The Ethics of Not Hiring Smokers.

14 Dec

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 both the  quality and length of your life.

This month, I want to talk about something you might advocate for your business that was featured in two recent New England Journal of Medicine op-eds that highlighted what we had done at the Cleveland Clinic (so forgive me if I use us and Ohio as a parochial example).

Those two recent New England Journal of Medicine op-eds asked a question: “Was it ethical for employers not to hire smokers?” That’s the wrong question.  It should be: Is it ethical for employers to hire those who smoke, a practice that fosters ill health, and therefore makes America less competitive in an international marketplace?

The expense of healthcare in the United States represents over 18 percent of GDP, more than any other country, threatening our sustainability as a nation, and now squeezing out social programs, education, and defense.  Therefore, we must do everything we can to bring down costs while improving quality.  At Cleveland Clinic, we have been able to do that by creating a culture of wellness, which promotes personal healthcare accountability and reduces the burden of chronic disease.  A significant component of chronic disease is tobacco use– accounting for one in every five deaths each year in the USA and in North America.

With a mission to heal the sick and cultivate a healthier community, Cleveland Clinic felt it had to encourage wellbeing to combat disease.  To us, supporting a habit that ultimately leads to death would be unethical.  In 2006, we began offering free smoking cessation to our employees; the following year we offered the same to Northeast Ohio (free, absolutely free).  In 2008, we stopped hiring smokers – a natural progression towards building a healthier community.

Self-reported tobacco use by employees showed that the rate of smoking declined from 15.4 to 6 percent, resulting in a savings of $2,000 per year for each smoker who quit – or $7.4 million less in medical expenses from 3,800 fewer smokers.  Savings are passed on to employees through lower health insurances costs.  By ridding our campuses of second-hand smoke, savings for non-smokers equally translate.

Cuyahoga County’s smoking rate decreased by 11.2 percent by 2009, generating a savings of about $260 million every year for our taxpayers and corporations.  Cost-savings such as this allow our community to remain competitive in the marketplace, create jobs, and fund social programs.

In contrast, the largest cost increase in our state (Ohio) that’s  causing the largest need for increased taxes is the removal by the prior Governor of the $40 million for tobacco prevention programs.  Ohio now spends less for tobacco prevention than any other state. As a result, we have gone from 20.2 % smoking rate for adults in our state (similar to the national average) to 25.4% while the rest of the USA has fallen to 19.2%  (CDC data from bi-annual surveys).  That will soon (there is a delay in costs of about 5 years though we have some increased costs now) result in a extra $1.1 billion in health care costs per year for the state of Ohio and our businesses, and taxes required from our citizens.  Yes, smoking is an addiction, but the fact that over 60 million smokers have quit and have stayed tobacco free means we have the ability to help most, if not all, to breath free, and even more possible to motivate many to never smoke.

What can be the incentive for the individual… if better health or more disposable income aren’t enough? The Gallup organization says the greatest feeling of self-worth and the greatest incentive is to have a job.  If the states and federal governments quit hiring smokers, and offered free smoking cessation to everyone they cover for health care, then that would be a strong incentive for the individual to quit or not start. We could take off over $100 billion a year from our health care bill (and maybe much more if you include things like our disability bills) to allow medical care for those who need it most, and to pay for those things we need like education and defense.

As a health system whose inherent mission is to heal the sick and cultivate wellbeing, does it make sense to support a habit that causes chronic disease and ultimately, higher healthcare costs for all?  At Cleveland Clinic, we don’t believe so.

Thanks for reading,

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.

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Fibromyalgia – Do We Know The Cause?

14 Dec

Fibromyalgia (FM) is a condition that is characterized by widespread pain, fatigue and an increased pain response. Symptoms can include tingling of the skin, muscle spasms, weakness in the arms and legs, nerve pain, muscle twitching, bowel disturbances, chronic sleep disturbances, and more. So, what can cause such a widespread, whole body condition? Though the “cause” of FM is unknown, several hypotheses have emerged. Here is what we know:

The brains of FM patients: Structural and functional differences have been identified in the brains of FM vs. healthy individuals. What is unclear is whether these identifiable brain changes cause the FM symptoms or are the result of an unknown cause. Some experts have reported that the abnormal brain findings may be the result of childhood stress, or prolonged, severe stress at any time in life. An area commonly affected is called the hippocampus, which plays a crucial role in maintaining cognitive functions, sleep regulation, and pain perception.

Lower pain threshold: Due to an increased reactivity of pain-sensitive nerve cells in the spinal cord and brain (called “central sensitization), FM patients feel pain sooner and worse than non-FM subjects.

