Thursday, April 28, 2016

How Cannabis Can Lower Your Need For Opioids And Reduce Risk Of Overdose

Cannabis and opioids may have a life-saving relationship.

Medicinal Cannabis Conference
Doug and I attended the 2016 Medicinal Cannabis Conference in Arcata, California last weekend where we heard from well known doctors such as:

Dr. Donald Abrams, chief of the Hematology-Oncology Division at San Francisco General Hospital and a professor of Clinical Medicine at UCSF.

Dr. Ethan Russo, a board-certified neurologist, psychopharmacology researcher, and Medical Director of PHYTECS, a biotech company focusing on the human endocannabinoid system.

Dr. Dustin Sulak, founder of Integr8 Health, an integrative health practice with 3 locations in New England that treats over 18,000 patients with medical cannabis.

The most exciting development from this conference, for me, was learning more about the interaction between opioids and cannabis and the enormous potential this has to help reduce the opioid epidemic in this country. My interest was already peaked by Dr. Sulak's article I had read in O'Shaughnessy's Journal of Cannabis in Clinical Practice. So it was really great to hear him discuss this in person, especially with all of the experience he has with cannabis patients. And with his practice in Maine, he is no stranger to the opioid and heroin epidemic and the urgent need to address it. 

The Problem
Opioid medications are handed out like candy. In 2012, 259 million prescriptions were written, enough to give every adult in the U.S. their own bottle of pills.

Sale of prescription opioids in the US nearly quadrupled from 1999 to 2014 even though there was not an increase in the amount of pain that Americans report and overdose deaths have risen accordingly. In 2014, there were 18,893 overdose deaths related to prescription pain pills. Another 10,574 overdose deaths were related to heroin. 

The problem is that when a person has surgery, or a back ache, or other forms of pain, their doctor prescribes them a pain reliever such as oxycodone, hydrocodone, codeine, or morphine. These drugs have many bad side effects, but the ones that are key here are:

* they are addictive
* people develop a tolerance to them, requiring them to increase their dosage
* they can cause respiratory depression which can lead to death
* as pain pills became harder to get, many turn to a more potent and cheaper opioid, heroin 

How Cannabis can help
Like opioids, cannabinoids (the chemical compounds found in cannabis) can reduce sensitivity to pain. In animal studies, cannabis added to opioids increased pain relief significantly more than the opioids alone. In addition, co-administering cannabis with opioids prevents tolerance building. What this could mean for humans is:

* a person could take a much lower dose of opioids if they take a little toke of cannabis
* they may not have to increase their dosage of opioids as the cannabis may prevent tolerance
* Cannabis is also safe because unlike opioid receptors, cannabis receptors are not very prevalent in the brainstem's cardio-respiratory center and does not increase the risk of respiratory depression or overdosing. No one has ever died from overdosing from taking too much marijuana.

Because cannabis is classified as a Schedule 1 drug, most of this research is still only confirmed by animal studies. As great as it is to prevent our rat population from opioid addiction, it would be far better to be able to prove this benefit in humans. Hopefully cannabis, with its many medicinal benefits will be rescheduled so this research can be done in the United States.

Some anecdotal accounts shared at the conference confirm these findings. Dr. Sulak described a patient who never needed to increase his small dosage of pain killers over a ten year period despite the severe chronic pain for the which it was prescribed. When the good doctor pointed this out, the patient readily pulled out a big joint from his pocket! 

The Obvious Question
With all the risks of prescription opioids, and the relative safety of medical cannabis, why not just prescribe medical cannabis for pain and skip over the prescription drugs completely? 

Recently my son had knee surgery and I'm sure went home with a big bottle of prescription pain killers. Luckily he lives in Oregon where cannabis is legal. He was able to completely control his post-surgical pain with cannabis alone. He didn't get addicted to it (he much prefers bourbon) and had a speedy recovery.

A group of researchers in Canada published a paper "Cannabis for the Management of Pain: Assessment of Safety Study" in the Journal of Pain where patients using an average daily dose of 2.5g of dried herbal cannabis a day for one year showed improvements in pain, function, quality of life and cognitive function.

