Are Headaches and Dizziness a “Dangerous Combination”?

22 Aug

Last month, we discussed some startling new research that found that lightheadedness upon standing up (orthostatic hypotension) may be more serious than previously thought. This month, we’ll look specifically at headache AND dizziness and if we should we be concerned about this combination of complaints and if so, when?

A team of researchers from Johns Hopkins University reviewed past medical records of 187,188 patients presenting to over 1,000 emergency departments (EDs) between 2008 and 2009. They found the combination of headache and dizziness—especially in women, minorities, and young patients—was a potential signal of an impending stroke!

Specifically, they reported that 12.7% of people complaining of headache and dizziness were later admitted for stroke and had been misdiagnosed and inappropriately sent home from the ED within the previous 30 days. Patients were told they had a “benign condition” such as inner ear infection or migraine, and in some cases, they weren’t given a diagnosis at all. Slightly less than half of this population had a stroke within seven days and over half had a stoke within the first 48 hours of the initial pre-stroke ED presentation!

The study reported that women were 33% and minorities 20-30% more likely to be misdiagnosed, suggesting gender and racial disparities may play a role. The researchers estimate that doctors miss 15,000 to 165,000 strokes that result in harm to the patient each year.

Studies have found that the early diagnosis and quick treatment of strokes is critical in reducing serious residuals in patients having a transient ischemic attach (TIA), sometimes referred to as a “mini-stroke” or “pre-stroke.” TIAs are often pre-cursors to a more catastrophic stroke leading to death or permanent disability without appropriate treatment.

Again, to put this in perspective, MANY people present to healthcare providers with headaches and dizziness with NO relationship to stroke—about 87%—though it is sometimes not possible to know whether a potentially dangerous problem may arise in the near future. The good news is that it usually does not!

The importance of this study is to alert both healthcare providers AND patients of the potential risk. When in doubt, it’s ALWAYS best to seek out multiple opinions. An MRI may be the best way to confirm the most common type of stroke (according the study reviewed above), as a CT scan may not show the brain changes early on and could lead to false reassurance.

Doctors of chiropractic commonly see patients presenting with headaches and dizziness. When this occurs suddenly, out of the ordinary, and/or at a relatively young age (women > men), it’s better to be safe than sorry and obtain multiple opinions, especially WHEN IN DOUBT!

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.

Fibromyalgia and Physical Activity

18 Aug

Are there differences in lifestyle between people with vs. without fibromyalgia (FM)?

A recent study found women with FM found spend more time engaged in sedentary behaviors and less time in physical activity. In the study, researchers followed 413 female patients with FM and 188 age-matched healthy female controls. Researchers used three different approaches to access physical activity: a triaxial accelerometer to examine sedentary time, time spent in physical activity, and step counts.

They discovered those who suffered from FM spent an average of 39 more minutes per day in sedentary activity and 21 fewer minutes per day in light physical activity, 17 fewer minutes per day in moderate physical activity, and 19 fewer minutes per day in moderate-to-vigorous physical activity. In addition, those with FM took a mean of 1,881 fewer steps that those without FM.

Now, this isn’t really a surprise given the fact that people with FM are in pain and more likely to have difficulties sleeping and tolerating prolonged activities. After comparing the sufferers to the non-sufferers, the researchers found only 21% of FM patients vs. 46% of non-FM controls achieved the recommended 150 minutes/week (a little over 20 min. / day) of “moderate-to-vigorous” physical activity. They also found that only 16% vs. 45%, respectively, walked the recommended ≥10,000 steps per day.

One of the BEST forms of exercise for most people is walking. A walking program should be a staple exercise. It’s important to note that this should be GRADUALLY introduced so as to avoid an overuse injury—strain or sprain of the muscles and joints. This gradual introduction into activity is ESPECIALLY important for the FM sufferer as overuse injuries can make them afraid to do something that can REALLY help when done correctly!

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

The Most Important Principles for Staying Young: Stem Cell Repair Mechanism

16 Aug

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.

One of everyone’s big hopes is to find ways for your body to use its own stem cells to repair itself. Your body naturally already uses its own stem cells to make you stronger, healthier, and more resistant to the conditions that have the potential to slug away at you day after day and year after year. The problem is, you lose stem cells as you age, whether by using them to repair damaged organs or because they’re destroyed by such toxins as chemotherapy or radiation or oxygen free radicals—leaving you vulnerable to many problems.

A key to slowing aging or reversing it is repairing damage with brand new cells. When you smoke, stem cells are sent to the lungs to respond to the damage that results from each drag of a cigarette. Or when your skin burns from the sun, stem cells go there to make repairs. But— and this is a big but—there are two unfortunate consequences of that repair, and it’s another example of how a valuable process has the power to flip you up-side your head.

