Weekly Health Update

Mental Attitude: Peer Support Decreases Depression Symptoms.
Peer support offers promise as an effective, low-cost tool for fighting depression. Programs where patients and volunteers share information were found to reduce symptoms of depression better than traditional care alone and were about as effective as cognitive behavioral therapy. Peer support has been found to decrease isolation, reduce stress, increase the sharing of health information and provide role models.
General Hospital Psychiatry, February 2011

Health Alert: High Use Of Acetaminophen Linked To Blood Cancers.
High use (4 or more times per week for four years or more) of acetominophen (Tylenol), a high-selling over-the-counter analgesic or non-steroidal anti-inflammatory drug (NSAID), is linked to a two-fold increased risk of certain blood cancers.
Journal of Clinical Oncology, May 2011

Diet: Milk Wars!
Some school districts have banned flavored milk, as it is seen as a part of the obesity epidemic. Florida is considering a statewide ban in schools. Other districts have sought a middle ground by replacing flavored milks containing high-fructose corn syrup with versions containing sugar, which some see as a more natural sweetener. On the flip side, the School Nutrition Association, American Academy of Pediatrics, American Dietetic Association, American Heart Association, and National Medical Association argue that the nutritional value of flavored low-fat or skim milk outweighs the harm of added sugar. Milk contains nine essential nutrients including calcium, vitamin D and protein.
The Associated Press, May 2011

Exercise: Benefits of Exercise.
Exercise helps you to more effectively manage stress, helps you to lose weight - especially fat weight, improves the functioning of your immune system, reduces your risk of getting heart disease, and reduces medical and healthcare expenses.
Surgeon General

Chiropractic: Adjustments Increase Your Breathing Capacity?
See for yourself. Before you get adjusted, take a few deep breaths. After your adjustment, try again. Now that you are breathing better, read up on how important oxygen uptake is for your overall health.

Wellness/Prevention: Body Fat Percentage: The Best Measurement Of Your Health Risks.
Did you know that a large belly carries a risk for coronary artery disease comparable to smoking a pack of cigarettes daily or having high cholesterol? People with coronary artery disease and expanded waistlines are at more than twice the risk of dying, including those with a Body Mass Index in the normal range. Even more dangerous is the visceral fat that surrounds the internal organs. This internal fat actually makes up a large proportion of the waist measurement. Visceral fat is more metabolically active and can produce hormones and other substances that have a negative impact on your health, including increasing the risk of heart disease; high blood pressure; stroke; type 2 diabetes; metabolic syndrome; some types of cancer; and sleep apnea.
Mayo Clinic, May 2011

Weekly Health Update

Mental Attitude: TV Viewing May Lead To Increased Obesity In Teens.
In a study, adolescents who had watched more than two hours of TV a day were 36% fatter in later adolescence than those watching less TV. TV viewing may lead to increased risk of obesity because watching TV is associated with increased dietary intake.
Journal of Sleep Research, February 2011

Health Alert: Alcohol Consumption And Computer Use?
Teenagers who drink alcohol spend more time on their computers for recreational use, including social networking and downloading and listening to music, compared with their peers who don't drink. Teenagers typically first experiment with alcohol at age 12 or 13. Family risk factors include lax parental supervision and poor communication, family conflicts, inconsistent or harsh discipline and a family history of alcohol or drug abuse.
Weill Cornell Medical College, May 2011

Diet: Best Diets?
Consumer Reports Health has ranked diets and Jenny Craig tops the list with 85 points, Slim Fast earned 63 points and Weight Watchers was third with 57 points. The scores were based on adherence to the 2010 US Dietary Guidelines and results of studies that analyzed the short and long term weight loss and dropout rates of seven popular diets. 92% of its participants stuck with the Jenny Craig program during the two-year study period and the dieters weighed an average of 8% less than when they began the program.
Journal of the American Medical Association, May 2011

Exercise: Skipping Exercise? You Might As Well Smoke!
"Failure to exercise a minimum of 3 times per week for at least 30 minutes in duration each time is the equivalent of smoking one pack of cigarettes each day. What this means is that exercise is no longer just good for you, it is bad for you if you don't exercise."
Surgeon General's Report

Chiropractic: Immunity? How About This Study!
Researchers at the Sid E. Williams Research Center of Life Chiropractic University took a group of HIV positive patients and adjusted them over a six-month period. Patients who were adjusted had a 48% increase in their CD4 cells counts. CD4 cells are an important immune system component. The measurements were taken at an independent medical center, under medical supervision for the condition. The control group (patients who were not adjusted) did not demonstrate this dramatic increase in immune function but actually experienced a 7.96% decrease in CD4 cell counts over the same period of time.
JMPT, 1991

Wellness/Prevention: Heart Patients And Painkillers.
The use of Nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with a 45% increased risk of death or recurrent heart attack within as little as one week of treatment.
Circulation, May 2011

