Archive for the ‘Treatment’ Category

Tips on a Locked Knee due to Meniscus Tear

Posted on: January 25th, 2015 by Richard Malik No Comments

A locked knee due to meniscus tear can be terribly painful and difficult to deal with. Trust me, I know. I have some looseness of my left knee from a sports injury that happened almost 25 years ago that has left me with a torn meniscus. Through an active lifestyle and sometimes strenuous physical activity (including running a half-marathon and intense hiking in the Rocky Mountains) it is often not a problem, but last weekend my knee locked up – I could not straighten it past 45º.

It is sadly funny that in spite of my active lifestyle, I felt my meniscus slip and my knee locked not while doing not much of anything at all; I was trying to meditate in a full lotus position. I knew I was in trouble when I tried to straighten my leg and I could only get it to a right angle. I was on the floor on a yoga mat and I could not get my self up onto a couch or a chair even though they were only a foot or two away. I was on my own because I knew that I would be home alone for at least 45 minutes. Fortunately, the knee was not painful and I could bend it all the way – I was surprised that I could sit on my knees on the yoga mat.

While waiting for my wife to come home and help me, I grabbed my computer (it was within arms reach) and tried to find on the internet how to unlock a knee with a torn and displaced meniscus. I found plenty of advice on the necessity to have arthroscopic surgery for a locked knee, but I could not find any advice on what to do to improve my knee before making an appointment with an orthopedic surgeon or going to the emergency department.

So, without Google’s help, I discovered several things that were very helpful to first unlock my knee and then help it feel better quickly before going to the orthopedic doctor.

  1. Let the lower leg of the affected knee hang while sitting on a tall chair like a bar stool for as long as you comfortably can (30 to 60 minutes at a time worked well for me). Spacing or distraction of the affected joint creates space for the impinging meniscus fragment to return to its normal position.
  2. Apply cold to the knee joint to prevent inflammation that can occur with a displaced or torn meniscus. 10 to 20 minutes of cold application per hour is adequate. A cold wet compress will be more penetrating and effective than an ice pack.  The application of cold will help to reduce inflammation in the joint that can cause pain and restricted range of motion.
  3. Apply heat to the muscles of the lower leg (calf) and upper leg (thigh) to encourage the muscles to relax and allow spacing in the knee joint, reduce pain from muscle spasm, and increase range of motion. CAUTION: apply heat ONLY to the muscles of the calf and the thigh. DO NOT APPLY HEAT TO THE INJURED KNEE until 72 hours have passed.
  4. Starting 72 hours after the injury, use contrast hydrotherapy to decrease the pain and improve the range of motion. Contrast hydrotherapy is the application of heat, then cold to an injury. Any form of heat is fine as long as it is safe for you. I used a sauna set to 175ºF for 30 minutes, then submerged the entire affected leg for 3 to 4 minutes in a bathtub filled with cold water. CAUTION: if heat is applied too soon to the injured tissue, it will increase swelling, cause more pain, and slow your recovery. You MUST wait 72 hours after an injury before considering applying heat to the injured tissue.

I am very happy with the improvement I have seen from implementing these steps. I hope they support others as well.

Be Well,

Richard Malik, ND

Naturopathic Doctor in Salisbury, CT

Naturopathic Doctor in Manchester Center, VT



Staying Healthy This Winter

Posted on: November 20th, 2011 by doctor No Comments

Between colds, flus and the winter blahs, winter can be a tough season.  Here are some  natural steps to ensure a healthy winter season for you and your family.

