Back Pain & "Swimmer's Back"


Dislocating Knee Cap

Gall Bladder Flush

Kidney Stones
• Jump and Bump Method

Leg Cramps

Migraine Headache


Posture Adjuster


Injury & Therapy


Varicose Vains

Increase Cirulation (prevent gangrene)





Causes of enlarged red blood cells (aka macrocytic anemia):

Vitamin B12 and Folic Acid tests: Two of the most common causes of enlarged red blood cells - that result in Macrocytic anemia, are low blood levels of vitamin B12 and folic acid.

A Schilling test: This urine test is done to help determine whether the body is absorbing B12 and the actual cause of why it may not be.

Homocysteine: Homocysteine is an amino acid normally found in minute amounts in the blood. A high blood level of homocysteine is a sign of B12 deficiency anemia.

Complete Blood Count (CBC): This blood test can easily spot problems with low levels of B12 by examining red blood cell count for anemia. It checks the red blood cells for shape, size, and quantity.

Methylmalonic acid (MMA) blood test: Methylmalonic acid is a substance in blood that increases when vitamin B12 levels decrease.

Be sure to ask your doctor for a copy of the lab results. Most labs will offer a normal and abnormal range value next to the result for reference. Having the results will help ease your mind and also can be reviewed against future lab results.

Low stomach acid, known as hypochlorhydria, interferes with the absorption of B12.




Protect your back when you swim: Sometimes lower back pain can be caused from swimming when the muscles in the lower back become hyper extended, or over stretched, during the breaststroke or other forward stokes. In addition to hyper extension of the lower back, the cervical spine, or upper spine and neck, can also become injured while swimming.

  • Repetitive jerking motions of the head during frontward stokes could also seriously injure the area.

  • Unnatural or awkward movements while swimming can easily damage tissue through the back, so it's important to maintain the correct stokes and movements.

  • tuck your head in and don't have it extended outward from your body.

  • Do not rotate your head too much when taking breaths. Do not let your head move up too much or deviate from the axis along the length of the body. When you're not going up for breaths, keep your head looking downwards. Rolling too much can easily lead to damage.

  • For the breaststroke, keep your head and neck still, while gently raising the head and back to take breathes.

  • Swimming with sidestrokes or backstrokes can also minimize stress on the back when compared with frontward strokes. When doing the front crawl or other forward strokes, make sure to roll your body when taking a breath and avoid jerking the head backwards so that you can reduce strain on the neck.

Repetitive jerking motions of the head during frontward stokes could also seriously injure the area. The neck and cervical spine are particularly prone to injury while swimming. The anatomy of this area of the spine is very complex and is composed of seven vertebrae surrounding the spinal cord, which extends downward from the brain. Stretching outward from the spinal cord are nerves which travel to muscles and other tissue throughout the body.

To prevent back pain while swimming, it's crucial that you use proper form and techniques. Unnatural or awkward movements while swimming can easily damage tissue through the back, so it's important to maintain the correct stokes and movements.

If you are actively involved with swimming and are experiencing neck or back pain, seek the advice of a coach or more experienced swimmer. If they spot you while swimming, they may be able to determine if something is wrong with your strokes and can advise you on proper technique.

Specific strokes can cause their own unique problems:

When back pain becomes a problem there are several methods to help relieve discomfort:

Stretching, icing, and aspirin.

• Back braces are also a common way to treat back pain since they help to limit awkward movements and aid in the treatment of injured tissue.

If swimming continues to be painful it's important to stop swimming and seek medical advice. By continuing to swim despite continual or worsening pain, the condition affecting the back may become worse and more serious forms of treatment may be required to reverse discomfort.


Intestinal Obstructions

Exercises For Bloating

A fat, bloated stomach on an otherwise thin person can be a sign of poor digestion. Controlled, enzymatic digestion is the normal way in which food is digested; when this is disrupted, putrification of the contents of the intestines is the result. The rotting products increase the likelihood of constipation. Often, one isn't aware of being constipated. There might be a bowel movement each day - but the contents might be eight days old instead of eight hours! This may be accompanied by foul smelling feces and wind. In such a case, a cure with apple vinegar can be helpful: 1 tablespoon in a glass of water, on an empty stomach, each morning. Colon hydrotherapy may also help.


Constipation is one of the most common causes of bloating. If constipation is a problem, gradually increase the amount of fibre-rich foods you eat such as fruit, veg, wholegrain cereals. Drink up to eight glasses of water a day, as a lack of fluid can make constipation worse, especially if you're eating lots of fibre.

Some foods are also known to cause bloating: beans, broccoli, cauliflower, cabbage, sprouts, onions and garlic – however, remember these are good sources of fibre.

Swallowing too much air can also give you a bloated abdomen and there are several habits that can result in this: talking while eating, using a straw or sports bottle, chewing gum, eating when you're on the move, drinking from a water fountain and eating when you're upset are all common culprits so try and eliminate as many of these things as possible.

Some people blame bloating on an intolerance to a certain food such as wheat or dairy products. However, food intolerances are notoriously difficult to diagnose as the symptoms can be so wide ranging, including everything from bloating, fluid retention, headaches and tiredness to constipation and diarrhoea. If you really think you might have an intolerance I suggest you keep a food and symptoms diary to see if there's any pattern and then see your GP for a proper diagnosis.

Irritable bowel syndrome is also often associated with bloating. Usually a healthy diet will help you lose weight and keep the symptoms of IBS at bay.


Bloating is largely caused by intestinal gas. Intestinal gas can result from eating gassy foods or swallowing air. Swallowing air while eating is often done unconsciously and may result in frequent belching during or after meals. To avoid swallowing air, slow down when eating, don't 'slurp' drinks, and don't talk while chewing.

Foods that commonly cause gas are Asparagus, Broccoli, Brussels sprouts, Cabbage, Cauliflower, Corn, Fructose, Lactose, Potatoes, Sorbitol, Wheat.

Once the bloating is already present there are a few different ways to treat it. Activated charcoal in tablet form taken before and after meals may help reduce gas and bloating.

To expel intestinal gas try a brisk walk or other form of exercise. Frequent exercise can help keep the intestines moving properly. If exercise fails, try laying quietly on your left side and bring your knees up to your chest. This position can sometimes help release trapped gas.



The "transversus abdominus" muscle holds in your stomach much like how a corset keeps your stomach from bulging. When this muscle is weak, your stomach becomes distended and looks much bigger, like a pot belly.

