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Insider Arthritis Tips Sept and Oct 2015
September 15, 2015

“Challenges are what make life interesting and overcoming them is what makes life meaningful.” – Joshua J. Marine

So what do you do when you’ve exhausted all the other treatments for gout? The answer next…

Anakinra an effective option in complex gout.

Reported in MedPage Today, anakinra (Kineret) is an effective treatment option for acute gout in critically ill patients, who traditionally are difficult to treat because of contraindications to standard therapy. In 13 critically ill hospitalized patients treated with anakinra for 20 episodes of acute gouty arthritis, half had responses within 24 hours, another 40% had responses by 48 hours, and the remaining 10% by 72 hours, report researchers from Minnesota Medical School, St. Paul, in Seminars in Arthritis and Rheumatism.

Comment: Every so often, a patient needs this treatment. Glad it’s available.



What causes the sound of knuckle cracking? The answer will definitely surprise you…

Why Knuckles Crack

Rob Stein writing for NPR reported scientists think they may have solved an old question about the cracking of knuckles: Why does it make that sound?

The crack apparently comes from a bubble forming in the fluid within the joint when the bones separate, according to a recent study. It's like a tiny air bag inflating.
The findings confirm the original theory about knuckle-cracking, which was first proposed in 1947 but challenged in the 1970s.

According to Greg Kawchuk, a professor of rehabilitation medicine at the University of Alberta, that second group of scientists came along and said, " 'No, no, no — wait! We think what's happening is, the gas bubble forms but then it subsequently collapses. That's what makes the big sound.' "
While many people accepted the bubble-bursting theory, no one was sure. So Kawchuk and a team of scientists figured out a little test.

They asked a volunteer to put his hand inside a special type of MRI scanner, and made a movie of the inside of his knuckles as they pulled on the end of each finger to make it crack.
What they saw was clear: The cracking sound comes when a bubble forms between the bones of the knuckle joint — not when it collapses.
The study appears in the online journal PLOS ONE.

Dr. Kevin deWeber, who studies sports medicine in Vancouver, Wash. "says the discovery also reinforces previous research that challenged a common misconception about knuckle-cracking — that it causes arthritis.

"It's mostly an urban myth ... perpetuated by mothers who are sick of hearing their kids crack their knuckles," deWeber says. He thinks cracking knuckles might actually be good for the joints — sort of a massage of the cartilage.

Comment: Very interesting indeed.



Got RA… on Xeljanz? You need to be concerned about when to get vaccinated… next

Certain vaccine responses diminish in patients with RA taking Xeljanz

Reported in Healio, patients with rheumatoid arthritis treated with Xeljanz, especially those taking methotrexate concomitantly, showed diminished response to the pneumococcal polysaccharide vaccine but not the 2011-2012 trivalent influenza vaccine, according to recently published research. Researchers conducted two independent evaluations related to Xeljanz (tofacitinib citrate, Pfizer) treatment of patients with rheumatoid arthritis (RA). All patients met the 1987 American College of Rheumatology criteria for RA.

Comment: This is always a concern. We really don’t know when the optimal time for vaccination is. Ideally before a patient starts a biologic but what if they’re already on one?



 An unexpected and worrisome complication of rheumatoid arthritis… even if things look like they’re under control…

Carotid plaque prevalent in RA even with low CV risk score.

Reported in MedPage Today, women with rheumatoid arthritis (RA) who have a low predicted risk of cardiovascular disease based on the SCORE risk factor equation may still have high-risk atherosclerosis that requires intensive management if they are middle age or older and/or have an elevated level of total cholesterol. In a cross-sectional study of women with RA, about one in four with a low predicted risk of cardiovascular (CV) events had atherosclerotic disease that represents very high CV risk. The study, by Spanish researchers, appears in Arthritis Research and Therapy.

Comment: All the more reason to be aggressive and maintain vigilance.




