Weekly Health and Fitness Corner

polycystic kidney disease is a condition characterized by the development of multiple cysts within the renal tubules of the kidney and is the most common hereditary renal disease the normal functional unit of the kidney is the nephron made up of a glomerulus and Bowman's capsule proximal convoluted tubule Loop of henle distal convoluted tubule and the collecting duct blood filters through the glomerulus forming filtrate which then passes through the tubules undergoing see and reabsorption eventually forming urine and passing into the ureter and bladder overall there are around 1 million of these nephrons in each kid in polycystic kidney disease these tubules develop into cysts which become filled with fluid and can range in size from being microscopic to several centimeters in size the process can start even in utero meaning in the womb as the tubules become cysts they cannot carry the normal filtering function therefore the number of functioning nephrons begins to decrease this is worsened by the fact that as the cysts grow they compress nearby nephrons also making them dysfunctional initially this may not be seen to have any clinical impact as the remaining number of nephrons may increase there to maintain the glomerular filtration rate but as the disease progresses and more nephrons are affected the remaining ones cannot make up the difference overall renal function then deteriorates eventually reaching end-stage renal disease by definition the presence of structural injury makes polycystic kidney disease a form of chronic kidney disease with end-stage renal disease being defined as needing renal replacement therapy like dialysis or transplant or a GF far below 15 ml per minute there are two main types of polycystic kidney disease both caused by genetics the first is autosomal dominant with two main types one coming from mutations in P KD 1 on a chromosome 16 which codes for the protein polycystic in this is affected in around 85% of cases and is involved in cell to cell or cell Matrix interaction cell cycle regulation and calcium transport the second coming from mutations in PKD to on chromosome for coding for Polly system to which codes for

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"...chronic kidney disease or chronic renal failure is a progressive irreversible condition characterized by either a reduction in kidney function or kidney damage as a result of any cause that a present for more than 3 months it is divided into stages based on the glomerular filtration rate which is a measure of how well the kidneys are functioning it shows the flow rate of filtrate through the glomerulus of the Nephron into the Bowman's capsule and ultimately through the renal tubules the stages are labeled 1 to 5 with 2 groups in stage 3 the definition of a reduced GFR is below 60 milliliters per minute but in groups 1 and 2 the GFR may actually be above 60 but there is evidence of kidney damage end-stage renal disease is classed as a GF are below 15 or the need for renal replacement therapy like dialysis or renal transplant kidney damage can be defined as signs of damage seen on Imaging or on testing such as a high albumin to creatinine ratio which is a measurement of the amount of protein lost in the urine in fact in combination with GFR these patients are divided into three food groups based on the albumin creatinine ratio with higher values indicating more damage and an increased likelihood of progression initially chronic kidney disease may not cause many problems and it is often asymptomatic however as it progresses it brings with it several significant complications these can include an elevated cardiovascular risk with patients are 5 to 10 times more likely to die from cardiovascular disease than end-stage renal disease the risk of stroke has been found to increase as the GFR lowers around seven percent for every 10 ml per minute lost this may also be the result of CKD contributing to hypertension as well as being caused by it this can be due to activation of the renin-angiotensin-aldosterone system and can also be because as the disease progresses the kidney is less able to excrete leading to retention and subsequent fluid overload signs of fluid overload could be dismissed near due to pulmonary edema or a fusion and peripheral edema or ascites anemia is also common which contributes to disappear and can come from a reduction in erythropoietin from the..."