Exhale all the air from your lungs hard while at the same time pulling your tummy in tight as if your belly button can touch your spine. Breathe lightly in this position and hold the posture for approximately 45 seconds. Repeat the exercise for 10 - 15 sets.

The second version involves doing the same exercise while on all fours in a crawling position. This adds gravity resistance. Do both exercises every other day. These exercises train your abs to continuously hold your stomach in, giving a flat appearance.When combined with a proper diet, weight training, and cardiovascular fitness you will get a flat stomach in a few weeks.


Intestinal Obstructions

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What are the symptoms?
Crampy abdominal pain, vomiting, and bloating are the main symptoms of small-bowel obstruction. If blood supply is cut off (strangulation), the pain may be severe. Obstruction of the large intestine also causes abdominal pain and bloating. A partial intestinal blockage may cause occasional diarrhea. A complete obstruction will cause constipation and a noticeable lack of gas (flatus) leaving the body.

A bowel obstruction can be caused by twisting or narrowing of the intestines, tumors, or the formation of scar tissue (adhesions); these are called mechanical obstructions. Obstruction of the bowel can also occur when the intestines stop moving because of inflammation or infection or as a side effect of certain medications.

Mechanical obstructions in the small intestine are most frequently caused by scar tissue formation (adhesions). Other causes include hernias, Crohn's disease. In the large intestine, mechanical obstructions can be caused by tumors, twisting of the intestine or narrowing that may occur because of diverticulitis or inflammatory bowel disease, or one part of the intestine folding like a telescope into another part, which is called intussusception.

Inflammation of the pancreas (pancreatitis).
Inflammation of the gallbladder (acute cholecystitis).

Abdominal X-Ray - can detect blockages in the small and large intestines.

Figure 1 shows a normal abdomen. Figure 2 shows air trapped in the bowels because gas, fluids, or solids cannot move through the bowels normally.
CAT Scan - can help distinguish between a partial and a complete obstruction and can help in diagnosing most cancers. It also can show signs that help determine whether the blood supply has been cut off (strangulated) to the affected part of the bowel.

Barium Contrast X-Ray - not used as often as abdominal X-ray and CT scan to diagnose obstructions.

Ultrasound is increasingly being used to find obstructions in the small intestine.

A proctosigmoidoscopy may be done to find blockage in the large intestine, but only if the obstruction is partial and there is no sign of infection that could spread from a ruptured bowel (peritonitis). [Proctoscopy looks inside the anus, rectum, and the lower part of the large intestine (colon) for abnormal growths (such as tumors or polyps), inflammation, bleeding, hemorrhoids, and other conditions (such as diverticulosis). ]

If the proctosigmoidoscopy is normal, an X-ray using contrast material may be done to try to locate the obstruction.

Blood Tests
A complete blood count may also be done if an intestinal obstruction is possible. Strangulated obstruction is associated with a high white cell count. Electrolytes: Intestinal obstructions may result in low electrolyte levels, requiring treatment with mineral replacements. Creatinine and blood urea nitrogen, which measure how well the kidneys are working and whether a person is dehydrated.

How is a bowel obstruction treated?
Treatment for a partial blockage in the small or large intestine usually begins with close monitoring while waiting to see whether the blockage goes away on its own in the hospital. You are not allowed to eat or drink. Fluids are given intravenously to maintain hydration. A nasogastric (NG) tube may be placed in the nose and down into the stomach to remove fluids and gas; this may relieve pain and pressure.

These and other nonsurgical treatments are usually tried first for partial obstructions. Surgery is almost always needed for a complete obstruction of the small or large intestine or if blood supply is cut off (strangulation). Obstructions can recur if the underlying cause is not treated.


Reasons for suspecting pseudo-obstruction include the feeling of standstill in the gastrointestinal tract, and severe episodes of distension (expansion of the abdomen). Disease mainly affecting the large bowel may manifest as severe constipation. Most cases involve pain, cramps, & sometimes malnutrition.

Like most gastrointestinal diseases, pseudo-obstruction cannot be recognised from the outside of the patient. Blood tests are usually normal and even an extensive investigation including ultrasonography, computed tomography, gastroscopy, barium meal, barium enema and colonoscopy may yield normal results. Dilated bowel loops can be seen in some patients, usually with advanced myopathic pseudo-obstruction.

Difficult to Diagnose:
Often the conclusion from such an investigation is that the patient suffers from a disorder such as irritable bowel syndrome. Patients are neglected and viewed as having a comparatively harmless disorder not requiring further treatment.

Different types of pseudo-obstruction:
The most common type of pseudo-obstruction is caused by damage to the nerve cells in the bowel wall. This is visceral neuropathy and the obstruction is called neuropathic pseudo-obstruction.

Another type is caused by damage to the muscles of the bowel wall. Damage to the muscle cells is called visceral myopathy and leads to myopathic pseudo-obstruction. Visceral ["primal"] myopathy [muscle disorder] causes weakening of the muscular contractions. Sometimes visceral myopathy can present as long-standing cramps in the muscles of the gut.

There is today no curative treatment for pseudo-obstruction. The disease is usually chronic and it does not resolve with time. The severity of the disease may vary with time so that episodes with few or no symptoms and good function can occur between periods of more severe symptoms.


A basic elastic knee brace helps prevent the kneecap from dislocating.
[Knee Braces]
Knee brace with straps, Sports Authority, $14.99 (Online). "TRU-FIT" #1798058
[Knee cap Removal]

Where the kneecap is removed the leg is usually put in a plaster cast for 6 weeks.
eventually the doctors decided to remove the knee cap. The result was a permanently stiff leg, somewhat shorter than before, which necessitated custom-made footwear...
Occasionally a dislocation of the knee cap will spontaneously correct.
"Chondromalacia Patellae" is a disorder characterized by pain and crunching in the front of the knee. Chondromalacia is the medical term used to describe worn out or arthritic cartilage. In many people this wearing out starts in or is isolated to the knee cap.

the most important cartilage in the knee is the smooth glistening stuff that caps the 3 bones in the knee. This cartilage can be thought of like the tread on a tire and over years of activity it can wear down. In many people the damage can affect all of the surfaces evenly, but in most the wear will be uneven and the symptoms produced correlate with what area wears first.

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Symptoms of chondromalacia patellae include pain over the front of the knee, catching or grinding behind the knee cap especially with deep bending, and knee swelling after activities. Stair climbing or activities that involve frequent and deep knee bending are the worst, and biking can be very painful. Usually people are asymptomatic with daily living activities but when they exercise, garden, or have to do climbing the knee acts up.