A major worry not a reality… next…

Prolonged NSAIDs don't damage kidneys in non-CKD patients.

Pam Harrison writing in MedPage Today reported that a Swiss study published in the Annals of Rheumatic Diseases showed prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs) has no negative effect on renal function in patients with rheumatoid arthritis (RA) except among patients who have advanced chronic kidney disease (CKD) on initiation of treatment.

Comment: For years we’ve worried about the effects of NSAIDS on kidney function. It appears that if kidney function is normal, it’s not as big a deal as we once thought.




If a patient is in cloinical remission from their RA, don’t taper their biologics until you do this one test…

Don't taper RA meds before checking Doppler for synovitis

Reported in MedPage Today, Doppler-detected synovitis is strongly associated with failure of biological therapy (BT) in patients with rheumatoid arthritis (RA) who are in sustained clinical remission, a new prospective observational study has found. Baseline clinical remission as determined by the Disease Activity Scale in 28 joints (DAS28) and the global score of Doppler synovitis were independent predictors of BT tapering failure at 6 and 12 months, with the presence of Doppler synovitis being the strongest predictor for tapering failure, according to Esperanza Naredo, department of rheumatology, faculty of medicine, Universidad Complutense in Madrid, Spain.

Comment: Doppler ultrasound is the rheumatologist’s stethoscope.




A cure for psoriasis… maybe

New antibody treatment blocks immune signaling protein crucial to psoriasis

Reported in News Medical, many patients suffering from psoriasis showed significant recovery after just a single dose of an experimental treatment with a human antibody that blocks an immune signaling protein crucial to the disease, researchers report. By the end of the trial, conducted at Rockefeller University and seven other centers, nearly all of the 31 patients to receive treatment saw dramatic, if not complete, improvement in their symptoms.

"The striking result we achieved using a human antibody that targets the signal interleukin-23 suggests we are on the threshold of doing something very different from our current model of treating psoriasis with immunosuppressive drugs throughout an adult lifetime," says study author James Krueger, director of the Milstein Medical Research Program. "It raises the possibility of working toward long-term remission — in other words, a cure."

Comment: Terrific news!




A simple activity that could prevent rheumatoid arthritis… next

Exercise may be protective against development of RA in women

Reported in Healio, physical activity may be protective against the development of rheumatoid arthritis in women, according to researchers from the Karolinska Institutet in Stockholm. The researchers studied 30,112 women enrolled in the Swedish Mammography Cohort who responded to a questionnaire in 1997 regarding physical activity. The questions were designed to assess daily energy expenditure during occupational and home activities and during leisure time.

Comment: Exercise is a medicine… good medicine.

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Complete Wellness

Many people are already taking dozens of pills.  And some people are probably taking far more than necessary of some ingredients and not enough of others.  One comprehensive formula may solve this problem.


Complete Wellness has all the essential ingredients that you want, blended in one convenient and affordable daily wholefood based formula.  Complete Wellness uses fresh, high quality and high potency ingredients, and leaves out the wasteful fillers.  No added sugar, no yeast, wheat, rice, corn, silica, artificial flavoring or coloring.  Get a quality vitamin and you’ll save time and money. 

The only missing ingredient is… you!


This 80 ingredient super supplement formula is known as Complete Wellness.  This wonderful food based Vitamin/Mineral/Herbal Complex is quickly becoming part of the daily health program for people all across the country.  Our family of loyal repeat customers continues to grow.

Complete Wellness gives your body more nutritional support in a single daily formula than you might find in more than a half dozen different products.  Stop by our office and see the comparison!


It is highly recommended that you take our food based Complete Nutritional Formula “Super Supplement” every single day.  Give your body the optimal nutrition it needs to achieve optimal health.


Dr. Wei is so confident that you will find Complete Wellness the best vitamin – so he’s giving you a special offer…


Buy two months of Complete Wellness and save $20.00.  If you haven’t noticed an extra “pep in your step” or difference in your health within three months, we’ll refund your purchase 100 percent.  Guaranteed!


