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Shoulder joint, another problematic region of the body that frequently come across in orthopaedic practice. Shoulder joint is a ball and socket joint and is formed by several bony structures with muscles and tendons within it, allowing wide range of motion. In view of its nature of high mobility, this can lead to increasing problems such as instability, soft tissue or bony injury and impingement resulting in pain.

Shoulder problem usually presented with pain can be acute or chronic. It may also be presented with difficulty to move due to stiffness. A history of injury may or may not be recalled by the patient. Some of this injury is due to a collective of trivial but repetitive injury that eventually give rise to the symptoms.

Some of the commonly seen shoulder problems:

1. Tendon inflammation namely bursitis or tendinitis. (Impingement)
2. Tendon tear (acute or chronic)
3. Instability such as acute dislocation or recurrent dislocation
4. Osteoarthritis (degenerative)
5. Fractures.

The management of shoulder pain is very much depended on the history of the presentation. In an acute injury such as a fall or direct blow, a fracture/dislocation or tendon tear should be the diagnosis. If the shoulder pain happens over a period of time or after some trivial injury such as carrying heavy object or moving the shoulder joint in an extreme position in order to reach an object, then tendinitis or bursitis may be likely the cause. Shoulder osteoarthritis is more commonly seen in elderly people and the pain is usually chronic and recurrent.

A simple x-ray is good enough to look for fracture dislocation and osteoarthritis. But if a tendon tear is suspected, then MRI of the shoulder will be necessary. Depending on the cause of the shoulder pain, in most cases, these problems can be treated conservatively with rest, ice compression, physiotherapy and medications. Shoulder dislocation should be treated immediately with close manual reduction. Surgery in the form of open or key hole (arthroscopy) may be needed in some cases of tendon tear. Shoulder joint injection (steroid, PRP or hyaluronic acid) may sometimes are helpful for tendinitis or bursitis.

 

Chemical Sensitivity

Text by Dr Mecherl Lim, MD (MA) Naturopath (ND), Holistic Kinesiology

There are numerous factors that may participate in the development of hypersensitivity, to even minute levels of toxic and generally non-toxic chemical substances. Normal responses to subtoxic doses of chemical substances may be affected under the following conditions.

Genetic and individual abnormalities in enzyme and protein synthesis. Approximately 50% of the population are slow acetylators, example : they detoxify some chemicals slowly and thus are at risk to chemical sensitivity.

  • Poor diet and deficient nutritional states
  • Obesity and or increased fat / muscle ratio.
  • Age extremities-elderly and new born
  • Disorders of kidney and liver function
  • Gender of the individual.
  • Unstable hormone status.
  • Environmental stress conditions-heat, cold, dehydration, deficiency of oxygen (asthma), noise.
  • Achlorhydria is common in many chemical sensitive individuals and hence Vitamin B12 absorption may be impaired.

Chemical sensitivity or the allergic tendency of an individual can be inherited. However, allergic tendency, with no previous family history of allergy, can also be acquired in a number of ways. Hypersensitivity may follow viral infections such as mononucleosis or viral pneumonia, or severe emotional reactions such as grief. The most common incitement appears to be low grade, long term chemical exposure, although a short term high level exposure, such as seen in industrial accidents, may produce similar effects.

There is apparently no consistent pathway by which the immune system mediates chemical hypersensitivity or loses its control mechanism and begins to sensitize inappropriately to chemicals. The pathways used by the immune system to develop this phenomenon not only vary from chemical to chemical but from exposure to exposure, and certainly differ from individual to individual.

There are also the secondary effects or pathways of allergic inflammation to be considered, for instance, gastrointestinal symptoms range from vague indigestion to full blown colitis (inflammation of the colon). These may result in nutritional deficiencies.

The deficiencies begin with increasing the sensitivity of the immune system to food. Generalised inflammation of the gastrointestinal tract secondary to food sensitivity often causes poor nutrient absorption that leads to vitamin and mineral deficiency. Eventually the individual may become deficient in digestive enzymes, which in itself will initiate food intolerance or sensitivity.

