“Memory Check” - Prevent Cognitive Decline with the NEURO Plan, “The 30-Day Alzheimer's Solution” and MoCA Testing…

As people age they have concerns about heart disease, diabetes, vision loss (macular degeneration, etc.), mobility issues and painful joints but what almost everyone has highest on their list is remaining independent as long as they possibly can. And the number one concern for many patients that will allow them to remain independent (aside from money) is keeping their “mind,” memory and cognition intact.

Almost all those chronic diseases mentioned - heart disease, diabetes, arthritis, being overweight, and to a lesser extent macular degeneration have temporary medical “fixes” that can “buy” the patient time with their independence. Then in the future, if the patient significantly changes their lifestyle, they can reverse or improve these chronic conditions….Not so with cognitive decline. There is no medical treatment (medication, medical procedure or surgery) that “buys” you time with memory. Some medications may work for a few months but they don’t provide lasting results or reversal of cognitive decline.

If people (the individual, family or support people) wait too long to start addressing the issues that cause cognitive decline, which are multi-factorial, the individual or family may not have the energy, knowledge, finances or where-with-all to do something about changing diet, exercising, taking supplements, detoxifying (i.e. heavy metals, mold, chemicals, treating Lyme, etc.), supplementing with physiologic doses of hormones, improving gut health and the microbiome, and other factors that can effect cognition after the patient has “slid” to a point where they can’t make these changes on their own. Then the person has to go into some type of extended care facility, have extensive home care, or have their partner and family try and do all the care-taking….

PREVENTION, EARLY DETECTION AND TREATMENT
OF COGNITIVE DECLINE IS IMPERATIVE!

CALL FOR A 60 MINUTE “MEMORY CHECK” APPOINTMENT 916-489-4400
AND FIND OUT WHERE YOU ARE COGNITIVELY AND GET A PLAN…

I recently re-certified to administer the MOCA (Montreal Cognitive Assessment) TEST designed by neurologist Dr Ziad Nasreddine, a graduate from the University of Sherbrooke, Québec, and a fellowship in Cognitive Neurology/Neurobehavior at UCLA.

It is a quick 10-15 minute screening test to evaluate the patient for mild, moderate or severe cognitive impairment or the individual can have a normal test. The test gives a numerical score for levels of cognitive impairment. It evaluates:

• Short-term memory

• Visuospatial abilities

• Executive functions

• Attention, concentration and working memory

• Language

• Orientation to time and place

It is a very important test because it is objective and gives you a picture of where you are compared to others in a short, minimally stressful period of time. While some people are fearful of finding out their cognitive state the test is a real gift to see where you stand. It will give a baseline and motivate you (hopefully) to apply very practical things that can be done RIGHT NOW to improve your cognition and prevent it from getting any worse.

MAINTAINING AND IMPROVING COGNITION

I have studied, interviewed and taken courses from the researchers and clinicians below that will give you tools to help slow, prevent or reverse your cognition and memory the moment you leave our office. It is important to act sooner than later with respect to cognitive issues. I really mean “SOONER THAN LATER!” As I mentioned above, unlike the other chronic diseases modern medicine has medical treatments that can buy you time, then you could address the disease years later and possibly still reverse your disease (though I don’t recommend that approach, prevention is best!). But cognitive decline really has no good medical treatments that “buys you time.” If you wait too long the burden of any therapy, including lifestyle, diet, supplements, hormones, medication, environmental control and detoxification, etc. relies on your care-taker, spouse or family to administer it. If you don’t initiate a total program early it may not even get started and the person either has to have expensive home care or goes into a facility. So START NOW with your “Cognition Tuneup and Plan”! There is so much you can do right now! Just keep reading below!

RESOURCES

I have been influenced and studied the works of Martha Morris, PhD on her “Mind Diet” research (Diet for the Mind ) and have interviewed her ; taken practitioner trainings with neurologist Dale Bredesen, MD, have interviewed him, read several times his two books “The End of Alzheimer’s” (2017) and “The End of Alzheimer’s Program” (2020) and read neurologists Dean and Ayesha Sherzai’s excellent books “The Alzheimer’s Solution” (2017), “The 30-DAY Alzheimer’s Solution” (2021) and heard them speak on multiple occasions.

Printout Free Handout Below by Kirk Hamilton PA-C

Alzheimer’s Disease & Cognitive Decline Prevention & Reversal Patient Resource Guide (12 page PDF of key principles from “Diet for the Mind”, “The Alzheimer’s Solution”, “The 30 Day Alzheimer’s Solution”, “The End of Alzheimer’s” and The End of Alzheimer’s Program)

READ DRS. AYESHA AND DEAN SHERZAI’S LATEST BOOK “The 30-DAY Alzheimer’s Solution” (2021) RIGHT NOW! I have read it in print and have listen to the audiobook 3-4 times. I have heard them speak several times at medical conferences. Though the recipes are fabulous in this book, even if you never try a recipe I want you to read the first 87 pages of their book. It is easy to read, understandable, and will give you both “brain saving” and “life saving” information in a totally understandable and immediately applicable format! Get this book…. Read those 87 pages and start applying the five principles of the NEURO PLAN right now. All the other books I mentioned above are great! But they can be overwhelming with too much good information as you begin your journey. Their first book (The Alzheimer’s Solution 2017) goes over these five steps in the NEURO Plan but there is so much detail that you can get overwhelmed and might not take immediate action. The other reason to apply the 5 steps in the NEURO Plan is not only will they help your cognition and help prevent Alzheimer’s disease but these steps will help prevent heart disease, cancer, diabetes, arthritis, degenerative eye and other nervous system disorders while normalizing your weight as well (Did I say reduce your Covid 19 co-morbidities too!). The United States and the world could use a lot of this!

If you or a family member already have mild, moderate or severe cognitive impairment or Alzheimer’s then this visit will be of significant help for implementation of the NEURO Plan PLUS be evaluated for environmental toxins such as mold, Lyme and heavy metals, hormone deficiencies, blood sugar and lipid abnormalities, excessive inflammation, nutritional deficiencies (vitamin and minerals), possible sinus infections, and gut health which can all contribute to cognitive decline. Medicare actually pays for a fair amount of these tests. If you are not Medicare, but an HMO (i.e. Kaiser, etc.), then these lab tests are available at cost and can be drawn at our clinic.

HIGHLIGHTS FROM “THE 30-DAY ALZHEIMER’S SOLUTION” The Definitive Food and Lifestyle Guide to Preventing Cognitive Decline by Drs. Dean and Ayesha Sherzai, MD, 2021:1-87

NEURO PLAN (pages 4-27)

NUTRITION - Whole, unprocessed foods, mostly plant-based. Avoid saturated fat from all sources (cheese and chicken are huge sources), but consume plant foods with good fats such has sea algae, nuts, seeds (chia and flax) and avocados. Get omega-3 fatty acids, especially DHA from flax and chia seeds but also from sea algae (1-2 capsules per day). No processed carbohydrates or added sugars are to be consumed. No refined foods at all. Also eliminate alcohol for a month.

EXERCISE - Exercise is critical and it’s the big “free-bee” in preserving you cognitive decline. If you are concerned about your memory and you don’t exercise then you are not serious about improving it or you just don’t know how important it is. Exercise reduces inflammation and oxidative stress. It helps parts of the brain communicate with other parts. Exercise can help you build millions of new brain connections (in the white matter) even later in life. Exercise increases BDNF (Brain-Derived Neurotrophic Factor) a secreted protein that regulates many aspects of neuronal development and function in the nervous system. BDNF regulates neural stem cell survival and differentiation, axon/dendrite differentiation, synapse formation and maturation, and refinement of developing circuits. It is also a key regulator of synaptic plasticity and late-phase long-term potentiation AND it is FREE! Just move your body!

UNWIND (DISTRESS) - Avoid or reduce overwhelming stress. Apply stress reduction practices into your daily lifestyle. Good stress can increase your oxytocin and reduce cortisol and adrenaline levels which can improve brain function. Bad or uncontrolled stress can alter dopamine and serotonin levels and increase anxiety and depression. Bad stress increases cortisol, alters thyroid and growth hormones, and can alter your insulin and immune system. Overwhelming stress effects billions of connections between neurons which in turn effects concentration, attention, decision-making, judgement and memory formation. It causes your brain to shrink by inhibiting the formation of neurons and axonal growth hormones. It causes your scavenger microglia cells to start attacking good brain structures, like the hippocampus, negatively effecting memory. Uncontrolled bad stress negatively effects you immune system, weight, heart rate and blood pressure. Overwhelming stress can effect your satiety centers making you either very hungry or have a reduced appetite. It is important to identify your bad stressors and try and reduce them.

Meditation, mindful breathing, journaling, exercise, yoga, listening to music, de-cluttering your environment, stimulating healthy relationships and living a purpose-driven life all can help reduce uncontrolled stress.

Good stress is following a purpose-driven life with completion of milestones. This helps your brain be more resilient.

RESTORE (SLEEP) - For the brain sleep is our “Super Spa”. During sleep the brain 1) Removes the days waste - inflammation and oxidative by-products; abnormal proteins and toxins 2) Is converting short-term memory to long-term memories and gets rid of useless ones. 3)It is organizing thought processes and building new connections. 4) With restorative sleep you are happier, more focused, more coordinated, smarter, less likely to have strokes or headaches, will be able to control your weight better and have a better libido.

Restorative sleep has both REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. Stage 2 and 3 of NREM sleep are where memories are formed and memory retention occurs. Slow-wave sleep (stage 3) is where most of the consolidation of the memory takes place. During REM sleep the brain “defrags” itself and organizes information. This allows for better focus, concentration, creativity and reason. If we don’t get passed stages 1 & 2 we can have brain fog. Sleep deprivation can lead to hormonal imbalances (leptin and ghrelin) that can lead to increased cravings and food intake.

Alternate work cycles can throw off hormones like melatonin and negatively effect circadian rhythms which can negatively effect cognitive function.

Sleep aids are hit or miss if they work. There are a “million” things people try AT BEDTIME. Here are some of mine - melatonin 3-6 mg, calcium and magnesium citrate 500 mg : 500 mg, 5 http 50-200 mg, L-tryptophan 1000-2000 mg; L-theanine 200-400 mg, valerian root 500 mg 1-2. Good sleep hygiene is very important - going to bed early, at the same time, avoiding before bed TV, phones, tablets or computer screens.