In rare instances operations can be done to remove the knee cap entirely or move the knee cap to reduce pressure on it. {NOTE: This is talking about knee PAIN, not Dislocating Knee Caps, so their mention of "Removing the knee cap" isn't as urgent] Some day many years from now we may be able to inject cartilage into the knee and have new smooth surfaces grow but that is far in the future.
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In modern knee surgery, there is no place anymore for patellectomy, meaning the removal of the knee cap in cases of severe damage.

The left MRI shows severe arthritis with a dislocated knee cap and complete cartilage loss following repeated dislocations of the knee cap. The right MRI demonstrates the result achieved with lateral release, medial reefing, abrasion arthroplasty and medial displacement of the tuberosity. The repaired cartilage can clearly be recognized.

Dislocated Kneecap: An injury, ligament damage, or simply the way your bones fit together can cause the kneecap to dislocate (slip out of place). It may slip only once. Or it may slip many times without warning. You may feel sudden, sharp pain, or your knee may "give out."

Avoid braces with opening at knee cap. These can "grab" the cap and dislocate it during movement.
Possible treatments include:
Straightening the leg to see if the kneecap will pop back into place.
Medicine and ice packs to reduce pain and swelling. / A brace to help the knee heal.

Exercises to strengthen the knee. These are done with limited knee bending.

Surgery to correct the problem if the kneecap keeps dislocating.

Q: My kneecap keeps dislocating. What can be done about this?

A: If a kneecap (patella) keeps dislocating, there is generally an anatomical problem preventing proper alignment and tracking of the kneecap as the knee bends and straightens. This may be due to faulty development of the kneecap itself, faulty development of the condyles of the femur, over which the kneecap slides, or over tight lateral structures or over weak medial structures. Operations (in order of magnitude) may include lateral release or medial reefing (which concentrate on the medial and lateral structures), Roux-Goldthwaite or Elmsley-Trillat procedures (which concentrate on re-aligning the patellar tendon) and finally trochleoplasty (which re-shapes the groove in which the kneecap tracks.
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Hi, has anybody had keyhole surgery on the knee for cartilage problems?

Mine keeps just locking, and then will not hold me. Damn painful. Your daughter has my every sympathy.

When my brother had it for a rugby injury, I think he had to convalesce for three weeks, but the operation itself was done in an afternoon at out-patients

It has happened three times now. The cartilage is unstable and her knee just pops out. Last time it didn't go back

Hi I am probably too late to answer this now. I have had keyhole surgery on my knee twice. Th first time was about 5 years ago, day patient, stitched the entry wound, 2 very tiny scars, very little pain but on crutches for about 1 week.

Looking at the end view of the knee shows how loosening these ligaments may relieve pressure on the articular cartilage. Once the ligaments are cut, the patella moves more into the center of the femoral groove, and tracks more in the center of the groove. In some cases of severe malalignment, a lateral release alone may not be enough. If the malalignment is so bad that the patella (Kneecap) dislocates repeatedly, then the operation will have to include a more involved realignment of the quadriceps mechanism. In addition to the lateral release, the tendons on the inside edge of the knee (the medial side) may have to be tightened as well. In very severe cases of malalignment, the attachment of the patellar tendon may also have to be moved.
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Dislocated Patella (Kneecap)

Your patella (kneecap) is shaped like a disc and sits at the end of femur (thigh bone). When your knee is bent, it rides in a groove at the end of your thigh bone. Two types of dislocations can occur: complete or subluxing. Complete occurs when your kneecap becomes totally dislocated and won't sit in the groove.

Subluxing occurs when your kneecap slips out of the groove slightly, causing pain but not limited motion. When either of these scenarios occur, parts of the kneecap can fracture. The fragments of cartilage and bone can become loose and create mechanical problems in the joint.

Signs and Symptoms: If your dislocation is complete, you won't be able to straighten out your knee without experiencing some pain. If it's subluxing, you'll feel pain when you climb stairs, and when you arise from a seated position or squat. You'll also have the anxious feeling that your kneecap is going to shift out of place.


1. Twisting. You normally dislocate your patella while doing some twisting activity like swinging a bat , or quickly changing direction.

2. Direct Trauma. Your patella can become dislocated by a hard blow, like you may experience while playing football or another contact sport.

3. Muscle Imbalance. Often, one of your quadriceps muscles (Vastus Medialis) is weaker than another (Vastus Lateralis). The stronger outside quadriceps (vastus lateralis) contracts, it pulls the patella to the outside, leading to a dislocated patella.

RX Measures: With an acute dislocation of the kneecap, the knee must be straightened out and the kneecap can usually, fairly easily, be pushed back into place. The knee must then be immobilized for four to six weeks followed be an aggressive rehabilitation program.

See your physician if your patella is completely out of place. It may require reduction under an anesthetic. You'll need to wear a brace for several weeks. Your doctor will determine at this time whether any further damage has been done. If it has, or if it becomes recurrent or there are mechanical problems, arthroscopic surgery may be discussed.

To Avoid Future Problems: Quadriceps strengthening exercises are strongly recommended. If you have a chronic subluxing dislocation, aim to keep all of your quadriceps muscles strong, especially the Vastus Medialis muscle. Leg extensions must be performed in the final 30-degrees of extension, for this is when this muscle is most activated. You should talk to your physical therapist about this. In addition hamstring and iliotibial band flexibility is imperative.

Surgery. In cases of chronic dislocations, surgery to realign the kneecap may be needed. However, the need for surgery is relatively rare.

Safe Alternative Training: Any activity with the knee in full extension will usually not cause great discomfort and can be considered safe. This could include isometrics of the quadriceps muscle, straight leg raising exercises, etc.

Gall Bladder Flush

Too many peoople have their gall bladder removed when problems occur. A gallbladder flush will usually get things back in working order.

The gallbladder is a small pear shaped organ under the liver in the upper right side of the abdominal cavity. It collects and concentrates bile, which the body uses to digest fats. Some gallbladder problems include:

  • Inflammation of the gallbladder
  • Obstruction of the flow of bile
  • Poor contraction of the gall bladder wall.
  • Stones forming in the gall bladder and bile ducts.


  • No solid food. Drink apple juice throughout the day. Consume at least 5 glasses a day.

  • Drink nothing but pure water and herbal teas.

