Published April 7, 2010 in the North Island Weekender 

Sally, our 45 year old patient is undergoing her nutritionally oriented physical exam and we conclude  by examining her pelvis and extremities.

Pelvis: It is recommended that women get PAP smears every 2 years, if the PAP history is normal, until the age of 69.  The common symptom we see in women as they enter peri-menopause is the prolapsing of the pelvic organs either the bladder or the uterus or both. For this reason I encourage Pilates and Yoga to strengthen the pelvic core. After delivery it is recommended that women prop their pelvises up for the first month to give the pelvic ligaments a chance to resume their normal shape and integrity. Frequent urinary tract infections (UTI’s) in younger women are often aggravated after intercourse and during peri-menopause are due to the thinning of the walls of vagina and urethra. I will do routine urinary testing to check for this. Taking probiotics regularly and keeping the intestinal dysbiosis under control is the best preventive measure against UTI’s. If a female patient complains of intestinal gas that does not go away with routine naturopathic therapy then further evaluation of the uterus and ovaries is imperative, including a blood test called CA 125 for ovaries. Sally did admit to having more UTI’s since peri-menopause but that they were gone now after her treatment program.

Men should have their PSA (prostate specific antigen) and DRE (digital rectal exam) every year starting at the age of 50. Blood in the urine is common for women but not for men so this is also routinely monitored in my office and referred to a urologist if this persists. Infections of the prostate, acute or chronic, and the urinary tract respond very well to naturopathic remedies.

Extremities: Non steroidal anti-inflammatory drugs are in the top ten drugs that are taken by North Americans for the treatment of joint pain and arthritis. Due to the negative effects of COX-2 inhibitor drugs they were taken off the market leaving many patients without adequate tools to help with their pain control. In naturopathic medicine we try and look for a cause of the arthritic pain.

1. Diet: nightshade foods aggravate any arthritis so avoiding them is recommended. They include all white potatoes, eggplant, the pepper family including hot peppers, and tomatoes. Sweet potatoes and yams are fine.

2. Deficiency: a lot of people respond well to comprehensive mineral complexes containing good quality calcium, magnesium, manganese and zinc; essential fatty acids and vitamin D.

3. Natural anti-inflammatories include glucosamine, curcumin, bromelain and MSM combinations. There are many on the market and all have differing results so keep trying until you find one that works. Be careful if you are sensitive to shell fish, as most glucosamine on the market is made from the shells of shellfish. Extra Strength Recovery formula is vegetarian, loaded with anti-oxidants and is very effective for many types of arthritis. Sally was having some initial tenderness at the end of her finger joints so after taking a few Recovery capsules per day for 4 weeks and continuing with the cod liver oil, this symptom completely cleared. She had previously eliminated the nightshade foods and felt better for it.

Another type of pain in the extremities is carpal tunnel syndrome, an inflammation of the tendons in the wrist, causing pain when the wrist is flexed. This is often a sign of vitamin B6 deficiency and high doses may be effective to avoid surgery if taken for 6 months. Bursitis or inflammation of the bursa of shoulders and hip joints may be effectively treated with a series of B12 injections. See Part 3 of this series for a review. Inflammation of the elbow called “tennis elbow” is often due to repetitive motions such as typing or playing sports. Topical applications of ice and homeopathic arnica are excellent for this as well as evaluating the structure of the neck, shoulders and hips. “The hip bone is connected to the shoulder bone!”

Another common condition is tender soles of the feet diagnosed as plantar fasciitis, inflammation of the connective tissue. This is common in peri-menopausal and menopausal women and can be due to poor posture and alignment of the pelvis as well as poor arch support. I often see these same patients have lots of shoulder problems too. I recommend yoga for opening up the pelvis, hips and shoulders. For foot and pelvis support I also recommend Masai Barefoot Technology (MBT) shoes. Gout is a common inflammation of the greater toe and ball of the foot. This is a result of excess uric acid in the body due to the intake of high fat foods and alcohol. Bromelain and curcumin also work well for this condition.

Sally is now very healthy and armed with many tools to help turn her aging process into a graceful one. Ever since she started wearing the MBT shoes the small amount of back and knee pain that she was  experiencing disappeared! She comes in once per year for her healthy check ups and to keep up with my latest research.