OPTIMIZE (PURPOSE) - Purpose driven stress can increase your cognitive reserve and be good for you. Cognitive reserve is the measure of connectivity we develop in our brains throughout our lives. Cognitive reserve is a summation of how much information we take in, the risk, adventure, joy, learning and experience we accumulate over a lifetime. A life that is well lived usually results in a higher cognitive reserve. Cognitive reserve is building redundant connections between billions of neurons and brain structures so as the brain ages we can still function at an optimal level. Challenging our brain increases cognitive reserve. Cognitive reserve is built by engaging in multiple areas at once, especially around your passions and purpose. Reading a book and then discussing it integrates different parts of your brain. Multi-functional practices like knitting are ideal. Social interaction is key for reducing the risk to dementia. Something like a card game or a knitting group then talking to friends at the same time is ideal. Or eating around a table with family and friends talking about different topics and issues. Food consumption should be intertwined with social behavior and ideally with a strong sense of community.

Putting all the components of the NEURO Plan together creates an effect of “The Sum is Greater Than The Parts” as far as preventing or improving cognitive decline (i.e. diet, exercise, sleep, stress, purpose). Likewise our cognition can decline rapidly if these components to the NEURO Plan are not at all optimal.

THE ALZHEIMER’S SOLUTION “7 RULES FOR EATING”
“The 30-Day Alzheimer’s Solution” by Drs. Dean and Ayesha Sherzai, MD, 2021:11
1. Eat plant-based diet (and the NEURO 9 foods every day)
2. Avoid foods high in saturated fat
3. Avoid refined carbohydrates and sugar
4. Reduce salt and season your food with herbs and spices
5. Avoid processed foods
6. Drink water
7. Eat homemade meals

THE ALZHEIMER’S SOLUTION “THE NEURO 9”
“The 30-Day Alzheimer’s Solution” by Drs. Dean and Ayesha Sherzai, MD, 2021:9
1. Green Leafy Vegetables - 3 cups raw or 1.5 cups cooked
2. Whole Grains - 3 servings (1/2 cup cooked oatmeal, quinoa, brown rice, or 100% whole-wheat is
1 serving)
3. Seeds - 2 tablespoons (2 servings)
4. Beans and Legumes - 3 servings of 1/2 cup cooked beans or tofu / tempeh, 1/4 cup hummus,
or 1/2 cup peas
5. Berries - 1/2 cup (1 serving)
6. Nuts - 1/4 cup (1 serving)
7. Crucifers - 1 cup (2 servings)
8. Tea - At least 1 cup daily
9. Herb and Spices - At least 1/4 teaspoon daily

RISK FACTORS TO COGNITIVE DECLINE AND ALZHEIMER’S
(The Alzheimer’s Solution, 2017;18) Teamsherzai.com ; Facebook.com/SherzaiMD /
(Prevention & reversal of cognitive decline)
• Alcohol abuse
• Blood pressure -high
• Cholesterol -high
• Diabetes (or prediabetes)
• Diet –highly processed, high sugar, high saturated fat
• Head trauma
• Obesity
• Sedentary Behavior
• Sleep problems, poor sleep
• Smoking
• Stress
• Vascular disease –small vessel

TOP TWENTY “BRAIN NOURISHING” FOODS
(The Alzheimer’s Solution, 2017:95-98)
• Avocados
• Beans
• Blueberries
• Broccoli
• Coffee
• Dark Chocolate
• Extra-Virgin Olive Oil
• Flax Seed
• Herbal Tea –Mint, lemon balm, hibiscus
• Herbs –cilantro, dill, rosemary, thyme, oregano, basil, mint, parsley
• Leafy Greens
• Mushrooms
• Nuts
• Omega-3 Fatty Acid (algae)
• Quinoa
• Seeds (Chia, sunflower)
• Spices –Cinnamon, cloves, marjoram, allspice, saffron, nutmeg, tarragon
• Sweet potatoes
• Tea –green
• Turmeric –curcumin
• Whole grains

TOP TEN FOODS TO AVOID FOR OPTIMAL “BRAIN HEALTH”
(The Alzheimer’s Solution, 2017:98-99)
• Processed foods –high in sugar, salt, saturated fats-clogs blood vessels to the brain and damages
brain tissue
• Processed meats –preservative, salts and saturated fats that cause inflammation and damage blood
vessels to the brain
• Red meat –contains inflammatory saturated fatty acids
• Chicken –main source of cholesterol in American diet. 3 x fat as protein and major contributor to
obesity
• Butter and margarine –saturated and trans fats cause clogged arteries and brain shrinkage
• Fried food and fast food -trans fats reduce brain volume and increase cognitive decline
• Cheese –high saturated fat damages brain blood vessels
• Pastries and Sweets –inflammation and brain burnout
• Sugary Drinks –inflammation, damages neurons
• Excessive alcohol –neurotoxic to brain cells

CALL FOR A 60 MINUTE “MEMORY CHECK” APPOINTMENT 916-489-4400
ASSESS WHERE YOU ARE COGNITIVELY AND GET A PLAN…

Visit Will Include:
• MoCA Cognitive Test
Personal Cognitive Risk Factor Review
• Medical History
• Medication History
• Diet History
• Environmental History
• Risk Factors for Cognitive Decline
• Review The Need For Assessment Tests for Cognitive Decline - Glucose, lipid and inflammation markers, hormone levels, vitamins, mineral, fatty acids, stool/microbiome assessment, Brain MRI with Neuroquant, environmental toxins (toxic metals, mold, measurement of CIRS markers, Lyme disease)
• Review need for additional therapies to lifestyle and supplements including intravenous NAD, vitamins/minerals, glutathione, chelation therapy, mold and metal detoxification

***Special discount price for 60 minute “Memory Check” is the 30 minute Medicare Office Visit Charge - $150***

Individualized Cognitive Prevention and Reversal Plan
1. Follow the the five point NEURO Plan Lifestyle Program found in the “30 Day Alzheimer’s Solution” and/or Alzhiemer’s Prevention and Reversal Handout Recommendations
2. Plan for further evaluation by appropriate testing with follow-up appointment and treatment plan

Call 916-489-4400 NOW to set up your Cognitive Risk Assessment and NEURO Plan Appointment with MoCA Testing and be on a path to prevent, reverse and optimize yours or a loved one’s memory and cognition!

Be Well,

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Weight Loss Made Easy! Hand Arthritis Disappears Too!

Weight loss is difficult for most people but every once in a while a simple approach really works…and works fast! A 56 year old female came in weighing 189 lbs with high blood pressure (she said it was white coat hypertension) at 189/88 and had arthritis pain in both hands on 1/11/21. Today, 5/10/21 she weighs 142.4 lbs, her hand arthritis pain was gone 2 weeks into the program and her blood pressure today is almost normal at 132/74, but she swears it goes up every time she comes in to the office. That is still a lot better by any measurement than 184/88 when she first came in.

So in 4 months she has lost 46 1/2 lbs along with the pain in her hands and she has almost normal blood pressure. And did I mentioned she happens to feel great!

So What Did She Do?

1) Inflamx (All Spice flavor from Metagenics we have at office) 2 scoops two times per day mixed in cold or iced water. You could also mix it with a nut milk, greens and fruit which is fine but adds a few calories.
2) Ate unlimited non-starchy vegetables and whole fruit of my BED Food List (page 2)
3) Did the Prolon Fasting Mimicking Diet 5 days out of each month (she has done four 5 day fasts to date - available at our office)
4) Had 1 handful of raw nuts or seeds daily
5) Walked or rode her bike 1/2-1 hour per day
6) After the first month she had some sweet potatoes and yams added to her non-starchy vegetables
7) The fourth month (April, 2021) I said she could do whatever she felt like doing but the goal was to lose 5-10 lbs over the next month. She chose to add some beans or brown rice to her large vegetable salads which she had daily
8) She just started to do some strength training this last month

Comments:

1) Her quick pain relief within the first two weeks was getting off all dairy, eliminating meats and eggs, and getting off all processed foods rich in processed carbohydrates (usually wheat) that contain bad fats, sugar and no fiber
2) She was on a low calorie, lower protein diet which is fine for weight lost. Each Inflamx drink (2 scoops) is 170 calories and 13 gms of protein. Double that since she took it two times daily. That is still a low amount of protein (from pea and rice) though adequate at 26 gms. Non-starchy vegetables and fruit made up most of the rest of the diet and they are high in water content and nutrients but low in calories (low caloric density / high nutrient density).

Aside from containing a low strength, but broad spectrum amount of vitamins and mineral the All Spice Inflamx contains anti-inflammatory substances such as alpha lipoic acid, curcumin, Fenugreek, polyphenols from hops, quercetin, rosemary and ginger. ($70 per bag/week supply)

3) She did the Prolon Fasting Mimicking Diet each month for five days. This “purchasable” fast puts you into a fasting state, enhancing autophagy, stem cell production, anti-inflammation. controlling lipids, insulin resistance and weight loss by eating the foods provided each day. It is simple as it gets. It’s doable for the working person. To me the best thing about repeatedly doing the Prolon Fast is it helps people gain control of their food intake and it cuts cravings. Those later two reasons are why I think it is important to do monthly fasting (Prolon/$200 per box/5 days) until you get to the place that you feel good and are at the weight you want.

Other Tricks to Stimulate Weight Loss If Stuck…
1. Double your daily exercise time daily
2. Just eat for 5 days whole fruit and all the non-starchy vegetables you can eat (can be raw, water stir fried, baked, broiled, steamed, etc. Just not sauteed or fried with a lot of oil
3. Water fast on Mondays and eat whole fruits and non-starchy vegetables on Tuesdays (currently this is what I am doing) BED Food List (page 2)
4. Eat a Whole Food Plant Based Diet BED Food List (page 2 - minus animal foods)
5. Eat a palm full of animal food and non-starchy vegetables only off BED Food List (page 2)

Yes I will look at your hormones and screen you for chronic diseases. But these approaches are simple, safe and work.

If you want to talk to me about “jump starting” your weight loss program give me a call between 8-9 a.m. M-F at 916-489-4400 or just make an appointment. I love to see people get control of their food intake, lose weight and feel better.

Be Well,

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Use of Shock Wave Therapy in Acute and Chronic Pain Syndromes – An Interview with Dr. Hani Saeed, DPM

Kirk Hamilton PA-C interviews Dr. Hani Saeed, DPM director of the Red Rocks Foot and Ankle Center after spending a typical busy Saturday morning treating acute and chronic pain syndromes, especially of the lower extremities, with focused and radial shock wave therapy devices which are available in the United States through Curamedix. LISTEN TO PODCAST/INTERVIEW HERE

Dr. Saeed has been using shock wave technology for more than a decade. He has used the combination of these two similar, but different devices (Focused  Radial Devices) in treating patience for more than five years. He treats both acute and chronic pain as well as injuries in the general public and in world class athletes to speed healing, reduce pain and enhance their performance.

Dr. Saeed’s passion and compassion for his patients is obvious after watching him see patients on a busy Saturday morning. The appreciation of his patients for his skill, caring and rapid results is inspiring and heart warming. Dr. Saeed explains both the art and science of using these shock wave technologies to help people heal from their common health problems.