Last year an article by Dr. Kevin Hill in The Journal of the American Medical Association reviewed the medical literature over the past 66 years and found that "the use of cannabis for chronic pain, neuropathic pain, and spasticity due to Multiple Sclerosis is supported by high-quality evidence."

Can Cannabis Cure Addiction?
We've discussed how cannabis can safely potentiate the analgesic effect of pain killers and how it can reduce pain all by itself. But can it cure someone who is already addicted to opioids?

This is certainly a critical area that needs far more research. But there are doctors who have shown that it can.

For example, Dr. Gary Witman of Canna Care Docs claims that he has successfully treated 15 patients with cannabis who have weened themselves off of opioids without relapse. And some individuals have told their own story of successfully using marijuana to cure their addictions.

Most states with medical marijuana now allow addiction to be on the list of qualifying conditions, showing the willingness to consider this as a viable treatment option. Maine Representative Diane Russel asked, "why take a solution off the table when people are telling us and physicians are telling us that it's working?"

The irony is not lost when cannabis, a supposed "schedule 1 drug that, by definition, has no medical benefits" can help prevent and potentially cure drug addiction caused by legal pharmaceutical drugs. 

Wednesday, April 20, 2016

Chili-Chipotle Corn Muffins
Vegan And Gluten Free

Gluten free muffin with corn, diced green chili and Daiya cheese.

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A Great Side Dish
You don't usually think of a muffin as a side dish but perhaps you should. It is, after all, a grain and can carry with it some other goodies. In this case, whole kernel corn, diced green chiles and Daiya vegan "cheese." It makes a great side dish for a morning tofu or egg scramble or a raw fruit salad. And when accompanying a big green salad, it makes the perfect lunch. 

To ensure that you are avoiding GMO corn, always select organic corn kernels and corn meal for this recipe.

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Chili-Chipotle Corn Muffins
Vegan, Gluten and Dairy Free
[makes 12 muffins]

Requires a muffin pan and best with an electric hand beater. 

1/4 cup extra virgin olive oil plus some for the pan
2 tablespoons ground flaxseeds
6 tablespoons room temperature water
3/4 cups organic cornmeal
1 cup Bob's Red Mill's gluten free all purpose baking flour
2 tablespoons organic cane sugar
2 packets stevia
1 tablespoon aluminum-free baking powder
1/2 teaspoon salt
1/4 teaspoon ground chipotle chili, or to taste
1/2 cup unsweetened almond milk or other non-dairy milk
1 cup frozen organic corn, defrosted
1 (4.5 ounce) can diced green chiles
1/2 cup Daiya pepper jack style shreds

Preheat the oven to 400 degrees F. Grease a 12-muffin pan with some olive oil or, if you prefer, Earth Balance, and set aside.

Prepare flaxseed eggs. Stir the ground flaxseeds in water vigorously with a fork in a large bowl. Set aside while preparing the dry ingredients, stirring occasionally while it thickens.

In a medium bowl, combine the cornmeal, flour, sugar, stevia, baking powder, salt, and ground chipotle.

Add the olive oil and milk to the flaxseed eggs. Blend with an electric hand beater until smooth. 

Add the dry ingredients and blend until well combined. It will look a bit dry but completely moistened. It it's too dry, add a touch more milk.

Fold in the corn, green chiles, and Daiya shreds. 

Scoop the batter into the prepared muffin cups and bake until a toothpick comes out clean when inserted in the center of the muffins, about 20 minutes.

Before baking
After baking
Remove from the oven and cool in the pan for 5 minutes. Release the muffins and serve warm. 

All corn muffins tend to get a bit dry the next day. To moisten them up, slice the muffin horizontally, warm them in your toaster oven, and slather them with Kite Hill vegan cream cheese or Earth Balance. So yummy!

Enjoy them for lunch together with a nice raw salad.

Nutritional Information
Per muffin: 153 calories, 7 g total fat, 1 g saturated fat, 0 mg cholesterol, 304 mg omega-3 and 635 mg omega-6 essential fatty acids*, 3 g protein, 22 g carbohydrates, 2 g dietary fiber, and 226 mg sodium.

Thursday, April 14, 2016

Should We Stop Taking Wildcrafted Herbs?

