Natural Health and Herbal Remedies Blog

Several research laboratories have tried using FES to enable paralyzed individuals to perform highly complex functional activities such as walking, bicycle riding, stair climbing, and self-feeding. However, they have encountered problems with electrode design, tissue tolerance, and detection and processing of the relevant sensory information.

The problems with electrode design are due, in part, to the difficulty in controlling each muscle individually. When a muscle is stimulated through the skin, all nearby muscles are stimulated indiscriminately. And deep muscles cannot be stimulated through the skin at all. To address this problem, several laboratories are working on tiny stimulating electrodes that can be implanted surgically, with electrode wires that extend under the skin to the target nerve or muscle. Unfortunately, the wires tend to weaken and may break over time, so new materials are being developed to do the job better.

The tissue tolerance problem relates to scarring at the site of stimulation. Although low-level FES is quite safe, it promotes gradual scar formation. The scarring can make the stimulation of underlying nerve and muscle tissue increasingly difficult, so higher levels of stimulation are needed to achieve the same muscular response. Eventually, the area may be so scarred that the desired response is no longer possible. The stimulating electrodes then have to be moved to a new location, which can require another surgical procedure.

The requirement for continuous detection and recording of information about the position of the body in space and the motions of the many joints and muscles creates yet another problem. Proper control of even a single joint requires constant monitoring of that joint’s position, with continuous feedback to the FES computer controlling the motion. The activity of multiple muscles must be properly coordinated to control motion at that joint.

Multi-joint systems have even greater complexity, and the amount of information to be processed and integrated increases dramatically with the increasing number of joints and muscles to be controlled. Developing a system that is powerful enough to produce real functional human movement, yet small enough to be practical for use outside the laboratory, will require miniaturization of all parts and materials.

Another major problem with FES is dealing with the tremendous complexity of human movement in a natural environment. Functional movement involves some interaction with the environment, such as transporting the body through space (as in walking, climbing, lifting, or carrying) or changing the body’s orientation in specific ways (as in moving the body from a lying to a sitting position, or turning the dials on a radio). In either case, control of motion requires measuring changes not only in body position but in the body’s interaction with the environment. For example, planning foot placement for walking requires a way of measuring the shape of the surface of the ground. Lifting heavy objects requires an assessment of the physical stresses applied to the bones and joints, so as to prevent stress fractures and other damage. And the lifting of fragile, lightweight objects (such as a glass of water) requires measurement of the force applied to the object in order to prevent accidental breakage.

A final problem with FES is that it does not work for everyone. Injuries of the lower lumbar spine usually involve the cauda equina, not the spinal cord itself (which extends only to the LI level or thereabouts in adults). The cauda equina is a bundle of nerve fibers carrying impulses to and from the spinal cord. When the motor nerves in the cauda equina are damaged, the muscles associated with these nerves do not respond to FES. (It is technically possible to stimulate these muscles electrically to produce contraction, but this requires an enormous and potentially harmful shock.) The same phenomenon may occur with injuries of the spinal cord itself, if there is also damage to the nerve roots at their junction with the spinal cord. Thus, for a given muscle, it is difficult to predict whether FES will be effective. The muscles can be tested individually to determine whether they are responsive to FES. If they are not, no therapy can make them respond to FES.

FES holds great promise for restoring movement to paralyzed muscles and limbs. The greatest success thus far has been with highly specialized systems for performing specific, narrowly defined tasks use of FES for improved hand function. With technological advances in designing electrodes, measuring positions and forces, rapidly processing huge amounts of information, and precisely controlling the electrical output to each individual muscle, FES will steadily become more useful. It is reasonable to assume that FES will improve the lives of many people with spinal cord injury within our lifetimes.

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A long list of medications negatively affect your bones, so if you use any of the problematic ones (below) over the long term, be sure to consult with your doctor about how to protect your bone density. Pay particular attention to diet, exercise, and calcium supplements, and make bone density evaluation a regular part of your medical follow-up. If you are a women near or past menopause, think long and hard about the risks and benefits of HRT.

Many of these medications cause rapid bone loss at the outset, and the rate slows over time, so it pays to think about prevention as early in your treatment as possible, preferably before you take your first dose. It is never too late to take action, even if you’ve been taking something for years, unaware of the potential harm to your skeleton. If you get to work now, you can stop any further loss and build back much of what is already gone.

Steroids—corticosteroids or adrenal corticosteroids, officially— are among the leading offenders because they interfere with calcium absorption, block calcium from being deposited into bone, and increase the amount of calcium you excrete. All this results in bone loss, primarily from decreased bone formation (as opposed to increased breakdown). This group includes prednisone, commonly used for asthma and arthritis, cortisone, and many other drugs commonly used to treat asthma, psoriasis, rheumatoid arthritis, lupus, Crohn’s disease, ulcerative colitis, and multiple sclerosis, among others, and sometimes given along with chemotherapy for cancer and to people receiving an organ transplant.

You should consider getting a bone density scan before starting long-term treatment with a steroid drug, with a follow-up six months or a year later. In patients on oral or systemic cortisone, and especially in children, dramatic bone changes develop within three months. If you take it for longer than three months, or if your bone density drops more than 5 percent, you should adjust your dosage if possible, follow a serious bone-density boosting nutrition and exercise program, and consider adding a drug treatment like alendronate, calcitonin or risedronate preventively.

