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Trigger Point Injections (w/ Micro-Dissection)

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Dr. Hanson now has several locations in the Vancouver, BC area where he routinely provides trigger point injections.


Physical pain can often be caused by a mechanical source, which is why pills don’t always work.  Trigger points are painful sites inside our muscles or connective tissues. They behave like a burr caught in the moving parts of our body. Trigger points are defined as having the following characteristics:

  • Pain related to a specific point inside a muscle (like a knot in a wooden plank) or in the tight fascial layer covering the muscle. These are not caused by an obvious local injury or infection.
  • Palpable nature: these can feel firm, like a small walnut embedded in muscle, or they can be palpated as a thin sheet of tenderness in the overlying fascial layer. 
  • Reproduction of symptoms: Direct pressure over the correct trigger point will reproduce the symptoms, often not in the same place.
  • Invisible on images such as x-ray, ultrasound or MRI.  As such, they are often missed. 


Commonly, pains present in one or more parts of the body, while the root cause comes from a distinct trigger point. For example, pains in the arm could be coming from a trigger point in the neck. Or a tender trigger point in the sacro–iliac joint (low back) can cause a person to “walk funny”.  This can shift the burden of weight- bearing, thus setting up myriad muscle pains in the back or limbs. We usually do not need to treat each of these extra sore spots, just the one or two that are the root cause.

For decades, doctors have used cortisone shots into trigger points, with some good effects. However, the cortisone itself carried considerable risk of side effects in the local tissues, such that it could be only used three times a year in the same site. Happily, it turns out that the shape of the needle was more important than its contents.  Researchers found the same results injecting plain saline, or using a dry needle, as long as it passed through the trigger point.


The trigger point needle is hollow and has a beveled edge, which makes it possible to mechanically break down these painful spots.  We only treat one or two spots at a time, to maximize benefits.   The needle tip is used to gently explore around the area of pain through a single point of entry, using a drop of local freezing if needed.  Through touch, the needle will detect areas of inflammation, scar tissue, or calcification. Once discovered, these targets are then microdissected with the tip of the needle.  This allows restoration of normal blood supply and function.


The procedure takes only a few minutes and, with a few drops of local anesthetic, is basically painless.  Results are usually quick, although a few patients may experience a temporary soreness for several hours before improving.  It is helpful to drink lots of water following the treatment, and to be moving rather than resting or sitting for the next while. One can go straight to the gym or yoga class or back to regular activities.

Examples of acute and chronic cases we treat: back pains, from upper to lower, rotator cuff and frozen shoulders, tennis elbows, and tendon pains in wrist and hand.  In the lower limbs we treat hip pains and stiffness, sciatica, sacro-iliac strain, knee, calf and iliotibial (lateral thigh) pains, ankle and foot issues including plantar fasciitis.



This depends on the root cause. If the injury is recent and unique, a few visits may be all we need.  If the root cause is a recurring one, such as bad posture or poor ergonomics, then the complaint is likely going to come back.

Side Effects:

The technique is done with the usual sterile protocols. Because there is no cortisone, there are no drug interactions, nor any problems interfering with current medications. If you are on blood thinners – please consult your doctor first. We do use a few drops of local anesthetic, Xylocaine 1% (Lidocaine). This is only injected if the patient feels discomfort. In case of allergy to local anesthetics, treatment can be done with nothing in the needle.

Other treatments: Trigger Point Injections work well in conjunction with other disciplines such as physio, acupuncture, IMS, therapeutic massage, yoga and chiropractic treatments.  Indeed, by restoring blood supply to trigger points, simple medications like Advil will work better, and stretching and exercises will be easier to do. 

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Feeling tired? You might want to check your iron levels

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Feeling tired?  You might want to check your iron levels. 

Iron is one of the key ingredients  of your next batch of red blood cells.  These cells last only about three months; the old ones are broken down in the liver, and new ones are generated in  the  bone marrow.  If our iron levels fall, then we can end up anemic, and, commonly, fatigued.

