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Fibromyalgia and the Importance of Sleep

28 May

One of the most frustrating symptoms of fibromyalgia (FM) is the inability to get a good night’s sleep! Recently, at an Harvard-sponsored conference on the subject of pain, it was stated that “…no one should have to live in constant pain with what is known about pain management in this day and age (paraphrased).” Many attendees agreed that improving sleep quality may be the #1 way to improve the quality of life for patients with widespread pain. So the question is, what can be done to improve the sleep cycle for all of us, not only the fibromyalgia patient? Let’s take a look!

The importance of sleep has long been discussed as being not only key in managing the FM patient, but some experts even suspect it’s the probable cause of the disorder itself. It has been found that we must get at least four hours of continuous sleep in order to reach a deep sleep stage, and only at this level of sleep can we fully relax. If we can’t get to that deep sleep stage, our muscles (and mind) can’t fully relax and over time, the gradually increasing tightness may result in pain and the vicious cycle continues to chip away at the quality of life of the FM patient.

Exciting new research from the United Kingdom reports that for those over age 50, non-restorative sleep – the type where you wake up tired, foggy, and listless – is STRONGLY tied to widespread pain, the “hallmark” of FM. The researchers also report that anxiety, memory loss, and poor physical health are linked to widespread pain in older adults. In the journal Arthritis & Rheumatology, author Dr. John McBeth wrote that musculoskeletal pain becomes more common with aging and affects four out of five seniors on a daily basis! Widespread pain is a KEY FEATURE of FM, which also includes fatigue and tenderness in muscles, joints, tendons, and other soft tissues. It is estimated that about 5 million American adults are affected by FM with women being affected four times more often than men (for reasons unknown). FM can occur insidiously (for no known reason) or secondary to an injury or illness.

After studying a group of 4,300 adults (> age 50) of which 2,700 had some pain but not widespread pain, Dr. McBeth and his colleagues found several factors that can increase an older individual’s risk of developing widespread pain. At the start of the study, participants completed questionnaires about pain, mental and physical health, lifestyle and health behaviors, medical conditions, and more. After three years, they were reassessed in a similar manner and 19% reported NEW widespread pain. This included 25% of participants who initially reported some pain and 8% who reported no pain at the study’s start. The most important link for the development of widespread pain was non-restorative sleep. Other links included pain status, anxiety, physical health-related quality of life, and some form of cognitive complaint (such as memory loss). They also note that brainwave studies of FM sufferers often show the inability to reach deep sleep. Moreover, in an experiment where healthy volunteers were woken during each period of deep sleep, a number of them soon developed typical signs and symptoms of FM!

Chiropractic care includes treatment methods that reduces pain and muscle spasm and as a result, frequently improves an interrupted sleep pattern. Doctors of chiropractic are also STRONG ADVOCATES of home exercise and typically offer in-office training. Before attempting drugs with significant side effects, you owe it to yourself to include chiropractic care in your FM management “team!”

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Neck Pain – Management Strategies

27 May

As discussed last month, when you make an appointment for a chiropractic evaluation for your neck pain, your doctor of chiropractic will provide both in-office procedures as well as teach you many self-help approaches so that as a “team”, together WE can manage your neck pain or headache complaint to a satisfying end-point. So, what are some of these procedures? Let’s take a look!

In the office, you can expect to receive a thorough history, examination, x-ray (if warranted), and a discussion about what chiropractic care can be done for you and your condition. Your doctor will map out a treatment plan and discuss commonly shared goals of 1) Pain reduction, 2) Posture/alignment restoration, and 3) Prevention of future episodes. Pain reduction approaches include (but are not limited to) joint mobilization and/or manipulation, muscle/ligament stretching techniques, inflammation control by the use of physical therapy modalities (such as electrical stimulation), ice, and possibly anti-inflammatory vitamin / herbal therapies. Your chiropractor will also teach you proper body mechanics for bending/lifting/pulling/pushing, and help you avoid positions or situations where you might re-injure the area. Posture/alignment restoration can include methods such as spinal manipulation / mobilization and leg length correction strategies (heel and/or sole lifts, special orthotic shoes, and/or foot orthotic inserts). These are often GREAT recommendations as they “work” all the time they are in your shoes and you don’t have to do anything (except wear them)! The third goal of future episode prevention is often a combination ongoing treatments in the office and strategies you can employ at home. This includes (but is not limited to): 1) whether you should use ice, heat, or both at times of acute exacerbation; 2) avoiding positions or movements that create sharp/lancinating pain; 3) DOING THE EXERCISES that you’ve been taught ON A REGULAR BASIS; and 4) eating and an “anti-inflammatory” diet (lean meats, lots of fruits/veggies, and avoid gluten – wheat, oats, barley, rye).