  • Get your rest – sleep is a nutrient that is important for health and happiness.
  • Use a humidifier – dry winter air contributes to the increased rate of respiratory tract infections.
  • Eat plenty of vegetables, including fruits (yes, fruits are vegetables).  Vegetable soups,  roasted vegetables, and bean dishes are very warming in winter months.  Fruits always make a healthy snack or dessert.
  • Make sure you are getting enough vitamin D – up to 2,500 IU daily for children 1 year or older and up to 4,000 IU daily for anyone 9 years or older.  This almost always requires supplementation since we get no vitamin D from sunlight in winter months and a glass of milk has only 100 IU.
  • Omega-3 essential fatty acids are so important for healthy immune function and mood – they also help prevent cracked lips and dry hands.  If you like fish, great sources that are low in mercury and other environmental toxins include sardines, Alaskan salmon, herring, cod, and mackerel.  If you don’t like fish, taking fish oil capsules will do the trick – just make sure your brand is tested for rancidity, heavy metals, and environmental toxins.
  • Stay active – getting outside when the sun is out can have a remarkable affect on our health in the winter months.
  • I know, I know it is not fair to bring up during the holidays, but sugary sweets slow down the function of white blood cells that devour bacteria and can have negative affects on mood.  Refined carbohydrates like sugar (white, brown, sugar cane crystals, dehydrated cane juice, etc.) corn syrup, honey, and maple syrup are all culprits.  For homemade sweets, stevia extract is a wonderful, healthy, natural sugar substitute.  Apple pie, anyone?

If cold or flu symptoms start, liquid extracts of echinacea root and elderberry taken by mouth help symptoms while reducing the duration of illness.  Goldenseal (warning – a very bitter herb) works great in a neti pot for reducing nasal congestion or by mouth for sore throats.

Be Well,

Richard Malik, ND

Does Vitamin D Improve Depression?

Posted on: May 14th, 2011 by doctor No Comments

A recent study published in the British Journal of Psychiatry finds that vitamin D supplementation does not improve symptoms of in women older than 70.  The researches identified women who had vitamin D deficiency and gave them 500,000 IU of vitamin D one time each year for three to five years.  Hmmm.  This is an unusual vitamin D dosing regimen.

In my experience, providing 5,000 IU vitamin per day, every day, for adult patients is a safe way of maintaining optimal vitamin D status – using less than 4,000 IU does not usually work.  In my clinic, this approach has been a part of a successful program for improving depression in patients with vitamin D insufficiency or deficiency.  This means taking almost 1,800,000 IU of vitamin D per year – much more than what was provided in this study.

According to the Institute of Medicine, 4,000 IU of vitamin D is the upper intake limit for universal safety in people older than 9 years old.  At this level of intake, the annual dosage of vitamin D is 1,460,000 IU – again, much more than the 500,000 IU used in this study.

Honestly, I don’t know if randomized control trials will end up showing that vitamin D supplementation prevents or treats depression.  However, providing one third of the usual annual dose to maintain vitamin D sufficiency is not a very good way to assess the effectiveness of vitamin D for depression.  Providing that dosage all at once makes even less sense.

This is an example of how the results of research and the headlines may not provide an accurate assessment of the question that is trying to be answered.

Be Well,

Richard Malik, ND

Proton Pump Inhibitors and Fracture Risk

Posted on: May 14th, 2011 by doctor No Comments

A recent article in the New York Times reports on research that links long-term Proton Pump Inhibitors (PPIs) with a 30% increased risk of bone fractures.  According to the article, the long-term use of PPIs may decrease absorption of calcium in the intestines.

PPIs reduce the acidity in the stomach in order to reduce symptoms of heartburn.  While this is an effective approach for reducing the burning pain caused by the regurgitation of stomach acid into the esophagus, lowered acidity in the stomach decreases the absorption of some nutrients – including calcium – and increases the chances of getting several types of infection including infections of the digestive tract and lung.

Some forms of calcium do not require stomach acid in order to be absorbed.  These forms include calcium citrate and calcium citrate/malate.  When taking PPIs or other antacid medicines, it is a good idea to supplement calcium intake with these forms of calcium especially if you are at increased risk of osteoporosis or of fracture.

The only drawback of calcium citrate and calcium citrate/malate is that these forms of calcium are very bulky – capsules usually contain only 150mg of calcium.  This means that the usually recommended dosage is 5 to 10 capsules per day.

Ensuring healthy vitamin D status is also very important for calcium absorption.

For more information on addressing osteoporosis, read my previous blog post on osteoporosis.

Other nutrients whose absorption can be decreased by acid lowering medications include magnesium and vitamin B-12.