Conditions Treated by Dr. Saeed on this Saturday Morning in His Littleton, Colorado, Clinic With Extracorporeal Shock Wave Therapy (ESWT) Using Both Radial and Focused Shock Wave Devices

Acute and Chronic Pain
Ankle pain / post surgery pain
Athletes – semi-pro football players - muscle strains
Back pain– low back
Groin pain
Hamstring pull
Hand and finger contractions from severed median nerve accident
Heel pain
Knee pain
Neck pain
Neuritis
Neuropathy with shock wave 15-25 minutes and then 20-30 minutes with Neurogenx 4000 PRO
Plantar fasciitis
Thigh – anterior thigh numbness
Trapezius /neck pain
Wound Healing

PATIENT RESPONSE

Almost all patients noted an immediate benefit (decreased pain, increased mobility and function) after the treatment.

Most patients had some degree of mild to moderate discomfort during the treatment but the treatment was well tolerated. Those who had been treated before noted it as a “good hurt” while being treated and expected it in a positive light.

All THE PATIENTS were extremely grateful and thankful for Dr. Saeed’s treatment.

TO ENHANCE HEALING & BENEFITS OF SHOCK WAVE THERAPY

Avoid icing if possible - slows the benefit of the shock wave treatment.

Avoid Non-Steroidal Anti-Inflammatory Medications (ASA, Advil, Aleve, Ibuprofen, Naproxen, etc.) if possible - slows healing. Can use Tylenol.

Avoid Cortisone Injections if possible - slows healing.

Drink Water - hydration after treatment is very important.

Sleep – getting good sleep is critical for healing - Trial of Ashwagandha at night 500 mg/d. Dr. Saeed has found low dose amitriptyline 25 mg at night to be helpful.

Exercise - Doing half of your normal exercise activity while healing and see how you feel.

NOTE: Dr. Saeed treats people who have had cortisone injections, who are taking NSAIDs and
doing techniques like icing but noted there is greater and quicker improvement if those
medical approaches can be avoided during EPAT therapy.

TREATMENTS last10-20 minutes for each area (i.e. hand, foot, knee, etc.) done weekly for 3-5 treatments.

IMPRESSIONS

My own impressions of my following Dr. Saeed while he was treating patients with radial and focused shock wave devices were 1) his positive passion and caring for what he does 2) his confidence, skill and efficiency of his treatment techniques 3) his ability to keep pain patients focusing on the positive side of their treatment and progressive improvement 4) the immediate benefit that almost all patients felt after the treatment 5) patients came from all over Colorado and even out of state to see him 6) those who had been treated by him before had tremendous belief that they would feel better almost immediately.

__________________________________

At Health Associates we can add to the benefits and efficacy of shock wave therapy for pain relief and healing by:
1) Low allergy, anti-inflammatory and nutrient dense dietary advice along with selective modified fasting techniques for pain reduction (Prolon - Fasting Mimicking Diet, Inflamx, etc. both products available at our office).
2) Weight loss assistance.
3) Selective nutrient deficiency replacement discovered by blood testing (fatty acids, vitamins, minerals).
4) Correction of insulin resistance and better glucose control which helps nerve function and circulation.
5) Selective hormone deficiency replacement to physiologic levels which can be anti-inflammatory, enhance healing and balance mood (testosterone, DHEA, pregnenelone, estrogen, progesterone).
6) Improve gut health and the microbiome which is a major source of inflammation by whole food, unprocessed diets that are high in fiber and whole good fats.
7) Selective intravenous and intramuscular nutrient therapy which can reduce pain, enhance energy and mood.

If you are a patient and you would like to get started on shock wave therapy (or called EPAT - extracorporeal pulsed activation technology) call and make a 1 hour initial appointment with me, Kirk Hamilton PA-C, so I can take a history, do an exam, outline a treatment program, and give you a treatment at that visit. If you are not a patient then that first visit is 75-90 minutes which includes an initial history and exam and a treatment session usually. Then treatments are usually 20-30 minutes every 5-7 days for 3-5 visits if one body part is being addressed. More time needs to be scheduled if multiple areas are to be treated. The actual treatment cost after the initial visit is - $150 for 1 body part (15-25 minutes), $210 for 2 body parts (30-45 minutes) and $270 (45-60 minutes) for 3 treated areas if indicated. The treatments are paid for at each visit and they are not insurance reimbursable. You can call me between 8-9 a.m. 916-489-4400 and if available we can talk briefly if EPAT may be beneficial for you or schedule a FREE 10-15 minutes phone call with me during the day to go over your individual situation. Just tell the staff it’s Kirk’s FREE 10-15 minute EPAT phone call.

Be Well,

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Successful Treatment of Erectile Dysfunction (ED) in an 80 Year-Old with Hypertension and Memory Loss and A Prostate Cancer Patient with Nerve Damage

A Little Background…

I have been administering extracorporeal shock wave therapy (ESWT) for erectile dysfunction (ED) for almost a year (May 2020). One of my goals was to use this non-invasive therapy that delivers pulsed sound waves in conjunction with lifestyle change and low dose PDE5i medications (“Viagra type”) if necessary, to help men/couples achieve successful intimacy. At the same time, I was hoping to motivate men (and their partners) to reverse their heart disease, diabetes, obesity and  reduce their medication use for chronic diseases which are common contributors to ED and inhibit healthy aging.

Intimacy Is A Lot About Confidence…

One thing is obvious in talking to my male patients is if you do not have confidence that you can get an erection and maintain it, you probably won’t start or attempt to be intimate for fear of performance failure. This could be taken wrong by the partner as not being desired or the male partner just does not care if they have intimacy or not. My experience is men care very much about intimacy and closeness, especially as they get older.  

What is Success?...

In doing this work for almost a year “success” isn’t just about just helping a fellow male get and maintain a firm erection. It’s about helping a man move to a position that he feels confident in sharing his caring and physical enjoyment with his partner and “does not hesitate” to do so.

The Great American Anti-Depressant…

Almost everyone who undergoes the above combined approach to ED has some improvement within the first 4-8 treatments. The patient will walk in with a grin on their face, a little more swagger in their step, mention something regarding an old lost friend in an “early morning erection”, or just an unexpected “rise” without intended stimulation for the first time in years. This does not mean a perfect erection for successful intercourse, which is a main goal, but it is a sudden change for the better. You can see the confidence boost, hope and relief. This is rewarding to see!

Erections are Back Now What?...

This was a surprise finding to me in working with men (couples) on the ED issue. But the more I think about it (and listen to my patients) it should have been obvious. The patient’s physiology may work good enough to have an erection from this combined treatment program, but the relationship or partner may not be ready for intimacy for a variety of reasons!…?

What? You thought the problem was just the male’s inability to have a good enough erection for intercourse? Not exactly! The relationship AND the partner’s health/physiology must be on solid ground for intimacy to start occurring again.

This was a problem that I was not thinking about when I started on this journey of treating men using ESWT, medication and lifestyle change. But it is a BIG issue! Probably bigger than trying to help fix the patient’s inadequate erections. I would say that of all the men who have improved their erections to where they could have intercourse maybe half AREN’T having regular relations with their partner. Not because they cannot but because their relationship with their partner or their partner’s health/physiology is not ready, or a combination of both. And most of these situations where there is no regular intercourse is usually in long-term married couples! The “whys” of this are a discussion for another day.

Two “Stories (Cases) From the Stirrups!”

Let me explain the title of this section. It has brought laughs from everyone I have shared it with as a a possible book chapter title of case studies of men receiving ESWT.

When this pulsed sound wave therapy is administered it can be done with the patient flat on their backs on the table with their legs in “V” like position with heels together or apart to help expose the perineal area which is the space underneath the scrotum to the rectum. On either side of this area is the Crura which are areas treated with the sound waves or “shocks waves” (not electrical shocks). These areas are usually treated after either side of the shaft of the penis is treated and around its base. So for the first few months I treated people in this laying flat position with the patients heels together and legs in a V shape to get access to crura. Then one day a patient came in and said he was treated at another clinic and received these treatments while in the “stirrups.” Like females have to do for their female exams. So I tried it. It was easier on my back and no problem for the patients so I have been doing the treatment with men “In the Stirrups” ever since. So at the first visit the man is bit apprehensive and looking at the table, then me kind of funny. Like they are saying (thinking) “Really?” Even though I have shown them the device before and how it works, getting up on the table undressed from the waist down can make a man a bit “hesitant.” But after the first treatment it’s like getting into the neighborhood ”Barber Shop Chair”. And being a 63 year old male myself men quickly feel comfortable sharing with me many things about their lives as we do our 1/2 hour treatment once or twice weekly.

By the way I always invite the partner to come and see the device, how it works and the room. The female partners have a “quiet laugh” when they see that their man has to get up in the “Stirrups” for their treatment. It lightens things up which is good!

Case #1 - You are Never Too Old to Have Intimacy…Never!

Here is a joyful, rewarding “case study” embodying the concept that you are never too old to enjoy intimacy, sex and play.

First let me say I am not seeing “young bucks” in their 30s, 40s or early 50s with ED just needing a “tune-up”. Most of my patients are in their late 60s, mid to late 70s and a couple of 80 year-olds and one 90 year old… It’s never too late and you never are too old to think about sex and take action on it. This type of thinking and action will help keep you young and functional in other ways besides just sexual activity. And, enjoy more of your life in those “Golden Years”.

 “Success!”, Intimacy and Play at 80!

An 80 year old male came to see me who had NOT been sexually active for 10-15 years. Actually, he could not remember how long really, but it was a long time. His wife had died several years ago. He could not remember the last time he had an erection.

He met another widower who had gone through a stressful care taking experience with her husband before he died. He met her at a party. Asked her out. And the rest is history. They hit it off from the moment they met. Since then, they have been having a “blast” together. You can just tell by the way he (and she) talk that they are having so much fun just being together. What is great about this couple is how playful and genuine their gratitude and appreciation is for this relationship, especially both having lost their spouses at this stage in their lives. After a few months they decided to live together.

All this joy and fun initially occurred without having physical intimacy. Well, I should say having sexual intercourse, the intimacy was there.

This 80 year old individual came to me with a desire to have functional erections and more importantly to improve his fading memory. He also had a problem with high blood pressure and was on two blood pressure medications.  

His “new” partner and he were at the first visit togehter and while ED was a big issue the bigger issue was memory. Blood pressure was a secondary but a significant problem. The good thing is all these problems are connected and have about a 95% similar lifestyle approach to improving these conditions. If you improve circulation and artery function (relaxation of the inner lining of the artery – endothelium) you will improve memory, heart disease, blood pressure and probably erections.

Combining Therapies Because of Cognitive and Vascular Issues

I recommended IV chelation therapy along with comprehensive lifestyle and diet change to this patient because I was concerned about his vascular health and questioned how fast and how willing he would be to dramatically change his diet. He also has received some intravenous NAD which at least initially has improved cognition and energy in some patients.