  • Drink an Epsom Salt solution in the late afternoon - early evening, and again at the end of the day. (1 teaspoon epsom salt in a glass of water.)

  • Just before going to bed, mix 2/3 cup of olive oil (at body temperature) with 1/3 cup of fresh lemon juice. Sip this, and then retire immediately. Lay only on your right side drawing up your right leg and in the morning stones should pass in the stool.

  • Do an internal cleanse (enema) the second day (if doing a multi-day flush) and at the end of the procedure.

Repeat this for 2 to 4 days if needed.

GOOGLE: Gallbladder Flush
GOOGLE: Epsom salt solution


[Hernia, belts]

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Hernias are very common and are easily treated. If left untreated they get bigger and cause pain. More dangerously, the bowel can sometimes get trapped in the weak spot of the muscles. This can cause a blockage of the bowel, which can eventually cause it to become strangulated. An emergency operation is then required to deal with the problem.

It is usually caused by the body wall being weak from birth. Sometimes the body wall weakens with the passing of time. Sometimes the body is overstrained by coughing, heavy work or sport, etc. A hernia is a weakness in the muscles which form the front of the body wall. Usually, the bowel, and more rarely other organs, can push through this weak spot and create a bulge in the area.

Kidney Stones

To "Jump and Bump" Method

Kidney stones develop when the urine is supersaturated with salts that can form into stones. This includes overexcretion of salt, having acid urine or having a low volume of urine. The primary risk factor for kidney stones is family history.

Kidney stones can develop as a result of:

  • Hyperoxaluria, which can be caused by eating too many foods that contain oxalate. This includes rhubarb, spinach, cocoa, nuts, pepper or tea. Absorbing too much oxalate into the body as a result of various enteric diseases including chronic pancreatic or biliary disease or ileojejunal surgery can also cause it.

  • Hyperuricosuria, which is almost always a result of eating too much purine. Purine is is found in meat, fish and poultry.

Substances that can form crystals include calcium, salt, oxalate (oxalic acid), uric acid (from consuming a lot of meat/animal protein), and cystine.
Substances that prevent crystal formation include citrate and magnesium.

• A diet high in protein, from sources such as meat, chicken, or fish, may increase your risk, as could a diet low in fiber from sources such as fruit and vegetables.

• Lack of fluid intake can increase your risk of developing kidney stones. If you live in a warm climate, you may have a higher risk of developing kidney stones unless you drink plenty of water.

• foods high in oxalate (including spinach, nuts, chocolate, and tea).

How are kidney stones treated?
By drinking plenty of fluids (2 to 3 quarts a day), you can help move the stone along the urinary tract and out of the body. You will need to urinate often and passing the stone can be very painful.

What are they symptoms?
Feeling the need to urinate often --- Inability to urinate (when a stone blocks the urinary tract) --- Nausea --- Vomiting

Some kidney stones are called "silent stones" because they do not cause symptoms.

Factors that increase a person's likelihood for kidney stones, including:

  • Age (more common during middle age)
  • Sex (three times more common in men than in women)
  • Activity level (more common in people who are immobilized or after excessive fluid loss through sweating)
  • Climate (more common in hot climates or during summer months)
  • Having a family history of kidney stones
  • Urinary tract infections, kidney disorders and metabolic disorders such as hyperparathyroidism

Kidney stone pain usually appears first in the back or "flank" on either side of the body (depending on which kidney has developed a stone). You usually feel a sharp, cramping discomfort in the back and side or in the lower abdomen. Later, pain may spread to the groin. As the kidney stone moves toward the bladder, a person may feel an increased need to urinate, or a burning sensation when urinating.

Severe kidney stone pain may last a few minutes... or it may go on for hours as the kidney stone moves and irritates the lining of the urinary tract or blocks the flow of urine. Then, for no apparent reason, the pain stops and may not come back for hours--or days.

If the kidney stone is too big to pass, the muscles in the wall of the tiny ureter strain to squeeze the kidney stone along into the bladder.

Treatment for Kidney Stones

  • Lemon Juice. Drinking one-half cup of pure lemon juice (enough to make eight glasses of lemonade) every day raises citrate levels in the urine, which might protect against calcium stones.

  • Avoid Orange Juice, Grapefruit Juice, Cranberry and Apple Juice: these raise oxalate levels & therefore increase the risk of develooping stones.

"Jump" & "Bump" Methods
of Kidney Stone Removal



At the very beginning of kidney stone pain, begin drinking lukewarm water. Drink as much as you comfortably can, as quickly as you can, one or two pints minimum in the first 10 minutes. Put on a pair of shoes sturdy enough for jumping in. Decide what hard surface area, such as garage or basement floor, you will use.

After about 25 - 30 minutes from the time you began to drink the lukewarm water, you are ready for step number two. You may experience some increase in pain during the 25 - 30 minutes of prep period; however, this should be assurance that you have developed a nice, heavy, jet of urine that will quickly (within 15 - 25 minutes) move your stone to the bladder. In fact, if you do not experience some small increase in pain, it could mean that a small stone (3-4 mm or less) is involved, creating only partial obstruction. This results in a small, lightweight, liquid tool, in which case it could take as much as 40 – 50 minutes to move the stone to the bladder.

Step Two:

Now you are ready for the "exercise". Jump vertically, at least an inch or two, and land as stiffly as possible, with the ankles, knees, and hips "locked." Immediately repeat the jump,

Wait about 5 minutes and do another pair of jumps.

Wait about 5 minutes and do another pair of jumps.

Wait about 5 minutes and do another pair of jumps.

Continue this pattern for about 45 – 50 minutes, or until complete cessation of pain, whichever comes first.

After about 5 to 10 minutes from the first pair of jumps, empty the bladder, and continue to do so about every 10 minutes thereafter. There is a good reason for keeping the bladder nearly empty during the procedure. The literature clearly shows that there is less resistance by the bladder to the transfer of urine from the ureter to the bladder when the bladder is empty than when it is full, or partially full. Therefore, we can assume that this might also be true for a stone. It makes sense that a stone will go into the bladder more easily when the bladder is empty, or nearly empty, than when it is full or partially full.



All of the basic instructions for the jump method apply to the bump method. With the bump method, the bumping site might be different than the jumping site. An open toilet seat should be ideal for most individuals. The main reason is that no special arrangements need to be made to protect the genitals from damage, as would be required on a hard flat surface. As for males, since the testicles can be pulled upward by a jock strap or by hand, toward the navel, most any hard, flat surface of suitable height is fine.

