Estelle's Weekly Wonderings

To <<First Name>>,

I was sent a fabulous email this week from a lovely patient. An email telling me about the current investigation by NICE into MRT (MBST!). That's right ladies and gentlemen, they are looking into adding MRT to the services offered by the NHS. How exciting is that?! An entire National Health Service looking to avoid surgical interventions and treat patients without  medication. This is fantastic! What a change it signifies in the UK's approach to health care. And excellent choice in focusing on knees - they generally respond so well and so fast! 

Other Ways to treat Knees

Obviously MRT and surgery are not the only treatment options out there for knee pain. Another common one is injections. 
These come in a few different forms these days. 
Cortisone injections - basically a massive anti-inflammatory dose that acts as a short term painkiller. Great for getting you through a plane journey home or a stressful event but not a long term solution as they start to break down the joint tissue if used regularly and can also affect blood sugar and blood pressure long term (not a good idea for the diabetics!). This doctor gives a more detailed explanation of when/how to use them. 
Hyaluronic acid - which is, despite the name, actually a lubricant! And the same stuff often used in contact lense solution. The idea being to artificially lubricate the joint. The downside is that it can take several weeks to feel the effects and it needs to be done regularly. Also, each doctor will have his own combination, it can be combined with cortisone injections for immediate relief. So don't be afraid to ask what's going in! 
PRP or Stem cells - these are new additions to the menu. Often confused with each other. Unlike hyaluronic acid and cortisone injections, these aren't just painkillers but are intended to treat and heal the joint. 
PRP is your own blood that's extracted, shaken about a bit to seperate the platelets and then those are injected into the knee. The idea being that you get the "good" blood to help the knee heal. 
Stem cells are taken from your bone marrow, fat or blood and then injected into the knee. As stem cells can become any kind of cell, the idea is that they will become new, strong versions of the damaged cells (like cartilage) and replace the worn ones. 
Neither are cheap or quick - both take 3-6 months to show effects and might need repitition. And both are quite divisive in their opinions - doctors will love one and loathe the other (or loathe both!) 
And, as new science, the studies on both are still sketchy - The British Journal of Sports Medicine (BJSM) was very underwhelmed by stem cell research
Obviously the patients I see were the unsuccessful ones! But neither seem to be associated with long term negative side effects. 

My kind of exercise!

There are certain studies that are my favourites as they show just how crazy the human body is.
Like the one showing that a beer has the same painkilling effect as a paracetamol.
And the one that shows swearing will also help pain relief.
(Perhaps swearing while drinking a beer is the best of all?!).
And now we have the one showing that a really hot bath has the same health benefit as going for a run
Apparently sitting in a hot tub (a proper one) or a sauna has as many health benefits as going for a run. Now we know why those clever Scandinavians all look so healthy - it's the saunas! A top health tip that no one has been telling us about. 
Which obviously means that installing a hot tub and sauna are a legitimate business expense for a health clinic! Mmmm toasty all year round! 

Numbers that do lie

BMI - what an anger inducing guideline! Based on research done on white European men (so that puts the girls and anyone of a different ethnicity completely out!) and not recognising a huge amount of other variables (muscle mass being a key one there!).
I'm thrilled that the UK is reducing the obsession with this figure. So much of our health care is based on this useless figure. 
This is an even more important conversation when we talk about diabetes - particularly Type 2 diabetes. Decisions on when to treat and how to manage it are so often reduced to BMI. 
I found this quote from Professor Roy Taylor (the chap who figured out how to cure type 2 diabetes with diet) particularly interesting: 
One of Taylor’s most important new discoveries is that everyone has their own fat threshold: an individual level of tolerance for levels of fat in the body. “It’s a personal thing. It’s nothing to do with the sort of information that’s often provided about obesity, which is about average BMI and what the population is doing. The bottom line is, a person will develop type 2 diabetes when they’ve become too heavy for their own body. It doesn’t matter if their BMI is within the ‘normal’ range. They’ve crossed their personal threshold and become unhealthy.”
If you are concerned about your own personal threshold don't forget that most pharmacies will be able to do a quick blood sugar test onsite here in Spain. 

I would walk 500 miles 

People take on the most extraordinary tasks. Things beyond the imagination of us mere mortals. Like this lady who decided to walk around the world. As one does of course! Even continuing after being assualted in Mongolia and raising money for young women around the world as she went. I'm fascinated by her choice and her determination to continue regardless. Yet can't help but wonder about the state of her feet on her return, did she have good orthotics do you think?? 

Well, that's it from me this week, I'll see you next week, let me know your adventures! Be sure to send me any interesting things you find on your travels that you think I should include! 


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