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"...nephritic syndrome is a collection of signs and symptoms that result from glomerulonephritis which is inflammation of the kidney specifically the glomerulus this could be remembered because it means inflammation rather than being a disease itself nephritic syndrome is the manifestation of an underlying disease that causes the inflammation and there are many of these causes it is easily confused with nephrotic syndrome which instead is a collection of signs and symptoms resulting from a high amount of protein being lost through the kidneys in the urine this leads to hypoalbuminemia meaning low levels of albumin in the blood these are the two defining features in nephrotic syndrome there is some overlap but nephritic syndrome is different in that the degree of proteinuria is lower and there is the dozens of hematuria meaning blood in the urine which could be microscopic or macroscopic red blood cell casts in the urine sterile / urea which is the presence of white blood cells without evidence of bacteria hypertension and oliguria which is a reduced urine output typically between 80 and 400 ml per day the functional unit of the kidney is the Nephron which includes the glomerulus and modified capillary surrounding this there are multiple layers which together form a filter these include a fenestrated endothelium the glomerular basement membrane and the foot processes of podocytes which are cells that wrap around the capillary in most cases of nephritic syndrome there is a trigger causing inflammation in this area overall featuring cellular proliferation complement activation recruitment of leukocytes and production of proteases and free radicals that ultimately lead to injury of the kidney this then leads to the characteristic features for example injury to the glomerular filtration membrane allows protein to leak into the urine though not as much as is seen in nephrotic syndrome red blood cells can also pass through causing hematuria and they can be dysmorphic with a camping sites in particular suggesting glomerular injury red blood cells can also Clump together within the tubules forming cylindrical structures called castes in fact this is considered suggestive of glomerulonephritis the injury and inflammation means white blood cells are recruited and can pass into the urine and as we said it's termed sterile pyuria because there..."

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"...tennis elbow and golfer's elbow a to similar conditions causing pain in the elbow and a medically know is lateral and medial epicondylitis respectively this means inflammation of the epicondyles which are bony protuberance has on the distal of the humerus the elbow is made up of the humerus articulated with the radius and ulna and allows for flexion and extension of the forearm however there are muscles that attach to the epicondyles that allow for wrist hand and finger movements like grasping and twisting and repetitive use of these muscles is thought to lead to micro attendance generating pain for this reason the conditions are known as enter Sapa these-- which means attachment point disease in act more recently it has been recommended that the conditions be referred to as tendinosis or epicondyle Alger rather than epicondylitis as histologically there is usually granulation tissue and a lack of traditional inflammatory cells suggesting that degeneration of the tendon maybe more an inflammation in the pathogenesis Motions like using handheld tools or even drawing are associated with the conditions and the names are slight misnomers is playing tennis can give you golfer's elbow and vice versa over all the movements causing the conditions do not necessarily need to be sports-related in some cases they can be triggered by a sudden contraction possibly from trauma elbow pain is the primary symptom in each lateral like this is 7 to 10 times more common and the pain is on the lateral or outer part of the elbow usually on the dominant hand it is generally worsened by extension of the wrist or fingers as the muscles responsible for these movements attached to the lateral epicondyle collectively known as the extensor tendons in particular the extensor carpi radialis brevis is commonly affected in lateral epicondylitis there is typically worsening of the pain with wrist extension against resistance when the is extended known as cozens test medial epicondylitis is less common but features pain on the medial or inner of the elbow it comes from tendinosis of the flexor and pronate attendance which originate from the medial epicondyle in particular the carpi radialis and the pronator teres and most commonly affected the pain is usually reproduced when the wrist is flexed and pronated against resistance well the is flexed called the reverse cozens test overall it is usually a gradual onset of pain that progressively get worse and can persist at night it also tends to be worsened by use of the forearm such as grasping and the pain may also be elicited by palpating several millimeters distal to the air condyles which corresponds with the location of the tendons people may also experience weaker grip strength the diagnosis is largely meaning no specific test or Imaging is required to make a diagnosis however Imaging like x-ray may be done to rule out arthritis of the elbow..."

