Tag Archives: mechanicsburg pa chiropractor

Fibromyalgia Diagnosis: A Breakthrough!

12 Dec

Confirming the diagnosis of fibromyalgia (FM) is challenging, as there are no blood tests to verify accuracy of the diagnosis like so many other disorders. However, blood tests are needed when FM is suspected to “rule in/out” something else that may be mimicking FM symptoms. Also, FM is often associated with other disorders that are diagnosed by blood testing, so it is still necessary to have that blood test. So what is the CURRENT recommendation for diagnosing FM?

The American College of Rheumatology (ACR) developed criteria for diagnosing FM in 1990 and has updated it since then. The original 1990 criteria included the following: 1) A history of widespread (whole body) pain for three months or more; and 2) The presence of pain at 11 or more of 18 tender points which are spread out over the body. The main criticism regarding this approach has come from the poor accuracy and/or improper methods of testing the 18 tender points. As a result, this examination portion of the two main criteria has been either skipped, performed wrong, or mis-interpreted. This left the diagnosis of FM to be made based on symptoms alone. Also, since 1990, other KEY symptoms of FM have been identified that had previously been ignored including fatigue, mental fog (“cognitive symptoms”), and the extent of the body pain complaints (“somatic symptoms”).

As a result, it has been reported that the original 1990 approach was too strict and inaccurate because too many patients with FM were missed – 25% to be exact – by using this method. In 2010, the diagnostic approach was modified by using two different questionnaires: 1) The “Widespread Pain Index” or (WPI), which measures the number of painful body regions; and 2) the development of a “Symptom Severity” scale (SS). The MOST IMPORTANT FM diagnostic variables included the WPI score and scores of “cognitive symptoms,” which includes the “brain fog” common with FM, unrefreshed sleep, fatigue, and the  number of “somatic symptoms” (other complaints). The Symptom Severity scale (SS) incorporates these four categories and is scored by adding the totals from each category.  By using both the WPI and the SS, they correctly classified 88.1% of FM cases out of a group of 829 previously diagnosed FM patients and non-FM controls!

What’s important is that this NEW approach does NOT rely on the “old” physical exam requirement of finding at least 11 of 18 tender points. Because FM patients traditionally present with highly variable symptoms, removing the challenge of determining the diagnosis by physical examination is very important! Plus, now we can TRACK the outcomes of the FM patient to determine treatment success both during and after care. Since the 2010 approach has been released, it has been published in multiple languages and is starting to be used in primary care clinics. Recently, in July 2013, a study reported that the Modified ACR 2010 questionnaire is highly sensitive and specific for diagnosing FM, and its future use in primary care was encouraged. What is most exciting about this is that a referral to a rheumatologist may not be needed since this tool can be easily administered by primary care physicians, which include chiropractors!

In past health updates, we have discussed the need for a “team” of health care providers to best manage the FM patient. This multidisciplinary approach offers the FM patient multi-dimensional treatment strategies that encompass manual therapies, physical therapies, nutritional strategies, pharmacology, exercise, and stress management, cognitive management, and behavioral management. Now, with the release of the Modified ACR 2010 criteria, we can diagnose FM more accurately, track progress of the patient, and make timely modifications to the treatment plan when progress is not occurring. This is a “win-win” for the patient, providers/health care team, and the insurer!

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

 

Tags: , ,

Neck Pain and Chiropractic.

12 Dec

Neck pain represents a major problem for people throughout the world with considerable negative impact on individuals, families, communities, health care systems, and businesses. Up to 70% of the general population will have neck pain at some point in their life. Recovery within the year from neck pain ranges between 33% and 65%, AND relapses are common throughout the life time of the neck pain patient. Generally, neck pain is more common in women, higher in high-income countries, and higher in urban regions. The greatest risk of developing neck pain occurs between 35 and 49 years of age. Since neck pain, very similar to low back pain, is very common and likely to recur over and over again, the question is, what is the best course of action regarding treatment?

A recent study on neck pain patients compared the effectiveness of manual therapy performed by a chiropractor, physical therapy performed by a physical therapist (PT), and medical care performed by medical physician (MD). The success rate determined at the seventh week was TWO TIMES BETTER for the manual therapy/chiropractic group (68.3%) compared to the medical care group. Those receiving manual therapy also had fewer absences from work compared to both the medical and PT treated groups. Lastly, both the manual therapy and PT groups used less pain relief medication compared to the medically treated group. Another study looked at the multiple approaches that chiropractors use for treating patients with neck pain to determine the “best” approach a chiropractor can use. They reported 94% had improvement or less neck pain after just one treatment when the mid-back (thoracic spine) was also adjusted. Similarly, after receiving two treatments over a one week time frame, the group receiving midback adjustments (vs. the group who did not) reported lower pain and disability scores. A similar study concluded that the best results occurred when the neck, upper back/lower neck, and mid-back were adjusted. This group, when compared to neck adjustments alone, reported greater reductions in disability scores. Thus, having the cervical spine, upper back, and mid-back all adjusted appears to yield quicker, more satisfying results than neck adjustments alone.