There is a sense of urgency when dealing with cognitive decline. You need to get the patients involved in their self-care when they are still independent. NOT after they have lost so much cognition they must rely too much on their partner, family or caretakers to maintain and/or improve their health. Early treatment with a comprehensive program is critical for cognitive maintenance and renewal. Yes memory and cognition can improve. And the initial push must be done consistently for 3-6 months (print out my Alzheimer’s prevention and treatment handout). Call and make an appointment with me for a 20-30 minute cognitive assessment test and a review of the key points and risk factors from this handout if cognition is a concern for you. Visit $150 Call 916-489-4400 Make with Kirk Hamilton PA-C.

Brain, Erections and Vascular Health

I digressed a bit in this ED case study because cognition was the major issue in this patient even though improving sexual performance was very important. The patient has been on multiple blood pressure medications for years. His blood pressure came down over a two month period mainly by lifestyle change and presently he is off both medications and his blood pressures are normal. Blood pressure medications can effect ED and they are a sign you have some endothelial dysfunction which is not good for ED, hypertension or your brain. He has also been able to stop his GERD (heart burn medication) mostly by diet change.

The truth is if you really improve the contributors to cognitive decline you will probably be well on your way to improving the physiology of erectile dysfunction and improving one’s blood pressure as well (endothelial dysfunction).

We added physiologic testosterone therapy because his levels were low and because testosterone can help all three conditions (blood pressure, memory and erections). What I mean by “physiologic testosterone replacement” is replacing the testosterone to blood levels in the upper half of the normal range of free and/or bioavailable testosterone. Not necessarily “young buck” 20 year-old levels. Though many men want to go there. Testosterone helps with memory, mood, assertiveness, “can do” attitude, lean muscle mass, libido, to a lesser extent helps with erections and normal blood levels are generally cardioprotective. So, correcting this one imbalance helps with ED, cognition and vascular disease.

Back From Brain and Memory Preservation to Erectile Dysfunction

So back to this wonderful patient who has improved his ED dramatically, resolved his high blood pressure at least for now, and has stabilized his cognitive decline doing these multiple therapies.

A happy patient who has the return of his erections hopefully gets a “shot in the arm” to continue practicing the lifestyle factors that will also help keep his blood pressure and improve his cognition.

So, the happy beginning of this story, along with energy improvement, blood pressure and BP medication reduction (off both BP medications for now), was erections that were firm enough to have successful intercourse several times per week after only 2-3 weeks (4-6 treatment sessions) on the “total” program.

For me it is a great joy and incredibly rewarding to see the pieces come together where a patient combines non-invasive, low risk therapies with lifestyle change and you see not only the main complaint improve but other complaints as well. And to see a happy couple genuinely enjoy each other more! The Best!

There is more work to be done with this patient. With the erections working for happy sexual relations my biggest concern is keeping the patient’s focus on living a lifestyle and doing therapies that continue to maintain and improve his cognitive decline (see handout) and vascular health (see handout) . The effort has to be for the rest of his life!

Case #2 - An ED Success Story Working Through Prostate Cancer Treatment, “Nerve Damage” and Recovery

A 68 year old male who had prostate cancer and recovered but the treatment left him with erectile dysfunction and a numb penis for a year or two with some partial improvement in sensation over the last 2 years. When he came in he still had partial numbness, his erections were “soft” and if there was intercourse he could really not “feel” during sexual intercourse. He had been taking low dose Cialis 5 mg twice daily and used a penile pump daily for “penile rehabilitation” after the prostate cancer treatment for the last 4 years.  

Since he had this ED problem for several years and he had numbness he committed to 18 treatments, twice weekly using a radial shockwave device (rSWT) initially and then a focused device (fSWT) for the rest of his 18 treatments. They both produce pulsed sound waves but by a different mechanism. A mechanical air driven pellet versus and magnetic coil. Both ways can be effective in the treatment of ED.

His began to feel a “sensation” in penis after 3 or 4 treatments. This was a dramatic result since he has had partial numbness for almost 4 years. His erections started to improve midway in those 18 treatments and now they are working very well. He is on 5 mg of Cialis daily down from 10 mg. He is not doing the penis pump any longer. The amount of semen and strength of ejaculation continues to increase in volume and strength on a consistent basis. He is having strong orgasms. His sexual desire is very good (he is not on testosterone but has “normal” levels). While he has great desire and is sexually functioning well his wife had some issues with comfort which had to do with her physical health and probably hormonal status. But they are working through them. His wife’s discomfort was improved considerably just by changing positions. They continue to communicate and work on ways to make intimacy more comfortable for her.

Him having feeling in his penis has been a dramatic positive change since having the treatments. Having a firm erection without feeling would be better but not satisfying. So whether the treatments help with nerve regeneration or increased blood flow or both good sensation along with the erections is great for him and his wife.

In a sense now he is “ahead” of his wife in being able to have a more active and more frequent sex life. His physiology is working great and “on demand” and he can count on it. He is ready to go because so many things have improved, including arousability and desire. How much renewed confidence has in all this is hard to tell but I think it is significant.

ESWT Side Effect? Less Nighttime Urination!

Along with improvements in his erections, desire, orgasm, arousability, sensation this patient also had more sensation of complete emptying after urination. He is not urinating at night at all. So nighttime urination and complete voiding have improved significantly. This improvement is probably do to the second part of the ESWT where the shock waves are directed at the Crura on both sides of the area underneath the scrotum to the rectum that are treated with shock waves as well. These areas are rich in arteries and nerves. There is evidence that treating over the middle portion, or directly “aiming” at the prostate, can help with enlarged prostate symptoms of nighttime urination frequency and incomplete emptying with urination (Radial Extracorporeal Shock Wave Therapy as a Novel Agent for Benign Prostatic Hyperplasia Refractory to Current Medical Therapy) . Lifestyle, especially what you eat and drink, plays a big role in effecting nighttime urination. Try an eliminate dairy products, caffeine, coffee and alcohol for a week and see what happens to nighttime urination along with doing the shock wave therapy.

This patient is on a monthly treatment (ESWT) maintenance for six months then he will see what he feels he needs to do to maintain his progress.  

Continued communication with this wife’s comfort is key. Hormones vaginally or topically would be reasonable and probably helpful once the concern about a breast abnormality found on a recent scan is clarified.

This patient is on the following supplements of which all of them, except the multivitamin, are to improve blood flow and artery health.

SUPPLEMENTS
Aged Garlic Extract 2/d
Algal Oil 2/d
Arterosil 1/d
Berkley Life Nitric Oxide 1/d
DGF Multivitamin 1/d
CoQ10 100 mg/d
Red Yeast Rice 1/d

EXERCISE every other day 1 ½ hours

MEDICATIONS:
Armour Thyroid 150 mg a.m.
Cialis Tabs 5 mg 1/d
Tamulosin HCL Caps 0.4 mg 1/d

________________________

Prostate Help, Nighttime Urination  Treated with ESWT and Diet

Patients being treated for ED with ESWT and diet change have mentioned on numerous occasions that their urinary frequency at night has been reduced from 3-5 times to 1-2 times per evening and they have a more complete urination after 3-5 treatments for ED in which I frequently treat the prostate as well. I have only had one “treatment” failure using ESWT for frequent nighttime urination. This person didn’t have a big prostate on exam or elevated PSA so the urination issue may not have been related to the prostate. I recommend diet change including  a low-allergy (no dairy, wheat, eggs and yes caffeine), whole food, mostly plant-based diet (palm full or less of animal food daily, pages 1 & 2)  for 2-4 weeks along with weekly ESWT treatments (20-30 minutes each, virtually pain less, $150 per treatment). Eight weekly ESWT treatments is a fair trial (see study). I would HIGHLY recommend taking a 2 week trial off alcohol and caffeine, yes your beloved coffee, and alcohol, to see how these two liquids effect your nighttime urination.

You can make a scheduled FREE 15 Minute phone appointment with me to discuss your prostate or urinary situation before committing to 4-8 treatments. CALL 916-489-4400 to schedule your FREE 15 minute appointment with me Kirk Hamilton PA-C.  

______________________

Appointments for ED Program…

If you have interest in improving erections and sexual intimacy, make a free 15 minute phone appointment with me to discuss. Tell the office it’s Kirk’s Free 15 minute EPAT appointment. If you are a patient tell them so they can pull your chart. If you already know that is what you want to work on, then just make a normal 90 minutes appointment with me and we can get the program going which is usually 12-18 treatments over 2-3 months though most people start to feel some improvement in 4-8 treatments. All ED patients have a complete physical exam and blood work screening for heart disease, diabetes, blood sugar metabolism, inflammation and hormone status before they start, and on an annual basis at least.  

Appointment for Memory and Cognition Check…

If you have a concern about your memory (or a loved one) and cognition see me for a 20-30 minutes just to do a screening cognitive test and educate you on preventive things you can do right now and how you or your loved one might be assessed before going forward on a comprehensive memory improvement program. I will go through risk factors for cognitive decline, potential treatment approaches (see handout) and do a standardized cognitive screening test that takes 15 minutes to give you an idea if you or loved one has mild, moderate or severe cognitive decline.  Cost $150.  

The three books to read on cognitive decline are The End of Alzheimer’s Disease Program by neurologist Dale Bredesen and The Alzheimer’s Solution and the The 30 Day Alzheimer’s Solution by neurologists Dean and Ayesha Sherzai . My handout outlines their books. I have done physician trainings under Dr. Bredesen and am very familiar with his work as you will see from the handout. I would also recommend Dr. Bredesen’s NeuroQ assessment and supplement. I have heard the Sherzais speak many times. I think their work is great for prevention and reversal of early cognitive issues.

CALL 916-489-4400 and make this 20-30 minute “Memory Check” appointment ($150). Unlike heart disease or diabetes where you can wait and reverse those disease years later with diet and lifestyle, and ,be “held” together with medication or procedures for years, there is no traditional medical therapies that buy you time with your memory. With cognitive decline you need to act sooner than later. Like NOW because the individual with cognitive decline will not be able to do the complexed program on their own later if their memory and cognition are poor, even though their body is functioning well. Call now and get your “Memory Check” visit (916) 489-4400.  

CALL ME WITH QUESTIONS OR MAKE AN APPOINTMENT...916-489-4400

Be Thankfull!

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

A Case of Autoimmune Hepatitis (Cured?) with IV ALA, Oral Supplements and Diet?

