Whiplash Self-Care: Part 2

22 Jul

Last month, we started the discussion of self-care options in the management of whiplash or CAD (cervical acceleration-deceleration) or WAD (whiplash associated disorders). In this series, we are describing various treatment methods that you can be taught to help facilitate in the management process during the four stages of healing (acute, subacute – discussed last month; remodeling and chronic – addressed this month).

Like in the acute and subacute stages, many of the same self-care techniques can be applied here as well. You will NEVER “hurt” yourself with ice or ice/heat combinations (done properly), so they can be continued indefinitely. Many patients find this helpful. Using the analogy of a cut on the skin, in the acute stage, the cut is fresh and new. It is quite pain sensitive and unstable and it will continue to bleed if you don’t take it easy. After 72 hours (entering the subacute stage), the wound has an immature scab on it and it can still easily be re-injured, and if this occurs, especially by NOT self-managing properly, the recovery time can be significantly prolonged. So, “DON’T PICK AT YOUR CUT!!!” As we enter the later subacute phase (fourteenth week), the wound’s scab is quite mature, and self-care can be appropriately more aggressive. Think strengthening and activity restoration!

Stage 3 – REMODELING phase (14 weeks to 12 months or more): In this stage, we are now three months to a year out from the injury date and hence, we SHOULD now be more “aggressive” with care. During the late acute and subacute stages, you would have been performing exercises focused on movement restoration (range of motion / ROM exercises with LIGHT resistance) in addition to self-applied myofascial release techniques using foam rolls, tennis balls, TheraCane, and/or the Intracell (and possibly others). It is NECESSARY to continue the use of these methods, as they help reduce the chances for any scar tissue to become permanent. In this stage, we will guide you into more advanced exercises that include aerobics (walking, walk/run combinations, etc.) as studies show that whole body aerobic exercise helps MANY specific area injuries, including WAD/CAD injuries. Stretching short/tight muscles, working on balance-challenging exercises (rocker or wobble boards, balance beams, gym balls, eyes closed specific action movements) are VERY IMPORTANT, as they retrain your neuromotor system and reintegrate neural pathways that have been disrupted by the injured tissues and retrain faulty movement patterns you’ve developed from compensating due to pain. Strengthening exercises will include the core since the head sits on the neck, the neck on the trunk, the trunk on the legs, and ALL of this sits on the feet (so we’ll even consider stabilizing the sub-talar joint at the ankle and if pronation is excessive, foot orthotics can help whiplash patients)!

Stage 4: CHRONIC (Permanent): ALL OF THE ABOVE can be employed after the one to two year point to “maintain” your best level of function. If you still have pain, try to “ignore it” and KEEP MOVING, stay active, stay engaged in work, family activities, and DON’T let the condition “win.” AVOID CHRONIC DISABILITY by staying active and fit!

Fibromyalgia: Do I or Don’t I Have It?

17 Jul

Fibromyalgia (FM) is one of the most common types of chronic pain disorders with an estimated five million sufferers in the United States alone. A “hallmark” of FM is the difficulty its sufferers have in describing their symptoms. When asked, “…what type of pain do you feel?,” the response is often delivered with uncertainty such as, “…it’s kind of achy but sometimes gripping…it makes me stop what I’m doing sometimes for only a second or two, but othertimes, I have to sit or lay down until it passes.” It’s sometimes referred to as “deep inside” or radiating, shooting, tender, pins and needles, and locating the pain is another big challenge. It’s often a “generalized” deep ache that includes multiple body areas, sometimes all at once. At other times, it’s spotty and moves around. It’s typically NOT restricted to one side of the body but rather on both sides. It is these inconsistencies that makes diagnosing FM so challenging, sometimes to the point where it can literally take YEARS before a patient is diagnosed. One study reported that of the 92% FM sufferers who had discussed their complaints with a primary care doctor, only 24% lead to the diagnosis of FM! It is often asked what makes FM so difficult to diagnose and the answer is simply, “…we can’t see it,” and, there are no definitive diagnostics like a blood test, an x-ray, or even more sophisticated tests that can be relied upon to easily make the diagnosis. Moreover, many FM sufferers have other conditions that overshadow FM signs and symptoms that often become the focus of her (or his) doctor.

