The “TOP 10” FACTS of Fibromyalgia!

29 Sep

What are the ten most important attributes of fibromyalgia (FM)? Let’s take a look!

  1. FM definition: It’s characterized by widespread muscular pain and tenderness (in all four of the body’s quadrants) that’s NOT caused by inflammation or joint damage.
  2. FM can be primary or secondary: Secondary FM is caused by something else (often after trauma) in association with another disorder like rheumatoid arthritis (RA), irritable bowel syndrome (IBS), lupus, chronic fatigue syndrome, and more. Primary FM has no known association with another condition.
  3. FM is OFTEN chronic: Because FM is diagnosed by EXCLUDING other conditions, it’s often left undiagnosed for years! To further complicate this, when a person has a diagnosed condition such as Lyme disease, RA, etc., those conditions get all the attention and FM is left undiagnosed. In fact, the National Fibromyalgia Association reports that it takes about an average of five years to get an accurate diagnosis of FM!
  4. Sleep & Chronic Fatigue: A reported 90% of FM patients suffer from severe fatigue or a sleep disorder. Non-restorative sleep contributes significantly to fatigue and poor cognitive function, and is a hallmark of FM making it an important problem to address in treatment.
  5. FM Symptoms are many: Headache, IBS, memory problems, TMD (jaw pain), pelvic pain, noise-light-temperature sensitivities, restless leg syndrome (RLS), depression, and anxiety are ALL associated issues with FM (more reasons for a delayed diagnosis and treatment challenges)!
  6. FM includes both physical and psychological aspects: One study of 307 FM patients followed over an eleven-year time frame found that 33% had severe physical and psychological problems, another 1/3 had mild issues with both, and the last third had only mild physical symptoms.
  7. FM is HIGHLY VARIABLE: With the widespread pain, variable disability rates, variable physical and psychological aspects (see #6 above), and symptom/condition variability (see #5 above), a treatment approach to manage FM must be individualized! There is no “recipe” for managing FM!
  8. FM Tests: There are none! Diagnosing FM relies on the patient’s history of widespread pain and associated disabilities more than the physical exam, blood tests, and x-rays which are used to help “rule-out” other disorders.
  9. FM Treatment: The “best” management strategies for FM include a multi-disciplinary “team” of providers including primary care (medications), chiropractic (manual therapy, nutrition, exercise training), clinical psychology (depression/anxiety management), and other forms of treatment such as massage therapy, acupuncture, and meditation / relaxation therapy. Programs that are individualized work the best! The patient MUST BE an active participant who is willing to do the work!

    10. “Stats” about FM: First of all, it’s common! It affects women more than men, and about 2-4% of the population overall. What is left out of the stats is the intensity of symptoms, how well each patient responds to the different management strategies, and the patient’s coping skills with this chronic, sometimes totally disabling condition (see #6 above). Other “facts” about FM include: increased “substance P” (a chemical that increases nerve sensitivity), decreased blood flow to the thalamus (brain), hormone imbalances, low levels of serotonin and tryptophan, and abnormal cytokine function….and more!

REMEMBER as stated in #9, the “team” approach yields the BEST RESULTS!

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

The Great Challenge: Chiropractic Adjustments vs. Acupuncture vs. NSAIDs!

29 Sep

Wouldn’t it be nice if we could assess three common types of treatment for neck and back pain to determine which is the most effective? Here is a look at three studies that compared three popular forms of care for chronic spinal pain to determine the short-term and more importantly, the LONG-TERM benefits of chiropractic manipulation, acupuncture, and non-steroid anti-inflammatory drugs (NSAIDs, like Advil).

The FIRST published study included a pilot group of 77 patients complaining of chronic spinal pain (neck, mid-back, or low-back pain). These patients were separated into one of the three treatment groups and received either NSAIDs, acupuncture, or chiropractic manipulation. Patients received care for four weeks with outcome measures (questionnaires) used to assess changes in pain and disability. After a 30-day time frame, only patients who received chiropractic manipulation (CM) reached a level of statistically significant improvement, supporting CM to offer the best SHORT-TERM BENEFITS for those with chronic back/neck pain.

The SECOND study included 115 patients, again randomized, to receive either one of the same three treatments, but this time the outcome data was gathered two, five, and nine weeks after the start of treatment. Again, those who received chiropractic manipulation (CM) experienced the best overall improvement at nine weeks.

The THIRD study involved follow-up from the same patient group from the SECOND study two years later. Once again, participants completed outcome assessments that measure pain and disability. This time, the results showed that only patients in the chiropractic manipulation group maintained long-term improvements in pain and disability.