While most iron deficiencies have been seen in women of menstruating age, it can occur in men as well.

Here are some considerations if you have low iron in your blood test:

1. INTAKE:  Iron is found in foods that are green (like fresh vegetables, including Popeye's famous spinach), and also in foods that have red blood (meat, fish, chicken).  If you are vegan ,  eat green veggies,  beans and whole grains.   One easy trick for anyone low in dietary iron  is to use an uncoated iron frying pan, as it will add a lot of real iron to your foods.   If you are a junk food fan, remember they don’t call it “junk” for nothing: there is usually little iron (or anything else) in it.

2. ABSORPTION:  Certain kinds of stomache or intestinal conditions make it difficult to absorb iron, even if enough is presented in one's diet.  This can be seen in cases of malabsorption, including patients with surgically shortened intestines.

3. OUTFLOW: Two major sources of blood loss to consider;

    a)  Vaginal loss: heavy periods, or constant slow leaks throughout the menstrual cycle can lose more blood than the body can produce. If this is the case, it is not something to put up with, it should be investigated by your doctor.

     b) Rectal loss:

          -Visible loss of blood is an obvious cause of low serum iron for men or women. Remember that blood can be black if it comes from higher up in the stomache or upper intestines, or it could be bright red, if it comes from a hemorrhoid .  These are very important to investigate.

          -Invisible loss of blood:  A slow daily leaking of trace amounts of blood in the stool can indicate important problems inside the colon. One way to screen for this is with the home kits for Fecal Occult Blood, which comes with a stick, and a fold-over place to put the stool sample.  To read more about this test, click this link: FDA: home fob tests.  If any hidden blood is detected, then colonoscopy comes next.  This gives the doctor a clear view of any bleeding polyps, which are often fixable on the spot.  Through the colonoscope, it is also possible to biopsy and photograph any other pathology, such as inflammatory diseases like colitis or diverticulitis. 

Once the cause has been determined, then a solution becomes clear.  In cases where the problem lies in low intake, one needs more iron in the diet, or an iron supplement from your doctor.  In cases where there is an excessive loss, one must plug the leak, or at least have one's doctors solve this. In all cases, remember to recheck your blood after three months, to make sure your body is back on track.

In any case, this is just another reason to check the silent signals in your body, to make sure you stay as bulletproof as possible.  Its a stressful world out there, and we all need to be in our best shape!

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How to treat that pain in the ear

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Ear pains can be outside the eardrum, or inside.  The first is common with swimmers in summer, and the second with airplane travelers any time of year.  Let’s take a look at some strategies to avoid trouble.


For swimmers, when water enters the ear canals, bacteria can come along, from ocean, lake, or pool.  Once entrenched as an infection along the wall of the ear canal, it can become very painful.  A simple tugging of the outer ear can produce great pain.  A visit to your doctor can quickly identify and treat the problem,  usually with antibiotic drops.  However, a good way to prevent these is to use a freezer  zip-lock bag, with a handful of cotton balls.  Add a few ounces of rubbing alcohol to the bag, zip it shut, and roll it up with your beach towel.  As soon as you come out of the water, open the bag, and squeeze the contents of one of the cotton balls into your ear, while tipping the head to the side.  Hold it for a few moments,  then use a fresh cotton ball to do the same in the other ear.  Re-zip the bag and you are ready for the next time.  The alcohol doesn’t need to contact the bacteria for long, as we can see when we use the same swab technique to sterilize the skin before an injection.  Great trick for the kids, and handy for  adults as well.


Fluid inside the drum is produced all day, every day.  The problem is when the drain is clogged.  The drain, or Eustachian tube runs from the middle ear chamber behind the eardrum to the nasal passage on that side.  