Genetic predisposition: It has been reported that FM is often found in multiple family members. This genetic propensity also includes other conditions that often co-exist in FM patients such as chronic fatigue syndrome, irritable bowel syndrome (IBS), and depression.

Stress & lifestyle: Stress by itself may be an important cause of FM. It is not uncommon to develop FM after suffering from post-traumatic stress disorder. An association between physical and sexual abuse both in childhood and adulthood has also been identified. Poor lifestyle issues including smoking, obesity, and lack of physical activity increase the risk of developing FM.

Dopamine dysfunction: Dopamine is a chemical needed for neurotransmission and plays a role in pain perception. It is also connected to the development of restless leg syndrome (RLS), which is a frequent complaint of FM patients. Medications found effective for RLS such as pramipexole (also used for the treatment of Parkinson’s disease) can be helpful for some FM patients.

Abnormal serotonin metabolism: Another neurotransmitter, serotonin, regulates sleep patterns, mood, concentration, and pain and can be involved in causing FM. Decreases in other neurotransmitters (especially norepinephrine), when combined with serotonin depletion, can especially cause FM (more so in women than men). Hence, medications like duloxetine (Cympalta) originally used to treat depression and painful diabetic neuropathy, have been found to help FM patients, especially women.

Deficient growth hormone (GH) secretion: Abnormal levels of GH have been found in FM patients, but studies report mixed results when treating FM with GH.

Psychological factors: Strong evidence supports the association of FM and depression. Similarities include neuroendocrine abnormalities, psychological characteristics, physical symptoms and similar treatment benefits using the same approach (medication, counciling, etc.).

Physical Trauma: Trauma can increase the risk of FM. One report found a direct association with neck trauma and increased risk of developing FM.

Small bowel bacterial overgrowth: This can contribute to FM and may explain the association with IBS. The autoimmune response to the presence of bacteria resulting in FM symptoms has been hypothesized in these cases.

CONCLUSION: As previously stated, it is clear that a “team” of providers is needed to effectively treat FM. We’d be honored to be part of your team!

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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Headaches and Chiropractic Care.

14 Dec

Did you know that 9 out of 10 Americans suffer from headaches? There are many different types of headaches with a multitude of symptoms including achy, throbbing, nausea, vomiting, dizziness, numbness, blinding, noise, light and/or odor sensitivity, and more. The causes of headaches can include genetics (familial traits like migraine headaches), stress or tension (probably one of the most common), environmental (allergies, seasonal, bright sunlight, loud noises, certain foods), behavioral (insomnia, excessive exercise, blood sugar problems, depression), and many more.

Environmental factors can “trigger” the onset of a headache. About 95% of headache sufferers have “primary headaches” such as tension, migraine, or cluster headaches. The other 5% may be caused by other physical conditions or problems and the headache serves as a “warning sign” that something else is wrong. The “key” in the 5% of potentially dangerous types of headaches is to pay attention to when there is a rapid onset (“…it came out of nowhere fast!”), if they are very intense, and are “different” from other headaches previously suffered. When nervous system symptoms occur that are unusual for that person, such as lapses in memory, the person is not responding, rapid onset of dizziness, balance disturbance,  and/or a “blinding sharp pain,” these should trigger a warning sign that something specific and potentially dangerous may be causing the headache.

For the main 95% of headaches sufferers, neck tension is a common complaint with the headache. Research supports that spinal manipulative therapy (SMT), the primary form of care utilized by chiropractors, is an effective option for tension headaches. A 2001 Duke University study reported that SMT resulted in almost immediate improvement for those headaches originating in the neck, had fewer side effects, AND longer-lasting relief of tension-type headaches compared to those receiving commonly prescribed medication. Another study found that SMT was effective, not only for relieving the headache, but had a sustained benefit AFTER it was discontinued after a 4-week treatment period. This was NOT seen in a similar tension-type headache group receiving prescribed medication treatment only.

Here is how to help yourself:

Improve your posture: Most of us are “chin pokers” and “slouchers.” The weight of the head pulls on the neck and upper back muscles and when held in that fixed position while driving, typing, watching TV, the static muscle tension can create a headache.

Take “mini-breaks” every 30-45 minutes from static fixed positions and perform some exercises. A good stretch is to reach over to the opposite side of the head and gently pull to stretch the sides of the neck. Repetitively, poke and tuck your chin in & out to stretch different muscle fibers. Then, add flexion, extension and/or rotation to the same movements for about 10 sec./side. Try it now!

Avoid clenching your teeth and shrugging your shoulders. We do these things without being conscious that we’re even doing it. Those static loads play havoc with our neck muscles.