Echinacea is a popular herb used to boost the immune system. But is it over harvested?

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Wildcrafted Herbs
I've always had the notion that wildcrafted herbs were superior to ones that were cultivated. With this belief, I would always select wildcrafted herbal products when I had the choice. But the demand for herbal and botanical supplements has become a multi-billion dollar business which has resulted in large-scale wildcrafting. This itself is an oxymoron. When I think of wildcrafting, I imagine a herbalist wondering through a beautiful forest with a wicker basket on their arm, carefully pruning or gathering a small amount of leaves, flowers, roots, or bark to meet their needs or the needs of their clients. But, unfortunately, the reality of it can be a large-scale producer bulldozing trees for bark, or over harvesting herbs to near extinction. Besides herbal remedies, many prescription drugs are based on plants. For example, the plant-derived anti-cancer drug taxol was first isolated from the Pacific yew. 

Species at Risk
Here are just a few of the plants that are at risk:
Wild Echinacea angustifolia and Echinacea purpurea have become such a popular remedy for boosting the immune system during cold and flu season, that they have been commercially over harvested.

Slippery elm is a popular soothing agent for coughs and GI issues. Many of the slippery elm wood trees are stripped of their bark and left to die.

American Ginseng is used to fight infection, for stress, and as a stimulant. Wildcrafted American ginseng is in such high demand that it has been declared an endangered species in some states in the U.S.

The bark from the Pacific and Chinese yew, as mentioned above, are used to produce taxol. These species have been identified in need of protection.

Pacific yew bark

Black cohosh, a popular herb that women take to alleviate menopause symptoms, as well as to treat colds, rheumatism, and pain, are at great risk from over harvesting, especially since nearly 100% of the supply comes from wild harvesting.

Goldenseal, used for many conditions such as the common cold and upper respiratory infections, is already considered rare and endangered in many states.

Look For Organically Cultivated Herbs
An organically cultivated plant is one that is grown on unpolluted land without the use of chemical fertilizers, herbicides, or pesticides. If grown in this natural way, they can have the same medicinal efficacy as their wild counterparts. So if you are in the health food store looking for herbs, you may opt for one that is organically cultivated rather than one that is commercially wildcrafted. 

Responsible Herbalists Allowed, of course
I'm not suggesting that a responsible herbalist stop wildcrafting. Most have great respect for mother earth. They know how not to damage the plant and not to take more than they need. An experienced herbalist would use sustainable practices and would not over harvest an endangered plant. But for those of us who buy our herbal supplements, I gently suggest that organically cultivated herbs, from a respectable company, will be just as effective and will cause less stress to our plants in the wild.

Plant an Herb Garden
Many popular herbs will grow in your garden. I planted calendula a few years back when we had our nephew's wedding here and it has reseeded itself every since. It makes a lovely oil infusion and skin remedy.

Calendula from my garden

I think it's best to make a list of plants you would use. Then check on the growing conditions that are required and see if they will grow in your area. Pick one or two and give it a try. Be careful, some herbs are pretty invasive and can take over your garden, such as lemon balm, comfrey and any kind of mint. You may want to plant them in an individual container and either leave the container above ground, or recess them into the garden. Once you've grown the herb, the fun begins. You can learn to make infusions, tinctures, herbal pills, and more!

Mother Earth has provided us with all the food and medicine we need but we must remember to be good stewards and to take care of the gifts that nature gives us.

Tuesday, April 12, 2016

Green Chia Seed Blast
Raw Vegan Smoothie Packed With Healthy Fats

This rich and delicious smoothie blends
green veggies and fruits with healthy fats.

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Green Smoothie
This is one of the tastiest green smoothies I've ever made. It was inspired by the Green Machine that I had at VegeNation in Las Vegas last month. I started with their main ingredients of kale, parsley, cucumber, avocado and grapes, and added some healthy fats to provide omega-3 and omega-6, monosaturated fats, as well as medium chain triglycerides.

Do Not Fear Fat!
Fats are critical to your diet. For one, they help you absorb fat-soluble vitamins. A recent study showed that "the presence of fat in a meal with which a vitamin D-3 supplement is taken significantly enhances absorption of the supplement." That study showed an average increase of 32% absorption. Other fat-soluble vitamins, such as A, K and E, also benefit from the presence of fat in the diet.