I recently saw a patient with an apparent happy ending. At least for now. She is now a 41 year old mother of six who in January of 2018 saw a functional medicine physician for fatigue and migrating arthritis. By March, 2018 she was jaundiced and sent to a GI physician who found that her liver enzymes and iron levels were high and then she was sent to a hematologist where she had 3 or 4 phlebotomies and her liver enzymes came down from 1600 and 1900 AST/ALT to 51 and 42. Then she was seen at UCSF in May of 2018 and was just observed, but then her liver enzymes started to go back up in June 2018 and peaked in July with the AST/ALT was 732 and 894 respectively (normal upper normal ranges are in the 30s). She had a biopsy done in July, 2018 which showed no cirrhosis but she was put on 60 mg of prednisone at that time. The UCSF physicians felt she had autoimmune hepatitis and they attempted to taper her prednisone as the elevated liver enzymes came down and then planned to switch to a different steroid, budesonide, and go on a trial of the immunosuppressive drugs Azathioprine (Azoran) and Mycophenolate Mofetil (CellCept). She declined and sought out and got treated by Burt Berkson, MD, PhD ,an expert in New Mexico on using intravenous alpha lipoic acids for the treatment of liver disorders including liver failure (Wow! I interviewed Dr. Berkson on this topic in 1995! 25 years ago! And his work is so relevant today! Read: Hepatic Necrosis and Thioctic Acid ).

At Dr. Berkson’s office she started at 20-40 mg of intravenous alpha lipoic acid (ALA) tapering up from 20-40-80-160-300 mg IV. The IVs were 30-40 minutes long and administered twice daily. She was placed on oral selenium, ALA, N-acetylcysteine (NAC), sylamarin and a multivitamin/mineral. She received ALA infusions twice daily for 5 days. She may have had some IV vitamin C as well.

Alpha-lipoic acid (also known as thioctic acid), is found to be active in various biochemical systems in mammals. It is involved as a coenzyme in the tricarboxylic acid cycle as a coenzyme essential for and involved in, ATP production and cell efficiency. As an antioxidant, lipoic acid works alone and interacts with glutathione to protect the cell. Dr. Berkson in his early work used it as an antitoxin in liver failure do to mushroom poisoning (read interview ) . ALA is also suggested to have neuroregenerative properties. Dr. Berkson had observed liver regeneration properties properties with IV ALA.

She came to our clinic in October of 2018 just after spending 5 days at Dr. Berkson’s clinic to continue ALA treatments. We started at 300 mg IV and then increased up to 600 mg 1-2 times per week. We usually start at 300 mg of IV ALA and then go up to the 600 mg per treatment dose after 1-2 at 300 mg.

Over the last 2 ½ years she has had over 30 ALA IV treatments at 600 mg per treatment of which 10 had an additional 1500 mg of glutathione piggy-backed in a separate bag after the IV ALA. She has had normal ASTs and ALTs since 9/20/19. She is on no medication. Her UCSF doctors originally said she probably would have to be on immunosuppressive drugs on and off for the rest of life.

She is feeling great right now. She had felt at the beginning of this allergy season for about a week and a half fatigued and had some body itching. She was concerned maybe she might be having a flare up of her liver function but it appears to be just the opening of the allergy season that was causing the symptoms because now she is feeling better and her liver function and labs are all normal. She has gained 4-5 lbs and has liberalized her diet.

For much of the program since October 2018 she was on a low allergy, whole food plant-based
diet and now she has liberalized her diet to consuming small amounts of animal foods. She is still
cautious about consuming dairy and consumes only small amounts.

The Family, Covid 19 and Ivermectin
It is noted she had documented Covid 19 in the middle of December 2020 as did her husband and
children. The children had mild cases. Her experience wasn’t fun but the infection was not severe.
Her husband has just got well but he had a much harder time. He had fevers up to 103 for 15
days. He was not hospitalized but she said he began to feel almost immediately significantly better
after being given the anti-parasitic drug Ivermectin at an initial dose (by weight) and then the same dose 48 hours later.

Presently she is on:

MEDICATIONS: NONE

SUPPLEMENTS
Algal Oil 1/d
Alpha lipoic acid 600 mg/d
Milk thistle 400 mg/d
Quercetin 250 mg with bromelein
Raw Food Multivitamin Mineral 1/d
Vitamin C 1000 – 2000 mg
NAC 500 mg/d
Essential Pro 250 mg/d

You can take what you want from this story. “Spontaneous Remission?” …No, I don’t think so. It doesn’t happen all the time that you get the right combination of therapies, a compliant patient, and someone who has the will, belief, strength and money to do all the therapies completely. Kind of a "positive perfect storm!"

This patient did this as a mother of “six”. An she has a daughter who is getting married so she
could be a grandmother sometime soon (she is 41). I sincerely hope she is done with her “autoimmune” hepatitis. I think diet is most important at keeping it at bay, mostly plantbased with lots of cruciferous vegetables which are very good for liver function. Avoiding things that insult your liver - alcohol, drugs, eating processed sugary and fat foods, high animal protein diets, being overweight, toxin exposure, etc.. I think the IV and oral ALA and the work of Dr. Burt Berkson played a huge roll in turning this condition around.

So I said at this last office visit she didn’t need any more IV ALA treatments unless she wanted to.

I encouraged her to keep taking the supplements above. See me twice a year and do liver function
testing with any symptoms but if there were no symptoms maybe twice this year and go from there.

It is a joy to see this patient and have this outcome.

We use ALA for a variety of neuropathies, most liver (and gall bladder) conditions, and sometimes 1-3 IVs as a trial for chronic fatigue. It is a reasonably short, painless IV treatment that takes under an hour.

Call me to discuss or make an appointment with me on the use of ALA IV therapy or other nutritional IVs by calling 916-489-4400.

QUESTIONS OR TO MAKE AN APPOINTMENT... CALL 916-489-4400

Be Well and Thankfull!

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Diet "Quickies" To Reduce Inflammation, Pain and Weight Loss While Enhancing Shock Wave Therapy’s Benefits!

Since beginning to use extracoporeal shock wave therapy (ESWT) either by using a radial pressure wave device (rSWT) (OrthoPulse 100 Ultra) or a focused shock wave device (fSWT) (Duolith SD1 Intelect) to create pulsed sound waves that go to different depths of body tissues to stimulate a healing response, and subsequently reduce acute and chronic pain syndromes, I have become even more aware of the role of diet in contributing to any pain condition - chronic or acute.

As much as I think these shock wave devices are wonderful inventions that non-invasively trigger a healing response that 1) increase the formation of new blood vessels, 2) stimulate stem cells and new tissue growth 3) reduces inflammation and 4) breaks up fibrous tissue (Difference between radial and focused shock wave treatments) it’s using these devices in conjunction with an anti-inflammatory diets that enhances the “magic” of self-healing and treatment effectiveness.

When I first started practicing “Wholistic Medicine” in May of 1983 in Marina Del Rey, California the first practice I worked put everyone on a two week vegetable puree with psyllium seed fiber and some vitamins and minerals. It was in those first six months of practice that I saw the power of food in causing many different health conditions including pain syndromes that would clear or be dramatically improved in this two week period. Essentially the client would go off all their commonly eaten foods and drink a bunch of “green stuff” with psyllium seed fiber added. Then within this two week period magic would happen! And in many cases “itises” would vanish along with the associated pain.

Ever since, over the last 38 years, I have put people on a variety of elimination diets for many common complaints including pain. Since I have been using these shock wave devices for mostly pain conditions (and ED) I have gone back to my “roots” and put people on some form of food elimination diets or modified fasts while I do the shock wave therapy. Many times when you fast or go on an elimination diet brain function and mood improves as well.

Here is a list of my simple “Quickie” diets or modified fasting protocols:
1) Eat of BED Diet Food List - page 2 of handout and/or
2) Water fast 4-7 days and/or
3) Fasting Mimicking Diet (can get Prolon 5 day program online or at our office at discount) and/or
4) Eat for 7 days only whole fruits and non-starchy vegetables (avoid nightshade family -
See BED Food List - page 2) - steamed, water stir- fried, roasted, baked, raw and/or grilled (no oil frying)
5) Inflamx (anti-inflammatory pea and rice protein meal replacement - try All Spice first) 2 scoops 2-4 times per day mixed with water (and ice) initially for 4-7 days (available from our office). If you can do it solely for 4-7 days then add non-starchy vegetables and whole fruit plus the Inflamx.

With regards to extended water fasting past several days, especially if you have other health conditions and are on medication, I recommend TruNorth Health Center in Santa Rosa, California to be medically supervised during the fast. They have experience conducting tens of thousands of water fasts over the last 25 years in people with all kinds of health problems. They are the “masters” of therapeutic water fasting.

FREE 15 Minute Phone Appointment: If you would like to discuss the use of diet, nutraceuticals, hormones, IV nutrients, modified fasting and/or shock wave therapy in treating any pain syndrome you can get a hold of me between 8-9 a.m. PST at 916-489-4400 for our open phone line or you can schedule a FREE 15 minute screening consult to see if shock wave therapy is right for you for your pain issue or if interested in using ESWT for erectile dysfunction treatment. Just call and say you would like to make a “Free 15 minute phone appointment with Kirk to discuss EPAT therapy”. If you are a patient please advise so the staff can pull your chart and I can review it. If not a patient let the staff know as well.

Diet is frequently overlooked in pain management conditions. Get more “bang for your buck” and do some form of elimination diet as mentioned above. Not only will you get quicker and longer last results but you will save a lot of money as well.

Great Book: “Foods That Fight Pain”

REFERENCES:

Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients. 2020 Aug 19;12(9):2510. CONCLUSION: Inflammation and oxidative stress are the main pathophysiological pathways of chronic pain and most focused on diets and dietary constituents that modulate these two pathways in order to alleviate pain. A low-fat, plant-based diet has multiple benefits for health, improving glycemic control, blood pressure, blood lipid concentrations, and decreasing inflammation.

Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med. 2020 Mar 5;9(3):702. CONCLUSION: plant-based diets may have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.

Fasting therapy for treating and preventing disease - current state of evidence. Forsch Komplementmed. 2013;20(6):444-53. CONCLUSION: There is evidence that medically supervised modified fasting (200-500 kcal nutritional intake per day) for periods of 7-21 days is beneficial in the treatment of rheumatic diseases, chronic pain syndromes, hypertension, and metabolic syndrome. The beneficial effects of fasting followed by vegetarian diet in rheumatoid arthritis are confirmed by randomized controlled trials.

Prolonged fasting as a method of mood enhancement in chronic pain syndromes: a review of clinical evidence and mechanisms. Curr Pain Headache Rep. 2010 Apr;14(2):80-7. CONCLUSION: Fasting treatments may be beneficial in chronic pain patients. The mood-enhancing and pain-relieving effect of therapeutic fasting should be evaluated in randomized clinical trials.

CALL ME WITH QUESTIONS OR MAKE AN APPOINTMENT...916-489-4400

Be Thankfull!

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Exercise vs. "Natural" Movement and a Program to Treat Knee Arthritis

Even though I am a big fan of structured exercise, the truth is "structured" exercise may not be needed to benefit our health, longevity and function. The key may be more in just moving frequently throughout our day with our "activities of daily living." The problem is we rarely have to do anything that is important for our survival anymore except pick up a fork or a spoon to eat.  So our movement of daily chores or to "hunt and gather" are generally gone so we "plan" our exercise somewhere in our day instead of it being part of our day without thinking about it.

