NSAIDS

Should I take an anti-inflammatory?  I work my regular paying job at Immediate Care/Occupational Medicine Clinic and the first thing we prescribe is an ibuprofen 200mg (3 tabs) 3xdaily for the life of the injury.  There are some orthopedic surgeons that say don't interfere/reduce the inflammatory process that follows injury because it slows down healing of the injury.  This thinking is based on the fact that a "normal healthy person", should be able to mount a response to halt inflammation and reverse the injury (assuming no further damage is added).  Problem my orthopedic surgeons forget is that the inflammatory cascade that gets triggered with the smallest microscopic fiber exposure (torn fiber from a muscle, blood vessel, skin, bone....) starts a local reaction in addition to a systemic reaction.  Those of you who are fibromyalgia sufferers, or chronic arthritis patients will know of how the rest of the body "kills" when you have only injured one joint.
The surgeons get to see the inside of joints that have been injected with steroid (cortisone) and they hate it.   You can't repair mush after 'roids have been used and expect a good outcome for the graft you are inserting for rebuilding an ACL.  So for the few joints that have multiple injections prior to surgical consult, I agree with the specialist.  For the millions of others that suffer countless nights not being able to sleep, not being able to walk, where every minute of every day is "I am in pain"; I think relief is worth it.  I would use over the counter anti-inflammatory first (just because anything over the counter is considered a "non-reportable" therapy-so employers don't have to claim it on insurance) but quickly go to prescription anti-inflammatory within 10 days if the first didn't work.
The proper use of NSAIDS is to start with minimum dose at the interval of when the med will wear off. ( For aleve/naprosyn it would be twice a day; for ibuprofen/advil/motrin it would be three times a day)  After 10 days if no response, increase to maximum dose of that same NSAID.  After 10 more days with no pain/inflammation control we switch to different NSAID - I usually go for the prescription meds....I rely on the older ones that were around from when I did a Sports Medicine fellowship in the 90's (nabumetone, etodolac, meloxicam.....or older ones like clinoril, indocin, mefanemic acid).  I have alot of options but most people would throw hands in the air if pain/inflammation isn't controlled by 2nd visit.  Usually it's 2 diff NSAIDs and if no response, time for a burst of prednisone.  OOOOHHH the "P" word!!!
Yes, in some cases prednisone is necessary for controlling inflammation before we have spasm from compensating during walking, or trigger points flare up, or distant joints flare up due to the overall inflammatory response being turned on.  Only 1 time in 20 years have I had weight gain in a patient given 5 days.  There is also no literature that says steroid use for 5 days or less needs a taper (to prevent Addisonian Crisis) so when we give the medrol dose pak-6 days of decreasing dose.....it is a waste of 3 submaximal doses.  Usually there is insomnia (thus the reason for morning dosing with my 3 tabs of prednisone for 5 days).  It can also raise blood sugar for my diabetics.
If the inflammation is not acute, I would highly suggest Turmeric in capsule form (roughly 40mg of extract 4times daily) by GAIA, Source Naturals, Organic India-since they blend it with micronized pepper for better absorption.  If you can afford it, curcumin (in nanoparticle) has great anti-inflammatory properties but if not distilled/extracted properly, you wont absorb the active ingredient without pepper derivative.   Glucosamine Sulfate is a great intra-articular anti-inflammatory and can be used for 3 months and discontinued to still have effect lasting 3 more months.....so you can save 6 months a year!! and still have reported improvement in range of motion to an arthritic joint.
Another option if you are between using herbal supplements to control inflammation and prescription use = topical pain relief.  Either herbal, over the counter or prescription/compounded medicine.  From former to latter, price increases significantly.  The benefit is less side effects if used topically.  The compounding pharmacist can actually mix NSAIDs/Muscle relaxers together so you avoid taking a pill form and it cuts back on systemic side effects beautifully.
The biggest problems with the NSAIDs I mentioned will be reflux.  There are other documented side effects like heart attack from Celebrex, liver congestion, kidney damage, bleeding.  Aspirin is an anti-inflammatory that has been used for decades to control inflammation in the arteries.  If you take an aspirin a day, wait for 2 hours before doing the NSAID or else the med you use for inflammation will turn off the aspirin heart protective effects.
Most important is to work with a therapist (massage or PT) for moving the muscle tissue, maintain an anti-inflammatory diet during the healing process, do no further harm, get a second opinion if you are not progressing within a month with all the above (or switch to Traditional Chinese Medicine).