Weekly Health Update

Mental Attitude: Stress And Cellular Health.
University of California San Francisco (UCSF) scientists report psychological stress leads to shorter telomeres - the protective caps on the ends of chromosomes that are a measure of cell age and thus, health. Their findings also suggest exercise may prevent this damage. They examined telomeres in leukocytes, or white blood cells, which defend the body against both infectious agents and cell damage. "Our findings suggest that traumatic and chronic stressful life events are associated with shortening of telomeres in cells of the immune system, but that physical activity may moderate this impact," said co-author Jue Lin, PhD, associate research biochemist in the laboratory of senior author and Nobel laureate Elizabeth Blackburn, PhD, professor of biochemistry and biophysics at UCSF.
UCSF, April 2011

Health Alert: A Natural Therapy?
An environment of pure oxygen at three-and-a-half times normal air pressure adds significantly to the effectiveness of artemisinin, a natural compound already shown to kill cancerous cells. In a new study, using artemisinin or high-pressure oxygen alone on a culture of human leukemia cells reduced the cancer cells' growth by 15%. Using them in combination reduced the cells' growth by 38%!
Anticancer Research, April 2011

Diet: Skeletal Muscles Affected By Obesity.
This new study shows obesity involves more than accumulating excess fat and carrying excess weight. During the development of obesity, skeletal muscles fail to adjust their molecular composition appropriately to the increasing body weight. Consequently, the muscles of obese mammals are not properly 'tuned' to the higher body weight they carry. This may explain why muscle strength and locomotion are impaired in obese humans and why it is difficult to lose excess weight.
Journal of Experimental Biology, May 2011

Exercise: Benefits of Exercise.
Exercise increases your level of muscle strength, improves athletic performance, can help relieve the pain of tension headaches, allows you to consume greater quantities of food (while still maintaining caloric balance) and helps you sleep easier (and better).
Surgeon General

Chiropractic: Patients Are More Immune?
The chiropractic immunology connection was strengthened in 1991 when Patricia Brennan, Ph.D. and other researchers found improved immune response following chiropractic treatment. Specifically, the study demonstrated the "phagocytic respiratory burst of polymorphnuclear neutrophils and monocytes were enhanced in adults [who] had been adjusted by chiropractors." In other words, the cells that act like "Pac-Man", eating and destroying bad cells, are enhanced through chiropractic care.
Circulation, 1992

Wellness/Prevention: Breast Cancer Risk Lower Among Coffee Drinkers.
Women who drink coffee regularly have a significantly lower risk of developing antiestrogen-resistant estrogen-receptor (ER)-negative breast cancer. Breast cancer may be sub-divided into hormone-responsive (ER-positive) and non-hormone-responsive subtypes (ER-negative). They discovered regular coffee drinkers were less likely to develop breast cancer compared to women who either never or rarely drank coffee.
Breast Cancer Research, May 2011

Whiplash: Can It Be Prevented?

Whiplash or Cervical Acceleration-deceleration Disorder (CAD) is primarily associated with motor vehicle collisions (MVCs) and in particular, rear-end collisions. Last month, we discussed how CAD can be prevented and focused greatly on paying attention while driving and, the position of the headrest. Whiplash is defined as an injury to the cervical spine (neck) caused by a rapid/sudden, usually unexpected, forceful movement. (Typically, forwards and backwards, if struck from in front or behind, or, a side to side movement if struck from the side.) Even worse, when coupled with the head being rotated at the time of impact, tearing of the ligaments, muscles, and joint capsules in the neck can cause a myriad of symptoms that can remain present for years, sometimes permanently. Some of these symptoms include:

• Neck and shoulder pain and/or stiffness
• Middle and low back pain
• Dizziness
• Vertigo (balance disturbance)
• Fatigue
• Numbness/Tingling
• Face/Jaw pain
• Cognitive dysfunction or brain injury (even without hitting the head directly)
• Sleep disorders

A report published in January 2011 discussed recent advances and a new law that goes into effect 9-1-11 regarding the design of head restraints that is aimed at significantly reducing the injury severity and consequently the costs associated with CAD. The Code of Regulations (CFR) describes the new bill, (FMVSS 202a) as a standard, "...to reduce the frequency and severity of neck injury in rear-end and other collisions." This new law requires testing the absorbency (springiness), the locking mechanisms, and the height by making sure the restraint is above the center of gravity of the occupant's head to reduce the "backset" (distance between the head and the restraint). This is done by testing the seat back and head restraint as a system to ensure the head restraint remains in its proper position throughout the collision. The concept is to reduce the rearward shift of the occupant's head relative to their torso or to avoid extreme hy perextension. Companies have been manufacturing both dynamic, as well as static, head restraint systems in response to this new requirement that becomes fully effective on 9-1-11 for both front and rear seats. So, how does this equate to costs?

Between the years of 1988 and 1996 from 805,851 whiplash injuries, the National Accident Sampling System (NASS) reported the total annual cost of treatment, excluding damage to property, was $5.2 billion. This amount includes costs derived from medical, legal, insurance, productivity loss and work loss. The report estimates, by improving the seat back and head restraint position to the occupant's head, a total reduction of 14,247 whiplash injuries is expected which will have a nearly $92 million total cost reduction through both direct injury costs and also the indirect societal costs!