Back in the early 1990s, the American College of Rheumatology reported “a system” for diagnosing FM. This consisted of a physical examination approach where a certain amount of pressure applied to at least 11 of 18 “tender points” had to be present. This was initially received with enthusiasm, as previously FM was a diagnosis made almost entirely on “gut instinct.” However, it soon became apparent that it was not so easy to interpret the patient’s response when these tender points were tested. Today, for a diagnosis to be made, there are three specific findings that are considered: 1) Wide spread muscle pain (in all four quadrants); 2) Pain that has been present for at least three months; and, 3) at least 11 of the 18 tender points are found – LESS emphasis is placed on the latter. The Fibromyalgia Pain Assessment Tool is a questionnaire filled out by the patient that can also help lead to the diagnosis of FM. Assessing the FM patient for other complaints or conditions commonly associated with FM include the following (% prevalence is reported by fibrocenter.com): 1) Irritable bowel syndrome (32-80%); 2) Temporomandibular disorder (TMD) (75%); 3) Chronic fatigue syndrome – sometimes to the point where bed rest is mandatory (21-80%); 4) Tension or migraine headaches (10-80%); 5) Multiple chemical toxicities; (35-55%); 6) Interstitial cystitis (21%) which includes  eight months of bladder pain, urinary urgency, and frequency (more eight times a day and two times a night); 7) Restless leg syndrome (32%); and 8) Numbness, especially the hands and/or feet (44%). Other common complaints include sleep interference, which prevents deep sleep to be reached, depression or anxiety, concentration and/or memory problems, and more!

As chiropractors, we are trained to assess the FM patient, establish the diagnosis, and offer management strategies such as spinal manipulation, massage, exercise training, nutritional counciling, modalities, and more, which can significantly improve the quality of life of the FM patient. To achieve the best outcome, you may require the services of other types of healthcare providers, as the importance of co-management cannot be overemphasized!

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

Buy Organic?

15 Jul

This month we are answering a question from Dr. Joe in Ann Arbor. He wrote, “My patients ask me if it is worth it to buy organic fruit. What should I tell them?”

Well Joe, let’s start with the story about how strawberries were created. It seems the Greek goddess Aphrodite was broken-hearted when she heard Adonis had perished. Myth has it her tears fell to earth as red hearts—and strawberries were created! Ironic, no? This oh-so-good-for-you fruit delivers a phytonutrient called anthocyanins that can help slash your risk of a broken heart because eating berries three times a week helps prevent heart attack! But wait, shouldn’t you buy organic, and isn’t that expensive? How do I eat these inexpensively?

So, tell your patients to reserve their money for organic produce that lets them dodge the fruits and veggies that come with the highest pesticide levels. (That’s apples, celery, strawberries, peaches, spinach, imported nectarines, grapes, sweet bell peppers, potatoes, domestic blueberries, lettuce, and kale according to the Environmental Working Group.) For females, the most important time to buy organic produce is when you are about to be or are pregnant.

Local, in-season produce is riper, tastier, and costs less than buying fruit out of season that’s shipped in. But often, buying frozen organically grown fruits is great choice, both financially (because they cost less) and nutrition-wise (frozen gives you just as many nutrients as fresh, more in some cases). Truth be told, organic blueberries dot my plate almost every Sunday.

Regardless if you buy fresh organic fruits and veggies or the frozen organic kind, you need to read the next two paragraphs.

You see, we want you to get the berry-benefits without risking a tummy ache, diarrhea, or worse. Berries, along with leafy greens, potatoes, tomatoes, and sprouts, are the produce most likely to trigger food-borne illness. That’s because they can harbor salmonella, norovirus, E. coli and other trouble-makers that climb on board when produce is exposed to contaminated water or mishandled during processing or shipping. Fruits and veggies can also pick up these bugs in your kitchen if you don’t store or cook them correctly or if they come in contact with raw meat or seafood. So…

Wash your hands for 20 seconds before and after handling produce, every time.

Cut away discolored or soft spots and outside or wilted leaves.

Wash all produce in running water, no soap or disinfectant, even if you’re going to peel or cook it. Dry to further remove contaminants. Scrub firm produce like melons, potatoes, or cucumbers with a vegetable brush. Dry well.

Store all produce in the fridge at 40 degrees Fahrenheit (~4 degrees Celsius).

Thanks for reading. And feel free to send more questions, you can always send us questions at 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 (and get updates on the latest and most important medical stories of the week) on twitter @YoungDrMike.

Feel free to continue to send questions to youdocs@gmail.com. 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 a new web site: YOUBeauty.com and its companion BeautySage.com the only site we know of where you can find skin products proven to meet the claims (opened for business on June 1st, 2012), and a new book: YOU: The Owner’s Manual for Teens.