First, the more stem cells you send in for repair (say, the more times you burn your skin from lying out by the pool unprotected), the more stem cell reproduction occurs. The more reproduction, the higher the chance that something will go wrong during cell division—meaning that your stem cells have a higher chance of differentiating into a tumor cell. Stem cells know how to replicate quickly, so, boom, you’ve got cancer. (That’s why repeated damage to an organ—via smoking, sunburn, alcohol abuse, or inflammation from saturated fat or just being fat—predisposes you to cancer.) Second, if your stem cells are constantly repairing sunburn, then there won’t be enough of them available to aid in maintaining your other organs.

Stem cells come in two varieties: Blastocysts (often mistakenly called embryonic, a charged word that has created a political and moral brouhaha) and Progenitor cells (also called adult stem cells): These adult stem cells retain the ability to grow into other kinds of cells. Why is this so exciting from a medical and scientific perspective? If your own stem cells—the cells you currently have—can be used to regenerate new tissue to replace broken-down or diseased tissue and fix your own organs, then you have the opportunity to punch frailty right in the face.

One of the goals of stem cell research is to harvest some of these universal cells, grow them in laboratories, and then use them to undo the damage done by such things as heart attacks, strokes, diabetes, Alzheimer’s, and many other diseases associated with aging. How do we know that this process has potential? Well, just look at the work that’s been done on the heart.

Cardiology was one of the specialties most resistant to the potential power of stem cells, and the damaged heart was considered to be a representative of the key organs that could not regenerate themselves. In research involving heart transplant, scientists studied groups of men who received a female heart (in heart transplantation, the sex of the heart doesn’t matter, but, rather, the size). In theory, the cells of a female heart, when transplanted into a man, should have only their original double- X chromosomes, with no male Y chromosomes in them at all. But when researchers examined the hearts only a few months after transplantation, they actually found Y chromosomes in the heart—meaning that the male stem cells were migrating from the bone marrow to the heart to make periodic repairs. Similar reinvigoration of almost all of your organs continually occurs with your own full- time stem cell repairmen.

In a recent story that you may have seen in the non-medical press, researchers found people who had lost some mobility following a stroke could recover substantial motor and brain function when their own adult stem cells (increased in numbers when grown in culture) were injected into the parts of the brain damaged by the stroke.

Thanks for reading. 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)

Carpal Tunnel Syndrome – Can it Be Prevented?

15 Aug

Carpal Tunnel Syndrome (CTS) is a VERY common condition where the median nerve is compressed or squeezed as it passes through the wrist. One reason that it’s so common is because MANY daily activities require fast, repetitive use of the fingers, hands, and arms, and the friction of the rapidly moving muscle tendons inside the tunnel results in swelling and compression of the nerve. So, can CTS really be prevented?

There are many factors associated with CTS, and some risks can be prevented. For example, some conditions like diabetes, rheumatoid arthritis, and IBS increase the risk of CTS. Therefore, it would be safe to assume those who better manage such conditions would have a lower risk for developing CTS.

Due to the many factors associated with CTS, there is no “one size fits all” when it comes to treatment and prevention of CTS. With that said, here are some VERY effective methods:

1) Ergonomic workstation modifications: Altering the work space (monitor height, keyboard/mouse style, different chair, chair/desk height, etc.) to reduce the number and speed of movements needed to perform commons work tasks.

2) Rest periods: Insert “micro-breaks” into a busy task. Combine breaks with stretching exercises of the wrist/hand/fingers and vary job tasks between fast and slow repetitive types.

3) Exercise: Shake the fingers and hands, lean back in a chair with the arms/shoulders stretched back (“Brugger’s Exercise”), move the neck (chin tucks, rotations, etc.), bend the hand/wrist backwards on a wall or the desk’s edge, self-massage and deep tissue release of the forearm and hand muscles. Do regular aerobic exercise (walking, swimming, biking, etc.) several times each week.

4) Posture: Sit up straight, elbows about 90° on height-adjustable arm rests or comfortably at the sides, forearms parallel to the floor; knees level or slightly lower than the hips, feet flat on the floor or on a footrest or box, if needed. Place typing materials at eye level / avoid prolonged head/neck rotation. Use a wrist rest for the keyboard and mouse, and use a headset when on the phone.

5) Reduce hand tool forces: Choose a tool that allows the wrist to remain neutral. Avoid side to side and flexion/extension wrist positions—especially if they’re prolonged! Tool handles should NOT dig into the palm of the hand or the wrist, and should not have sharp edges. A textured handle can improve grip. Minimize vibration from power tools. Wear shock absorbing gloves. Avoid cold work environments and cold tools.

6) Diet: Cut down on caffeine and smoking. Avoid obesity—a known risk factor of CTS! Consider an anti-inflammatory diet (Paleo, Mediterranean).

7) Splints: A wrist cock-up splint at night prevents prolonged faulty positions and REALLY helps!