12 Weeks to Change

About this time of the year, people who have thrown in the towel with a New Years resolution are looking for another way to resolve (weight, medicines or attitude).  Spring time junk mail usually brings on a flurry of products fictitiously endorsed by Dr Oz about detoxing.  When asked, most of the diabetic, over weight, high cholesterol, hypertensive, low back pain, snoring, fatigued patients I run into say "I know what to do, I just cant do it".   I disagree.  If you knew what to do, it would have lasted a lifetime.  The fact that it wasn't sustainable means it was too low in calories, too high in cardio, too many hours a day or too expensive.  My idea of sustainability is to formulate a life change that resonates with the individual.  This is the approach for Integrative Medicine, applying studied protocols in a personal individualized way that provides highest sustainable lifestyle change. (Like having an Uncle that owns a grocery to cherry pick the best items from each isle that he knows you would use and get the most out of.)
So how to start: my suggestion is to hire someone you will be accountable to every week.  The money spent will be worth every penny once you realize what you save from an annual contract with Lifetime Fitness, the prescription co pays, the non paid sick days you accumulate or the meals ordered online from outsourcing your weekly food.  If you do all this on your own and fall into the statistics that most people fail within 12 months-you just wasted a year of money, effort, exercise and morale.  Dead set on doing it alone?  At least do things to increase success of sustainability.  Get an over sized calendar, magnetize it to the fridge, note the start and end of 12 weeks and keep track of the weeks and your wins.  Start writing jotting down notes at the end of your day on 3 daily positives.  I would plan on having others in the house and at work know you are going through 12 Weeks to Change.  (You may find a family member and/or relative who was thinking the same thing!)  Having a quit buddy/group increases problem solving solutions when you hit the wall.  Everyone hits the wall.  Being prepared with maximizing on 'neutralizing stress response'/nutritional strategizing/compressing exercise (DrRics Thinking/Eating/Activity) will get you to get back on target quick.
I think the initiation of change is a detoxing.  Giving the body the break it needs from toxins, bad food, inflammatory thinking and sedentary life is refreshing.   The first morning you feel good about not having a "comfort food" craving, or your first "great" bowel movement, or think with creativity that's been missing since younger years will be glorious!  Yes the feeling and energy of youth is what most can relate to (in memory) but we've been swallowed up by this concept that you have to work like a slave, eat like a king, and move like a wounded animal in order to be "someone".  All the while we are in denial about the impending damage to our DNA we inflict with each drink of alcohol, puff of smoke or bite of synthetic food. What's worse is the concept of epigenetics says the damage we inflict on our own DNA is also passed to our children with the messages of uncoded disease glazed onto sperm and egg.
The key is to make the detox effective; and plan ahead so it doesn't have to be so aggressive next time.  The less disease you have, the less intense the detox.  If you just have to stop buying candy at the check out - easy! If you have to lose 50 pounds for a wedding in 4 months - challenging!  If you have to fight a diagnosis of metastatic cancer - probably should have started earlier but fight for your life!!! I believe most of use should be detoxing twice a year.  Ayurveda (ancient healing from India) says before change of season, we detox the body to prepare for the new harvest.  Different temperature requires different food, different harvest requires different digestion/preparation.  Change requires a well grounded emotional state since most humans prefer stability and ritual.  Especially now that we live in such a toxic environment, over dipping into food, inactivity, inflammatory relationships is such a daily activity we don't even notice how unhealthy we become; and accumulation is felt only when we are about to drown.  Wiping the slate clean is what hunter gatherers are supposed to do with each change of season.
I feel 12 Weeks to Change is slow enough to be subtle, but short enough to  impact confidence and morale. Just in time for rejoicing changes and launching into the next pilgrimage to life goals.  If you can see a doctor-good to attain baseline tests and make sure your body doesn't need extra monitoring.  If you can hire a registered dietitian- good to initiate a nutrition plan and reformulate it as you get past milestones in your journey.  If you can hire an exercise physiologist/yoga teacher/coach to move and inspire you when at your lowest you can avoid injury.   I divide the time into 3-week-blocks concentrating on
1-introducing walking breath work and supplement choices
2-food knowledge and exercise rethinking
3-detoxing, elimination, supplementation
4-intense work on Thinking/Eating/Activity and then planning for the next goal
If you cant hire the above, it's OK, keep your goals realistic, check off the days on the calendar, write your accomplishments in a bedside journal, add some form of meditation to the daily activity, try to avoid wasted time at the gym (shorten the rest times, speed up exercises, add walking to equal 130 minutes weekly) and try to follow my videos.
Set your intention for success every day/Set you attention for living clean every day!