Fat also improves carotenoid absorption and improves the conversion of beta-carotene into vitamin A. 

I added chia seeds, avocado, and coconut butter to this recipe. Chia seeds are a wonderful source of omega-3 essential fatty acids. Avocado contains healthy monosaturated fats, such as oleic acid. Coconut butter contains medium-chain triglycerides that are readily used as energy. Besides their health benefits, these foods provide a nice, thick texture for the smoothie and the coconut butter adds another level of deliciousness.

One serving of Green Chia Seed Blast smoothie provides approximately 1 entire gram of both omega-3 and omega-6 essential fatty acids in a 1:1 ratio.

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Green Chia Seed Blast
Raw Vegan, Dairy Free, Gluten Free
[makes 4 servings]

Requires a high-speed blender, such as a Vitamix or Blendtec.

Freeze the grapes the night before.
Allow 30 minutes to hydrate the chia seeds.

2 tablespoons chia seeds
1 cup room temperature water
1 cup loosely packed parsley
1 cup tightly packed kale, ribs removed
1 tablespoon raw coconut butter
1 cup cold water
1 large avocado, peeled, pit removed
1 large English cucumber, peeled and sliced
3 cups frozen grapes

Place the chia seeds in 1 cup of room temperature water. Stir vigorously and set aside until the chia seeds are completely hydrated, stirring occasionally - about 30 minutes.

Wait until the chia seeds are completely hydrated.

Place the parsley, kale, coconut butter, hydrated chia seeds, and cold water into the blender. Process until the greens are well chopped.

Add the avocado, cucumber, and frozen grapes to the blender and process until smooth. Serve immediately.

Per serving: 205 calories, 10 g total fat, 3 g saturated fat, 960 mg omega-3 and 996 mg omega-6 fatty acids, 0 mg cholesterol, 4 g protein, 31 g carbohydrates, 7 g dietary fiber, and 24 mg sodium.

Tuesday, April 05, 2016

Traditional And Alternative Methods Of Treating Morton's Neuroma - I've Tried Them All!

Morton's Neuroma is an extremely painful condition.
Here's what you can do about it.
Morton's Neuroma
About 4 years ago I started getting intermittent pains in the front of my feet, especially when I walked barefoot on hard surfaces. I was an avid Zumba dancer and wore these tight dance sneakers which crowded my toes. Of course this followed a 36 year corporate career where I wore high heals every day. Then, to make matters worse, I injured a toe on my right foot when I opened a heavy door over it. Now, every step I took created a sharp, electrical pain in the ball of my foot. I was diagnosed with Morton's neuroma.

Morton's neuroma is when the tissue around the nerves leading to your toes begins to thicken or becomes inflamed. Typically this occurs in the area between the third and fourth toes (or metatarsals) although it also can occur between the second and third toes. This thickening pinches and compresses the nerve causing various sensations and pain. Some people feel as if they are standing on a pebble in their shoe, or on a fold in their sock. I have not experienced this to a large degree. My symptoms were sharp and burning pain in the ball of my foot that radiated through my toes.

My search for a cure was a long one. I have tried practically every traditional treatment, from cortisone to surgery, as well as every alternative treatment, from acupuncture to cannabis. If you are reading this, I know how much pain you are in so I am going to share everything that I tried to relieve my pain and be able to resume my active life.

Sorry ladies, but that closet full of cute, pointy-toed shoes may have to go. Women's shoes are especially harmful to feet because they crowd the toes. About three out of four people who suffer from Morton's neuroma are women and I'm pretty sure our shoe wardrobe has a lot to do with it. But even men's shoes and most athletic shoes have a curvature from side to side that "cradles" your feet and causes your toes to scrunch up. So the first thing you should try to do is wear shoes that give you plenty of room.

Here are some of the shoes I've tried.
I particularly like Hoka's, which is a running shoe. I'm not back to running yet but if you are, these are great shoes. 

My most comfortable shoes that I now live in are Altra running shoes. The Olympus model, and perhaps some of their others, have a very large toe box. It's so wide, I affectionately call these my "clown shoes". I wear them almost every day.