Regularly a two month (3 bottles) supply is available at $101.70.


For September and October, we are giving you a Special Offer for a two month(3 bottles) for only $81.70


You Save $20

Call us at 301-694-5800 for more information and to order your Complete Wellness today.

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Grilled Shrimp 'Margarita' with Avocados & Garden Tomatoes ~ Servings:  4 to 6



  • 1 pound large shrimp in the shell (about 24), thawed completely if frozen and blotted dry

  • 2 tablespoons olive oil

  • 1/4 cup good-quality tequila

  • 1/4 cup fresh lime juice

  • 1/4 cup fresh orange juice

  • 2 tablespoons tomato ketchup

  • 2 tablespoons green Tabasco or other jalapeno hot sauce

  • Kosher salt and freshly ground pepper to taste

  • 2 cups diced ripe heirloom or garden tomatoes, drained (from about 3 medium tomatoes)

  • 2 medium to large ripe avocados, peeled, pitted, and diced

  • 1 bunch scallions (green tops only), thinly sliced

  • 1 small white onion, finely diced (optional)

  • Lime wedges for garnish

  • Coarse sea salt (optional; I like French fleur de sel)

  • Saltine crackers


  1. Heat a gas grill to medium high or prepare a medium-hot charcoal fire. (If using charcoal, be sure the grate is hot, too.) Put the shrimp in a large bowl and mix with the olive oil until well coated. Put the shrimp on the grate directly over the heat and grill until pink and almost cooked through, 4 to 5 minutes, turning once halfway through. Let cool completely.

  2. An hour before serving, whisk together the tequila, lime juice, orange juice, ketchup, and green Tabasco. Peel the shrimp, cut them into large pieces (about 1/2 inch), and toss with the tequila mixture. Cover and refrigerate for 1 hour. Just before serving, season the shrimp mixture with salt and pepper. (Alternatively, omit the kosher salt at this stage and sprinkle on a coarse sea salt like fleur de sel just before serving.) Gently fold in the tomatoes, avocados, and scallions, mixing well. Using a slotted spoon, portion the mixture into individual serving bowls or margarita glasses. Garnish with a sprinkling of onion (if using), a wedge of lime, and the optional sea salt. Serve immediately with the crackers.

10 Facts About Potatoes!

  • I love potatoes and did you know...
  • Potatoes were first eaten more than 6,000 years ago by indigenous people living in the Andes mountains of Peru./li>
  • The Incas measured time by how long it took for potatoes to cook.
  • Religious leaders denounced the potato because it wasn't mentioned in the Bible.
  • Potatoes are the world's fourth food staple - after wheat, corn and rice.
  • Potatoes are grown in more than 125 countries (even in space - in 1995).
  • Every year enough potatoes are grown worldwide to cover a four-lane motorway circling the world six times.
  • China is the world's largest potatoe producer.
  • Namibians each eat an average of 110 kilograms of potatoes every year - not quite as much as the Germans consume.
  • In 1778 Prussia and Austria fought the Potatoe War in which each side tried to starve the other by consuming their potatoe crop.
  • During the Alaskan Klondike gold rush of the 1890's, potatoes were so valued for their vitamin C content that miners traded them for gold.

12 Benefits of Walking

Arthritis Foundation

Walking is easy to do and offers many benefits, especially for people with arthritis.  What’s not to like about walking? It’s free. It’s easy to do, and it’s easy on the joints. And there’s no question that walking is good for you. Walking is an aerobic exercise; a University of Tennessee study found that women who walked had less body fat than those who didn’t walk. It also lowers the risk of blood clots, since the calf acts as a venous pump, contracting and pumping blood from the feet and legs back to the heart, reducing the load on the heart. Walking is good for you in other ways as well.