Read About This Topic...

Dr. Daniel Lieberman is a professor in the Department of Human Evolutionary Biology at Harvard wrote a very interesting article entitled "Just Move: Scientist Author Debunks Myths About Exercise And Sleep."

Some Key Points - Functional Exercise
Leisure time sitting appears to be the problem, not work related sitting. He coins a term "interrupted sitting" as being a beneficial practice...to get up about every 10 minutes to do something. Seems pretty easy. In hunter-gatherer "camps" people get up every few minutes to take care of the fire or a child or some simple tasks.

Another difference in these hunter gatherer populations is they don't sit with their back to a chair. It's sitting "backless" which helps strengthen our back muscles and posture. Makes too much sense! As we speak I am scooting my butt to the end of my desk chair. Until recently most human beings sat pretty much on the ground, or if they did sit they used stools or benches or something that was backless. Only rich people had chairs!

Weak Back Muscles Increase the Likelihood of Back Pain!

_____________________________________

Knee Pain and Arthritis and Exercise

In terms of "wear and tear" of the joints leading to arthritis people who run more are NOT more likely to get arthritis in their knees. In fact, they're actually get slightly less.

Shock Wave Therapy (EPAT or Extracorpeal Shock Wave Therapy ECSWT) for Knee Arthritis

That said the most common injuries for runners is knee injuries/pain and also problems such as shin spints, achilles tendon problems and plantar fasciitis. These latter three conditions are very responsive to Shock Wave Therapy (ECSWT) which I do in the clinic with our focused and radial devices. Call me if you have any of these conditions. Usually it takes 3-5 weekly treatments for the best results and 20-30 minutes per body part. (NOTE: I use a combination of this radial device, the vibrator (V-Actor) and the focused device which was not seen in these videos to treat these problems. Difference between radial and focused shock wave treatments).

Knee Pain and Anti-Inflammatory Diets

I also encourage people to go on anti-inflammatory diets because food can cause (knee) pain. 
Options:
1) Eat of BED Diet Food List - page 2 of handout and/or
2) Water fast 4-7 days and/or
3) Fasting Mimicking Diet (can get Prolon 5 day program online or at our office at discount) and/or
4) Eat for 7 days only whole fruits and non-starchy vegetables (avoid nightshade family -
See BED Food List - page 2) - steamed, water stir- fried, roasted, baked, raw and/or grilled (no oil frying)
5) Inflamx (anti-inflammatory pea and rice protein meal replacement - try All Spice first) 2 scoops 2-4 times per day mixed with water initially for 4-7 days (available from our office). If you can do it solely for 4-7 days then add non-starchy vegetables and whole fruit plus the Inflamx.

Evaluating Your Gut for Knee Pain
If you have lots of GI symptoms (gas, bloating, constipation, diarrhea, GERD) after food elimination you might get a comprehensive stool exam to see if there isn't something to treat in your gut like yeast, a parasite, an overgrowth of normal bacteria or lack of digestion. (G.I. Effects Stool Analysis ). We can order this and give you a kit in the office. Medicare pays for this test and your PP0 may pay part of it. Takes 1 day to do and 3 weeks to come back. Heeling the gut can reduce the inflammation that is aggravating your knee pain.

My Knee Journey...
I have had 7 knee surgeries in my life. First playing football at U.C. Davis back in the dark ages where they yanked out your entire medial meniscus (1977ish) and then 3 medial meniscus tears on my right knee "trimmed" arthroscopically 20 years or so ago on 3 different occasions (Aikido - a Japanese martial art where you are on your knees alot...and dancing and runner) and then ACL reconstruction on both knees a month apart in 2006-2007.

An Xray on my left knee, the original football injury which has also had an ACL repair, showed "bone on bone" a year or two ago. But I have NO knee pain. I do have fluid accumulation below my left knee cap for the last couple of years but again no pain or instability. My point is this...just because you have something on an Xray or MRI doesn't mean you have to get it surgically dealt with. NOW IF YOU HAVE PAIN then you have to do something. Hopefully you do some of the non-invasive lifestyle things below to reduce your pain before even thinking about surgery.

There may be a day when I have to have something done on my knee (s) but if there is no pain and I remain active doing things I love to do (run, walk, weight train, stretch and hopefully dance sometime again) then I will keep doing the things I am doing to 1) reduce inflammation in my body and joints - a low allergy, whole food, plant based diet 2) keep doing weight bearing exercise as long as it doesn't hurt....daily 3) Keep doing strength training on my quads and calves  4) Keep doing stretching and also doing plain old full squats with no weights daily as long as there is no pain 5) Treat myself weekly or biweekly with ECSWT and see if it makes any difference in the fluid build up below my knee cap, and even if it doesn't it may have some preventive effect since EPAT stimulates new blood vessel growth, tissue repair, anti-inflammation and breakdown of fibrous tissue.

SIMPLE EXERCISES FOR YOUR KNEES

Wall Sit - Sit with your back flat against the wall with your legs at 90 degrees like if you were sitting in a chair against the wall (but there is no chair underneath you) . Make sure your knees are directly over your feet/ankles not ahead of them. Sit against the wall for as long as your thighs can make it. Repeat 3 to 4 times. Your thighs should burn.

Calf Raises - Get on your tip toes and flex your calves and thighs. Hold 3-5 seconds and repeat times ten.

Straight Leg Raises - Flex your quads (thigh muscles) while laying down and elevate your flexed leg 10 times without letting your legs hit the floor.

Lock Knees with Knee Extensions
- For those of you who use leg machines in the gym when you do a leg extension while sitting lock your leg out for 5 seconds with a flexed quadracep muscle. Then let the leg go down. Bring it back up and lock your thigh with leg extended and then hold for 5 seconds then repeat.

Supplements
Algal Oil (omega-3 fatty acids from algae) 2-4/d
Curcumin/Turmeric (MERIVA is a good trademarked and tested product) 500-2000 mg/d
Magnesium chelate 200-500 mg/d
Vitamin B6 (in a B complex of 50-100 mg/d)
Vitamin C - 1000--4000 mg/d
Vitamin D - 2000-5000 IU/d
Other products that can be used include glucosamine and/or chondroitn sulfate, haluronic acid, collagen, Wobenzyme

A Whole Life Approach for Reducing Pain...

Consume a whole food, anti-inflammatory, low allergy, mostly plant-based diet; looking at gut
health to reduce inflammation (food intolerance, fiber for the microbiome, medication reduction,
pathogens in gut); reducing environmental toxins in some cases (metals, mold, etc. ); improving
blood flow to the whole body by reducing or reversing heart and vascular disease; and normalizing
blood sugar and insulin resistance which reduces inflammation, improves nerve health and blood flow; and do self-help exercises PLUS Shock Wave Therapy (EPAT) can be beneficial to speed the process of pain reduction.  But if nothing else at least go on the BED - Basic Elimination Diet for 2 weeks. Many of you will be surprised how much of your pain is reduced.

REFERENCES

Knee Pain Helped By Shock Wave Therapy

Dose-related effects of radial extracorporeal shock wave therapy for knee osteoarthritis:
A randomized controlled trial. J Rehab Med. 2021 Jan 13;53(1):jrm00144.  CONCLUSION: 1 of 4 treatment groups, which varied in terms of shock intensity (0.12 mJ/mm2, lower density, or 0.24 mJ/mm2, higher density) and shock number (2,000 impulses or 4,000 impulses), or to a placebo control. Each group received 4 sessions of radial extracorporeal shock wave therapy, one week apart. Scores decreased more at higher densities of shock intensity than at lower densities, while there was no significant difference between the 2,000 and 4,000 shock conditions.  Moderate-intensity radial extracorporeal shock wave therapy was effective, and a higher density might be more efficacious in alleviating pain in knee osteoarthritis.

Comparison of the effects between low- versus medium-energy radial extracorporeal shock
wave therapy on knee osteoarthritis: A randomised controlled trial. J Taibah Univ Med Sci. 2020 May 15;15(3):190-196. CONCLUSION: The radial extracorporeal shock wave device was placed firmly on the most tender points at the level of the medial tibial plateau in a continuous movement. Group A received low-energy radial shock wave therapy (2000 shock/session [10 Hz]; EFD, 0.02 mJ/mm2), Group B received medium-energy radial shock wave therapy (2000 shock/session [10 Hz]; EFD, 0.178 mJ/mm2), and Group C received sham shock wave therapy (2000 shock/session [10 Hz]; EFD, 0 mJ/mm2) once per week for 4 weeks. Low- and medium-energy radial extracorporeal shock wave therapies are effective modalities in the treatment of KOA, with medium-energy radial extracorporeal shock wave therapy considered superior to low-energy radial extracorporeal shock wave therapy.

A Randomized Controlled Trial on the Effects of Low-Dose Extracorporeal Shockwave Therapy in Patients With Knee Osteoarthritis. Arch Phys Med Rehabil. 2019 Sep;100(9):1695-1702. CONCLUSION: ESWT of 2000 pulses at 8-Hz frequency at 2.5 bars of pneumatic pressure with the first 1000 pulses evenly distributed to pain points (the maximum number of pain points is 4) with the the remaining 1000 pulses being delivered sliding back and forth on the patellofemoral and tibiofemoral borders. (radial SWT device).

Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis. J Rehabil Med. 2017 Jan 19;49(1):54-62. CONCLUSION: Three sessions of rESWTeach one week apart at 2,000 rESWT impulses per session with a positive energy flux density 0.10-0.16 mJ/mm2) or placebo treatment showed statistically significant improvement only in mean WOMAC scores for pain and a few of the pressure measurements suggesting to be successful in treating disabling pain due to primary knee osteoarthritis substantially higher energy flux densities are necessary for treatment success in this condition.

Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. Surg Res. 2013 Dec;185(2):661-6. CONCLUSION: 4000 pulses of shockwave at 0.25 mJ/mm 2 weekly for 4 weeks was effective in reducing pain and improving knee function better than placebo. (focused SWT device).

WHAT TO DO RIGHT NOW?…
Change your diet. Get some exercise. Strengthen your thighs and calves. Take a few nutrients.
Consider shock wave therapy for your knees (EPAT).

CALL ME WITH QUESTIONS OR MAKE AN APPOINTMENT...916-489-4400

Be Thankfull!

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Wrist Pain, Carpal Tunnel Syndrome, EPAT Therapy and Lifestyle Medicine

Recently I have had four patients come in with wrist pain, two of which were possibly the beginnings of carpal tunnel syndrome, and they all have been responded well within 1-2 shock wave therapy sessions (EPAT), using a combination of both focused and radial devices which I use in the office (Storz Medical, Focused and Radial Devices ). The usual treatment course for musculoskeletal problems is 3-5 weekly treatments.