This is a partial list of preventative measures that can REALLY help. Doctors of chiropractic treat the WHOLE person and can teach you the right exercises, ways to modify your diet, offer manual therapies and modalities, and help guide you in your self-management of CTS, as this can be a lifelong affliction. A multi-modal treatment approach generally works best!

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.

Best Exercises for Chronic Low Back Pain (Part 1)

11 Aug

Based on simple statistics, we’ve ALL had (or at least will have) some form of low back pain (LBP) at some point in our lives. The term “chronic” applies to LBP that’s been present for at least three months. It has been consistently reported that LBP becomes increasingly difficult to resolve when it persists for three or more months. This month’s topic is about which exercises have been found to BEST address chronic low back pain (cLBP).

Many studies have investigated the effects of stabilization exercises in patients with chronic low back pain. In a review of six recently published studies that followed patients over a four to sixteen week time frame, investigators noted that participants who engaged in exercise (the use of a Swiss ball, floor or “land-based” exercises, sling exercises with some focusing on the abdominal muscles while others looked the extensors) reported improvements in pain and disability that were not seen among those in the non-exercise control groups. Additionally, one study also looked at changes in bone density between both groups and found increased bone density in the exercise group and a reduction in bone density among participants who refrained from exercise. Another study reported waist isometric strength increases in their exercise group.

One study found the cross section of the multifidus (MF) muscles—the deep low back, fine motor muscle groups that is considered to be one of the most important targets for low back strengthening—significantly increased after eight weeks of exercise. Another study observed the same effect for the deep transverse abdominis muscles.

These and other studies clearly show that core stabilization exercises can improve pain and disability scores in patients with cLBP, while those who do not exercise do not improve and in fact, may actually worsen! So, what are core stabilization exercises?

Here are some Swiss ball options (try 5-10 times and increase reps/hold times as you improve your strength):

1) Sitting pelvic tilts – This can be done with both feet (or eventually one foot when you’re ready for an added challenge) on the floor while rocking the pelvis front to back, left to right, or in a circular or “figure-8” manner.

2) Bridge – Start sitting and then walk out so the ball is between the shoulder blades. Keep your trunk parallel to the floor. Push your heels into the floor to activate the hip extensors (buttock muscles) and then walk back up to a sitting position. You can further challenge your balance and hip extensor strength by raising one leg.

3) Sit-ups – Start sitting and roll halfway back and hold it for different lengths of time.

4) See-Saw – Hug the ball and roll out into a push up position. Position the ball under your pelvis and lift one leg at a time towards the ceiling. Alternate between the left and right legs. You can do BOTH legs together once you get used to this to make it more challenging.

There are MANY other Swiss ball exercises, but these are some good ones to start with. Next month, we’ll look at similar floor or land-based pelvic stabilization exercises!

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.

Positive Emotions Can Improve Memory

9 Aug

The way we understand learning has changed quite drastically over the years.  One big change has been moving away from stressful, pressured rote memorization to a cognitive and fun thought process.  The process of thinking through a situation and actively coming up with a solution is much different than simply memorizing dates and names.  The results are also much different when the student is actively engaged because they are having fun and being rewarded, versus being forced to achieve a result out of fear of punishment.  While this all makes sense, is there any proof?  Well, a new study adds evidence to the power of positive emotion in learning.

According to Science Daily:  “Combining a positive emotional component with a given stimulus promotes memory for future stimuli of the same type, report scientists.  Rewarding learning today can improve learning tomorrow; this is one of the conclusions reached by researchers from the Cognition and Brain Plasticity research group of the Institute of Biomedical Research of Bellvitge (IDIBELL) and the University of Barcelona (UB) in their last work on the impact of emotions on the way we remember things. The study, published in the Neurobiology of Learning and Memory journal, demonstrates for the first time in humans that the effects of the association of positive emotions in the process of acquisition and consolidation of memories extend selectively and prospectively over time.”

Here is what lead researcher Dr. Javiera Oyarzún had to say, “Our brain works as a sorting machine. Every time we expose ourselves to a stimulus, our brain sorts it out in a category, such as people, animals, objects, etc. This way, whenever we receive new information we can integrate it with similar available information thanks to our ability to generalize, and then anticipate our responses to similar stimuli that may occur in the future.  When storing these stimuli, it is known that emotionally charged events are remembered better than neutral events. For example, we usually do not remember the details surrounding our usual way back home, but if during that time we receive a phone call with good news, or we witness a car accident, we will remember those details with much more precision.” 

In one part of the experiment, researchers showed subjects pictures in different categories. For one particular category, the participant received a reward every time it was shown to associate those particular images with a positive action. As expected, the participants remembered images linked to rewards much better. However, the positive effects that rewards have on memory were not seen until about 24 hours later, suggesting that sleep may play an integral part that is necessary for the memory enhancing effects to take place.  So, is it better to tell a child to get an “A” or he or she is grounded or if they get an “A” they will get something they really want?    According to this study… the latter is probably the way to go.

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