Drink plenty of water – at least 8 oz., 8x/day (more when exercising or pregnant). If you want to be more accurate, take your current weight and divide by 2. (Eg., 130# person = 65oz./day; 190# = 95oz./day).

If you have chronic headaches, COME SEE US! This is what we do, and it helps A LOT!

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, 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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Chiropractic Care of Children.

12 Dec
Dr. Binder & Neela

Dr. Binder & Neela

Chiropractic techniques are not limited to any particular group. We see patients of all ages, sizes, genders, ethnicities, and so on. So, is the care of children “different” than chiropractic care applied to adults? If so, how?

There are studies that review the treatment of musculoskeletal (MSK) conditions such as low back pain, non-MSK conditions such as asthma, and chiropractic care of infants, adolescents, and teenagers for a variety of conditions. The management techniques utilized by chiropractors for children vary across the profession, but typically, they are modified methods of those applied to adult patients. When one thinks of “chiropractic care,” the immediate image is that of spinal manipulation where a high velocity, low amplitude “thrust” is made and joint cavitation occurs (the release of gas creating a cracking sound similar to knuckle cracking). Chiropractic treatment can also include dietary advice, nutritional or herbal supplement recommendations, posture correction, exercise training, and the use of physiological therapeutic modalities (like electric stim, light, ice, heat, traction, ultrasound, and more). Behavioral counselling may be included, depending on the patient’s condition and the individual training the chiropractor has focused on, especially on a post-graduate level. Chiropractors, like many health care providers, have post-graduate board certification options, of which pediatrics is one of many. Looking at research for children and chiropractic, here is what the current literature base supports:

Pediatric care: There is evidence that chiropractic methods, when properly modified and applied, are safe. However, more research is needed to determine what the current practice model should be for this patient group.

Children & adolescents: There is currently research support for treatment of this patient population for some MSK conditions, particularly low back pain. Again, additional, high-quality studies are needed to further support this category.

Non-musculoskeletal care (children & adolescents): Conditions such as colic, otitis media, asthma, nocturnal enuresis (bed wetting), and attention deficit hyperactivity disorder, all require additional high-quality studies before firm conclusions can be made. At present, there is little data to support or refute the effectiveness of chiropractic care for these conditions. However, the authors do recommend that a chiropractor may play a role on the pediatric healthcare team. They suggest that it is appropriate to utilize a four to six treatment “trial” to determine effectiveness of care for a colicky infant where all other serious diagnoses have been excluded. Similarly, in cases of enuresis and asthma, chiropractic may have a role on the management team. A call for more research is a common recurring theme for the management of non-MSK conditions.

ADHD in children and adolescents: One focused systematic review reported the need for more high-quality research in this area before conclusions can be made either for or against the utilization of chiropractic care for ADHD.

Possible adverse effects: In review of (again) limited studies in this area, chiropractic care appears to have little negative issues associated with it. Serious side effects are reported as “rare.”

Bottom line: Though more research is needed, in the absence of underlying pathology, chiropractic care may be considered as part of the pediatric management team for a four to six visit trial to determine treatment effectiveness.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

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Low Back Pain: Surgery vs. Chiropractic?

12 Dec

Low back pain (LBP) is the second most common cause of disability in the United States (US) and a very common reason for lost days at work with an estimated 149 million days of work lost per year. The total cost associated with this is astronomical at between $100-200 billion/yr, of which 2/3rds are due to decreased wages and productivity. More than 80% of the population will have an episode of LBP at some point in their lifetime. The good news is that 95% recover within two to three months of onset. However, some never recover which leads to chronic LBP (LBP > 3 months), and 20-44% will have a recurrence of LBP within one year with lifetime recurrences of up to 85%! What this means is that most of us have, have had, or will have LBP, and we’ll get it again! So the question is, what are we going to do about it?

Surgery has traditionally been considered a “last resort” with less invasive approaches recommended first. Chiropractic adjustments and management strategies have traditionally faired very well when compared to other non-surgical methods like physical therapy, acupuncture, and massage therapy. But, is there evidence that by receiving chiropractic treatment, low back surgery can be avoided? Let’s take a look!

A recent study was designed to determine whether or not we could predict those who would require low back surgery within three years of a job-related back injury. This is a very important study as back injuries are the most common occupational injury in the US, and few studies have investigated what, if any, early predictors of future spine surgery after work-related injury exist. The study reviewed cases of 1,885 Washington state workers, of which 174 or 9.2% had low back surgery within three years. The initial predictors of surgery included high disability scores on questionnaires, greater injury severity, and seeing a surgeon as the first provider after the injury. Reduced odds of having surgery included: 1) <35 years old; 2) Females; 3) Hispanics; and 4) those who FIRST saw a chiropractor. Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! WOW!!! This study supports the FACT that IF a low back injured worker first sees a chiropractor vs. a surgeon, the likelihood of needing surgery in the three years after the injury would be DRAMATICALLY reduced! In fact, the strongest predictor of whether an injured worker would undergo surgery was found to be related to who they saw first after the injury: a surgeon or a chiropractor.