Beginning the actual BUMP procedure:

Back up to the toilet seat - or other hard flat surface - as if to sit down. But instead of sitting completely down:

  • Stop for a second or two suspended 4 to 6 inches from the seat, then:

  • Free-fall the 4 to 6 inches to the seat, immediately rise to the previous position, hesitate a second or two, and free fall the 4 to 6 inches again.

  • Wait about 5 minutes and repeat the pair of bumps.

  • Wait about 5 minutes and repeat the pair of bumps.

  • Wait about 5 minutes and repeat the pair of bumps.

Continue this pattern for about 45 – 50 minutes, or until complete cessation of pain, whichever comes first. And don't forget to empty the bladder about every 10 minutes.

Other Remedies:

  • 2 oz. Lemon Juice with 2 oz. Olive Oil

  • Pomegranate Juice

  • Apple Cider Vinegar

  • Magnesium and Vitamin B-6 Tablets:

    "Magnesium is essential: it acidifies the urine and stones cannot be formed in acid urine. Vit B6 prevents the formation of oxalic acid kidney stones. Also take calcium: if calcium is lacking, the body will withdraw it from the bones and form the stones just the same. As magnesium interacts with calcium, if taken in the right proportions (300 mgs of magnesium per 1 gram of calcium), kidney stones are not formed and/or can be dissolved."

Google Search on "Jump & Bump"

2 0z. Lemon Juice w/ 2 oz. Olive Oil - Holistic Remedies

Kidney Infections

Native Americans used cranberry as a treatment for bladder and kidney diseases.

Kidney infections usually start in the bladder. If your resistance is low, germs from the bladder can travel up the tubes (ureters) that lead to the kidneys, take up residence, and multiply. An acute kidney infection starts suddenly with severe symptoms, then quickly comes to an end. A chronic kidney infection develops slowly, grows steadily worse, and hangs on. The chronic variety can lead to kidney failure

Diabetes, cancer, kidney stones, and abnormalities of the urinary tract can cause kidney pain. Usually symptoms come on very fast. They include fever, chills, pain, upset stomach, low back pain, vomiting, a constant need to urinate or an inability to urinate at all, blood in the urine, and pain or a burning sensation during urination.

Urinalysis to test for infection. You will need to take antibiotic medicine to fight the infection. If this is an ongoing problem, you may need additional tests to find the cause.
Kidney infection pain often travels from the back to the "flank" (hip).

Q: How can we tell the difference between a muscle strain in the back and the pain that is caused by a kidney infection?

A: Pain stemming from a kidney infection is in the area of the back where the kidneys lie, located to the sides of the spine, just above the hips. Kidney infection pain comes from the organ itself, but appears as back pain. Kidney pain is also quite tricky because it can radiate to many different parts of the body. It is also acute in origin, meaning that it usually has a very rapid onset, and typically does not last any longer than the infection in the kidneys will last. Kidney infection pain goes away with the healing of a kidney infection, or passing of a kidney stone. Back pain, however, does not go away this quickly.

Pain from a low back injury can initially appear very similar to the type of pain from a kidney infection. However, an injured back typically is not worsened by gently pushing on the area of the back directly over the kidneys.

Usually, there are other signs that distinguish the difference between a kidney infection and back injury. A kidney infection, for example, may also include pain with urination, fever, chills and blood may also be seen be seen in the urine by the naked eye or by laboratory analysis of the urine.

On the other hand, an acute onset of back pain may be due to a particular injury, especially if the patient recently hurt themselves with activities. I suggest to my patients, who are young women with new onset of back pain who may have a history of kidney infections, that they be tested for a possible kidney problem, since their history indicates that they may be prone to these infections.

Leg Cramps

The most common cause for leg cramps is insufficient intake of water.

Low water intake can cause a deficient flow of nutrients to parts of the body. Hydration of muscles is essential to avoid cramping during sleep or after exercise.

Another cause of leg cramps is mineral deficiencies: low levels of salt, calcium, potassium and magnesium in the body. Calcium deficiency causes muscle tremors and twitching which further leads to leg cramps. Potassium and magnesium help in controlling muscles and maintain body fluid balance. Deficiency of these two minerals can lead to painful, sudden leg cramps.

Some other factors that contribute to this condition are:

  • Muscle fatigue
  • Dehydration
  • Heavy exercising
  • Electrolyte imbalances
  • Sweating
  • Sitting or standing too long.
  • Medications like statins, prednisone, etc

Whether you're working out or lying in bed, nerves send signals to the muscles to tell them when to contract and relax. When these signals get scrambled, the muscle responds by cramping.

When you get a cramp, walk on the affected leg and then elevate it. Stretch your calf by grabbing your toes and pulling them upward toward your knee, with you leg extended straight.

The natural way to eliminate cramping in your muscles is to watch out for limited salt consumption. If you've been sweating - but neglecting your salt & water intake, this is the likely culprit.

Low electrolyte levels — salt, magnesium, potassium, calcium — cause leg cramps.

To prevent cramping:

  • increase your intake of salt and water, especially if sweating, e.g., during a workout.

  • Other helpful electrolytes are calcium, magnesium, potassium. Calcium is needed to contract the muscle, and magnesium is needed to relax it. An imbalance in this dynamic duo can irritate and confuse the muscle.

  • Stretching your calves regularly during the day and at night will help. Exhaust the stretch reflex before you go to bed by stretching your calf muscles with wall pushups and applying a heating pad for 10 minutes before going to bed.

  • Keeping blankets loose at the foot of the bed will help prevent unnatural positioning of your feet and toes which can cause night time cramping.

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Migraine Headache

A migraine headache is a vascular headache. It is caused by vasodilatation (enlargement of blood vessels).

This causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. This stretches the nerves and causes them to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain.

Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation can cause other symptoms related to fight-or-flight nervous stimuli.

  • Sympathetic activity also delays emptying of the stomach into the small intestine and can inhibit oral medications from entering the intestine and being absorbed.

  • The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.

  • The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.

  • Stress is a common trigger of migraine headache.

  • "A 1000 mg dose of aspirin could relieve moderate to severe migraine pain" (Wikipedia)

Vertigo & Migraines:

Migraine headaches that are associated with episodes of vertigo are known as vestibular migraines. The term “vestibular” refers to the inner ear where we sense balance. Vestibular migraines are not the most common type of headache, but they can be quite debilitating.

