Carpal Tunnel Syndrome and Self-Help Management Options.

9 Jan

Carpal Tunnel Syndrome (CTS) is the most investigated, researched, and talked about disorder when it comes to work related injuries to the upper extremity because it is often the cause of so much lost work time, disability costs, and the source of financial hardship for many of its sufferers. So, the questions are: Is there a way to detect it early? What can be done to prevent CTS? And, what can you do to facilitate in the treatment process of CTS?

1. EARLY DETECTION: Because CTS symptoms usually start out mildly, maybe a little numbness or tingling in the hand or fingers that can be easily “shaken off,” people usually do not identify these early symptoms as, “…a big deal” and consequently, do nothing about it. After a while, and the time depends on how severely the median nerve is pinched, you may start waking up at night needing to shake out your hands in order to return to sleep. Similarly, when driving, you may need to change your hand position on the steering wheel due to the same symptoms. If you are really stubborn (and many people are) and you STILL don’t give in and come to us for treatment, then buttoning shirts, writing, crocheting, knitting, playing piano, typing, etc., may all soon become affected. The KEY in early detection is to NOT ignore the early symptoms. Come in right away!

2. PREVENTION: There are many highly effective preventative tactics. For example, recognize that certain conditions predispose us to CTS and anything to avoid and/or properly manage these conditions will help. Some of these conditions include diabetes mellitus, pregnancy, the use of birth control pills, inflammatory arthritis (such as rheumatoid or lupus), hypothyroidism, and obesity. From an ergonomic approach, make sure your work station is set up properly including (but not limited to) the position of the monitor, the keyboard, the mouse, and your chair. Set up the area so the extremes of wrist bending can be avoided. If a wrist brace doesn’t get in the way, it may help, especially when there is a high incidence rate of CTS with your co-workers. Most importantly, small mini-breaks and stretching can be highly effective during the day. If you develop any symptoms, come in and see us RIGHT AWAY (see #1 above).

3.  SELF-MANAGEMENT: Certainly consider and implement the “prevention” approaches described above in #2. Specific exercises for stretching, strengthening, and dexterity REALLY HELP! We will teach you these, as it is important that you perform the correct exercises accurately. Improper exercising will only add to the problems that lead to CTS or, worsen it. Control your diet to avoid obesity, to control diabetes and the other sometimes preventable conditions described above. Wearing a wrist splint, especially at night can also really help. There are many types from Velcro wrist wraps with or without thumb loops to cock-up splints, carpal lock splints, and many more. The key as to whether to use a wrist splint or not during work is largely dependent on the comfort of the splint during the work day. Many occupations simply require too much wrist bending or movement for the splint to be comfortably worn during the work day which ends up bruising the forearm and/or hand due to the repetitive motion into the edges of the splint. If or when daytime use of the splint isn’t tolerated, use it only at night to prevent extreme wrist bending while sleeping. This usually REALLY helps. Bottom line, remember the saying, “…an ounce of prevention is worth a pound of cure!”

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

 

A Multi For Preventing Cancer.

9 Jan

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

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 your quality and length of life.

In these articles, we’ve repeatedly recommended a multivitamin (“multi”) as an insurance policy against deficiency from an imperfect diet.  Now, there is an even more important reason.  But first, let’s deal with our premise that a multi is an insurance policy against an imperfect diet. Since only 190,000 of the over 26 million people who have taken the full nutrition program at RealAge (it’s free at RealAge.com) get the right amount of vitamins and minerals from diet alone, we believe that taking half a multi twice a day is exactly that, an insurance policy against a less than perfect diet.

But, it is more than that.  A headline randomized controlled study (the gold standard of studies) from this October’s Journal of the American Medical Association indicates a daily multi prevents cancer.  That’s big! A daily multi (actually half a multi twice a day) decreased non-prostate cancer by 12%. Prostate cancer was equal in the placebo and multi group. (The data came from the Physicians’ Health Study-II, a long-term study of the health of male Physicians over the age of 50.)

50 to 87% of Americans are short of vitamin D in published studies and you need it to help fight cancer (see below), to keep arteries young, and to aid brain function. So, make sure you get it measured and take what is needed to keep its level normal. Also, vitamin D3 is essential for calcium absorption and incorporation into bone.  Why ½ of a multivitamin in the morning and half in the evening?  You pee out the water soluble vitamins in 8 to 16 hours so you need it twice a day.