 

Let’s talk exercise! Your doctor of chiropractic will teach you exercises that are designed to increase range of motion (ROM), re-educate a flat or reversed curve in the neck, and strengthen / stabilize the muscles in the neck. Studies show that the deep neck flexor muscles – those that are located deep, next to the spine in the front of the neck – are frequently weak in patients with neck pain. These muscles are NOT voluntary so you have to “trick” them into contracting with very specific exercises. Your doctor will also teach you exercises that you can do EVERY HOUR of your work day (for 10-15 seconds) that are designed to prevent neck pain from gradually worsening so you aren’t miserable by the end of work. Along these lines, he/she will discuss the set-up of your work station and how you might improve it – whether it’s a chair, desk, computer position, a table/work station height issue, or a reaching problem; using proper “ergonomics” can REALLY HELP! Your doctor will also advise you not to talk on the phone pinching the receiver between your head and shoulder, to face the person you are talking to (avoiding prolonged head rotation), to tuck in your chin as a posture training exercise, and more. Cervical traction can be a GREAT home-applied, self-help strategy, and these come in many varieties. Proper positions for the head when sleeping and a properly fitted contoured pillow is also important since we spend about 1/3 of our lives asleep!

 

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

 

A Quick Way to Lose 50 Pounds?

26 May

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you, and for you to teach others. We want you to know how much control you have over both the quality and length of your life.

Q: I need to lose 50 pounds. I’ve tried everything! Nothing seems to work well enough (or fast enough) to keep me on the right path. Can you help? — Kelly G., San Francisco

A: We feel your frustration. To get on the path to a lifelong healthy weight, you’ll need to learn how to change your eating habits while you’re losing weight and how to keep them up afterwards in order to keep the weight off. So to help you reach your goal, we’ve developed a jump-start program for weight loss, and we had it road-tested by more than 2.5 million folks.

  • Every morning, drink a cup of hot water with lemon. It’ll kick start your digestive process and help detoxify your system (lemon activates bile flow).
  • For breakfast, try a smoothie or tasty quinoa egg muffins (search for the recipe on Google).
  • The rest of the day, focus on protein-rich foods. Go for 12 ounces of lean protein daily from fish and skinless chicken.
    Don’t go hungry! Enjoy as much veggie broth as you want. Still hungry? Try two snacks daily consisting of quinoa with non-starchy veggies, unsalted nuts (try 12 walnut halves), 2 percent Greek yogurt, or an apple with nut butter.
    Enjoy 1 cup of coffee daily (decaf is okay, depending on the process used to decaffeinate it); use unsweetened vanilla almond milk or coconut milk instead of milk or creamer.
  • Ditch these foods: wheat; refined sugar; artificial sweeteners; dairy; alcohol; and processed foods.
  • Add these bonus boosters: Take 1,000 IUs of vitamin D daily and enjoy a nightly soak in a warm tub with 2 cups of Epsom salts and 1 cup of baking soda.

Thanks for reading. And feel free to send questions—to youdocs@gmail.com, and some of them we may know enough to answer (we’ll try to get answers for you if we do not know).

-Young Dr. Mike Roizen
(aka, The Enforcer)

 NOTE: You should NOT take this as medical advice. This article is of the opinion of its author. Before you do anything, please consult with your doctor.  You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have tow newly revised books: The patron saint “book” of this column YOU Staying Young—revised and YOU: The Owner’s Manual…revised —yes a revision of the book that started Dr Oz to being Dr Oz.  These makes great gifts—so do YOU: ON a Diet and YOU: The Owner’s Manual for teens.  And, the new book by Dr Mike Roizen: This is YOUR Do-Over Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on http://www.radioMD.com Saturdays from 5-7 p.m. He is the co-author of 4 #1 NY Times Best Sellers including: YOU Staying Young.

The Challenges of Carpal Tunnel Syndrome

25 May

Carpal Tunnel Syndrome (CTS) is one of the most common “peripheral neuropathies” patients have when they visit a chiropractor for the first time. Peripheral neuropathy (PN) is defined as “…damage or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.” Let’s take a closer look!