With increasing vitamin and mineral deficiency and enzyme deficiencies, the end result is an inability to detoxify chemicals giving rise to more food and chemical sensitivities. Thus a vicious cycle is set that will only be overcome by judicious supplementation of vitamins, minerals and digestive enzymes.

Common Chemical Exposures that Cause Chemical Sensitivity

  • TERPENES – These are natural, volatile chemicals released from plants. They normally give the characteristic odour or scent of the plant, e.g., odour of fresh pine needles, orange, eucalyptus, cloves, jasmine. The level of terpene exposure depends on the time of year, highest concentration occurs during the warmest part of the year.
  • HYDROCARBON FUELS – natural gas, petrol fumes, coal gas, kerosene. Gas stoves or ranges can be a source of gas leakage in homes. Parking station attendants and petrol station attendance are in the high-risk group for this type of sensitivity.
    SYNTHETIC Synthetic ripening of fruits – such as bananas may liberate potentially harmful residue of the ripening gas ethylene. Commercial coffee that is gas roasted is another example.
  • FORMALDEHYDE PRODUCTS – are notorious for their adverse reactions in sensitised individuals. Hidden sources of formaldehyde exposure are plastics, chipboard, home insulating material (foam type), nylon carpets, mouth washes, wood veneer, latex paints, detergents soaps, hair setting solutions and shampoos.
  • PERFUMES – heavily scented cosmetic, deodorants, sprays, tobacco, scented soaps, nail polish, strong cleaning solvents and synthetic clothing or garments have all been implicated in chemical sensitivity. Beauticians and hairdressers should be aware that some of their symptoms such as headaches, irritability and fatique may be due to scented products.
  • PESTICIDES – weedicides and agriculture chemicals must also be considered as potential problems in some individuals.
  • ARTIFICIAL – colourings and flavourings.
  • CHLORINATED WATER – is also a common culprit.Symptoms of chemical sensitivity vary quite widely and include headache, irritability, fatigue, hyper or overactivity, restlessness, anxiety, sluggish thinking, malaise, muscle pain, arthritis etc.

Nutrients That Decrease Chemical Sensitivity

  • Molybdenum are enzymes involved in the detoxification of various aldehydes, sulphites & nitrates.
  • Glycine, Taurine, BCAA, Methionine, are amino acids associated with the removal of toxic chemicals and metabolites from the body.
  • Thiamine (Vit B1) helps those excess intake exposure to formaldehyde, alcohols, glycols and it is also important in energy production. A relative deficiency will cause tiredness, weakness and anxiety.
  • Pyridoxine (B6), 60 percent chemically sensitive patients are deficient in B6, which is pyridoxal – 5 phosphate, which can be overwhelmed by exposure to aldehydes. Drugs such as contraceptive pills, amphetamine, chlorpromazine can all lead to a relative B6 deficiency.
  • Choline – ingestion of a diet deficient choline has major consequences that include hepatic, renal, memory impairment and growth disorders. All are seen in some chemically sensitive patients.
  • Folate B12 – chemically sensitive individuals are low in folate and 15% are deficient in Vit B12. Many medications such as aspirin, oral contraceptive and anti-convulsant interfere with absorption and metabolism.
  • Magnesium – Approximately 40% of chemically sensitive individuals are magnesium depleted. As magnesium involved over 500 enzyme systems.
  • Substances that deplete magnesium are pollutants, alcohols, diuretics, steroids, glucose, phosphate depletion and pesticides.

Nutritional Advice

  • Filter or boil all drinking water
  • Use toxic cleaning products sparingly
  • Reduce use of plastics, toxic paints and varnishes. When painting use odourless alkali based paints
  • Do not to wear synthetic under garments or clothes. Cottons & woollens are usually safe.
  • Do not use kerosene heaters, heating should be solar based or electrical.
  • An electric stove is preferable to a gas stove, and if not possible, ensure adequate ventilation within the cooking area.
  • Insulation material and floor coverings should be inert. Preferably hard, inert materials such as stone, terrazzo, hardwood, cement, brick and terracotta tiles should be used for flooring. Be careful of wool carpeting with latex or rubber backing.
  • Soft plastics, such as plastic bags, wrapping, plastic containers, and other plastics should be removed from the home. Use glass containers.
  • Remove any synthetic or rubber furnishing in the bedroom. Use cotton pillows, mattresses. Electric blanket should not be used. Cane hardwood, leather, wool or other fibre should be used in furnishings.
  • Other sources of chemical exposure are from chemicals released from glued parts and grouting, particularly when heated, chemicals used in hobbies such as photo copying machines, pesticides used indoors or in the garden, timber impregnated with chemicals, tobacco smoke.
  • Avoid all formulated foods or drugs that contain artificial flavourings, colouring or chemicals.