There have been other studies looking at the efficacy and benefits of SMT (spinal manipulative therapy) both in comparison with other forms of care (as presented here) as well as with different conditions or diagnoses. Perhaps the most exciting results were published in 2008 by the International Bone and Joint Decade 2000-2010 Task Force on Neck Pain. They divided patients into four groups (Group 1: Neck pain with little to no interference with activities of daily living – ADLs; Group 2: Neck pain that limits ADLs; Group 3: Neck pain with radiculopathy or radiating arm pain from a pinched nerve; Group 4: Neck pain with serious pathology such as cancer, fracture, infection, and/or systemic disease.) The researchers concluded that chiropractic care was highly recommended especially in Grades 1 and 2 (which includes the majority of neck pain sufferers). Interestingly, many multidisciplinary physician groups now incorporate chiropractic care as part of their “team” approach, which also offer pain management in the form of medications, injections, PT, and when necessary, surgery. They have seen the value of spinal manipulation for neck pain and often seek out chiropractic because it’s safe, beneficial, and cost effective!

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.

How Much Cancer Can Be Prevented By a Healthy Lifestyle?

28 Sep

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, we want to discuss a question sent by a reader of my new book, This is YOUR Do-Over: The Seven Secrets to Losing Weight, Living Longer, And Getting A Second Chance at the Life You Want (shameless plug—you can order it at Amazon.)  You can send us questions anytime to youdocs@gmail.com, just put the words “Question for Dr. Mike Roizen to answer” in the subject line and I’ll try to get to it.

Q) Why Are People in Developed Countries Developing More Cancer and What Can I Do To Prevent Cancer in Myself?

A) The average North American eats over 130 pounds (~59 kg) of added sugars and syrups annually and consumes more than 60 pounds (~27 kg) of saturated fat-laden red meat. Plus, the average American household has more television sets than people! No wonder 70% of North Americans are overweight or obese and cancer is the second leading cause of death. A massive new study published in JAMA Oncology online really brings that last point home!

It reveals that 62% of tracheal, bronchus, and lung cancer cases worldwide happen in developed countries, as do 78% of leukemia cases and 63% of breast cancer, 77% of stomach cancer, 86% of liver cancer, 85% of cervical cancer, 84% of esophageal cancer cases.

Clearly, a convenience-driven lifestyle that leads one to be overweight and inactive isn’t doing you any favors.

At least half of all cancers can be avoided if you maintain a healthy weight, get regular physical activity, and (of course) don’t smoke.  One study followed 500,000 Americans for over a decade and found adopting just those three cancer-fighting strategies reduced their risk for colon cancer by up to 48%.

It may be possible to cut your risk for cancer by up to 80-90% if you also manage stressful events more effectively, eat no added sugars or foods with saturated or trans fats, don’t drink excessive amounts of alcohol, get appropriate cancer screenings, and avoid exposure to secondhand smoke. (These were the findings of the Swedish Men’s study and the Nurse’s Health study in the United States.)

And if you’ve been making smart lifestyle choices and you are diagnosed with cancer (it can happen to even the most conscientious person), your chances for a good outcome skyrocket.

So, don’t let the phrase “developed countries” mean that’s where folks develop cancer! Instead, develop a plan to make your lifestyle a cancer fighter and follow it.

Young Dr. Mike Roizen (aka, The Enforcer)

Why Should I Exercise For Carpal Tunnel Syndrome?

27 Sep

Carpal Tunnel Syndrome (CTS) is an EXTREMELY common condition that can affect anyone at any age. In fact, there’s a strong probability that up to 50% of the people reading this today have or have had symptoms of CTS at some point in time and 10% or more have been treated for it! We have recently discussed various non-surgical treatment approaches for managing CTS but the question of WHY exercises should be included in that program remains a mystery to many!

In review of the anatomy of the carpal tunnel, we’ve got nine tendons that are the “shoe strings” that connect the muscles in the palm-side forearm to the fingers traveling through the tunnel along with the infamous MEDIAN NERVE — the culprit creating the numbness and tingling associated with CTS. The bony “roof” of the tunnel is made up of eight carpal bones that connect our forearm to our hand and allow us to bend the wrist in many directions. Without these eight little bones, we would not be able to bend our wrist at all! The “floor” of the tunnel is the transverse carpal ligament, and the median nerve lies directly on top of it. CTS occurs when the contents within the tunnel swell and apply pressure that pushes the median nerve into the floor, which is common when the wrist is bent, such as when sleeping with our hand curled under our chin at night – hence the reason for a night splint (cock-up brace) to prevent nighttime bending.

Now that we have a picture of the tunnel in our mind, exercises for CTS will make more sense. CTS occurs when forceful, repetitive tasks are performed over a lengthy period of time (examples include practicing a musical instrument, assembly line work, carpentry, etc.). The FRICTION between the tendons (“shoe strings”) inside the tunnel creates swelling and that results in tightness.

EXERCISE #1 is ICING using an ice cube or frozen Dixie cup of water and rubbing it over the tunnel. First you will feel COLD, then BURNING, then ACHING, and finally NUMBNESS (“C-BAN”). Quit at numbness as the next stage of cooling is frostbite! Many of you may not look at “ice massage” as an exercise, but it’s very important!