Shock waves are sound waves created by a mechanical pellet moving up and down via compressed air in a tube (radial or pressure wave device) or by an electromagnetic coil (focused device). The radial device’s maximum strength is delivered at the surface of the skin where the tip hits and spreads the energy in a radial fashion with minimal depth while the focused device’s maximum strength is a focal point below the skin surface which can go to several centimeters. Using a combination of both allows for more versatility in problems treated, though the radial device (“Lil Jack Hammer” from the way it sounds) has been used by itself successfully in most musculoskeletal conditions.

These two devices are “low intensity” shock wave devices (compared to high intensity shock waves used in the disintegration of kidney stones called lithotripsy for almost 40 years) that create a biological response from the body that releases healing factors that 1) build new blood vessels (neovascularization or angiogenesis) 2) increase nitric oxide, thereby improving blood flow 3) build new tissue (stimulates stem cells) 4) break down fibrous tissue 5) reduces inflammation and 6) reduces pain by both an immediate numbing action in some cases and more rapid healing do to all the above. ( see Handout: Benefits & Function of Shock Wave Therapy).

In the cases mentioned the wrist pain was due to inflammation from generalized arthritis; a prior trauma to the wrist (fall); and an over-use issue caused by riding a motorcycle and holding the throttle for long periods of time and typing on a keyboard. The cases that might have been the beginnings of Carpal Tunnel Syndrome presented with numbness, tingling and some pain in the palm from overuse and/or the ergonomics of using a keyboard and holding the throttle for long periods of time. These both responded very positively to the first treatment with SWT. As mentioned 3-5 weekly treatments is the common course of therapy with each treatment building upon the last treatment. The key to getting well faster is what you do to help your body heal along with shock wave or EPAT treatments (discussed below).

What is Carpal Tunnel Syndrome and It’s Causes?
Diagnosis & Treatment

Carpal tunnel syndrome is caused by pressure on the median nerve which comes down the middle of your forearm and through the middle of the wrist. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms include numbness, tingling and weakness in the hand and/or arm.

Ergonomic adjustments help some patients at their work stations while splinting, stretching and exercises are sometimes recommended. Anti-inflammatory medications can be used for the short-term but you should avoid long-term use if possible because these medications may increase gut permeability and eventually at fuel to-the-fire” by increasing molecules to pass through the gut wall in a larger state and cause of the inflammation. Nutrients such as vitamin C and vitamin B6 may be of value. But whatever you do you the goal is to reduce the swelling within the forearm around the wrist and palm (wrist joint) especially. Surgery is a last resort but done fairly frequently by cutting the ligament that crosses the wrist (to view scroll down to Surgery - Illustration) to reduce the pressure on the median nerve and thereby improve feeling and function.

So if there is a way to avoid surgery that would be a good thing. Extracoporeal shock wave therapy or what we call EPAT for short (can be radial shock wave therapy (rSWT) or focused shock wave therapy (fSWT) is a great tool along with diet, exercise/physical therapy, adjusting your environment, a few supplements and hopefully minimal medication. The great thing about EPAT therapy it is actually healing and correcting the problem, not just the symptoms.

Extracorporeal shock wave therapy (see videos and references below) is non-invasive and relatively pain-free (there is some very tolerable discomfort) that works rather quickly to stimulate the body to heal itself (See explanations on handout) .

Shock Wave Therapy Video Demonstrations
Carpal Tunnel (3:37 min)
Carpal Tunnel & Tennis Elbow (3:43 min)
Why Focused Shock Wave Therapy ( 1:54 min)
Radial Vs Focus Shockwave - What is the Difference? (8:42 min)

Wrist Pain Primary Causes
Arthritis (joint inflammation)
Diet Inflammation - processed foods, high in meats (poultry, pork, etc.), eggs and dairy, processed fats, processed oil and sugar-rich fiber-less, grain products, alcohol and caffeine products (needs to be checked)
Gut Microflora Imbalance - not enough fiber, too much sugar, high fat, medications i.e. acid blockers, antacids - increases intestinal permeability and subsequent inflammation; antibiotics can be problems
Over-Use - especially keyboard work
Tendinitis - from overuse or injury
Trauma - injury or overuse

Approaches to Wrist Pain and Carpal Tunnel Syndrome

Diet - Anti-Inflammatory Diet - 1) Eat of BED Diet Food List - page 2 of handout and/or 2) Water fast 4-7 days and/or 3) Fasting Mimicking Diet (can get Prolon 5 day program online or at our office at discount) and/or 4) Eat only for 7 days whole fruits and non-starchy vegetables (avoid night shade family - See BED Food List - page 2) - steamed, water stir- fried, roasted, baked, raw and/or grilled (no oil frying) 5) Inflamx (anti-inflammatory pea and rice protein meal replacement) 2 scoops 2-4 times per day mixed with water initially for 4-7 days (available from our office). If you can do it solely for 4-7 days add non-starchy vegetables and whole fruit plus the Inflamx.

Exercise - structured physical therapy with a professional or general common sense stretching, weight lifting, circuit training and doing your normal physical activities. Obviously don’t do an exercise that aggravates your wrist. Work up to and around the pain.

Wrist Stretches - Aikido (videos demonstrations 1. 2. 3. ) - For a decade or so I took Aikido a Japanese martial art that does a lot of wrist locks so we had to do 4-5 wrist stretches and exercises before each training session. I always thought these would be great stretches for office workers or those who have to do repetitive hand work that might make their wrists susceptible to repetitive movement injury. You do a minute or so with each wrist exercise and in five minutes you loosen up your wrists increasing blood flow, strength and flexibility. GENTLE when you start! Always go up to pain and around it, but don’t push through the pain! Especially at the beginning. Maybe after a week or two when you get a feel for the exercises and your progress. You could cause more pain if you do these valuable exercises too vigorously to an injured or inflamed wrist.

Supplements
Algal Oil (omega-3 fatty acids from algae) 2-4/d
Curcumin/Turmeric (MERIVA is a good trademarked and tested product) 500-2000 mg/d
Magnesium chelate 200-500 mg/d
Vitamin B6 (in a B complex of 50-100 mg/d)
Vitamin C - 1000--4000 mg/d
Vitamin D - 2000-5000 IU/d
Other products that can be used include Glucosamine and/or chondtroitn sulfate, haluronic acid, collagen, Wobenzyme

What Makes My Approach Different for Pain?
Emphasizing a whole food, anti-inflamamtory, low allergy, mostly plant-based diet; looking at gut health to reduce inflammation (food intolerance, fiber for the microbiome, medication reduction, pathogens in gut); reducing environmental toxins in some cases; improving blood flow to the whole body by reducing or reversing heart and vascular disease; and normalizing blood sugar and insulin resistance which reduces inflammation, improves nerve health and blood flow; and an emphasis on self-help exercises PLUS Shock Wave Therapy (EPAT) mentioned above.

WHAT NEXT?…
Change your diet. Get some exercise. Stretch and strengthen the body part. Take a few nutrients and consider shock wave therapy (EPAT).

CALL ME OR MAKE AN APPOINTMENT!
1) If you think shock wave therapy may be for you with regards to your joints or any musculoskeletal pain problem (See list of treatable problems ) make an hour appointment for the first appointment so I can take a history, do an exam and then we’ll do the first treatment that meeting. Then treatment sessions after that are 30 minutes or less per body part ($150). Two-three body parts 45-60 minutes ($270).
2) Call Kirk Hamilton PAC at Health Associates Medical Group for a quick discussion between 8-9 a.m. in the morning. If unavailable leave your name and number and I will call you back for a short discussion of your problem.
3) Call for appointment 916-489-4400.

Have a grateful and healthful day!

Kirk Hamilton PA-C

NOTE: Three of the studies below show that shock wave therapy is sometimes a better long-term treatment for carpal tunnel syndrome than steroid injections.

______________________

Research on Carpal Tunnel Syndrome and Shock Wave Therapy
Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehabil. 2020 Nov 9;66(4):388-397. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756840/ CONCLUSION: rESWT was applied with 1,000 shots, 0.05 mJ/mm2 intensity of energy at a frequency of 5 Hz weekly for 3 weeks. Pain and functionality significantly improved with ESWT. ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.

A randomized controlled trial: comparing extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome. Int Orthop. 2020 Jan;44(1):141-146. CONCLUSION: ESWT is a useful noninvasive short-term treatment for mild to moderate carpal tunnel syndrome and elicits a better recovery than local cortisone injections.

Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019 Aug;98(33):e16870. CONCLUSION: ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS.

Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2018 Jan 25;19(1):32. CONCLUSION: The rESWT group received shockwaves of continuous frequency and intensity (4 Bar, 15 Hz frequency, 5000 shocks, BTL-6000 SWT, radial shockwave mode). The duration of treatment was 3–7 min. A cold pack was applied for 15 min after rESWT. 1 ml. of triamcinolone (acetonide) 10 mg mixed with 1 ml of 1% lidocaine in a 3 ml disposable syringe was given with a 25 gauge needle applied 1 cm proximal to the wrist flexion crease between the palmaris longus and flexor carpi radialis tendons. The angle of the needle was about 45 degrees distally and was advanced 1 cm, where it penetrated the flexor retinaculum. Single-dose rESWT, showed significant improvement with clinical symptoms and functional recovery compared to LCsI from weeks 12 to week 24. The single rESWT provided greater symptom severity reduction and functional improvement compared to LCsI during weeks 12 and 24. Our single-dose rESWT protocol had a higher dose intensity than that study (3–7 min 4 Bar, frequency: 15 Hz, number of shocks: 5000 shocks VS 4 Bar, frequency: 5 Hz, number of shocks: 2000 shocks). This rESWT protocol provided a long-lasting effect, up to 24 weeks, without multiple-session attempts. Single-dose rESWT provides longer-lasting benefits than LCsI in the treatment of mild to moderate CTS.

The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep. 2016 Dec 2;6:38344. CONCLUSION: Compared to the control group, the three-session rESWT group demonstrated significant reductions in symptoms and the effect was much longer lasting in patients with moderate CTS than mild CTS. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. J Orthop Res. 2016 Jun;34(6):977-84. CONCLUSION: rESWT is a safe and effective method for relieving pain and disability in patients with CTS. rESWT was administered with 2,000 shots, at a pressure of four Bar, and a frequency of 5 Hz in 3 weekly session.

The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil. 2013 Apr;92(4):327-34. CONCLUSION: ESWT is as useful as cortisone injections for relieving symptoms of carpal tunnel syndrome and is noninvasive.