Be well,

Richard Malik, ND

Natural Therapies for Breast Cancer

Posted on: January 3rd, 2010 by doctor No Comments
When considering natural therapies for breast cancer, it is important to understand what medical or research-based evidence exists that shows which natural therapies are effective and for what circumstances.  While there are many claims made on packages and the internet about herbal formulas, special diets, or new-fangled technologies, the evidence for natural therapies that work to cure breast cancer on their own is paltry, at best.
However, natural medicine truly shines in supporting oncology patients so they have the best results through surgery, radiation, and chemotherapy.  The options to reduce adverse effects, improve outcomes, and help cancer patients feel well are diverse.  When used in this way, the goal of natural medicine is to support conventional treatment approaches without interfering its effectiveness and to address concerns as they arise; natural treatments are tailored for each individual set of circumstances.  Here are some examples of my favorite approaches.
Glutamine is an amino acid (protein building block) that high doses helps to improve recovery from surgery and helps prevent nausea, ulcerative lesions in the mouth and digestive tract, and neurological toxicity from some chemotherapy drugs.
Ginger is an excellent and safe way for chemotherapy patients to prevent nausea.  Using capsules, liquid herbal extracts or even lollipops made by a compounding pharmacist are options that support easy compliance for the patient.
Doxirubicin is a common chemotherapy drug that is used to treat breast cancer.  However, one of the most serious adverse effects of doxirubicin is toxicity to the heart.  Coenzyme Q10 and L-carnitine are nutritional supplements that have been shown in medical research to reduce doxirubicin related heart damage without interfering with the drugs ability to kill breast cancer cells.
Another common concern for oncology patients is maintaining their immune function and white blood cell status.  Some approaches that are promising in this area include maitake mushroom extracts, ginseng (a popular Asian herb), ashwaganda (an herb from India), and vitamin E supplementation.
It is clear that natural therapies have a supportive role in cancer treatment.  But, if not used wisely, natural medicine can have negative effects.  For example, studies show that the herb curcumin (turmeric) can decrease the cell-killing effects of some chemotherapy drugs like cyclophosphamide and doxirubicin (both are used in breast cancer treatment).  Other dietary supplements that may reduce chemotherapy effectiveness include coenzyme Q10, glutathione, and cysteine.  The most effective and safest way of using natural therapies is to consult with your oncologist and work with a qualified professional.

Be Well,

How Much Exercise for Weight Loss

Posted on: September 7th, 2009 by doctor No Comments

Weight loss is acheived increasing the calories burned in relation to calories consumed. But after your doctor suggest it, how much and how hard should you exercise? There is any easy way to determine appropriate exercise intensity regardless of your age or physical condition.

To determine your maximum heart rate, subtract your age from 220. I am 37, so my maximum heart rate is 183.

Exercise should NOT be done at your maximum heart rate, but at 70 to 85% of it. So, my optimum exercise level is at 128 to 155 beats per minute.

To encourage good health, this intensity of exercise should be performed for 20 or 30 minutes 3 to 5 days per week. For weight loss, exercise at your target heart rate for 30 to 60 minutes, 5 days a week.

Remember to get your physicians approval prior to starting an aggressive exercise program.

Be Well,

Stomach Acid is Important

Posted on: September 7th, 2009 by doctor No Comments

The acid that is secreted by the parietal cells in the human stomach play a couple of very important roles.  First off, it helps to break down proteins so that nutrients are more available in the intestines and easily absorbed.  Stomach acid is important for calcium absorption, among other nutrients.

Stomach acid is also an important part of the immune system of the digestive tract.  Acid kills many of the organisms that we are commonly exposed to and helps to prevent infection.

Over the counter and prescription medications used to treat heartburn or GERD focus on reducing stomach acid production.  As I mentioned in the previous post, stomach acid is not the cause of heartburn – it is caused by a loose lower esophageal sphincter.