EXERCISE #2 – Stand near a countertop, place the palm-side of your fingers on the edge of the counter and push until your wrist is bent backwards as far as you can stand it while keeping your elbow straight. Now reach across with your other hand and pull your thumb backwards as far as possible. Can you feel the “pull” in your mid forearm up to the elbows? GOOD! Hold that for three to five seconds, rest for five seconds and repeat it three times. Do this on both sides, even if the other hand is “normal” so you can feel the difference between the “tight” CTS side vs. the normal arm. CTS is often bilateral so you may not notice a difference. Now, set the timer on your smartphone to ring every hour to remind you to do this throughout the work day.

EXERCISE #3 is the fist / “bear claw” / hand open sequence. First, make a tight fist, followed by opening your hand while keeping the fingers flexed/bent, followed by opening the hand and fingers fully. Hold each position for two to three seconds and go through the sequence as often as needed (usually two to three times a session, multiple times a day) and do BOTH sides at the same time.

Why do these help? They break up adhesions between the tendons, their sheaths, and the surrounding tissues, and these exercises also force you to take “mini-breaks” during a busy day, which can reduce swelling in the carpal tunnel.

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.

Is Sitting BAD for My Back?

25 Sep

A major manufacturer of workstations reports that 86% of work computer users have to sit all day, and when they do rise from sitting, more than half (56%) use food as the excuse to get up and move. In addition to sitting at work, for meals, and commuting to/from work, 36% sit another one to two hours watching TV, 10% sit one to two hours for gaming, 25% sit one to two hours for reading/lounging, and 29% use their home computer for one to two hours. In summary, the average American sits for thirteen hours a day and sleep for eight hours. That’s a total of 21 hours a day off their feet!

The manufacturer’s survey also notes 93% of work computer users don’t know what “Sitting Disease” is but 74% believe that sitting too much can lead to an early death. “Sitting Disease” represents the ill-effects of an overly sedentary lifestyle and includes conditions like “metabolic syndrome” (obesity and diabetes), which is rapidly becoming more prevalent, especially in the young – even in adolescence and teenagers! Recently, the American Medical Association (AMA) adopted a policy encouraging employers, employees, and others to sit less citing the many risks associated with sitting including (but not limited to): diabetes, cancer, obesity, and cardiovascular disease. Standing is SO MUCH BETTER as it burns more calories than sitting, tones muscles, improves posture, increases blood flow, reduces blood sugar, and improves metabolism. Standing is frequently overlooked as “an exercise” and it’s both simple and easy to do!

So, what about the low back and sitting? You guessed it – sitting is hard on the back! The pressure inside of our disks, those “shock absorbers” that lie between each vertebra in our spine (22 disks in total) is higher when we sit compared with simply standing or lying down. It’s estimated that when we lay down, the pressure on our disks is the lowest at 25mm. When lying on one side, it increases to 75mm, standing increases disk pressure to 100mm, and bending over from standing pushes disk pressure to 220mm. When we sit with good posture, our disk pressure may reach 140mm but that can increase to 190mm with poor posture. To help relieve the pressure on our disks, experts recommend: 1) Getting up periodically and standing; 2) Sitting back in your chair and avoiding slouched positions; 3) Placing a lumbar roll (about the size of your forearm) behind the low back and chair/car seat; and 4) Changing your position frequently when sitting.

Because certain low back conditions “favor” one position over another, these “rules” may need modification. For example, most herniated disk patients prefer low back extension while bending over or slouching hurts. In those with lumbar sprain/strains, bending forwards usually feels good and extension hurts. Modifying your position to the one that is most comfortable is perhaps the best advice.

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

Can Yoga Help Patients with Chronic Pain?

15 Sep

Chronic pain is one of the most common complaints in the developed world. One of the biggest problems with chronic pain is its effect on the brain, both physically and emotionally. “Psychic exhaustion” is a term often used to describe this crippling effect. In fact, a study done at the Stanford University School of Medicine identified a set of changes in key parts of the brain that may explain chronic pain’s capacity to stifle motivation. Dr. Robert Malenka, the co-director of the Stanford Institute for Neuro-Innovation and Translational Neuroscience writes, “With chronic pain, your whole life changes in a way that doesn’t happen with acute pain. Yet this absence of motivation caused by chronic pain, which can continue even when the pain is transiently relieved, has been largely ignored by medical science.”

Dr. M. Catherine Bushnell, a scientific director at the National Institutes of Health notes, “Imaging studies in multiple types of chronic pain patients show their brains differ from healthy control subjects. Studies of people with depression show they also have reduced gray matter, and this could contribute to the gray matter changes in pain patients who are depressed. Our research shows that gray matter loss is directly related to the pain when we take depression into account.”

So, what does yoga have to do with chronic pain? Dr. Bushnell adds that studies show yoga practitioners have more gray matter than non-yoga practitioners in multiple brain regions, including those involved in pain modulation. She adds, “Some gray matter increases in yogis correspond to duration of yoga practice, which suggests there is a causative link between yoga and gray matter increases.” If further research confirms yoga benefits the brains of people who already have chronic pain, someday doctors may prescribe yoga to this class of patients as part of their overall treatment strategy.

← Older Entries
Newer Entries →