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"...Osgood-Schlatters disease also known as tibial tubercle apophysitis is a condition characterized by the anterior knee due to inflammation of the apophysis and apophysis is a normal developmental protuberance from a bone that provides an insertion site for tendons in this case the patellar tendon on to the tibial tubercle it primarily affects children and adolescents because by adulthood the apophysis will fuse with the rest of the tibia it is weaker than 10 and so is prone to injury Osgood-Schlatters disease is a stress or traction injury that occurs due to repetitive Force being applied through the strong patellar tendon on to the tibial tubercle typically from movements involving leg extension such as running or jumping but also during growth spurts the force can lead to small avulsion fractures of the tibial tubercle apophysis generating and pain and in rare cases a complete avulsion of the tibial tubercle knee pain is the most common symptom which is on the anterior portion of the knee just below the patella in most cases it is unilateral but both sides are affected in around 30 percent of cases in general it has an Insidious gradual onset with no trauma and may initially be episodic but go on to become continuous the tibial tubercle itself can be tender to touch and may have some Associated enlargement which can be felt as a prominent lump males in particular are up to seven times more likely to be affected..."

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"...ankle fractures a common injuries involving a break in one or more of the bones that make up the ankle joint there are three bones that make up the ankle the tibia fibula and tailless specifically the medial and posterior malleolus by the and the lateral malleolus of the fibula there is an additional joint between the tibia and fibula called the tibiofibular syndesmosis this is a fibrous structure made up of the anterior and posterior inferior tibiofibular ligament and the interosseous membrane the ankle is a hinge primarily allowing supplanter and dorsiflexion and is at its least stable in plantarflexion it is described as a mortise and Tenon joint which are essentially a hole and the that fits that hole in this case the space formed by the tibia and fibula and the projection which is the Dome of the talus bone ligaments helped provide more stabilization there is the medial or deltoid ligament coming from the medial malleolus which branches into four ligaments and is mostly involved in preventing / e-version while the lateral ligament comes from the lateral malleolus and is made up of three ligaments with the main function of preventing over inversion of the foot in 70% of cases there is an isolated fracture of either the medial or lateral malleolus if both the fractured this is termed a bye the fracture seen in twenty percent of cases and if the posterior malleolus is also fractured this is called a try malleolus fracture but this is only the case in fewer than ten percent of patients in roughly 10% of cases the syndesmosis is also injured there are multiple classifications of ankle weather is used in the lateral malleolus fractures based on the location of the fracture relative to the syndesmosis generally with more proximal fractures indicating a higher risk of instability a is below the syndesmosis B is at its level and see is proximal to it the log handsome classification is more detailed considering also the position of the anchor during injury and the forces sustained during it other types of fractures include Amazon nerve injury where there is a proximal fibula fracture with syndesmosis and deltoid ligament injury this is an unstable injury that will need surgical intervention this is..."

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...arm in an anterior dislocation due to the posterolateral portion of the humeral head being compressed against the anterior part of the glenoid labrum they can be compression fractures on the humerus known as Hill Sachs lesions they are closely linked with bankart lesions which is a rupture in the glenoid labrum these can also be accompanied by avulsion fractures which are then termed bony bankart lesions the arm is typically held in external rotation with some abduction and all movements are painful there is a loss of the normal Contour of the deltoid and the acromion can be particularly prominent posterior dislocation's make up only two to four percent of all shoulder dislocations and occur due to the head of the humerus being forced posteriorly while...

