to the magnitude or the number of stressors, the capacity to recover had been exceeded and adrenal fatigue then results.
Dr. James Wilson, a naturopath and chiropractic is the one who coined the term “Adrenal Fatigue” and has been a pioneer in addressing this problem. He notes that the primary components of lifestyle leading to adrenal fatigue are lack of sleep, poor food choices, using food and drinks as stimulants when tired, staying up late even though fatigued, being constantly in a position of powerlessness, constantly driving yourself, trying to stay perfect, staying in no-win situations over time, and lacking enjoyable and rejuvenating activities.
Common symptoms of adrenal fatigue are difficulty getting up in the morning. This person usually needs several caffeinated beverages then wakes up at 10a.m. but often crashes after lunch. Energy often is best after dinner and if patients can stay up past 9 p.m. they can get their best work done between 10 p.m. and 1 a.m. but then can’t get up the next day as they find their most refreshing sleep occurs between 6 and 9 a.m. There is often a craving for salty as well as sweet foods. For people with adrenal fatigue everything seems like a chore and they feel like they are walking around with cement shoes on. Sex drive is decreased and it can cause hot flashes in women. There is a decreased ability to handle everyday stresses and increased time to recover from illnesses, trauma or injury. There can be lightheadedness with standing and mild depression with a decreased enjoyment of life. Women may have aggravation of PMS symptoms. Memory may be foggy, thoughts less focused, and more fuzzy. All symptoms may be worsened if meals are skipped. This is not a comprehensive list but does include some of the more common symptoms of adrenal fatigue.
Diagnosing adrenal fatigue is best test done by salivary testing which is obtained at four daily intervals. The first specimen is obtained in the morning one hour after rising, the second between 11 and 1 p.m., the third between 3 and 5 p.m. and the fourth between 10 p.m. and 12 a.m. This is necessary because the adrenal gland’s output of cortisol varies during the day and blood testing does not accurately reflect levels of this hormone. The levels of cortisol are highest early in the morning. This is what wakes you up. Levels decrease during the day and are lowest at night, allowing us to go to sleep. Treatment of adrenal fatigue is complex and comprehensive. Dr. Wilson’s book Adrenal Fatigue is an excellent self-help guide to changing a person’s lifestyle to heal the adrenals. There are a number of vitamins and minerals that are important, the most significant of which is vitamin C, which is concentrated by the body in the adrenal
glands. Depending on the extent of the adrenal fatigue we will add herbal treatments such as licorice root, ashwagonda, Siberian ginsing or maca. In severe cases we may also add adrenal extract from animals. Replacement with cortisol is reserved for the most severe cases. As an anti-aging physician doing bio-identical hormone replacement, I find it is nearly impossible to normalize a person’s sex hormones unless the underlying adrenal fatigue is addressed and treated. Unfortunately, it often takes between 6 and 24 months to heal a person’s adrenal glands through lifestyle changes, vitamins, minerals, and herbs, so treatment is an exercise in patience, especially in our fast paced world that demands immediate results.
As an allopathic physician, five years ago I felt adrenal fatigue was a bogus and completely unsubstantiated diagnosis. After having learned about adrenal fatigue and studying it in the American Academy of Anti-Aging Medicine’s Fellowship program, I have been able to diagnose it and treat it (in family members as well as patients) with gratifying results.