Episodes of vertigo could last for minutes to an hour before a migraine starts. Some people who have vestibular migraines will also see changes in their vision like bright or flashing lights, or spots in their line of sight. They will also have many of the more common migraine symptoms, like photophobia, phonophobia, severe throbbing head pain, nausea, or vomiting.

Vestibular migraines are treated the same way as “normal” migraine headaches,


  • Hypoglycemia (low blood sugar)
  • Stress and altered sleep patterns
  • Diet
  • Chocolate, red wine
  • Coffee, sodas with caffeine
  • Cheeses, Monosodium glutamate (MSG)


[] How fast does Nexium work? It works within a few days for me, getting rid of most of my stomach pains and nausea. However, unfortunately the symptoms come back if I stop taking it. / / /

Nexium takes a about an hour to two hours to work. The way that you knw you have acid reflux is by having a burning sensation right above your breast bone up to your throat. Do you ever eat something (liquid or solid) and then a few minutes later, pieces of it come back up during a burp? That is acid reflux, it is a "shooting" burning sensation. If your throat hurts, did you ever get that checked out? What about your sinuses? / / /

hi I read your post and I just had to add something back to you. When you have acid reflux you dont have to have heartburn. Not everyone is the same. You can have a variety of symptoms.

Posture Adjuster

The posture corrector keeps you upright and standing tall by pulling your shoulders and supporting your back. Reinforced criss-cross bands, boned with metal stays keep your back straight, preventing pain while training you to develop posture and encouraging full deep breathing. A hook-and-eye front closure allows three levels of support. Aggressive, comfortable and effective for both men and women.

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What is the treatment for rabies?

If you are bitten or scratched by an animal that you think may have rabies, you should:

1. Wash the wound well with soap and warm water for at least five minutes. This lessens the chance of any infection.

2. Seek medical attention right away.

If treated in time, rabies in humans can be prevented.

If you require treatment, two products are used:

Rabies immune globulin; and Rabies vaccine.

If you will be travelling for a month or more to areas where rabies is often found in a number of different animals, consider being vaccinated for rabies before you go.




Rotator Cuff & Age


Impingement Syndrome

[ ]

1. Impingement syndrome is caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain is a result of:

  • an inflamed bursa (lubricating sac) over the rotator cuff, and/or

  • inflammation of the rotator cuff tendons, and/or

  • calcium deposits in tendons due to wear and tear.

Shoulder muscles - the rotator cuff - are sandwiched between the arm bone and the top of the shoulder. This layout invites impingement syndrome. If these muscles are injured for a long time, the muscle can tear in two.

Symptoms include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.

Aspirin, naproxen / ibuprofen remain the most common treatment. A patient must consistently take the medication for eight weeks to effectively treat their condition.

Daily stretching in a warm shower will help. Patients should work to reach their thumb up and behind their back. Finally, the patient should avoid repetitive activities with their injured arm, particularly where the elbow would move above shoulder level. Activities such as vacuuming, painting, raking leaves and washing a car should be avoided to minimize the use of the sore muscle.

Frozen Shoulder

2. Frozen Shoulder is slightly different from Impingement Syndrome. It's a severely restrictive condition in which the shoulder capsule contracts or becomes inflamed, causing adhesions and scaring that "freeze" the shoulder. Intermittent use may cause this. There is also a lack of synovial fluid to lubricate the gap between the arm bone and socket that normally helps the shoulder joint to move.

Normally, shoulder ligaments are elastic and tighten when you reach up. In a frozen shoulder, ligaments stick to the shoulder, or tighten at its resting position.

Frozen shoulder has a high incidence with individuals over 40. It is also linked to diabetes, obesity, or hormonal changes. Frozen shoulder often takes from several months to 2 years to completely resolve.

The shoulder is a tendinous area & it receives very little blood supply. Because of this, the tendons of the rotator cuff receive very little oxygen and nutrients, and as a result are especially vulnerable to degeneration with aging. This lack of blood supply is also the reason why a shoulder injury can take quite a lot of time to heal.

Exercise, stretch, and massage the area to encourage blood flow. There are areas of the body that have limited circulation because they depend on USE and MOTION to move the blood (e.g., the feet require sole stimulation for healthy circulation, as one would get during "natural" barefoot walking). This is true of the shoulder as well. Move your arms above your shoulders, or place your hands behind your head several times throughout the day. This will help stave off the degeneration caused by sedentary living.

Frozen shoulder causes a dull, vague pain over the deltoid region that worsens with movement and at night when lying on the shoulder. It's difficult to put on or remove a t-shirt, reach for a wallet in a back pocket, or comb his/her hair. Usually the person experiences a gradual onset of pain rather than sudden injury.

People with frozen shoulder often have a rounded-shoulder posture The involved arm is held in a hiked position close to the body. Movement is limited in external rotation (rotation outward), and limited in lifting the arm up and outward, and internal rotation.

Treatment: There are three stages of frozen shoulder. The first stage (the "painful stage") involves inflammation, pain at rest, and inability to move shoulder in all directions. This is treated with rest, gentle exercises (i.e. pendulums), anti-inflammatories (i.e., asprin) and pain medication, and ice/heat treatment.

The second stage is the frozen or stiff phase. Intermittent pain and stiffness limits movement in the shoulder. Pain occurs when the arm moves to the limit of range. This stage can last 4-12 months. A program of self stretching exercises prescribed by a physical therapist may help shorten the period of limitation.

And the third and final stage is the thawing phase. Shoulder stiffness is the main problem. Treatment includes: soft tissue massage, joint movement; and, therapeutic exercises. This can take up to two years. The entire duration from onset to recovery averages 30 months. [NOTE: The "Rotator Cuff Exercises," below, are also prescribed for "frozen shoulder" (gently, according to the "stage" of healing).]


  1. Rest – Avoid strenuous activity and any motion that causes pain. Sometimes a shoulder sling helps to rest fatigued muscles and inflamed tendons.

  2. Ice and Heat – Icing your shoulder for 15 to 20 minutes at a time may help reduce inflammation and pain. After 2 to 3 days, when the pain and inflammation have improved, hot packs or heating pads may help tightened, sore muscles. Limit heat to 20 minutes.

  3. Exercise – Rotator cuff injuries can be treated with exercise therapy: Therband Rotation, Pendulum Rotation, Towel Stretch, as described in "Rotator Cuff Exercises" section below.