The Olympus model is on close out so I just bought a second pair.

OESH shoes were designed specifically for women by Dr. Casey Kerrigan, specifically "to minimize the stress and strain that footwear inflicts on a woman's muscles, tendons, ligaments, and joints." For me, the OESH shoes didn't provide enough cushion and they are so shallow that they don't allow enough room for orthotics or other shoe inserts that you might need for better arch support. They are also very flexible and bend easily. Since people with Morton's neuromas feet hurt when their toes bend, it's better to get a shoe that has more structure. They might be a good shoe to prevent a neuroma in the first place.

Good shoes to prevent a neuroma but 
not stiff enough if you already have one.
Besides running shoes, some Keen shoes are quite comfortable because they provide room in the toe. They are also quite stiff and don't bend easily. 

When I dress up, I wear these SAS women's Nudu sandals. The straps allow you to customize the shoe to your foot and the cushioning is amazingly comfortable. It's like walking on a memory foam bed. 

Super comfortable and somewhat dressy
Metatarsal Pads
If your shoes don't provide enough relief, you might try placing a metatarsal pad on the insert of your shoe. When used correctly (have your foot doctor, chiropractor, or physical therapist place them for you), they can relieve the pressure from the neuroma. I suggest you start with a thin one first (1/8") and if that doesn't work, try a thicker one. Bigger is not better in this case so start off small. 

Proper placement is key 
Yoga Toes
By the end of the day, when your feet are burning and in pain, you might want to try YogiGems toe stretcher and separator. I placed them in the freezer first and slowly and carefully maneuvered them around my toes. Start off with just 5 minutes or so and build yourself up to longer times. After I had surgery, it hurt to stretch my toes apart but if you haven't had surgery yet, these can give you relief. 

Custom Orthotics and Off-The-Shelf Shoe Inserts
Before you spring for custom orthotics, try different off-the-shelf inserts. Sometimes they work just as well and they are a whole lot less expensive. You can buy Dr. Scholl's inserts at your neighborhood pharmacy for around $10. Some have machines you can step on to determine which product works best for your foot, especially your arch. 

Sof Sole makes a good product that ranges from $20 to $40. Aetrex Lynco Sport makes a very good insert that already has a built in metatarsal pad for around $60. 

From left to right, Dr. Scholl's, Sof Sol, and Aetrex Lynco Sport.
If you have an unusually high arch or foot condition that needs special attention (and you have $500 to burn), you can have custom-made orthotics made by your podiatrist. 

Podiatrist and surgeon, Dr. Chang 
making a cast of my feet
Resulting orthotics
The most important thing about orthotics is breaking them in slowly. A well-made pair of orthotics can be very helpful but I'm not sure they are worth the money. First of all, some of the off-the-shelf products are pretty darn good for a tenth of the price or less. Secondly, if you have more than one pair of shoes, it's a pain to constantly move your orthotics to another shoe. If you find a well-priced off-the-shelf product, you can buy a set for each pair of your shoes and it will still be cheaper than one set of orthotics. And you can trim each pair up to specifically fit each shoe.

I went to 4 different chiropractors, each of whom did something a little different to try and break up my neuroma. 
One doctor manipulated and "cracked" the bones in my foot numerous times - didn't work.
Another used a metal flat tool to break up the scar tissue and perhaps release the entrapment - this didn't work either.
A third doctor (Dr. Richard Fourzon in Santa Rosa) used a cold laser so many times and so intensely, he literally "fried" my nerves in my foot and lower back. I still have burning up and down my legs from this treatment. Avoid this guy at all costs.
A forth doctor gently manipulated my toes - this didn't work either. 
Bottom line, I did not get any relief from any of the chiropractic treatments. Three out of four of these doctors are extremely competent and have provided me relief for other issues but not for Morton's neuroma.

Foot Massage
John Crutchfield, a specialist in foot massage, brought my pain from a 10 to a 6. I drove hours to see him and it was worth it but unfortunately he has moved overseas. You can, however, get his Foot Self-Massage, The Basics DVD on how to massage your feet. This takes dedication but can help immensely. 