The mucous membrane that lines the drain also lines the nasal passages, including the sinuses.  So any common cold or allergy that makes the nose stuffy can restrict the drain, causing the middle ear to back up with watery fluid.  One way to respond to this is to take non-prescription (oral) medications  such as antihistamines with “cold and sinus “ properties.  Take one or two a day, as directed.  If you are in an airplane and have stuffy ears, carry a short acting tablet to take about 90 minutes before descent, not before landing.   Then use a nasal spray, such as plain saline, or one with a decongestant added.  Point the spray to the back of your head, not to the top, as the nasal passage runs over the roof of your mouth, (not up into your brain).  Tip your head to the same side as the nostril you are treating, and trickle the spray so that it will run over the opening of the Eustachian tube, helping to open the drain.  Try chewing gum, or yawning to see if you can further  make the drain open.  If not, try the Valsalva maneuver:   plug both nostrils, and blow out against a closed glottis, to make your cheeks bulge, and you may be able to force the drainage tubes open. 

The above can be done without prescription meds, but if you have any ear pains, please consult your doctor.  If you are flying, you may need prescriptions for antibiotics or for nasal steroid spray to enhance the above.

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Health hacks for help on a budget

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Drugs, both prescription and over the counter, can be very expensive, and may cause side effects.  Many of my patients are pleased to learn there are some economical options with products that they may already have in their home.

Here are a few examples, straight from your local grocery store:

Baking soda: For generalized itching, including the healing from sunburn, put a few big spoonfuls of baking soda in a lukewarm bath.


For smaller areas, use “soda-soaks” with a bowl of water and soda powder, and use it to wet a towel to cover the involved area. Sit in front of a fan or open window breeze, and the red itchy skin will feel much better in minutes. Use cotton ovals to apply over swollen eyelids.

For small spots, like insect bites, you can make a paste of mainly soda and a few drops of water, and apply as needed.

Salt: Just ordinary table salt will do. In solution with room temperature water, it has great curative powers for inflammation. You may remember a school science demonstration where a potato is placed in a pot of extremely salty water. The water inside the potato is relatively salt-free, so it rushes across the membrane (skin) to help dilute the overly salty water in the pot. Give it a little time, and the potato starts to shrivel like a prune.

The same thing happens across the membrane of the cells in a sore throat, or across the cells of the skin during a bite, burn, abrasion, or infection. For sore throats, do not use this mouthwash more than a couple of times a day, or you can change the pH of your mouth, and possibly engender a secondary infection, ending up with a blue or white tongue.  

For severe sore throats, try to gargle several times a day with enough salty water to provide three or four mouthfuls. Gargle for as long as you can, spit it out and repeat. You can rinse immediately after with regular water, and you can stop as soon as your throat is no longer sore.  

For inflamed skin, use salt water in a bowl, and soak a small towel or, for small areas, cotton balls or ovals. Then squeeze out excess moisture, and lay the towel or cotton against the skin.  

Coconut oil: One of nature’s great natural healers, coconut oil can replace many items in your first aid kit.  

It can serve as a moisturizer. Coconut oil starts out looking greasy, like Vaseline. But, unlike petroleum products, the underlying skin sucks up the coconut oil quickly. It’s a great choice for right after the shower. It’s good for your face, nails and even hair/scalp. A small container can also make a good portable lip balm.

Coconut oil is also a great mouthwash. A spoonful held in the mouth until it melts is an excellent trick to whiten teeth. This “pulling” technique simply involves swishing the oil around your teeth for as long as you can, then spitting it out. Not only is this a great whitening trick, but the oil has anti-bacterial and anti-fungal properties, killing many of the germs that can cause gum disease and bad breath.  

Try it as a wound dressing. Instead of antibiotic ointments that have a Vaseline base, you can use a dab of coconut oil over an abrasion, scab or scratch, or even to cover sutures after the first dressing change.  

Other uses for coconut oil include: removing makeup at the end of the day, as a shaving cream and, for babies, it makes a great treatment for diaper rash, instead of using cortisone-based creams every time.