A Case of Hip and Wrist Pain, Urination (Prostate) and Stool Problems Treated Successfully with Shockwave Therapy

A 54 year old male who is a long-time patient, cancer and stroke survivor was seen in early December 2020 for “prostate issues.” He was interested in receiving low intensity extracorporeal shockwave therapy (ESWT or EPAT) for urgent and frequent night-time urination. He had a history of esophageal cancer that was cured, hypertension, being overweight, a stroke four to five months ago, stool urgency, frequent night-time urination with incomplete voiding, a painful right wrist exacerbated by holding the throttle on his motorcycle, as well as left shoulder pain and an actual decreased pain recognition on the whole left arm believed to be caused by his stroke.

NOTE: A shock wave is NOT an electric shock. It is a pulsed sound wave (acoustic, pressure wave) that creates a response in body tissues that releases natural body compounds that promote healing, circulation, new tissue formation, anti-inflammation, and breakdown of fibrous tissue.

Prostate Treatment Protocol

He was started on a treatment regimen of focused shockwave therapy (fSWT) at 2000 shocks at .25 mJ/mm2 over the perineum (the area between the scrotum and rectum or in women the area between the vagina and rectum) and he also received radial shockwave therapy (rSWT) of 1000-2000 shocks at 2.5 bar/15 Hz over each crura which is the area on each side between the scrotum and the rectum. These treatments were done on a weekly basis approximately 20-30 minutes each.

Stool and Urination Controlled After 3 To 4 Treatments

He has had four such treatments and what he noticed over the last four weeks is a remarkable reduction in his night-time urination from four to five urination down to one and he is also noted a remarkable reduction in urgency when having to have a bowel movement where there were times where he could not hold his stool to get to the toilet. He also notes now more complete evacuations of the stool as well as more complete voiding of his urine.

Wrist Pain and Mobility Dramatically Improved

He also came in with the complaint of severe pain in the right wrist joint especially when he would ride his motorcycle and holding the throttle for long periods of time. He has had four treatments with a combination of vibration therapy (V-Actor) followed by focused shockwave therapy (fSWT) of 2000 pulses at .25 mJ/mm2 on the front and back side of his wrist (1000 shocks on each side). This has been followed by radial shockwave therapy (rSWT) of 2000 pulses on either side of his wrist, up and down is forearm, and the palm of his hand. All of the hand sessions repeat the vibration (V-Actor) at the end.

He noted immediate improvement in his right wrist the first treatment and today after four treatments he feels it is almost pain-free while flexing and extending the wrist.

Night-Time Urination Dramatically Reduced with Stool Normalization

His night-time urination has been reduced from 4 and 5 times per night to one-time per night. His sense of stool urgency has been reduced dramatically. He feels like he has a complete evacuation of his stool and at the same time he has much more control over his stool urgency where at times he would almost have an accident. 

Mobility and Pain Reduction in Shoulder

His right shoulder had remarkable improvement in its range of motion and reduced pain just from the first treatment. After the second treatment he had even further improvement.

Diet, Inflammation and Pain Reduction

Normally I have all patients go on some type of “anti-inflammatory diet” to enhance pain reduction. Food causes pain. If I could get every one of my patients to do a 5 to 7 day water fast, they would experience how much of their symptoms, and in these cases pain and mobility, would improve by going on very simple diet that eliminated commonly eaten foods. In this patient's case he was supposed to be on a hypoallergenic pea and rice protein supplement with anti-inflammatory components (Inflamx we sell at the office) but he got caught-up in the holiday spirit and consumed excessive amounts of food to the point where he actually gained six pounds over a two to three weeks while his pain was going down and these symptoms were improving. So, his pain reduction couldn't have been attributed to him going on an anti-inflammatory diet which makes most of the benefit, if not all, coming from the treatments using vibration (V-Actor), focused shockwave therapy (Duolith SD1, Storz Medical), as well as radial shockwave therapy (OrthoPuls 100 Ultra, Storz Medical).

Variations of shockwave therapy have been around since the early 1980s when high energy shockwave therapy (the above treatment is using low energy shockwaves) was used for the breaking up of kidney stones among other hard stones which is called lithotripsy. Over the next 20 to 30 years low frequency shockwave therapy (LiESWT) has been used to treat all kinds of musculoskeletal disorders or virtually any “…ITIS” as well as recalcitrant angina (chest pain), bone and wound healing.

Focused and Radial Shock Waves Promote

1)      Neovascularization the building of new blood vessels
2)      Release of growth factors such as endothelial nitric oxide synthase. This produces nitric oxide which is a powerful vasodilator
3)      VEGF (vascular endothelial growth factor) helps build new blood vessels
4)      PCNA (proliferating cell nuclear antigen) which helps build new tissue (DNA repair)
5)      An anti-inflammatory effect
6)      A breakdown of fibrous tissue
7)      Stimulation of stem cells

How Shock Waves Work  

All the above lead to increased blood flow to the area and promote growth of new blood vessels and tissue repair. All this is activated by the pulsed shortwaves through either method generated: 1) By an electromagnetic coil (focus shockwave therapy) or 2) air compression moving a mechanical bullet up-and-down a chamber moving a particular tip up-and-down rapidly against the skin surface (radial shockwave therapy). Focused shockwave therapy results in its maximum energy being delivered deep within the tissue where radial shockwave therapy delivers its maximum energy right at the surface of the skin and disperses in a radial fashion. They can be used individually or in combination which is how I use them.

 What to Expect With Shockwave Therapy?

When treated with shockwave therapy it is on a weekly basis or at least five to seven days apart and three things can usually happen after that initial visit.

1)      The pain goes away and when it returns in a day or two it is less than when you started.

2)      The pain is a little aggravated for a day or two and then it is reduced to something less than
when you started.

3)      Nothing happens in which you wouldn’t go past 5 weekly treatments and we would look for
an underlying cause (i.e. fracture, etc.).

4)      Both techniques can create some discomfort during treatment, but it is mild and very
tolerable. I constantly tailor the strength of the treatment by watching and talking to the
patient as I am doing the treatment.

How Long and The Cost

This therapy builds on the therapy of the week before and so at least three to five treatments needed for most conditions and then it is tailored to the individual response. Even after you stop the treatment these growth and healing factors continue to be stimulated for weeks. Increased blood flow to any tissue increases healing. That is why this therapy can be used for so many conditions. There cost is usually $150 per treatment (single body part) lasting 20-30 minutes.

Conditions Which Respond to Radial and/or Focused-ESWT
3-5 Weekly Treatments $150/per body part (20-30 min)

Achilles Tendinitis - Avascular Necrosis (hip) - Benign Prostatic - Hypertrophy (BPH) - Bicep Tendinitis - Bursitis Hip - Calcium Deposits - Carpal Tunnel Syndrome - Erectile Dysfunction (6-18 weekly or twice per week treatment sessions***) - Greater Trochanteric Syndrome (hip pain)
Low Back Pain - Lymphedema (8-12 weekly) - Muscle Strains - Overactive Bladder - Neck Pain (stiff neck) - Neuroma’s (feet) - Neuropathies (feet) - Nocturia (nighttime urination) - Patellar Tendinitis - Plantar Fasciitis - Rotator Cuff Partial Tears - Shin Splints - Shoulder Pain - Tennis Elbow (outside) - Trapezius Pain - Urinary frequency - Wound Healing

 Action Steps if Interested…

If you would like to receive this therapy make a one hour initial appointment (916-489-4400) with me where I can take a medical history, do a focused exam and then do your first treat (initial hour with treatment session is $245/$215) then each following treatment is $150 (20-30 minutes).

If you have questions you can call me between 8:00 and 9:00 in the morning, or you can make a short, free 10-15 minute phone call appointment to see if you are a good candidate for this therapy (916-489-4400).

 Keys To Reducing Pain

The keys to reducing pain and promoting healing are:

1. Going on an anti-inflammatory diet. I use the following options:
a) The basic elimination diet (BED)
b) The Fasting Mimicking Diet
c) Inflamx (2 scoops 1-3 x daily) plus non-starchy vegetables and whole fruit
d) In some cases a water fast

 2. Extracorporal Shockwave Therapy using individual or in combination radial and/or focused shockwave devices from three to five weekly treatments initially for most conditions. Conditions such as lymph-edema and erectile dysfunction may take 8-20 treatments. Neuropathies may have an initial series then ongoing monthly or bimonthly maintenance treatments.

3. Range of motion and strengthening exercises and some type of aerobics are critical to stimulate blood flow and healing.

4. Certain anti-inflammatory nutrients such as curcumin, vitamin C & D, omega-3 fatty acids, zinc, enzymes are commonly used.

5. Avoidance of cortisone or non-steroidal anti-inflammatory drugs/injections after EPAT/ESWT treatment if possible. Using a pain control medication such as Tylenol is preferred.

I would be happy to answer your questions and I'm excited about this new therapy with these two devices because it gives me an opportunity to help people initially with pain reduction and then lead them into living lifestyle patterns that improve their overall health and well-being because almost all chronic conditions (heart disease, diabetes, arthritis, obesity, etc.) start with increased inflammation and this combined program will help reduce body inflammation.

__________________________

Chronic Disease Reversal (And Lower Your Risk to a Bad Outcome with Covid)

If any of you have chronic diseases (diabetes, obesity, arthritis & autoimmune diseases, GI (bowel) diseases, heart disease, high blood pressure, high cholesterol, cancer, kidney disease, multiple sclerosis and depression) that you just can’t get a handle on the 12 Day McDougall Program may be something perfect for you. I whole-heartedly recommend this program that can be done from your home. https://mcdougall-program.mykajabi.com/  1-800-941-7111.

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 716-2295 (m) / (916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com

Eat More Weight Less with the CHIPS Program

I know many of you might be thinking about weight loss by restricting food intake at the beginning of this new year. If you eat the right foods you can eat without limit and normalize your weight. Check out this video about the successful CHIPS program.

Here are a few hundred simple recipes to help you out...
Whole-Food Plant-Based Recipes – T. Colin Campbell Center for Nutrition Studies (FREE)

• Forks Over Knives Recipes (FREE)

Try out Kaiser Permanente's Plant-Based Eating Guide

Keep it simple. Eat whole, real food. Mostly plants (palm full or less of animal food daily). Move your body every single day. Yesterday driving back from Arivaca, Arizona to Tucson to catch my plane even though I had gone on a slow long walk in the foot hills earlier in the day I pulled over at a rest stop and walked/ jogged for 20 minutes. You can really move anywhere.

Can check out my Arizona 2 day trip to see my high school football coach I hadn't seen
in 43 years... Yeh that is 4------3!. Blessed!

Should be top post on my facebook page.
https://www.facebook.com/kirkham.hamilton

Call 8-9 a.m. 916-489-4400 with questions.
Join my “Healthy Living Tips” Here

Be Well,

Kirk

Kirk Hamilton PA-C
Prescription 2000, Inc.
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 716-2295 (m) / (916) 489-4400 (w)
krhammer@surewest.net
www.KwikerMedical.com
www.HealthyLivingforBusypeople.com
www.StayingHealthyToday.com