What about the role of exercise in the management of neck pain patients? In November 2012, a systematic review of manual therapies for nonspecific neck pain reported that the addition of neck exercises to a treatment plan provided more benefits than spinal manipulation alone. Similarly, in September 2012 (The Annals of Internal Medicine), chiropractic adjustments were compared against exercise and pain medication treatment groups involving 272 patients tracked over a one-year time frame after a 12-week treatment. Both the chiropractic and exercise groups experienced the most significant pain reduction when compared to the medication treated group with more than double the likelihood of complete pain relief. The chiropractic and exercise groups also had the best short and long term results, but ONLY the chiropractic group found the benefits to last a year or more. The authors (Bronfort, et. al) reported the success of chiropractic treatment stems from its ability to address the CAUSE of the problem rather than simply addressing the symptoms!   

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck 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.

 

Tags: ,

Whiplash “Basics.”

12 Dec

Whiplash is a non-medical term typically describing what happens to the head and neck when a person is struck from behind in a motor vehicle collision. Let’s look at some basic facts about whiplash:

Before cars, trains were the main source of whiplash and was called “railroad spine.”

Better terms for whiplash injuries include “cervical acceleration-deceleration” (CAD) which describes the mechanism of the injury, and/or the term “whiplash associated disorders” (WAD), which describes the residual injury symptoms.

Whiplash is one of the most common non-fatal injuries involved in car crashes.

There are over one million whiplash injuries per year due to car crashes alone.

An estimated 3.8 per 1,000 people per year have a whiplash injury.

In the United States alone, 6.2% of the population has “late whiplash syndrome” (symptoms that do not resolve at one year).

1 in 5 cases (20%) remain symptomatic at one year post-injury of which only 11.5% returned to work and only 35.4% of that number returned to the same level of work after 20 years.

The majority of whiplash cases occur in the fourth decade of life, females>males.

Whiplash can occur from slips, falls, and brawls, as well as from horse-riding, cycling injuries, and contact sports.

Injury from whiplash can occur at speeds of 15 mph or less.

In the “classic” rear end collision, there are four phases of injury (time: 300msec)

Initial (0msec) – before the collision (the neck is stable)

Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the original position but the trunk is moving forwards by the car seat. This is where the “S” shaped curve occurs (viewing the spine from the side).

Extension (150-200msec) – the whole neck bends backwards (hopefully stopped by a properly placed head rest).

Rebound (200-300msec) – the tight, stretched muscles in the front of the neck propels the head forward immediately after the extension phase.

We simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer.

Injury is worse when the seat is reclined as our body can “ramp” up and over the seat and headrest. Also, a springy seat back increases the rebound affect.

Prompt treatment is better than waiting for a long time. Manipulation is a highly effective (i.e., COME SEE US!) treatment option.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, 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.

 

Tags: , , ,

Don’t Wash Your Chicken!

11 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.

Don’t Wash That Chicken:  A new campaign, “Don’t Wash the Chicken,” (it’s not a joke, Google it) was launched by researchers at Drexel University to alert you to the risks of washing raw chicken before you plop it in a pan to cook. Most people do that to remove contamination. But, rinsing the bird can splash Salmonella or Campylobacter bacteria or both onto adjacent surfaces, cutting boards, knives, plates in your sink, and other food. Around 200,000 folks a year come down with at-home food poisoning caused by those bacteria and have to deal with diarrhea, fever, cramps, and vomiting.  Or worse, hospitalization and risk of serious (even deadly) side-effects.

Tip for the day? Just unwrap, cut, and cook your chicken at 165 degrees in its deepest areas (you’ll need a meat thermometer—and afterwards wash that thermometer well too, but carefully so as not to splash). All raw meat has bacteria on it, and proper cooking wipes ’em out.  Wash any surface the chicken did touch with soap (it’s a great bacteria slayer), or Clorox and water. Store chicken and all meats in individual (double) plastic bags in the fridge to avoid leakage!