Naturally, the above are intended as options for self-help, not for self-diagnosis. Please see your doctor or walk-in clinic for a more specific assessment.

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Ear Wax Prevention and Treatment

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One of the most common conditions we see in the ear canal is wax.  Wax is supposed to be created in the outer quarter of our ear canals every day as a protective measure.  This forms a barrier against debris or dust that might damage the ear drum.  With normal movements of the jaw (eating, speaking, and yawning) this wax will  fall out harmlessly. 

There are a few people, however, who tend to keep their wax in one or both canals, and these are the ones that end up in my office for treatment.  There are three reasons for people to have retained ear-wax problems:

1. Bad luck.  Simply the shape of the ear canal, for example if it is quite narrow at the exit, could make a "bottleneck" effect, clogging pieces of wax. 

2. Ear pieces, for music or phone, have now become extremely popular.  Unfortunately, they also can be like a drain plug for the ear canal.  The situation only gets worse if wearers use the molded ones that really fit tightly into the canal.  For people who need hearing aids, the deeper fit is sometimes necessary to ensure good sound. In younger people, the object is to avoid needing a hearing aid, especially after loud music concerts, or exposure to loud noises such as gunfire etc. 








3. Q-tips - Instead of reaming out wax, these devilish weapons act more like a ram-rod in a rifle barrel.  

These pack the wax deep inside the canal, up against the ear drum.  This makes it almost impossible for the wax to be removed at home, and will require a visit to your doctor for syringing or curetting safely.  Some times even more damage is done, with the tip actually piercing the drum. 





So how do I prevent and remove wax in my ears?

1. Lubricate, with clear oil.  A few drops (or capful) of oil will lubricate and partially liquify dry wax in the ear canal.  Use olive oil, mineral oil, or any other clear oil.  (note to guys, NOT 10W30 ! ).  Tip your head to the side, insert the oil drops, then wait until you are bored (at least a few minutes).  Then catch the oil with a tissue, and jump into your shower (so oil won't end up dribbling onto your clothes). 


2. Do NOT use a candle.  This is about as idiotic a home remedy as one can imagine.  

 Great way to set fire to your hair.  The object is supposedly to create a vacuum in the ear, which actually never happens.  Then you get hot wax dribbling onto the side of your head, plus you look like a dolt.  If you have impacted wax, PLEASE don't try this at home!!  You will end up having your ear syringed with a FIRE HOSE!

3. Be very careful if you use a home bulb device. 

Really easy to hurt yourself if you force the issue.  Also, you are shooting blind, and could easily complicate the issue if the drum is already perforated, or if there is infection along the external canal.  Remember, even a doctor who treats himself at home has two problems: a fool for a doctor, and a fool for a patient!

4. Please see your doctor.  If you are a regular wax former, then get on a schedule to have the doctor or his assistant professionally syringe the wax out.  Then follow by regular oil every week, with revisits as required.   

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Caring for Sore Throats

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One of the most common reasons for patients to visit their doctor is the common sore throat.  For many years after the age of antibiotics began over a half-century ago, most doctors reached for Penicillin or Sulfa drugs, and most patients expected this prescription to be the “miracle” cure.  Which it might well be, if the underlying organism is a strep bacteria, and not a virus. 

However, times are changing, and so are bacteria.  

No longer will the common antibiotics guarantee complete recovery, even if the infection is purely bacterial.   In fact, the overuse of antibiotics has been not only in doctors offices, but in the food industry.  Mass-produced  livestock, such as  cattle, pork, chickens,  and even fish are kept in unnaturally close quarters, where they are basically bumping into each other, or the perimeters of their cages/fences. If they show superficial infections, they will not pass inspection.  So rather than have more space around each animal, it turns out to be a lot cheaper to dump antibiotics in with the feed.   This even shows up in eggs and milk in areas where this practice is not regulated. 