Consistent with the physiological importance of stomach acid, recent medical research indicates that medications that lower stomach acidity are associated with an increased risk of infection (gastrointestinal and pneumonia!) and osteoporosis.  Another of the known adverse effects of these medications is hair loss – treated naturopathically with specific nutrients.

The natural treatment of GERD involves identification and avoidance of aggravating foods and herbal and nutritional recommendations that soothe and protect the esophagus while improving gastrointestinal function.  Discontinuance of acid lowering medication and WITHOUT GERD symptoms is a real possibility for many patients.

Be Well,


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Hollywood and the Hyperacidic Stomach

Posted on: September 6th, 2009 by doctor No Comments

Tonight I saw the movie Julie & Julia. Eric, Julie’s husband, explains that he has a hyperacidic stomach while taking some Tums. Zollinger-Ellison Syndrome is a rare but serious medical condition that is caused by a hormone secreting tumor that triggers secretion of damaging amounts of stomach acid . Eric instead probably had recurrent heartburn, or GERD.

GERD is NOT caused by too much stomach acid; it’s caused by a loose valve that seperates the bottom of the esophagus from the stomach. This valve is called the lower esophageal sphincter (LES). Certain foods commonly cause the LES to relax and are triggers for GERD symptoms: fatty foods, alcohol, caffeine, onions, garlic, mint, and tomatoes to name a few.

So, heartburn is not caused by too much stomach acid. It is caused when the contents of an appropriately acidic stomach move into the esophagus.

In an upcoming post, I’ll discuss surprising adverse effect from acid reducing medications.

Be well,

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Vitamin C and the Brain

Posted on: September 5th, 2009 by doctor No Comments

When the body needs a specific nutrient to do a specific job in a specific organ, that nutrient is found in higher concentrations in that organ. Vitamin C is found in high concentrations in many organs including the brain.

Vitamin C is important for many functions in the brain. As an antioxidant, it plays an important role in protecting brain cells from oxidative damage – the kind of damage implicated in Alzheimer’s disease. Vitamin C is also important for neurotransmitter synthesis – improving neurotransmitter levels is the therapeutic goal of many psychiatric medications. Vitamin C can be a basic part of many natural protocols for depression.

Vitamin C can can cause loose stools if taken in too large doses (this can be used to help with constipation). It is commonly used as a basic, supportive therapy for mood concerns like depression or anxiety.

Be Well,

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Natural Swine Flu Recommendations

Posted on: September 2nd, 2009 by doctor No Comments

Centers for Disease Control recommendations for preventing the spread of influenza include:

  1. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  2. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.
  3. Avoid touching your eyes, nose or mouth. Germs spread this way.
  4. Try to avoid close contact with sick people.
  5. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
While there is no scientific evidence showing any natural therapies are effective against swine flu, there is good evidence for some therapies against influenza. I thought I would share the recommendations I make to family and friends for the upcoming flu season.
There are no medical studies looking specifically at swine flu and natural therapies because it is a relatively recent medical concern.  However, the natural therapies with the best medical research supporting their use for influenza are Andrographis, Echinacea, Elderberry, and Siberian Ginseng.  For Swine Flu prevention, I recommend:
  1. get your rest
  2. avoid sugar and refined carbohydrates (honey, maple syrup, white flour) as they reduce immune function
  3. humidify your environment – good research indicates that flu season occurs because of less humid air in winter.  However, humidifiers need to be clean to prevent mold problems.
  4. make sure your vitamin D status is optimal (at least 45ng/ml on a 25-OH vitamin D test).  This usually requires 2,500 to 5,000 IU per day, but you should get checked for safety
  5. take your multi-vitamin
Many more people are exposed to swine flu than you might think because their immune systems handle the infection well.  If you start to feel ill, I recommend:
  1. Andrographis and Echinacea are excellent immune stimulating herbs.  I recommend Andrographis Complex by MediHerb
  2. Echinacea, Elderberry, and Pelargonium Herbal Extract (a custom herbal formula I prepare for children and adults)
  3. Other herbs for your specific symptoms (cough, nasal congestion, runny nose, etc.)
  4. Sugar-free zinc lozenges – Zand makes a good product
Be Well,
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