Integrative Practitioners
I have two naturopaths that are also board certified doctors.
One tried a TENS unit for pain - it didn't work. 
The other doctor, Dr. Lois Johnson, who is also an herbalist, put me on a regimen of herbs and supplements. They include R-lipoic acid and a tonic of St. John's wort, oats, ashwaganda, and motherwort. To this I add a good B-complex and additional benfotiamine (an oil-soluble form of vitamin B1 - thiamine). These help a lot to dull my nerve pain. 

Since Podiatrists specialize in feet, I visited three of them in my quest for foot relief.

Cortisone Injections
The very first thing a podiatrist will do is give you an x-ray. An x-ray cannot detect a Morton's neuroma but it will rule out some other causes of foot pain, such as a stress fracture. When they diagnose Morton's neuroma, they will most likely suggest a cortisone injection. And if it doesn't work, they will administer another one. Although cortisone is a powerful anti-inflammatory and, for some, can offer quick relief, these have never worked for me. Plus, too many cortisone injections can cause tissue damage and even rupture tendons. The worse part is, the relief doesn't usually last. I had three, none them worked, and I am sorry I ever allowed the doctors to administer them. There are more effective treatments.

Alcohol Injections
If you are open to having injections, you might consider skipping the cortisone and go directly to alcohol injections. Although it sounds scary, alcohol injections, or sclerotherapy, is where they shoot a dilute mixture of alcohol into the neuroma area. They freeze up the foot with a numbing spray first. Dr. Chang gives a great shot and it didn't hurt nearly as bad as one would expect sticking a needle full of alcohol directly into a nerve would feel. You can get up to 7 shots. I opted for all 7. These injections eventually kill the nerve so you no longer feel the pain. But, I still felt the little "click" with every step I took because the physical neuroma was still there and it was large. If it had been smaller, I would have declared victory after the shots. You guessed it, the next step I took was surgery.

Dr. Thomas Chang freezing my foot and
giving me an alcohol injection
It took me 3 years before I decided to have surgery. During this time, I did all the things I described above and more. So I didn't take this lightly. Reading various chat groups, you will quickly see that recovery can sometimes take a very long time. But some lucky people claim they are out jogging in a matter of weeks or months while others are still in pain a year or more later. Everyone is going to react differently.

Immediately after surgery, you have to wear a surgical shoe and you may need crutches or a cane. But it's best to just lay still for a while with ice and your foot elevated. They put some kind of pain block in because you really don't feel your foot for a day or two. But then the fun begins. 

A few days after surgery. Even the
unaffected toes were black and blue.
My recovery was long and painful. For months I had shooting pains in the toes surrounding the neuroma surgical site. My doctor seemed surprised at this, as if I were the only person whose foot hurt months after surgery. But it's not uncommon so if you are still having pain for months or even a year after surgery, don't give up hope. It just takes a long time to heal.

Day 16 - removal of stitches.
6 weeks after surgery
One year after surgery

During the first few weeks after Morton neuroma surgery I had lots of nerve pain which I didn't expect. After all, didn't they just cut out my nerve? I took the drug Gabapentin which worked very well in mitigating the nerve pain. However, after people in various chat groups talked about how it hurt their vision, I quickly stopped taking it. My daughter also had vision problems after taking this drug. 

I honestly thought my pain would never go away, even after surgery, until I starting seeing Dale White, a Sebastopol acupuncturist. I went once a week for several months. His treatments were nothing short of miraculous. I had tried another acupuncturist before and after my surgery but it didn't do much good. But Dale is an experienced and skilled practitioner. So ask around and find the best.

Medical Cannabis
One of the other things I did for pain was to get my medical cannabis card. Being a farmer, I immediately planted a CBD-rich plant (similar to hemp with little THC and no psychoactive properties). It seems ridiculous that this hemp-like plant is considered marijuana, but it is. Anyway, I developed a salve using this plant along with other healing herbs and essential oils and I rub this on my feet two to three times a day. 

Walk on the Beach
One final thing I recommend is to walk barefoot in the ocean to soak your feet in cold salt water and walk in the sand to strengthen your feet. After surgery, your toes will feel really tight and weird - like they are held together with a rubber band. Stretching them out, gently bending them, walking on your toes, and especially walking in the sand, will loosen them up again. But take your time. I didn't get to this for many months.