Other food safety tips:

Keep raw chicken meat separate from produce, and keep each variety of produce separate from others.

Maintain a fridge temp of 40°F or lower.

Wash your hands with soap and water for at least 20 seconds after handling food or when switching from handling one type of food to another.

Maybe next month we’ll do more on food safety, but I want to give you a follow up on the potential Alzheimer’s breakthrough we recently wrote about (many of you sent us emails asking for a follow-up). Bexarotene and Alzheimer’s Follow Up… Last year, March I think it was, I wrote:

“[Probably] no subject is more emotional to women and important to men than keeping your memory and brain functioning. So it was with interest that I got an email forwarded from my wife with the subject line “Alzheimer’s Breakthrough!” Now, I didn’t even bother to open that email for a day because I have seen that type of headline before and such a subject usually mean BS (bad science). But I WAS BLOWN AWAY.   I couldn’t believe the study – Three different mice models of Alzheimer’s disease treated to an already approved FDA drug given by gavage (that is pushed down into the stomach of the test mice like you would take a pill); and their beta amyloid plaque melted away.  More importantly, the mice had return of cognitive function, or at least as best as that can be tested in mice.  And such was based on a predicted response by the drug in turning on the Apo E gene.  As it was an approved drug, we may know very quickly if this works in humans.” 

Since March of last year, Bexarotene has undergone trials in several other laboratories to see if these results could be replicated before it went into human trials. Like many things, there were mixed results. Half the time, there was a decrease in some anatomic markers of Alzheimer’s (often not plaque size but commonly the amount of soluble amyloid in the brain).  Better than that, there appeared to be improvements in cognitive function in the one study that tested it (these studies were reviewed in Nature in May of this year). There was enough uncertainty that it was unclear whether or not human trials would proceed… But, since this is a devastating disease with no drug that gets at the basis of the ailment, the Cleveland Clinic Las Vegas Lou Ruvo Center on Brain Health is starting a study of 20 patients to see if any biomarker by radiograph (sensitive scans are now available that can measure plaque burden), and/or cognitive testing improvements can be detected.  If so, pharma firms may look for a relative of Bexarotene to bring to market because this drug, while approved for use for some lymphomas, has some pretty serious side effects.  Jeff Cummings, MD, PhD is leading the study group.  Keep reading these columns, we’ll keep you informed, and thanks for reading. 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.

 

Tags: , ,

Chiropractic “Wholistic” Care.

11 Dec

A chiropractor’s role in treating a person is not limited to only addressing their musculoskeletal system. In fact, it is best to use the “triangle of health” concept with patients. There are three equal sides to address: the “physical,” the “emotional,” and the “chemical” aspects of health and well-being. If any ONE of the three sides becomes distorted or out of balance, all three aspects of health are negatively affected. Although chiropractic typically embraces the “physical” aspects of the person, care must also help bring the emotional/spiritual side AND the chemical side into balance. These three aspects of health do not exist by themselves. The triangle of health approach follows the recommended treatment guidelines known as the “biopsychosocial model” of health care. We do not have the luxury of separating these three aspects of health, and each patient who presents with low back pain, neck pain, headaches, a rotator cuff strain, or a knee injury must be managed wholistically in order to obtain optimal and satisfying outcomes/results. Frequently, there are barriers that can block or prevent a person from improving in a timely manner. Since each person is different, there is no way of knowing what barriers (if any) exist that may prevent them from recovering as one would expect. When this occurs, it’s usually because some other aspect of their health is preventing their condition from improving or resolving. The focus today is on the “chemical” side of the triangle of health and the associated chiropractic management strategies.

Using a case study approach, let’s say a patient presents with “typical” localized low back pain (LBP). During the course of the initial evaluation (which includes a “review of systems” that tells us about their general health), in addition to their low back problem, we find out that they have other health issues that include headaches, difficulty sleeping, flushing of the skin, muscle aches, tenderness and weakness, general fatigue, drowsiness, dizziness, nausea or vomiting, abdominal cramping/pain, bloating/gas, diarrhea and/or constipation, and they have a rash. They are also complaining of memory loss, mental confusion, and have high blood sugar (Type II diabetes). This type of patient may NOT improve to a satisfying level because of the other health issues creating a barrier, blocking recovery from their LBP. So HOW do we figure out what’s going on? We sometimes perform blood tests and/or work with other health care providers who do. That may be a good place to start. Also, many times, people have had blood work done recently and we can simply send a signed release and obtain a copy of the records, including their blood work.