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"...for those of you who have not tuned in to us we run essentially a chronic pain practice board Gates is board certified functional neurologist I'm a board-certified functional medicine practitioner we melded those two disciplines into a model of care to address a substantial portion of chronic conditions chronic Jesus and and although we cure few we're able to help most get under some some control quite considerable control and be able to manage their case and the properly selected and the properly cite the patient the reason we cure for you is because pretty much everybody walks in here ends up having an autoimmune problem and they also usually walk in here under a chronic stress with a chronic stress response usually we caught a sympathetic dominance or fight-flight system is engaged and it doesn't tend to let go these things can lead to anxiety Sia T panic attacks depression things of that nature and I lead off with that to say one of my one of my one of my points with people when they come in and I address this with them is my observation based on watching what happens with the brain rehab exercises that we do in certain other types of supplementation is that these are not necessarily personality disorders their poor frontal lobe this sort of and there's a lot of things that add to causing your frontal lobe to not work properly poor poor lack of blood supply to your Bruno lobe from anemias be your frontal lobe needs oxygen inflammation which are probably going to talk about a little bit blood sugar stress hormones and and so but lately we've been seeing last couple of years maybe we've been even seeing little kids come in we're stressed out of their minds and like two or three years old and say what's going on with that and then other people who've had just this kind of stress responses that seemed to be like even a little bit over a top for what we see and and dr. Gates is going to share with you some of the things that he's come across in that in the literature that we've been implementing and what are our Protocols are and kind of giving you the understanding that I know stress hormones now can cross the placenta from the stressed mother into the young person but there's even more to it than that our genetic components that need to be considered if they're there and that oftentimes respond well to the types of things that can be done wow without drugs frankly so yeah we treat a lot of patients with fibromyalgia in our clinic at least we have and that's actually started off with yeah that's kind of how we got into depression because a lot of patients were coming in with their fibromyalgia and they didn't want to take medications for the depression so they said well can you handle what could you do so that started us on this quest in this journey of..."

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"...so we're going to talk about Hashimoto and Plastics today Hashimoto's is a subject that we've been long associated with frankly probably for most people are associated with and we're taking quite a bit of use for even diagnosing people at and so and getting heat on it and the point from that is that Hashimoto is the understanding of what's going on with Hashimoto's is the number of things it's related to the things that can create a Hashimoto's isn't it is an immune attack on your thyroid primarily and so you're always looking for the things that are creating the immune attack and and and it can be a multitude of things and I was just mentioning to dr. Gates we're talking about Plastics that I remember reading about that at like 10 years ago but wondering is actually something that has something to do with it because back then it was I was everything was Metals was right it was it was is there anything you could think of the alternative groups were putting out as yet avoid all of this which is basically everything in life it seemed like but it turns out that Plastics do create a negative effect on the condition of Hashimoto's and so we're going to discuss that this probably fairly briefly it's not a long topic I would assume and so and if it's not brief then that's fine too so so Plastics as the famous gentleman in the Dustin Hoffman movie from many years ago The Graduate said to Dustin Hoffman when he had him in his graduate courses okay so I'm 65 days going to be people more my age The Graduate it was the famous line for the decade when people would say what are you going to do with your life and people Go Plastics because the gentleman at his college graduation party pulled him over and he was wondering what he was going to do for a because back in 1965 r68 Plastics were just coming into that was the whole point of plastics were done where Evolution just coming in and nobody knew anything about them they were going to save the world now we've got some mass of plastics I guess twice the size of Texas under the Pacific Ocean from what I read in the the other day and the National Geographic so could be a problem that was the whole point of that that aside that I was warned not to do yesterday but I did so good so the whole question is why is Hashimoto's so much more common and..."

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"...and today we're going to talk about a concept that has time so I think been controversial I think at times been considered theoretical when I first got into functional medicine years ago is actually a prominent Conrad of the immune system and because what we started to realize was in chronic pain we have a chronic pain practice for those of you who haven't watched us before and we treat just about anything that won't go away and we've combined two disciplines functional neurology and functional medicine to address fibromyalgia and periphery often chronic fatigue and chronic got problems chronic thyroid problems and dizziness vertigo balance things that won't go away people get things they go away B they don't go away you need to know why and the immune system was an obvious first place to start I think for those in the field at that time that there must be something with the immune that's causing the problem there's a concept called th1 th2 shifts th1 th2 balance I've drawn the little seesaw picture of it and I think a thousand times and try and explain to people and and and I think it's I don't I think dr. Gates is going to explain to me today whether it's getting more credibility or just something that you're using more because you see it's a valuable tool because it is affecting people frequently will talk about that Gates does all the treatment now and he's always researching and frequently will tell talk to me about how this was a that this was a shift during pregnancy this is the mystical why do I get pregnant and then I feel good and then all sudden I don't after I deliver the child it's this is the if you have allergies you have a shift more towards one side than the other so and certain autoimmune problems have a certain quality..."

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