Some studies suggest some inhaled corticosteroids may cause less harm than others. When they are more targeted to specific parts of the body, as with nasal cortisone for allergies, for example, you don’t get the same interference with your adrenal glands and your metabolism. However, more investigation is needed before we can simply switch to the inhaled form and rest easy. Again, let me stress that every improvement helps.

Taking thyroid hormone is another risk factor for low bone mass. Hypothyroidism (not making enough thyroid hormone) is a common—and probably underdiagnosed—condition. Despite the problems associated with the treatment (which you’ll see in a minute), it is a condition you want to address. The thyroid helps balance the calcium level in your blood and assists in bone formation, so you want to be assured of having enough of it. Once diagnosed with hypothyroidism, the standard treatment of taking supplements of the hormone (like Synthroid) is quite effective. But if you don’t strike just the right balance, it can quicken bone breakdown. If your body makes too much thyroid hormone on its own—hyperthyroidism—you’ve got the same problem.

The thyroid is normally involved in bone remodeling, so an overactive thyroid means overeager bone turnover. Be sure your doctor tests your blood regularly and adjusts your prescription until you find the lowest dose that works for you and keeps blood levels of the hormone in the normal range. From the perspective of your bones, most doctors wait too long to treat for low thyroid levels: thyroid stimulating hormone (TSH) levels up to 4 are considered normal, which is when most doctors would become concerned, but I recommend treatment if it is over 2.5-3. Another common mistake is to treat too aggressively, pushing TSH levels as low as possible. Though the low end of normal is considered to be just .4, the lowest levels are associated with bone loss, so I try to help my patients stay in the 1 to 2 range.

Do not suddenly stop taking thyroid hormone, but try cutting down gradually, with your doctor’s supervision, spending a few weeks at each new level before deciding whether to go lower still. If you deal with thyroid disease with natural remedies, even better! Norwegian kelp is sometimes recommended, as is the yoga shoulder stand (which is said to stimulate the thyroid), among other things. If your original diagnosis is far in the past, a thorough new evaluation is in order to make sure you in fact still need the hormonal supplement. Either way, if properly controlled, thyroid conditions won’t negatively impact the bones, but if not handled properly, are a common contributor to low bone density.

Antacids containing aluminum are another area of concern. Long-term, frequent use can cause bone loss because aluminum combines with phosphorus and calcium and prevents them from being absorbed. Aluminum, on the other hand, can also be absorbed into the bones, causing osteomalacia. Antacids are a very common source of aluminum, but no matter where the aluminum comes from (polluted air or water, for example, or soda cans, or the pots and pans your food is cooked in, or other medications), it is hazardous. Even low levels of aluminum can step up the loss of calcium. The combination of osteomalacia and bone pain has been observed in people using this kind of antacid over a long period of time, so the importance of avoiding them is clear.

The newest antacid medicines, like Zantac, Tagamet, Pepcid, and Axid, which you take to prevent too much acid (as opposed to neutralizing what is already there) can be even worse. They work by preventing stomach acid from being made, which interferes with digestion and absorption of all nutrients, including calcium.

Some antacids, like Alka-Seltzer and Turns, have little or no aluminum, so they are your best option if you must use an antacid. The best tactic is to improve your diet and digestion so you don’t need antacids at all, and to rely on natural alternatives when you do need relief. In any case, always read the label of any antacid (any medicine, actually) so you know exactly what you are getting.

Many chemotherapy drugs—toxic as they generally are—can damage your bones. In addition, many patients undergoing chemotherapy are inactive, which isn’t good for bones. Many patients also have less of an appetite than they normally do, and if they don’t eat enough, they won’t get the nutrients their bones need. There are some options to relieve nausea and boost your appetite, and you should seek out appealing, nutritious foods, and be sure to resume exercising when you feel up to it. Cancer treatment is always difficult emotionally, and often difficult physically, but don’t forget that preserving your general health is important, too, and bone density is an important aspect of that.

Diuretics used to treat high blood pressure, edema, and congestive heart failure are another danger because the increased urine output means an increase in the nutrients excreted, including calcium.

Anticonvulsants, including phenytoin and barbiturates, taken to prevent seizures or for any other reason, can damage bone over time. This includes medicines to treat epilepsy.

If you have to take a long-term course of antibiotics, including tetracycline, or if you take them often, you will excrete more calcium—calcium that then won’t be available for your bones. Antibiotics can interfere with absorption of nutrients in general. Make sure you really need antibiotics before you take them; resist pestering your doctor for a prescription on the off chance your colds are actually bacterial (almost all are viral, and antibiotics won’t do anything good for them). Sometimes you do really need them, and then of course you should take them—antibiotics are one of the most beneficial discoveries in the entire history of medicine. But if you use them a lot over time, you must take the necessary steps to protect your bones, including exercise, diet, and supplements.

Other drugs that interfere with bone remodeling include cholestyramine, cyclosporin A (for organ transplants), and gonadotropin-releasing hormone analogues and agonists. You should also be concerned about methotrexate (for arthritis, cancer, psoriasis, and immune disorders); anticoagulants, including heparin and warfarin (Coumadin); lithium (and other drugs that treat bipolar disorder); benzodiazepines; warfarin; and other drugs. There are no doubt many more that impact on bone density, only we don’t know it yet.

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