Common causes of PN include systemic conditions such as diabetes, vitamin deficiency, medication side effects (such as chemotherapy meds), traumatic injury, after radiation therapy, excessive alcohol intake, an autoimmune disease such as rheumatoid arthritis, and/or viral infection. PN can be linked to an individual’s genetics that are present from birth. For others, it can be unknown which is then referred to as “idiopathic.”

PN can affect one nerve (mononeuropathy) or multiple nerves (polyneuropathy) and can be acute (which means it comes on quickly) or chronic (which means it comes on gradually over time and progresses slowly). PN symptoms can include cramp/charley horse-like pain, muscle twitching, muscle atrophy or shrinkage, numbness, tingling, pins and needles, burning or cold feeling, and can also affect other tissues such as bone causing degeneration, skin changes, and hair and nail changes. PN can also affect a patient’s balance and coordination which can increase an individual’s chances of falling. If organs or glands are also impacted, PN can lead to poor bladder control, heart rate or blood pressure changes, and/or affect the sweat glands.

Getting back to CTS specifically, one of the challenges of this condition is determining the cause/s. Here’s what we know about CTS: 1) it is more common in women than men; 2) it is more common in those who are overweight; 3) it is more common in those who work in highly repetitive environments; 4) it is more common over age 50; 5) it is often accompanied by other upper extremity “over-use” conditions like tendonitis in the hand, wrist, elbow, and/or shoulder and can also involve the neck (as CTS cases improve faster when treatment is also applied to the cervical spine); and 6) it commonly includes one or more of the conditions previously mentioned that can cause neuropathy such as diabetes and rheumatoid arthritis. Other conditions such as hypothyroid can also cause or worsen an existing case of CTS, in part due to “myxedema,” a type of swelling that occurs with this condition. Here, the additional swelling can add to the compression or pressure pushing on the median nerve in the carpal tunnel and either cause CTS or worsen an existing case.

Because CTS can have more than one underlying cause, it’s important that your doctor determine as many as possible in order to achieve the best treatment results. We’ve all heard of the cases that fail to respond to surgical intervention, which in many cases is because there were MULTIPLE CAUSES and only one was addressed with the surgical approach. Surgery has always been described as “the last resort” and indeed it’s appropriate in some cases. However, MANY CTS patients respond well to chiropractic management, which often includes (but is not limited to): 1) joint manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck; 2) use of a night-time splint; 3) home/work exercises; 4) physical therapy modalities; 5) nutritional considerations; and 6) ergonomic modifications (work station assessment). If these approaches fail to achieve satisfying results, your doctor will refer you to a hand surgeon to determine which procedure might be best for you.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Low Back Pain? Should You Take an NSAID?

21 May

Statistics suggest that low back pain (LBP) will plague most of us at some point in our lives, if it hasn’t already. Most healthcare professions that manage patients with low back pain focus on pain management. In fact, studies have reported that 67% of patient satisfaction is driven by pain elimination. One of the most common strategies for reducing pain is managing inflammation. The “easiest” way to do this (according to the many TV commercials and magazine advertisements) is to take one of the many non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Nuprin), Piroxicam Flurbiprofen, and Indomethacin. Let’s take a closer look to see if this is a good or bad idea!

In a recent March 2015 article, researchers investigated the use of NSAIDs between 1993 and 2012 in patients who had fractures that failed to heal, technically called “non-union fractures.” They found that non-union fractures increased during years when NSAID use was increasingly recommended for patients with fractures and dropped in years when NSAID use declined. This isn’t the first study to report poor fracture healing results from NSAIDs when they’re used as the primary form of pain relief and in fact, studies on this subject date back to the early 1990s. So how does this equate to LBP? Most directly, fractures are one of the many causes of LBP, so for that population, the answer is clear. However, LBP is much more commonly caused by sprains (ligament injuries) and strains (muscle/tendon injuries), as well as cartilage injury. Here too, studies show that the healing rate of sprains, strains, and cartilage is also delayed when NSAIDs are used as the primary pain relief approach. This healing delay is reportedly due to NSAIDs’ inhibition of “proteoglycan synthesis,” a component of ligament and cartilage tissue regeneration and repair. NSAIDs also inhibit release of prostaglandins (especially prostaglandin E2), which is needed for tissue repair. These effects are ESPECIALLY observed with long-term use, but recent studies show injured athletes are best off NOT taking NSAIDs AT ALL as these drugs delay the healing process and thus the athlete’s ability to return to their sport.