WHAT IS THE DIFFERENCE BETWEEN FOOD ALLERGY & INTOLERENCE

Dr Mecherl Lim

An Intuitive Medical Practitioner in Alternative Medicine (MD) (MA), Naturopath (ND), Holistic Kinesiology (HK), and Functional Medicine (FM)


Food Allergy occurs when the body has chemical reaction to eating a particular food & drink. The symptoms for mild to moderate food allergy or intolerance may sometimes be similar, but food intolerance does not involve the immune system and does not cause severe allergic reactions (Anaphylaxis)

A Food Allergy occurs when the immune system reacts to harmless food. Learn to read food labels so you can avoid foods that cause allergic reactions.

Food Allergy & Food Intolerance

Symptoms of food intolerance occasionally resemble those of food allergy so food intolerance is commonly confused with food allergy. Food intolerance does not involve the immune system and does not cause severe allergic reactions (know as anaphylaxis). Food intolerance also does not show on allergy testing. Food intolerance can be a difficult concept to understand and is poorly understood by doctors as well. Sometimes, substances within foods can increase the frequency and severity of migraine, headaches, rashes (such as hives) or stomach upset such as irritable bowel.

Professional diagnosis and confirmation of allergies is important. In Australia, about one in 10 infants, one in 20 children up to 5 years of age, and two in 100 adults have food allergies.

Food Allergies has been Increasing

Allergies in general are on the increase worldwide and food allergies have also become more common, particularly PEANUT ALLERGY in preschool children. About 60 per cent of allergies appear during the first year of life. Cow’s milk allergy is one of the most common in early childhood. Most children grow out of it before they start school.

Inherited Allergy

Children who have one family member with allergy disease (including asthma or eczema) have a 20-40 percent higher risk of developing allergy. If there are two or more family members with allergy disease, the risk increase to 50 to 80 percent.

Most of the time, children with food allergy do not have parents with food allergy. However, if a family has one child with food allergy, their brothers or sisters are at a slightly higher risk of having food allergy themselves, although that risk is still relatively low.

Allergy is an Immune Response

Allergies are an overreaction of the body’s immune system to a protein. These proteins may be from foods, pollens, house dust, animal hair or mould. They are call ALLERGENS. The word allergy means that the immune system has responded to a harmless substance as if it was toxic.

Food Intolerance is a Chemical Reaction

  • Food Intolerance is a chemical reaction that some people have after eating or drinking some foods: It is not an immune response. 
  • Food Intolerance also does not show on allergy testing.
  • Food Intolerance can be a difficult concept for doctors as well. Sometimes substances within foods can increase the frequent severity of migraine headaches, rashes (such as Hives) or stomach upset.
  • Food Intolerance has been associated with Asthma, Chronic Fatigue and Irritable Bowel Syndrome (IBS).
  • Professional diagnosis and confirmation of allergies is important in Australia, about one in 10 infants, or in 20 children up to 5 years of age and two in 100 adults have food allergies.

Therapy

The preferable approach to the nutritional management of immunological food reactions or food hypersensitivities consists of dietary avoidance and the treatment of symptoms resulting  from inadvertent exposure. Nutritional supplements are needed when major food groups are being avoided.  This will ensure the optimum nutritional intakes are maintained. Digestive enzymes example: Dr MH zyame should be taken by individuals who seems to be sensitive to many foods. Bicarbonate of soda , Dr MH Proflora A, taken one hour after meals can improve symptoms. By improving digestion the allergenic load may be destroyed or digested more thoroughly.


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