As a consequence, the bacteria are so used to antibiotics that they frankly are not impressed; and the infections are mutating with such speed that we cannot make new families of antibiotics fast enough. 

So with this as background, you will not be surprised when your doctor today is much less likely to dole out these medications.   Even if you have green or yellow discharge from your nose or in the back of your throat, and even if you have bright red tonsils the size of golf balls.

Instead of reaching for the prescription pad, doctors now will suggest a throat swab to test for strep, before prescribing any antibiotics.  This can be done as an instant test (which may be an extra charge, depending on your insurance), or as the kind that takes two days for the lab to report.  Over 80% of the time (in my practice) these are negative for any treatable bacteria, meaning the infection is caused by an untreatable virus.

So how do we deal with these painful viral episodes?  Here are a few tips that may help:

  1. Consider holding back on dairy products for a few days.  Milk products in many people will have an effect (not an actual allergy) to thicken mucus.   That’s why singers never drink warm milk between songs.  As soon as the mucus clears, you can happily resume your favourite milk, cheeses, or ice creams.  If milk does no such thing to you, don’t worry about this step.
  2. Grandmother’s Chicken Soup: turns out to be an excellent choice to help thin mucous discharge from the nose, throat, and airways.  Keep a few boxes of chicken stock handy, or use boullion cubes to fill your mug with a nice hot drink.  Remember to rehydrate your body with water.  Lemon and honey can prove soothing in a mug of hot water, as can herbal teas or ice water. 
  3. Saline gargles: Do NOT use commercial mouthwashes more than a few times a day, or you can change the pH, as well as the  ecosystem in the mouth, and end up with a fungal infection, with a  blue or white tongue.  If you have a really sore throat, including swollen tonsils, you need to gargle a lot, even hourly.  The best way is to use saline, stirring a few spoonful’s into a half-glass of warm water, until no more will dissolve.   Gargle as long as you can with the first mouthful, then spit it out, and repeat a couple more times.  You can immediately take a swig of something tastier, so you don’t need to endure the salt for long. 
  4. Treat symptoms with off-the-shelf medicines.  For fever, sinusitis, and pains, something like an ibuprofen or aspirin based cold/sinus pill will help. 

If the above is not working, go back and see your doctor.  Even if it turns out that your case is caused by a bacteria that will respond to an antibiotic, the above steps are still very useful.

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Emergency Instructions: Often Missing or Muddled!

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Ah, yes.  The instructions.  One of those Venus and Mars examples: women read them, men blunder ahead without them.  But even with written instructions, results are not always assured.  Just ask anyone trying to assemble a Swedish bookshelf with an Allen wrench, a bag of metal pieces and instructions in twenty languages other than your own.  To make matters worse, it seems there is always one missing Umvaart. 

But sometimes instructions are a matter of life and death.  A case in point is with emergency self-injections of adrenaline, and with puffers for acute asthma attacks.

A recent US study shows a dismal 16% rate of correct usage of prescribed adrenalin auto-injectors, like the EpiPen. If someone is highly allergic to something, such as a bee sting or foods such as peanuts or shellfish,  then swift and proper injection of adrenaline is lifesaving.  Common errors include not pushing down forcefully enough to have the needle tip penetrate through the skin, or not holding  the device in place for at least 10 seconds.  Not to mention forgetting to carry it with you on that canoe trip.

For acute asthma, where one expects to have a greater frequency of crises than food allergies, the error rate for puffers was even worse.  Only 7 % of asthma sufferers could use their puffers properly, according to the Annals of Allergy, Asthma and Immunology. 

The leader of the study, Dr. Rana Bonds from the University of Texas Medical Branch, notes that people were not trained properly in the first place, and/or “forgot the instructions over time”.   Similar studies show the problem is universal around the world.

Apart from the obvious personal distress, the financial consequences are immense.  Asthma medications constitute literally billions of dollars of expense, and if most of it is squandered, then our tax and insurance dollars are being wasted. 