I know my four year journey is probably worse than some and not as bad as others. Some people have double neuromas in both feet and face far greater pain and suffering. But after seeing 4 chiropractors, 2 naturopaths, 1 foot massage specialist, 3 podiatrists, 2 acupuncturists and a cannabis doctor to finally get some relief, here's what I have learned and what I would advise someone to do if they have Morton's neuroma:

1. First of all, throw out all of your tight fitting shoes. Get shoes with a big toe box and use inserts for additional cushioning.

2. Do self-massage foot care nightly.

3. Find the the best acupuncturist you can, like Dale White, and try acupuncture for 6 to 8 weeks. Don't give up - it takes time.

4. If that doesn't work, I would skip the cortisone shot and get alcohol injections.Try finding someone who will use ultrasound-guided techniques. My doctor didn't but I think if he did, it wouldn't have taken as many shots to get relief.

5. Work with an herbalist or naturopath and start on a regimen of supplements and herbs to address your nervous system and pain. I know the drug Gabapentin (also known as Neurontin) works pretty well, but avoid it if you can and try going natural.

6. If you live in a civilized state where medical cannabis is legal, play around with cannabis salves and maybe some edibles (be careful with dosing on the edibles) for pain relief.

7. As a last resort, consider surgery if none of this works and you cannot bare the pain. Interview doctors and talk to people who have had the surgery. But only do this as a last resort. Having said that, I'm sure there are many people who have had more successful surgical outcomes and wish they had done it sooner. But it's hard to tell if you are going to be one of the lucky ones.

8. Months after surgery, to help recover, walk in the cold ocean and the sand.

I'm happy to report that I'm back to Zumba dancing but only on a thick, cushiony rug and I recently walked 6 miles, two days in a row. It's still hard to walk barefoot on hardwood or tile floors but I'm pretty happy to be mobile again!

Good luck with your journey. Pain is hard to deal with but don't give up on finding the right doctor or alternative practitioner to help you.

Latest Update February 24, 2020
I've developed a new neuroma right next to the last one. It occurred when I was jumping and twisting - an exercise I found on UTube that targets love handles. So now my foot is killing me and I still have love handles! 

I tried many of my favorite treatments like acupuncture, supplements, cannabis salve, massage, etc. but nothing was working. I returned to my surgeon but he was really relying on me to tell him exactly where the neuroma was before we administered alcohol injections. The pain seemed to be all over and I really couldn't pinpoint it. I really wanted to find a doctor who did ultrasound-guided injections so that we would be certain we were hitting the correct spot. So I did some research and found Dr. Peter Redko in Petaluma, CA. 

I went to visit Peter to ask for ultrasound-guided alcohol injections. I knew that I did pretty well with the alcohol treatments for my last neuroma so I wanted to skip the cortisone (which never worked for me) and go straight to the alcohol injections. 

He suggested I try something less invasive first, specifically MLS (Multiwave Locked System) laser treatments. So I signed up for 6 treatments (it could possibly take 10). I'm taking 2 laser sessions per week. I've taken 3 treatments so far and I'm really hoping that this works. He's even treating the adjacent area where I had surgery since it still feels spongy and is occasionally painful. Although I don't have results yet, I was very excited to share this new development and treatment option with you. Stay tuned ........

MLS laser

July 13,2020 update:
So I completed 6 MLS laser treatments and they were actually starting to work when Dr. Redko suggested I take a stem cell injection. BIG MISTAKE!! After the injection, I was in severe pain (couldn't even walk for a day) and then I started having worse symptoms than before - like the classic feeling that you are walking on a rolled up sock.

Then the pandemic hit so I just lived with the pain for a few months. I went back for more MLS laser treatments thinking that would help counteract the pain from the stem cell injection. After 5 more MLS laser treatments, I just gave up as they seem to be making it worse. And, at a $100 a pop (not covered by insurance), why keep doing something that wasn't helping. I do think, however, had I not had the stem cell injection, the MLS treatments would have improved the pain.

Today, I am returning to my surgeon, Dr. Chang, for alcohol injections. Wish me luck!!