In a January 2015 study, researchers criticized the common use of NSAIDs in elderly patients for the treatment of non-cancerous pain. They found 75% of the elderly population studied was prescribed NSAIDs which, in retrospect, the researchers determined to be inappropriate!  Because NSAIDs interfere with healing, the net effect is an ACCELERATION of osteoarthritis and joint deterioration! In 1995, a North Carolina School of Medicine study compared four groups of patients with soft tissue injuries (tendon strains): Group 1 received NO treatment (control group); Group 2 received exercise only; Group 3 received exercise AND Indomethacin; and Group 4 received Indomethacin only. At 72 hours post-injury, ONLY the exercise group had an INCREASE in prostaglandins (E2 particularly – necessary for healing). This effect was even more profound at 108 hours after injury. The research team also found DNA synthesis in the fibroblasts (an important part of the repair mechanism) was greatest in the exercise group and was completely lacking in the NSAID-only group.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

How to Prevent Whiplash! (Part 2)

20 May

Last month, we covered the importance of your car seat’s head restraint for preventing whiplash. This month, let’s discuss additional measures one can take…

AIRBAGS: In addition to a correctly positioned head restraint, having a vehicle that is equipped with airbags has been described as “essential in the prevention of injuries and/or death,” especially in frontal or head-on collisions. Airbags are inflatable devices that fill up in a fraction of a second during a serious motor vehicle collision (MVC). Depending on the year, make, and model of your vehicle, airbags are located in the front of the steering column, by the glove compartment on the passenger side, and possibly in the doors and/or in the column between the doors. These offer additional protection that seatbelts alone cannot provide and can prevent the head and chest from striking the steering wheel, dashboard, or the door in the case of side-impact airbags. The front airbags typically do not deploy in rear or side impact collisions whereas the side airbags will deploy in side impacts and rollovers, thus providing protection between the occupants and doors, side windows, and roof. In order to maximize your protection from injury in a front-end collision, make sure you do the following each time you get into your vehicle: 1) always wear both your lap and shoulder seat belts as airbags are designed to work WITH the lap/shoulder belt system; 2) maintain a safe distance between you and the driver’s side airbag of at least 10 inches / 25 centimeters (if you’re too close, you risk making contact with the airbag as it inflates which can cause abrasions and bruising); 3) position the steering wheel towards your chest (not your head or neck); 4) move the passenger seat back as far as possible because of the greater distance/larger airbag that exists between the passenger and dashboard; 5) make sure passengers avoid putting their feet up on the dash or placing any objects between their body and the dashboard.

SEAT BELTS: It has been estimated that in Canada alone, if all drivers and passengers wore their seat belts, 300 road fatalities could be avoided each year! Seat belts have always been considered the BEST way to protect against injury or death in a car crash. These typically cross the lap and chest and prevent the occupant from being ejected or thrown about inside the vehicle in an accident. Here are some important points to remember: 1) wear a lap/shoulder belt system whenever possible; 2) sit up straight, positioning the lap belt low over the pelvic bones/hips, NOT over the stomach; 3) place the shoulder harness over the shoulder, across the chest, and NEVER place the belt under the arm or behind the back; 4) all occupants must wear a seat belt regardless if the vehicle is moving or not; and 5) a pregnant occupant should place the lap belt over the pelvic bones below the baby, not over or above the stomach/baby.

 ANTI-LOCK BRAKE SYSTEMS (ABS): Here, electronic controls stop your wheels from locking up when the brake pedal is forcibly pressed to help the driver maintain control on rough, wet, and slippery surfaces. This helps prevent skidding and can result in a shorter stopping distance.  An ABS can also help drivers more safely steer around what they’re heading towards while allowing for maximum braking pressure. Tips include: 1) HOLD / DON’T PUMP the brake pedal firmly; 2) keep steering around objects while fully braking; 3) DO NOT expect the braking distance to be shorter; 4) have the ABS inspected at the recommended number of miles noted in your vehicle’s manual; and 5) MOST IMPORTANT, stay a safe distance behind the vehicle ahead of you – NO TAILGAITING!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

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