A highly-effective stretch: Place your hands behind your head and move your arms rearward - gently - several times throughout the day. When sedentary, the muscles get conditioned to the arms-lowered position as though it were the "stretched" position & freeze that way. The shoulder muscles receive very little blood supply & depend on motion to pump the blood through & prevent degeneration.
Straight postures also improve frozen shoulder, as rounded-shouder postures hike the arm at the shoulder, restricting natural motion. (see above, right column).

Symptoms of a rotator cuff tear may develop acutely or gradually. Acute pain mainly is caused by injury. Usually, though, the onset is gradual and caused by repetitive overhead activity or by wear and degeneration of the tendon. You may feel pain in the front of your shoulder that radiates down the side of your arm.

"WALL-ANGELS" (left) Raise arms while brushing against wall for resistance.
SIDE LIFT (right) with light weight.

At first the pain may be mild and accompany overhead activities such as painting, stocking shelves or construction, or activities like swimming, pitching and tennis. It may be relieved by over-the-counter medication such as aspirin or ibuprofen. The pain may become noticeable at rest or with no activity at all. There may be pain when you lie on the affected side and at night. Other symptoms may include stiffness and loss of motion. You may have difficulty using your arm to reach overhead to comb your hair or difficulty placing your arm behind your back to fasten a button.

The motion used in these exercises is also effective without exercise bands or weights. The forearm is kept level and pulls fore-to aft within the range before pain is felt. The arms are kept level rather than raised. Performing the same motion by itself throughout the day will increase range.

Treatment options include: Rest and limited overhead activity / Use of a sling / Anti-inflammatory medication / Steroid injection / Strengthening exercise and physical therapy.

It takes 12 weeks for the tendon to begin to heal down to the bone, and that the attachment continues to mature and strengthen for 2 years.

Treatment of rotator cuff disease includes rest, activity modification, nonsteroidal anti-inflammatory medications (aspirin), and physical therapy. Therapy may include heat, cold, ultrasound, electrical stimulation, massage, but the hallmark of effective rotator cuff rehabilitation is therapeutic exercise. Finally, muscle re-education to normalize the mechanics of shoulder motion can help return the patient to his or her full function.

2 types of behind-the-back rotator cuff stretches. In the first 2 pictures, the injured arm grabs the towel behind the back, and the uninjured arm pulls the towel slowly over the head until a stretch is felt. On the right, the injured arm is is pushed slightly with the other arm. Hold 5 seconds.


These exercises should be performed after heating for five minutes once or twice a day. As your symptoms improve, the diameter of swing may be increased somewhat.

* * * * * * *

THE WEIGHTED PENDULUM STRETCHING EXERCISE used to restore flexibility to the shoulder joint. It also relieves pressure on the rotator cuff. The exercise is performed as follows:

Relax your shoulder muscles.
While standing or sitting, keep your arm vertical and close to your body (bending over too far may pinch the rotator cuff tendons). Allow your arm to swing back and forth or in a small diameter circle no greater than 1 inch in any direction. Initially perform the exercise with just the weight of your arm. As pain subsides, hold a 5- to 10-pound weight in your hand (a filled gallon container weighs 8 pounds). Perform exercise for five minutes once or twice a day.

Armpit stretch — Use your good arm to lift the affected arm onto a shelf, dresser, or any object about breast high. Gently bend at the knees, opening up the arm pit. Try to push the arm up a little farther with each stretch.

Finger walk — Face a wall about three quarters of an arm length away. Using only your fingers (not your shoulder muscles) raise your arm up to shoulder level.

Towel stretch (See Photo) — Take a three foot long towel, grasp it with both hands, and hold it at a 45 degree angle BEHIND YOUR BACK. Use the upper, good arm to pull the arm toward the lower back. This can be repeated with the towel in the horizontal position.

Therband rotation (See Above Photo, Left) - Start gently until strength is developed over a period of weeks. (Limit use, according to feel, to avoid rupture of tendon.)

Therband rows (See Above Photo, Right) - Draw arm(s) laterally, toward the trunk of the body (not overhead).


Rotator Cuff Exercise Site

IMAGES (Google) for Frozen Shoulder

[More Exercises on: ]

TherBands & Other Fitness Equipment -
Cheaper Substitute for "TherBands"


Low back pain and/or leg pain that usually travels down the large sciatic nerve, from the lower back down the back of each leg, is generally referred to as sciatica and is fairly common. It is usually caused by pressure on the sciatic nerve from a herniated disc in the lumbar spine.

Often a particular event or injury does not cause sciatica, but rather it may develop as a result of general wear and tear on the structures of the lower spine. The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical treatments.

Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg. Low back pain may be present along with the leg pain, but usually the low back pain is less severe than the leg pain.

Possible causes:

  • fractures of the pelvis, gunshot wounds, or other trauma to the buttocks or thigh.

  • Prolonged sitting or lying with pressure on the buttocks may also injure it.

  • Systemic diseases, such as diabetes, can typically damage many different nerves, including the sciatic nerve.

    The sciatic nerve may be harmed by pressure from masses such as a tumor or abscess, or by bleeding in the pelvis.

  • A ruptured lumbar disk in the spine may cause symptoms that simulate the symptoms of sciatic nerve dysfunction.

  • In many cases, no cause can be identified.

What Most Runners Call "Sciatica" is Actually Pain From Another Source...

... and the possibilities are many. A pain in the butt is not easy to diagnose.

  • Hamstring: The hamstring muscle is attached to the base of the buttocks as it attaches to the ischial tuberosity, which is that area of the butt that hurts after you have ridden your bike too much too soon. It runs down to the back of the knee.

  • Piriformis Syndrome: the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the the path of the sciatic nerve.

Contributing Factors to Piriformis Syndrome:

  • If the leg is externally rotated for an extended period of time (such as when driving) the piriformis muscle can shorten.

  • Faulty foot mechanics.

  • Faulty spinal mechanics.

  • Gait disturbances.

  • Poor posture or sitting habits.

In short, no one seems to know anything about it.

For more fun, here's a Google search: Lower back pain

Varicose Veins & Internal Varicose Veins

Internal Varicose Veins are actually secondary varicose veins.
Aching and heaviness in a limb, sometimes with swelling, but without any prominent or visible blue vein, may signal a deep varicose vein.

Causes: To push blood back to the heart, veins rely on surrounding muscles and one-way valves. As blood flows through a vein, the valves open to allow blood through, then close to prevent backflow.