When you think about it, much of what we do and use for our health really boils down to protection. For example, we wear helmets to protect us from an accidental brain smoosh and running shoes to protect us from shards of glass. Perhaps the greatest protector of all is the one that you can’t buy in any store or order from any online discount warehouse (though there’s an idea). It’s the p53 tumor suppressor gene, which has the job of recognizing when your cells are at risk of developing into cancer and doing what it can to put a stop to it. Its job (that of biological guard dog and computer spell-checker rolled into one mean gene) is to protect your body. Do you know what is essential to turn on your p 53 gene? It seems it is something in that multi.  In that randomized study of a multi or placebo, the individuals less likely than usual to get cancer were those physicians with 1/5th the smoking rate of the general population, exercised more than usual, took a daily aspirin more than the population as a whole, and were thinner.  Thus, a 12% reduction in all non-prostate cancers (what the multi had) was a very big deal.  A big enough deal for me to take the multi for that reason alone.  Even though I eat 9 servings of fruits and veggies a day on average, I also need a multi as an insurance policy against an imperfect diet.

Thanks for reading.

Young Dr Mike

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.

 

 

Low Back and Obesity.

4 Jan

Losing weight can dramatically reduce Low back pain (LBP). For the next 2 months, we will look at easy ways to lose weight without the need for fancy, hard to follow diets. As the saying goes, this is a “no-brainer.”

Time you meals. Set a timer for 20 minutes and “pace yourself” so that you eat slower. This is one of the most effective ways to reduce weight without a complicated diet plan. Make each bite “count” and enjoy the food’s flavor! This tricks your brain into thinking you’re more full while wolfing down your food in a hurry blocks those brain signals, resulting in over-eating.

Sleep an extra hour. This can result in a drop of 14 pounds a year according to University of Michigan research.

Serve three vegetables and/or fruit vs. one in your evening meal. You can eat more and STILL reduce weight!

Add a broth-based soup to your day. It fills you up without adding calories. Avoid creamy soups as they can be high in fat and calories.

Eat more whole grains. Add brown rice, barley, oats, buckwheat and/or whole wheat when consuming waffles, pizza crust, English muffins, and pasta. If you are gluten sensitive, look for alternatives like quinoa.

Visualize your favorite “skinny clothes.” Think about, or literally take out, a favorite dress or pair of pants that you no longer fit into and use it as a target or goal to wear them again.

Skip the bacon! If you avoid that 2 strips of bacon at breakfast or on your sandwich at lunch, you’ll save about 100 calories / day, about 10 pounds per year! Instead add tomato slices, banana peppers, roasted red bell peppers, grainy mustard, or a light spread of herbed goat cheese.

Pizza perfect! Choose a veggie topping vs. meat and shave 100 calories from your meal. Consider going light on the cheese, use reduced fat cheese and choose a thin, bread-like crust made with olive oil.

Drink “smart!” Trade that soda in for water or zero-calorie seltzer and you’ll avoid about 10 teaspoons of sugar! Add a lemon, mint or frozen strawberries for a much more satisfying beverage.

We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

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Carpal Tunnel Syndrome – More Facts!

4 Jan

Carpal Tunnel Syndrome (CTS) is a condition where a nerve in the wrist gets pinched resulting in numbness, tingling and sometimes grip strength loss. One of the first symptoms of CTS involves waking up at night due to the numb, tingly sensations. This initially occurs once in a while but  eventually  becomes more frequent, leading to very un-restful, sleepless nights. Most people do not initially attribute this sleep interruption to CTS but rather report, “…it’s coming from sleeping on my arm or lying in a funny position.” Because restful sleep is a very important health issue, this early CTS symptom should prompt the person to investigate the problem, but usually they wait, sometimes for months or even years, making treatment more challenging.

Other symptoms may include waking up in the morning with wrist and/or hand pain, difficulty buttoning a shirt or threading a needle, radiating arm symptoms into the forearm, shoulder and/or neck, dropping silverware, pens, coffee cups, and, a specific pattern of numbness such as the index, middle, and part of the ring finger. The degree of functional loss varies from none to total disability, not being able to work or carry out many home activities. Some people notice the symptoms during the day while performing fast, repetitive movements such as playing piano, typing, using a computer mouse, crocheting/knitting, writing, assembly work, and more. Some of the most frustrating complaints from CTS patients are lost work time (due to both CTS symptoms and fatigue from not sleeping at night), a loss in earnings, lack of dexterity (buttons, tying shoes, turning a key in a door or car, fixing hair, applying make-up), daytime grogginess, and irritability that can impact their quality of life, including their relationships.