If this isn’t enough evidence, another recent study (University of British Columbia) looked at the safety of spine surgery and reported that (taken from a group of 942 LBP surgical patients): 1) 87% had at least one documented complication; 2) 39% of the 87% had to stay longer in the hospital as a result; 3) 10.5% had a complication during the surgery; 4) 73.5% had a post-surgical complication (which included: 8% delirium, 7% pneumonia, 5% nerve pain, 4.5% had difficulty swallowing, 3% nerve deterioration, 13.5% wound complication); 5) 14 people died as a surgical complication. Another study showed lower annual healthcare costs for those receiving chiropractic vs. those who did not. The “take-home” message is clear: TRY CHIROPRACTIC FIRST!!!

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 both presently and in the future.

 

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Carpal Tunnel Treatment Options.

12 Dec

The goal of any treatment approach for Carpal Tunnel Syndrome (CTS) is to return the patient to normal. That means addressing all OTHER health related conditions that can cause CTS such as diabetes, hypothyroidism, birth control pill use, pregnancy, rheumatoid arthritis (and many of the other related arthritic-like disorders), as well as double or multiple crush (pinched nerve) syndromes. That’s right! CTS can be caused by MANY other conditions besides simply overusing the arms and hands. When overuse PLUS any of the above mentioned conditions “gang-up” on you, managing BOTH is necessary.

One “universal” goal in CTS treatment is to reduce inflammation. This can be accomplished by several approaches: 1) STOP, reduce, and/or modify the causing activity. Examples include repetitive use of a hammer, screw driver, stapler, assembly line work, typing/computer work, driving with a firm grip on the steering wheel, bicycle riding, and MANY more! The key to successful management of CTS is to slow down, stop/rest, and for long-term success, change how the task is performed (modify the work station). 2) Wearing a cock-up wrist splint. This is usually restricted to night time use since we cannot control our wrist position while sleeping and the pressure inside the carpal tunnel “normally” doubles at the extremes of the wrist forwards or backwards. Thus, keeping the wrist straight at night significantly reduces or eliminates the numbness/tingling that can cause multiple sleep interruptions. It can also be worn during the day IF it doesn’t interfere with the person’s activity. If the activity requires frequent bending of the wrist, you’ll end up fighting against the wrist splint and that can actually worsen your CTS! 3) Ice cupping or massage. Freeze water in a Styrofoam or paper Dixie cup (like home-made popsicles) and peel away the top third to expose the ice. Rub it over the palm side of the wrist until you feel numbness. At first, it will feel Cold, followed by Burning, Aching, and finally Numbness (hence the acronym, “C-BAN”). The length of time to achieve numbness is usually three to five minutes, but make sure you quit at the point of numbness as the next stage is frostbite! 4) Anti-inflammatory nutrients. An anti-inflammatory diet is one that is rich in fruits, vegetables, lean meats, omega-3 fatty acids, and avoids glutens, omega-6 fatty acids (fast foods, etc.), and refined carbohydrates (sweets, sodas, etc.). Also, there are many REALLY GOOD nutritional supplements that can effectively reduce inflammation without the typical side-effects that affect the stomach, liver, or kidneys which are common to NSAID drugs like aspirin, ibuprofen, or Aleve. Also, NSAIDs can inhibit an important chemical (a prostaglandin) that is needed for healing, and therefore, it can actually slow down the healing process (so try the nutritional approaches first)! Nutritional options include proteolytic enzymes, Bromelain, papain, bioflavonoid, Vitamin C, Vitamin D, Vitamin E, Coenzyme Q10, and many more.

Treatment options beyond those mentioned above are typically surgical, IF you decide to go to a surgeon. However, chiropractic care includes identifying and treating the source(s) of nerve irritation, as it is often more than just nerve pinching at the carpal tunnel. Other common locations of median nerve entrapment includes the pronator teres muscle in the forearm just past the elbow on the palm side, less often at the shoulder, and again quite frequently in the neck where the nerve exits the spine. If these areas of nerve pinching are not released, recovery is less likely (with or without surgery)! Bottom line, you can always have surgery but you can’t “un-do it.” Try chiropractic first as it’s the least invasive, least costly, and often the quickest way to find relieve from CTS!

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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