So here is how to use the epipen:

For video demonstration of the epipen use:


And here is how to use your inhaler for asthma:

For video demonstration of your inhalers:



And for the use of an inhaler with the spacer, please review this video:

One last point about the inhaler, it would make far greater sense to extend the neck into a straight line, rather than expecting the inhalations to bend around a 90 degree corner to get from lips to lung.  Just as the sword-swallower at the circus knows, along with the bronchoscopy surgeon in the operating room, you need a straight line to get a straight shot.  That’s not in the instruction manual, just one of my own observations.

Be sure to discuss with your pharmacist as well, in case any different brand or model is being substituted, there may be a new set of instructions to review. 

As a precaution, remember to carry a spare.  Just like propane tanks for that big weekend bbq, inhalers are hard to check for remaining capacity.  Also remember to check stale dates, as there is no point  trusting your life to an out-of-date product. 

Please make sure you check regularly with your doctor, and follow any instructions for additional testing, monitoring, or changes of strategy. 


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The Smart Phone: A Key Part of Your First Aid Kit

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We already know that the cell phone has changed the world. 
At our fingertips, it can bring us countless new apps to monitor our blood pressure or calorie intake, and, in a crisis, it can help you find the nearest medical clinic, or get the fastest taxicab to a hospital. If you are lost in the wilderness, your cell phone can be traced by rescue teams, and it could save your life. 
But there are a couple of other ways you can use the basic features of your cell phone for medical purposes. These are free, and don't even involve apps.

The Back of the Phone
Label your name, a work number or email to get hold of you. If you leave your phone on the bus, and the batteries are dead, how else will a good Samaritan be able to get hold of you? However, as with the labels on your suitcases, do not list your home address, as it could invite crooks to rob you while you are gone. While you are at it, you might also put down any drug allergies or other important medical alerts; if you are unable to communicate your issues in an emergency, the medical staff will be able to see it on the back of your phone, even if the phone doesn't work. Just to be sure, also use a permanent marker to put medical alert info on the back of your driver's license or health insurance card, both of which are usually reached for by emergency staff.

The Camera
Today's cell phones have great resolution with their cameras, and almost infinite storage. You can archive photos in any way you wish. Use your cell-cam to record the following:

  • Your doctors' names and contact info, so followup info like test results or prescriptions used can be sent after the fact. In an extreme emergency, it could also help attending doctors get direct advice from your own team.
  • Any rash or other visible injury should be captured on your camera to help your doctor make a diagnosis. This is especially true if the signs have changed or gone by the time you see your doctor. This can also help document damage to your car or bike if you are in an accident; it might be important for both your medical and your insurance claims.
  • Any prescription drug you ever get! This one can save your life. If you have just returned from holiday, and are finishing the last of your pills for a local illness, take a picture of the prescription. If you break into a severe rash the day you get home, and have tossed the bottle before you climbed on the plane, please don't tell your doctor that it was a "little oval pill," or that it was "kind of pink or orange," or that it "began with the letter "C." I have worked in emergency departments, and can promise you none of us will be able to guess which drug you are talking about -- ever! Each country has its own drug colors, many use different brand names, and some have blends with different ingredients. But all of them list the generic chemical names, which are, thankfully, universal. With a simple click of your phone-cam, you can let us know what that drug was. It could be the one good drug that works better than the rest in your body, or it could be one bad drug that might kill you with the next dose. Don't leave us guessing, and don't assume that your doctor's computer can somehow capture the input from another doctor's computer. We are not like the banks with their ATM trackers; medicine is still in its computer infancy. So please back up any important medical info with a click of your camera. 

The same goes for an X-ray. Photos can be used to show us the exact fracture you got skiing. Or with an abnormal EKG, you can take photos so your doctor at home can see what happened.
For the same reasons, if you have any known disease, take a picture of any relevant tests before you leave for a trip. If you have any prior abnormalities, your baseline EKG or blood tests could prove very important to a new doctor that has to come to your aid in a distant city. And don't forget to take a picture of your list of medications before you leave home!