A question that often arises is, what is carpal tunnel syndrome? A simple answer is “tendonitis” or, inflammation of the tendons that connect the muscles on the palm side of the forearm (flexor muscles) to their respective tendons that attach in the hand and fingers. Digging a little deeper, there are nine of these tendons that travel through the tunnel, rubbing together as we move our fingers and all is usually well unless there is too much friction resulting in swelling in this confined space. In fact, CTS remains silent until the swelling starts pushing or compressing the median nerve at which point the numbness, tingling, pain, etc., are noticed.

So, the next question is, what can be done to stop the inflammation from compressing the nerve? A very common treatment approach is the use of a cock-up splint at night, which stops us from bending the wrist in our sleep. In a normal, non-CTS wrist, the pressure in the carpal tunnel increases 2-fold when we bend our wrist; however, if inflammation already exists inside the carpal tunnel, the pressure increases by many multiples. This is why sleep interruption is so common in CTS as we just can’t control our wrist position at night. Another common anti-inflammatory approach is cortisone shots into the carpal tunnel and/or taking an anti-inflammatory drug like ibuprofen. The chiropractic answer to anti-inflammation is ice (preferably ice massage over the palm side wrist) and anti-inflammatory nutrients such as ginger, tumeric, boswellia, and others. What gives chiropractic the “edge” over non-surgical medical care is the addition of joint and soft tissue manipulation of the hand, wrist, forearm, elbow and when needed, the shoulder and neck. The latter improves circulation, reduces fixation or adhesion between tissues and allows the tendons to slide with less friction resulting in better function as noted by longer ability to play piano, type, write, etc.

Another “key” item to CTS treatment is identifying and finding a solution to a poorly designed workstation so the wrist/hand does not have to work in an awkward manner. Here, the position of a computer screen, how a tool is held, and how long repetitive work is allowed are modified.

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

 

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You’re Not Dead Yet!!

4 Jan

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

Our basic premise is that your body is amazing:  You get a do over: it doesn’t take that long, and 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 then to teach others. We want you to know how much control you have over your quality and length of life.

This month, one of our readers, John (not his real name, he asked that not be printed) wrote in with: “I recently had a heart attack while having sex… [I] want to know when I can start enjoying sex again… and how will I know if I am in trouble short of serious chest pain…that was the first sign last time. My doctor doesn’t seem to want to address those questions with me.”

I’ll start my answer by referencing a favorite PBS show, Monty Python’s Holy Grail (look it up on YOUTube).  In one memorable (for me at least) scene, John Cleese carries out John Young (a dead body), when John Young utters the immortal words, “I’m not dead.”

I want to be very clear about this, John: If you’ve had a heart attack and you’re reading this, you’re not either! That means you can live life passionately.

Yes, check in with your doctor, but if it’s been 10 days since you were released from the hospital and you’re healthy enough to walk at a nice pace for a mile or so, and climb two flights of stairs (a la Jack Nicholson in “As Good As It Gets”), then you’re likely to be cleared for sex.

Your doc is unfortunately typical. Most docs don’t talk about post-heart-attack sex with their patients. Only half of male and a third of female patients are ever told when to restart their love machine. Without that info, many patients are too timid to test the waters. So, I am glad you asked the question. Two long flights easily we say, and then get cleared by the doc.  I’ve been very disappointed that 87% or so of patients after heart attacks (both nationwide and in Cleveland and surroundings) do not avail themselves of either the usual cardiac rehab or any of the three Intensive Cardiac Rehab programs we offer [the ICR of Dean Ornish –paid for by Medicare, The Granddaddy of all programs–the Esselstyn Program (developed in Cleveland)—or the Lifestyle180 program].

You should take one of these programs (many are offered in other parts of the country) if you are at high risk of a heart attack, so you don’t have another one.