  1. Walking improves circulation. It also wards off heart disease, brings up the heart rate, lowers blood pressure and strengthens the heart. Studies at the University of Colorado at Boulder and the University of Tennessee found that post-menopausal women who walked just one to two miles a day lowered blood pressure by nearly 11 points in 24 weeks. Women who walked 30 minutes a day reduced their risk of stroke by 20 percent – by 40 percent when they stepped up the pace, according to researchers at the Harvard School of Public Health in Boston.
  2. Walking shores up your bones. It can stop the loss of bone mass for those with osteoporosis, according to Michael A. Schwartz, MD, of Plancher Orthopedics & Sports Medicine in New York. In fact, a Brigham and Women’s Hospital, Boston, study of post-menopausal women found that 30 minutes of walking each day reduced their risk of hip fractures by 40 percent.
  3. Walking leads to a longer life. Recent research out of the University of Michigan Medical School and the Veterans Administration Ann Arbor Healthcare System says those who exercise regularly in their fifties and sixties are 35 percent less likely to die over the next eight years than their non-walking counterparts. That number shoots up to 45 percent less likely for those who have underlying health conditions.
  4. Walking lightens mood. A California State University, Long Beach, study showed that the more steps people took during the day, the better their moods were. Why? Walking releases natural pain¬killing endorphins to the body – one of the emotional benefits of exercise.
  5. Walking can lead to weight loss. A brisk 30-minute walk burns 200 calories. Over time, calories burned can lead to pounds dropped.
  6. Walking strengthens muscles. It tones your leg and abdominal muscles – and even arm muscles if you pump them as you walk. This increases your range of motion, shifting the pressure and weight from your joints and muscles – which are meant to handle weight – helping to lessen arthritis pain
  7. Walking improves sleep. A study from the Fred Hutchinson Cancer Research Center in Seattle found that women, ages 50 to 75, who took one-hour morning walks, were more likely to relieve insomnia than women who didn’t walk.
  8. Walking supports your joints. The majority of joint cartilage has no direct blood supply. It gets its nutrition from synovial or joint fluid that circulates as we move. Impact that comes from movement or compression, such as walking, “squishes” the cartilage, bringing oxygen and nutrients into the area. If you don’t walk, joints are deprived of life-giving fluid, which can speed deterioration.
  9. Walking improves your breath. When walking, your breathing rate increases, causing oxygen to travel faster through bloodstream, helping to eliminate waste products and improve your energy level and the ability to heal.
  10. Walking slows mental decline. A study of 6,000 women, ages 65 and older, performed by researchers at the University of California, San Francisco, found that age-related memory decline was lower in those who walked more. The women walking 2.5 miles per day had a 17-percent decline in memory, as opposed to a 25-percent decline in women who walked less than a half-mile per week.
  11. Walking lowers Alzheimer’s risk. A study from the University of Virginia Health System in Charlottesville found that men between the ages of 71 and 93 who walked more than a quarter of a mile per day had half the incidence of dementia and Alzheimer’s disease, compared to those who walked less.
  12. Walking helps you do more, longer. Aerobic walking and resistance exercise programs may reduce the incidence of disability in the activities of daily living of people who are older than 65 and have symptomatic OA, shows a study published in the Journal of Clinical Outcomes Management.

Eating for better sleep

By Katie Cavuto Boyle MS, RD


Sleep plays a key role in our health, including stress management and the recovery from illness.  Getting enough sleep, for some, is easier said than done. But there's hope.  Your diet can have an effect on your sleep, and poor sleep can cause poor food choices.  But eating well-balanced meals and snacks will support your body's desire to stay in its natural rhythm. At the end of the day, you'll be ready for a relaxing transition to sleep.


What to avoid

 Most people know to avoid caffeine – found in coffee, chocolate, soda and tea – later in the day, especially within a few hours of bedtime.


Alcohol can also disturb sleep. While it can make you drowsy at first, its sugars create heat in the body as we metabolize them; which can cause us to overheat and result in waking or poor quality sleep. The same result will happen when eating sugary desserts or treats late in the evening.