The Alarm

  • For remembering ergonomics: Set it to vibrate every 15 minutes during your work day, and you will have the perfect reminder to correct your posture and add in some movement. Straighten your spine, roll your shoulders and neck, and pull your shoulder-blades together (see our blogs on neck pain, and back pain, the postural challenge). Also, straighten and bend your knees and ankles. No longer do you need a kitchen alarm or a "cuckoo" clock on your desk or in a meeting, now you can silently remind yourself without disturbing others. 
  • For remembering pills: I have one patient who reminds herself to take her birth control pills every day at 10 minutes before noon, for 21 days in a row. Then, the alarm goes silent for a week, before starting the next cycle of 21 pills. No more mishaps! This feature is also good to ping people who are on more complicated medications, to remind them to take their eye drops, pills, or insulin shots.
  • To help with jet lag: Use your phone alarm to wake you at the proper local time, so you don't sleep until afternoon in your new time zone. Don't always assume your hotel will be perfect in its wake-up calls. If you do sleep in, you will mess up your body's clock for days, and have a miserable week of travel adaptation.

The Calendar 
To remind yourself to call for your next Pap smear, or general check up, use your phone's calendar to keep your appointments past and future. If you need to go back for repeat tests in six months, don't trust your memory, just enter it into the phone. If you can't be sure of the exact date that far in advance, just remind yourself to call in to fine-tune the details a week or two ahead.

Some of these tips may save your life. If you think of more ways your phone can be a life-saver, let us know at

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Toenail Fungus Treatment Tips

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Almost one in four people will get toe nail fungal infections in their lifetimes, and, for many, it seems to last a lifetime as well. The condition is fostered by warmth and dampness seen in closed shoes, and causes thickening of the nail, with pitting and yellowish discoloration. In sandal season, it looks ugly, but that is about the only problem with it. This is not a condition that invades the blood stream or causes any other health issues. However, we can’t make the same claim about some of the treatments advertised. 

The big drug companies naturally would like people to take their drugs for months or years, not just a couple of weeks every time they have an acute infection. So there is a big money motive behind all the ads we see for oral drugs to fix this problem. 

That’s the deal with toenail fungus treatments that we see advertised, showing little cartoon creatures (“fun-guy’s?”) climbing out from under your toe nails. With the usual tag of “ask your doctor”, patients are told that happiness lies in taking a prescription drug orally. Based on the rate of nail growth, this could easily take 9-18 months for a toenail to grow completely out as normal. (If you have ever dropped something on your toe, and had the whole nail turn black with a bruise, you can confirm how long it took that nail to grow out completely. Finger nails grow quicker, toenails are much slower). 

The problem I have with this is one of side effects. The oral medications are not without risks, mainly to your liver. So we need to run liver tests at intervals along with the treatment, to make sure you don’t have a serious side effect to a drug that is given for a completely non-threatening nuisance.

There are a list of topical products you can see at this site:

Toenail Fungus Reviews

However, before even using any of these products (also not cheap, as you will see in the above site), consider the basics:

Daily nail management: try to spend a few minutes on the affected toes every day. Twice daily is not a bad idea if you have the time:

  • Wash your feet in good soap to kill the fungi. As you know from pedicures, soaking the nails make them easier to trim.
  • Use nail clippers, and a nail file, preferably one made of metal or ceramic, so it can be cleaned. (The cheap cardboard nailfiles are hard to sanitize after use). Note that the fungus grows underneath the nail, so use the pointed end of your nail tools to scrape out the dead stuff. Sand off the top and tip of each affected nail, to prevent it from becoming too thick and unmanageable.
  • Apply rubbing alcohol (or pure white vinegar) with cotton balls after all the trimming, scraping and sanding is done. Just a few minutes will do the trick. This is the same alcohol we use as a swab to kill all bacteria and fungi when we insert a medical needle for lab tests. It will still kill the same fungi in the nail.
  • Consider getting a professional pedicure as an occasional treat. With the right approach, the pedicurist can dig into the edges of the nail a little better than you might be able to yourself, and this can dramatically go after some of the hiding places that fungi like.
  • If the above is not sufficient, then it makes sense to try one of the topical products mentioned in the article above. However, everything takes the same length of time as dictated by your speed of regrowth of that nail. 