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.healthradio.net Saturdays from 5-7 p.m . E-mail him questions at YouDocs@gmail.com. He is the co-author of 4 #1 NY Times Best Sellers including : YOU Staying Young and YOU: The Owner’s Manual. He is Chief Medical Consultant to the two year running Emmy award winning Dr Oz show– The Dr Oz show is #2 nationally in daytime TV. See what all the fun is about, and what he, The Enforcer, is up to. Check local listings or log onto DoctorOz.com for channel and time. And for more health info, log onto youbeauty.com anytime.

Great Imposters of Carpal Tunnel Syndrome.

14 Jul

Carpal Tunnel Syndrome (CTS) is caused by compression and subsequent irritation of the median nerve as it travels through the carpal tunnel and into the hand where it innervates the palm side of the second to fourth digits. As stated last month, the median nerve is sometimes referred to as, “…the eye of the hand” since we rely so heavily on activities of daily living (ADLs) that require its health and function. Some of these ADLs include buttoning a shirt, picking up small objects, tying a shoe or neck tie, writing, holding a book or coffee cup, gripping items such as a phone or steering wheel, opening jars, household chores, and carrying objects, especially with the finger tips.

When patients present with CTS signs and symptoms, one would think that the examination and treatment would be fairly straightforward and “routine.” The problem is, no two cases of CTS are identical because of all the possible mitigating factors, or the presence of OTHER issues that may be contributing or may be the REAL cause for CTS in that particular person. This may explain the reason surgical release of the transverse carpal ligament doesn’t always work!

The “Great Imposters” of CTS include both physical and chemical factors. Physical factors include (but are not limited to): 1) Cervical nerve root compression: Since the median nerve originates from the C6-T1 (and a little from C5) nerve roots exiting the spine, it only makes sense that a pinched nerve in the neck can mimic a pinched nerve at the wrist. The difference here is “usually” that the whole arm is involved, which is less likely in CTS only. Moving down from the neck, the next most common location for a mechanical pinch is at the 2) Thoracic outlet: Here, the nerve roots coming from C5 to T2, like merging lanes of a highway, come together to make the three main nerves that enter the arm and along with the blood vessels, this “neurovascular bundle” leaves the upper chest region and travels through the thoracic outlet to enter into the arm. The thoracic outlet can become narrowed if there is an extra rib, a shift in the collar bone or shoulder blade, from muscles that are too tight (especially the anterior scalene and/or pectoralis minor), or from anything that occupies space within the thoracic outlet. 3) Struther’s ligament: In a few of us (only about 2%), there is a ligament just above the elbow that can entrap the median (as well as the ulnar) nerve, creating a pinch and subsequent numbness below that point, mimicking CTS. 4) Pronator tunnel: The median nerve is more commonly entrapped by the pronator teres muscle just below the elbow, and treating this location can be highly rewarding when managing stubborn CTS cases. Less common is entrapment in the mid-forearm, though it’s possible by either the interosseous membrane that connects the ulna and radius or from fracture of the ulna and/or radius. The most distal point of median nerve compression is at the carpal tunnel. Entrapments can be singular or multiple and when more than one “tunnel” compresses the median nerve, the term double or multiple crush is utilized. Management MUST address ALL points of compression to obtain long-term satisfying results. Other “imposters” of CTS include a host of conditions including (but not limited to) thyroid disease, diabetes, arthritis, pregnancy, birth control pill use, obesity, and MANY others! Chiropractic makes the most sense when it comes to managing CTS from mechanical causes. If response is slow or not satisfying, we will order tests and/or consults to get to the bottom of what “imposters” may be contributing to your CTS symptoms!

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.

WARNING: Coughs and Sneezes Travel Much Further than Expected!