We’ll also gather a list of their medications and can look for side effects or drug interactions. This may be important, especially when so many complaints involving multiple systems are present. In this case, we’d look to see if they have elevated LDL’s (“bad” cholesterol), a high HDL level (“good” cholesterol), or are taking a medication like Lipitor (a statin medication that reduces cholesterol). If there is myositis (muscle pain caused by inflammation), we may order a muscle enzyme test (called CPK or creatine phosphokinase) which, if elevated, may determine the reason for nearly ALL the side effects listed above (not just muscle aches and weakness). A dangerous side effect of statin medications is “rhabdomyolysis” (protein breakdown in muscles causing muscle damage). In this case, discontinuing the medication is ABSOLUTELY necessary to stop these side effects before the damage becomes permanent (especially kidney damage!). Through weight management (such as a gluten free diet), proper nutritional counseling, and whole person care, we can NOW find a remedy for that LBP that was not responding and for a good reason. With statins being one of the most prescribed medications on the market (about 17 million users) and 1 in 10,000 developing the rhabdomyolysis as a side effect, it’s NOT an uncommon finding!!!

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, we would be honored to render our services.

 

Tags:

Fibromyalgia and Nutrition.

11 Dec

Fibromyalgia (FM) is truly a challenging condition to manage, as anyone with this condition will attest to! In the past, we’ve discussed many management strategies, including dietary suggestions. Although much of the nutritional information available about FM management is not supported by a lot of “scientific study,” the National Institute of Health through the NCCAM (National Center for Complementary and Alternative Medicine — formed by Congress to evaluate and appraise alternative treatments) provides information on dietary recommendations and supplements. They also provide dietary guidelines and define the benefits and effectiveness for FM patients and us doctors to follow. This month, we will dive deeper into nutritional considerations as this can REALLY make a huge difference for the FM patient!

Since fatigue, sleep quality, and muscle pain are three VERY common FM complaints, the FM patient can track their response to different dietary approaches as they add, modify, or delete various foods and/or supplements from their diet. We recommend “grading” these three symptoms daily on a 0-10 scale (0=good and 10=bad) as this can REALLY help the FM sufferer keep track of various changes that are made in the diet and is extremely useful for future reference.

FOODS: Since many FM sufferers have “sensitivities” to certain foods (reported to be as high as 42% of all FM patients), eliminating these foods makes GREAT sense.

First, it is REALLY IMPORTANT that you KEEP A FOOD JOURNAL for future reference (using the 0-10 scale) as it is impossible to remember all the reactions or responses to various foods even a day or two later, but especially a week or month later! Some common food offenders include MSG (commonly found in Chinese food – simply ask for the MSG to be NOT included when you place your order), certain preservatives, eggs, gluten (grains like wheat, oats, barley and rye), dairy, as well as other common allergens (such as chocolate, nuts, shellfish, and others). Common symptoms may include headaches, indigestion (irritable bowel syndrome), fatigue, and sleep interruptions. When using an “elimination diet,” it is important to make sure you’re getting the essential nutrients in your diet, in which supplementation can help.

Secondly, make it easier to eat in a healthful way! Have fruits and vegetables cut up and ready to eat so when you’re hungry, you can QUICKLY satisfy that urge. Lean meats or proteins are also VERY important! Remember, a well balanced diet gives you the “ammo” needed to fight fatigue, hurt less, help you sleep more deeply, and give you energy. By doing so, you will be able to stay more active and productive. Accept the fact that unless you pre-prepare the foods, you will instinctively reach for pre-packaged, no prep time, “fast food” options that most likely have poor nutritional content. Look for healthy foods that do not require a lot of preparation such as buying pre-washed, pre-cut vegetables. Some deli sections have pre-prepared foods like beet salad or quinoa that can be purchased in small quantities to add variety to your diet.

Third, plan for WHEN you eat. It is well known that eating small meals frequently during the day helps increase energy levels, such as at 9-10am and 2-3pm, especially if you’re feeling tired. Make sure the word “SMALL” is understood or else you’ll gain weight and not be hungry for the next meal! ALSO, DON’T SKIP BREAKFAST, AND DON’T EAT LATE AT NIGHT!!! Our metabolic rate (which regulates how efficiently we digest and breakdown our food) is highest in the morning and slowest at night. Try to include some protein and whole grains with your breakfast such as a boiled egg and oatmeal as this keeps the blood sugar from spiking and provides energy that lasts longer. Next month, we will look at supplementation including vitamins, minerals, and herbs that GREATLY help as well.

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

 

Tags: ,

← Older Entries
Newer Entries →