When we're tired, we lack the energy to prepare meals for ourselves; we also tend to crave comfort foods that can be higher in fat and calories. Take-out and processed foods often contain simple carbohydrates (such as white flour and sugar); our bodies quickly convert these to blood sugar, and that spike in blood sugar creates stress in the body.   


On the same note, processed foods, as well as many convenient snack items and baked goods, can be high in fat.  It is smart to avoid high-fat foods before bed as they take longer to digest and may cause stomach upset, which will hinder restful 'Zs'.


What to eat for better sleep

  • Eating whole foods – especially those which provide complex carbohydrates – throughout the day might be the best way to support healthy sleep.  A combination of whole grains (such as brown rice, amaranth, millet, barley, bulgur, and quinoa) paired with a variety of vegetables will maintain a steady rise and fall of the blood insulin.  

  • Balance your meals with protein, especially those containing tryptophan (found in poultry and dairy) which is a precursor to the sleep-inducing hormone serotonin. 

  • Add some calcium which helps the brain utilize tryptophan, and you will be counting sheep in no time.  Maybe mom did know best when she offered you a before-bed glass of warm milk as it contains carbohydrates, protein, and calcium!

Top 7 after-dinner snacks

  • For a nutritious bite that helps you nod off and sleep deeply, these snacks all fit the bill. Ideally, you should eat them around 90 minutes prior to sleep to allow time for digestion. 

  • Cottage cheese and fruit

  • A string cheese and a few whole-grain crackers.

  • A small serving of salmon or turkey (about 2 oz.) and ½ cup of brown rice

  • Plain yogurt with wheat bran

  • Peanut butter on whole-grain toast

  • A few tablespoons of hummus with whole-grain pita

  • One egg (hardboiled, or scrambled with low-fat milk and cooking spray) and a piece of whole-grain toast

Sleep well!

Wei's World

Life 101

Life is a series of irritations, disappointments, calamities, and catastrophes interspersed with triumphs.

So what do I mean by that? 

For example, right now, we’re going through the process of transitioning to electronic medical records in our practice.  And it is a trying time.  A lot of frustration and headaches.  Sometimes I feel despair. On the scale I describe above, it’s an irritation.

I remember the angst of applying to medical school and getting rejection after rejection.  When you’re a 21 year old who has wanted to be a doctor all his life, it feels like your world is collapsing.  That’s a disappointment.  The triumphs were getting into medical school (finally) and making the waiting list at others.

Both calamities and catastrophes are a different kettle of fish.  For example, having your house burn down or swept away by a flood, would be a calamity.  Being in an awful auto accident with serious injury would be a calamity.  Having a loved one pass away would be a calamity.

Catastrophes, fortunately, don’t occur often. Some examples that come to mind though would be the Holocaust, Jim Jones and Guyana, the Rape of Nanjing, and 9/11.

Fortunately, we tend to have many more triumphs in life.  Waking up in the morning on the green side of the grass is a triumph.  Witnessing the sunrise and sunset are triumphs. Other triumphs…being able to take an undisturbed nap on the couch, preparing a nice dinner, enjoying a nice glass (or more) of wine, catching a fish out of the surf, hugging your spouse, having a nice conversation with your children, trying on a new shirt, having a patient get their life back (a big triumph), being able to work out and get a nice sweat, working with nice people, watching a movie that either makes you feel good or makes you cry, sleeping in a comfortable bed, having a nice house to come home to, going on a vacation, breathing deeply, reading a good book, receiving a compliment, getting someone to smile- all triumphs.

Many of us, including myself, tend to focus our attention on life’s irritations and disappointments.  I’m trying, as I mature, to change that and realize that life’s triumphs are worthy of more of my attention. It’s a difficult process to make that transition, I think, because too often we take our triumphs for granted.

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