By all means see your doctor, but don’t assume that medications belong at the front end of the treatment plan. Even with the oral drugs, you will still need to do the daily treatments anyway.

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Hip Pain? Hip Tips...

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One of the common complaints I see in my office is that of hip pains, which come in two varieties:  

ACUTE hip pains:   We see these cases a lot as injuries to the groin muscles on the inside aspect of the hip.  These are usually pretty obvious in their origin, for example when a hockey player collides with legs straddling the ice, or when a football player is tackled with one leg extended out to the side.  (Hip fractures are the subject for a separate blog).  These cases often respond quickly, as long as there is no serious tear in the muscle/tendon structure as it inserts from the inner thigh.  Other cases involve the outside of the hip joint, seen with cases of bursitis or capsulitis from extended exercises like rowing, biking, or running.  Treatments include rest, physical therapies like ultrasonic vibrations, electro-stimulation, and medical acupuncture are often all that is required. An anti-inflammatory medication can also help settle things down.  If this is not working, then further investigation with images can prove helpful, and more aggressive treatments like cortisone shots could be considered.  Gentle movements are encouraged, along with a graduated program of stretching and toning of the inner thigh muscles to rehab the area. Assuming the root cause was a one-time injury, recovery is usually excellent.  If continued trauma occurs, then the problems become more chronic.    

CHRONIC hip pains: These occur if the root cause is repetitive, such as the constant pounding felt by rodeo riders, snowmobilers, or moto-cross cylclists. This can lead to the destruction of the cartilage and the build-up of extra bony growth causing osteo-arthritis.   l More commonly, the root cause is just the repetitive effects of gravity as seen in the daily movements of an obese patient.  Especially with the morbidly obese ( 100 pounds or 45 kilograms over their ideal weight) this means the simple acts of standing up, walking, and stair climbing all cause daily damage to the hip joint.  Other conditions such as systemic forms of arthritis can certainly also affect the hip joint itself, leading to “bone-on-bone” instead of smooth surfaces where the hip joint is supposed to move.  Again, we look for any correctable root causes.  This would entail routine blood-work and images, to assess underlying diseases.  It would also involve corrective action for the obese patient, with proper diet and exercise regimens.  In severe cases, that are beyond any such help, replacement of the hip joint may be needed. 

In the meantime, here are some hip tips:

  • Watch your posture: Sitting is hip-hostile.  Try to stand up a few times per hour if you can.  We have already written about the benefits of sitting on a pilates ball for back pains, 
  • it also helps hip pains by introducing some movements into an otherwise frozen posture.  If you can, try to rig your work station for standing up all the time. 
  • Select non-impact exercises, like the bike or elliptical machines in the gym.  Also try yoga and pilates to help with toning and flexibility.
  • Watch your weight.  One of the rules of medicine is that pain is fattening.  If you are in pain, you can’t move much to burn off your daily calories.  This becomes a viscous circle, where any excess calories are simply added to one’s fat stores, adding to the pains of simple movements.  To compound this, junk foods such as white sugar, white flour, etc are all known to cause more inflammation, further adding to the damage to the hips and other joints.
  • See your doctor to seek out underlying diagnoses, from systemic diseases to simple things like one leg being significantly longer than the other.  Depending on the underlying causes, you may also benefit from massage, physical therapy, or chiropractic treatments. Follow their exercise tips to stretch and tone the surrounding hip structures.

For more info,

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