9 Jul

Researchers have known for some time that coughs and sneezes travel quite a distance. You have probably seen slow motion videos showing the huge droplet mist caused during a sneeze. Well, new research conducted by researchers at Massachusetts Institute of Technology (MIT) shows that coughs and sneezes have associated nearly invisible gas clouds that travel much further than previously thought. According to Dr. John Bush, a Professor of Applied Mathematics at MIT, “When you cough or sneeze, you see the droplets, or feel them if someone sneezes on you. But you don’t see the cloud, the invisible gas phase. The influence of this gas cloud is to extend the range of the individual droplets, particularly the small ones.” The new research shows the smaller particles travel between 5 to 500 times further! Even more shocking is that because particles are suspended in a gas, they are much more likely to be picked up by air circulating systems such as heating and air conditioning vents. This can spread “germs” throughout an entire building, just about instantly. Oh the horror!!! Or is it?
The first thing to understand is while this research is new, the distance traveled by sneezes and coughs is not. In other words, “germs” from sneezes and coughs have been suspended in small gas clouds that travel large distances and possibly through heating and air conditioning vents since there have been sneezes, coughs, and vents. Researchers (and you and I) knowing about it is the only thing that is new. So, two things are clear. (1) Knowing about it does not mean more people will get sick and (2), which is the most important, this is just further evidence that “germs” are everywhere. Everyone breathes them in constantly. If you are breathing “germs” in all day, and germs make you sick, then why aren’t you constantly sick?
The answer is quite simple. Germs will never be eradicated, and they should not be. They are an essential part of our ecosystem. Beyond living in a bubble, you are always going to be in contact with germs. So, the best way to deal with “germs” is to make sure your immune system is functioning to your genetic potential. This is because “germs” easily invade a body with a weak or weakened immune system, take hold, and make that person sick. On the contrary, “germs” are easily fought off by a strong, well functioning immune system. This is why), holding all other factors constant, people who do not get enough sleep, drink excessively, smoke cigarettes, have high stress levels, and eat a poor diet (loaded with processed food and sugar) are more likely to get sick when exposed to the same “germs.” Even worse, their sickness can be worse and last longer which is all the more reason to focus on the things you can control like diet, sleep, and stress reduction.

The Mysteries of Low Back Pain!

8 Jul

Do you realize how complicated the low back region is when it comes to investigating the cause of low back pain (LBP)? There can be findings on an x-ray, MRI, or CT scan such as degenerative disk disease, arthritis, even bulging and/or herniated disks that have NOTHING to do with why the back hurts. Similarly, there are often other abnormal findings present in many of us who have NO low back pain whatsoever! Because of this seemingly paradoxical situation, we as clinicians must be careful not to over-diagnose based on the presence of these “abnormal findings” AND on the same hand, be careful not to under-diagnose them as well.

Looking further into this interesting paradox, one study reported findings that support this point. Investigators examined 67 asymptomatic individuals who had NO prior history of low back pain and evaluated them using magnetic resonant imaging (MRI). They found 21 of the 67 (31%) had an identifiable disk and/or spinal canal abnormality (which is where the spinal cord and nerves run). Seven years later, this same group of non-suffering individuals were once again contacted to see if they had developed any back problems within that time frame. The goal of the study was to determine if one could “predict” who might develop low back pain based on certain abnormal imaging findings in non-suffering subjects. A questionnaire was sent to each of these individuals, of which 50 completed and returned the questionnaire. A repeat MRI scan was performed on 31 of these subjects, and two neurologists and one orthopedic spine surgeon interpreted the MRI studies using a blinded approach (without having knowledge about the subject’s symptoms or lack thereof). Each level was assessed for abnormalities including disk bulging/herniation and degeneration. Those who had initial abnormal findings were defined as “progressed” (worsened) if an increased severity of the original finding was evident or if additional or new spinal levels had become involved over the seven-year time span.

Of the 50 who returned the questionnaire, 29 (58%) had NO low back pain, while 21 had developed LBP. In the original group that had the MRI repeated seven years later, new MRI findings included the following: twelve remained “normal,” five had herniated disks, three had developed spinal stenosis, and one had “moderate” disk degeneration. Regarding radiating leg pain, four of the eight had abnormal findings originally, two of the eight had spinal stenosis, one had a disk protrusion, and one an “extruded” (“ruptured”) disk. In general, repeat MRI scans revealed a greater frequency of disk herniation, bulging, degeneration, and spinal stenosis compared to the original scans. Those with the longest duration of LBP did NOT have the greatest degree of abnormalities on the original scans. They concluded that the original MRI findings were NOT PREDICTIVE of future development of LBP.

They summarized, “…clinical correlation is essential to determine the importance of abnormalities on MR images.” These findings correlate well with other studies, such as 50% or more of all asymptomatic people HAVE bulging disks and approximately 30% of us have herniated disks – WITHOUT PAIN. To be of diagnostic (clinical) value, the person MUST have signs and symptoms that agree with the imaging test, which is used to CONFIRM the diagnosis. Bottom line, If you have LBP, come see us, as we will evaluate and treat YOU, NOT your x-rays (or MRI) findings!

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.

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