By the way, beta blocking drugs like metoprolol were commonly prescribed after heart attacks until two months ago for rhythm control if you had abnormal heart beats after your attack.  But, they caused patients to eat more, have insulin resistance and even have problems achieving an orgasm. New data supports rhythm control with rhythm specific drugs, which means you won’t need those beta blockers and can probably perform better (better orgasms for both males and females). If you are at high risk (50% of men over 65 are), and don’t go for Intensive Cardiac Rehab, and do have a heart attack, you’ll probably feel like a dolt – and you should. You can prevent all that pain, and suffering for you and your loved ones, and not have that heart attack in the first place. (The Essy program is only one day!)

Worse, worrying about sex after a heart attack can be harder on the heart than having sex. Sex reduces stress, and reducing stress and having a great partner with whom you enjoy life helps reduce heart-stopping belly fat. That’s one reason why sex twice a week cuts your risk of heart attack in half.

By the way, why would Medicare pay for it? Probably because it just might save your life, allow you much more fun (I’m not sure Medicare cares about your fun), and reduces your lifetime Medicare costs (Intensive Cardiac Rehab does in randomized controlled trials). So, don’t be an 87 percenter and remember, if you are reading this, you aren’t dead yet.   So John, and all you John wannabees, after that two flights of stairs test and after Intensive Cardiac Rehab has started, snuggle up with your honey and remember: you’re doing this for your health!

Thanks for reading.

Young Dr Mike

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.  It makes a great (even late) graduation gift.  Thanks for reading.

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.

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.

 

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Fibromyalgia and Foot Orthotics.

4 Jan

Fibromyalgia (FM) is a condition that (typically)  evolves slowly over time and often occurs for no apparent reason. The diagnosis is usually made by excluding other conditions leaving you with a diagnosis that in the absence of anything else, “….must be fibromyalgia.” Of course, the problem with that approach is that we all want to know, “…what caused this problem to start with?” In the end, we typically have to accept the fact that, “…it just did,” and move on to, “…now what are we going to do about it?”

A multi-disciplinary (involving several different types of doctors and approaches) treatment approach has been found to work well with Fibromyalgia patients. This approach may include medications from a primary care doctor who is aware and sensitive to this potentially disabling condition, massage therapy from a muscle relaxation point of view, clinical psychology when the stresses associated with FM become overwhelming and out of control, and chiropractic to quarterback joint mobility, diet management, exercise training, modality use, as well as offering foot orthotics. Coordinated care effort utilizing several disciplines is what is reported to be the most successful approach.

Because chiropractic embraces the concept of treating the whole person, this premise fits perfectly in the treatment plan for the FM patient since the entire body is considered, not just a specific area or system. In this approach, we assess posture, movement, alignment, and function and implement treatments to improve each of those areas.

During the postural assessment, because we are a 2-legged species, the feet must be carefully assessed for function and alignment. If you watch people walk, you will often see their ankles roll in with each step and for some, this can be quite dramatic where the ankle rolls in almost hitting the floor. What’s interesting is that most people don’t even know they are doing it! The truth is, most people with flat feet (technically called pes planus) and rolling-in ankles (or, ankle pronation) don’t have any foot pain or symptoms associated with the altered function. In fact, people with very high arches (pes cavus) usually have more foot pain than the flat footed person. If you look at shoes of those of us who pronate (which is about 80% of us), the wear pattern is usually quite excessive on the outer corner of the heel. Sound familiar? It is very common! So, why bother “fixing” ankle pronation if it doesn’t hurt? The answer is that biomechanical function is altered and it negatively affects the rest of the body quite significantly. Here’s what happens. When the ankle rolls in, the knee has to “knock” inwards, the hip has to impinge inwards, the pelvis on that side drops and the spine has to compensate for the pelvic drop and bend away from that side. Watch the shoulders and head sway back and forth as the pronated/flat footed person walks the next time you’re walking at the grocery store, mall, or airport.

So, how does the use of foot orthotics help the FM patient? It has been reported that it takes up to seven times more energy to walk when the ankles pronate excessively. Chronic fatigue is a frequent complaint in the FM patient, and the less energy expended from walking, the more energy will be left over for other daily tasks. Also, the biomechanical stresses on the ankle, knee, hip, and spine will be smaller from wearing foot orthotics, correcting the excessive side-to-side strain on the various joints. The journal Clinical Rheumatology recently reported a significant benefit when foot orthotics were used in the treatment of FM. The bottom line is that this is a VERY SIMPLE FIX and when so much of FM is so difficult to treat, this a no brainer!

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

 

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