Varicosity results from a chronic increase in blood pressure, which dilates the vein. When the vein walls are pushed apart, the valves no longer seal properly, making it difficult for the muscles to push the blood 'uphill.' Instead of flowing from one valve to the next, the blood begins to pool in the vein, increasing venous pressure and the likelihood of congestion while causing the vein to bulge and twist. Because superficial veins have less muscular support than deep veins, they are more likely to become varicose.

How to treat internal varicose veins by lifestyle measures:

  • Walking and swimming are considered excellent therapy, as are gentle leg-muscle stretches and utilizing a rocking chair while watching television.

  • Start your morning with a brisk walk or finish your day with a swim or bike ride.

  • Exercise regularly. Staying fit is the best way to keep your leg muscles toned, your blood flowing, and your weight under control.

  • Eat foods low in fat, sugar, and salt. Drink plenty of water. Take supplements of vitamins C and E.

  • Stretch and exercise your legs as often as possible to increase circulation and reduce pressure buildup.
  • Take occasional breaks and put your feet up. Periods of rest with your feet a few inches above your heart level let gravity work in your favor, helping pooled blood drain from your legs.

  • Avoid high heels in favor of flat shoes.

  • Wear loose clothing. Tight garments can restrict venous blood flow to leave blood pooled in the legs. Particularly harmful are girdles or pantyhose too snug in the groin area, garters, calf-hugging boots, or waist-cinching belts.

  • Take an aspirin every day. This will thin the blood and prevent blood from clotting.

Traditional non-surgical methods for treatment of varicose veins:

Elevating the legs or affected area regularly helps to relieve the symptoms.

Anti-inflammatory drugs like ibuprofen and aspirin are sometimes useful when there is blood clots (thrombosis) combined with inflammation (thrombophlebitis) in superficial varicose veins.

Increase Blood Circulation

  • Cayenne pepper is very effective for increasing blood flow, as it dilates the blood vessels.

  • Compression socks are socks with stronger elastic bands that create significant pressure on the lower legs to help increase blood circulation.

  • COMPRESSION SOCKS use super-strong elastic materials that fit tightly at the feet and less tightly up by the knee. This change in strain keeps the calf muscles constantly squeezed and stimulated, sending blood back again towards the heart and reducing swelling along with the possible for forming clots.
  • There's a natural pump in the sole of your foot: a series of large veins called the Venous Plexus. These veins fill with blood and when we walk, and the blood is forced out and up the leg.

    The veins however, work in a different way than the arteries. The blood is pushed through the arteries by the pump action of the heart, and are regulated by the restricting and dilating of the smooth muscle around the arteries. The veins don`t have as much smooth muscle, and they work differently.

    The blood returning to the heart is being pushed up mainly by the Venous Plexus in the soul of the feet, and by the calf muscles.


    Massaging the leg from ankle to leg improves the circulation by manipulation with the blood flow.

    Start at the ankle: place your palms on each side of the leg. Using your thumb, firmly press down and push in a straight line all the way up to the knee. You will feel the bone in between your thumbs on the way up. Now go back down to the ankle, spread your thumbs a little farther apart and repeat the pressured straight line up to the knee. If you are able to reach around and do this to the back of the leg, repeat the pressured line.

    Step 2. Firmly hold the ankle with one hand and place the other hand with the four fingers (not the thumb) on the calf muscle. Begin rotating deep,circular motions into the calf. Continue as long as desired.


In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle".

BPPV is a common cause of dizziness. The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea. symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common "problem" motions . Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called "top shelf vertigo." An intermittent pattern is common. BPPV may be present for a few weeks, then stop, then come back again.

The most common cause of BPPV in people under age 50 is head injury . In older people, the most common cause is degeneration of the vestibular system of the inner ear. In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason.

BPPV has often been described as "self-limiting" because symptoms often subside or disappear within six months of onset. Symptoms tend to wax and wane. Motion sickness medications are sometimes helpful in controlling the nausea associated with BPPV but are otherwise rarely beneficial. However, various kinds of physical maneuvers and exercises have proved effective.

The Epley maneuver is also called the particle repositioning, canalith repositioning procedure, and modified liberatory maneuver. It is illustrated in figure 2. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

While some authors advocate use of vibration in the Epley maneuver, we have not found this useful in a study of our patients (Hain et al, 2000). Some authors also suggest leaving out some of the positions in the Epley maneuver, especially position 'D'. We suggest that you avoid therapy using this methodology. After either of these maneuvers, you should be prepared to follow the instructions below, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear.

1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins," or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home.

2. Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.

3. For at least one week, avoid provoking head positions that might bring BPPV on again.

Use two pillows when you sleep. /
Avoid sleeping on the "bad" side. /
Don't turn your head far up or far down. /
Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No "sit-ups" should be done for at least one week and no "crawl" swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley maneuver, unless specifically instructed otherwise by your health care provider.

4. At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can't fall or hurt yourself. Let your doctor know how you did.

Comment: Massoud and Ireland (1996) stated that post-treatment instructions were not necessary. While we respect these authors, at this writing (2002), we still feel it best to follow the procedure recommended by Epley.

The Brandt-Daroff Exercises are a method of treating BPPV, usually used when the office treatment fails. They succeed in 95% of cases but are more arduous than the office treatments. These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times.

1 repetition = maneuver done to each side in turn (takes 2 minutes). Suggested Duration for the Brandt-Daroff exercises is 5 REPITITIONS, 2 MINUTES EACH (For a total of 10 MINUTES), 3 times a day - morning, noon, night. Start sitting upright (position 1). Then move into the side-lying position (position 2), with the head angled upward about halfway. An easy way to remember this is to imagine someone standing about 6 feet in front of you, and just keep looking at their head at all times. Stay in the side-lying position for 30 seconds, or until the dizziness subsides if this is longer, then go back to the sitting position (position 3).

Stay there for 30 seconds, and then go to the opposite side (position 4) and follow the same routine. These exercises should be performed for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. In approximately 30 percent of patients, BPPV will recur within one year. If BPPV recurs, you may wish to add one 10-minute exercise to your daily routine (Amin et al, 1999). The Brandt-Daroff exercises as well as the Semont and Epley maneuvers are compared in an article by Brandt (1994), listed in the reference section.
For at least one week, avoid provoking head positions that might bring BPPV on again.

Use two pillows when you sleep. /

Avoid sleeping on the "bad" side. /

Don't turn your head far up or far down. /

Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No "sit-ups" should be done for at least one week and no "crawl" swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.


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