Weekly Health Update

Mental Attitude: Shorter Hours Please.
If your workday averages 11 or more hours, you probably earn more than your 8-hour a day colleagues, but your risk of developing heart disease will be 67% higher! Researchers believe doctors should include data on a patient's working hours when listing risk factors for heart disease (smoking, total body weight, diabetes and blood pressure).
Annals of Internal Medicine, April 2011

Health Alert: Adverse Drug Reports Swell!
In a new study of adverse events linked to medications-compiled by the FDA since 1969, researchers at the University of Maryland School of Pharmacy revealed only 55% have been reported to the agency in the past decade! According to the FDA's website, the agency's Adverse Event Reporting System (AERS) is "designed to support the FDA's post-marketing safety surveillance program for all approved drug and therapeutic biologic products. The FDA uses AERS to monitor for new adverse events and medication errors that might occur with these marketed products." In the past decade, 2.2 million events reported to AERS represented a 1.65-fold increase from the prior decade.
Archives of Internal Medicine, April 2011

Diet: Divide Your Plate!
When putting food on your plate, fill half of it with veggies or salad (but watch out for fatty dressings). One-quarter of the plate should have lean protein, such as fish, chicken or beef that's been grilled, baked or poached. The last quarter of the plate should be a healthy starch -- but don't load it up with butter or oil.
Family Features, April 2011

Exercise: Have Some Standards!
Adults who adhered to the US Department of Health and Human Services' 2008 Physical Activity Guidelines reduced their mortality risks. To meet the guidelines, do moderate-intensity aerobic exercise at least 150 minutes per week or vigorous-intensity aerobic exercise at least 75 minutes per week and perform strengthening exercises at least twice a week. Adults who met the guidelines had lower risks of dying by 27% among those without health conditions and 50% less in those with an illness.
Mayo Clinic

Chiropractic: Some Nerve!
Growing evidence suggests that immune function is regulated, in part, by the sympathetic nervous system. Simply put: the nervous system has a direct effect on the immune system due to the nerve supply to the important immune system organs.
Journal of the American Osteopathic Association, 1974

Wellness/Prevention: Shedding Skin Helps?
The flakes of skin we shed (at the rate of 500 million cells a day) actually reduce indoor air pollution. The flakes contain squalene, a skin oil that reduces indoor ozone levels roughly 2-15%.
American Chemical Society, May 2011

Headaches and Chiropractic Treatment

We are often asked, "..what do chiropractors do for headaches?" To answer this question, let's look at what a patient might expect when they present with headache complaints.

The last three "Health Updates" reviewed the differences between tension-type headaches, migraine headaches and dangerous types of headaches. Keeping in mind those differences, the history and examination will focus on differentiating between these three types of headaches.

The presenting patient will be given the "usual" paper work to fill out that includes biographical information (name/address, type of insurance, HIPAA forms, and so forth), as well as a history, past history, medication list, family history, current habits, and systems review. Specific questionnaires about headaches that can be scored and compared to future scores are particularly helpful in determining the percentage of change in the condition. The main historical piece of information that differentiates the tension vs. migraine headache is the presence or absence of nausea or vomiting, which is unique to migraines. Migraine headaches are usually preceded with an "aura" or, a pre-headache symptom such as ringing in the ears, flashes of light in the visual field, a numbness or tingling sensation - some odd type of "hint" that a migraine may soon strike, often within 30 minutes after the aura. This is importan t as a chiropractic treatment given prior to the onset of the migraine can sometimes stop the migraine from starting or progressing. Migraines will often occupy half the head vs. tension-type headaches that often occupy both sides. The history can also give us information about things that may trigger a headache (primarily migraines) such as odors, certain foods (like chocolate, nuts, spicy food), and this can lead to specific diet oriented treatment recommendations.

The physical exam include observing the patient's posture, head carriage, skin color/moisture and touching the muscles (palpation) feeling for spasm/tightness, temperature/moisture, pain location or radiation. Various "orthopedic tests" include movements of the head and neck in attempt to reduce, reproduce or increase symptoms with the primary goal of trying to figure out which structures may be generating the pain. Cervical range of motion tests are performed to see which movements increase or decrease the pain. The neurological exam - testing reflexes, muscle strength, sensation (sharp/dull) may reveal areas of the skin on the head that are either increased / hypersensitive or reduced in sensation (numb). Looking in the back of the eyes is a unique place where blood vessels can be viewed and increased blood pressure, diabetes, increased pressure in the head and more can sometimes be detected, which can help determine i f a dangerous headache is lurking. A cranial nerve exam is also sometimes done as part of the neurological examination.

The chiropractic treatment protocols for headaches include (but are not be limited to): Spinal manipulation or mobilization (this is applied to the areas of the neck and/or upper back where the joints are either fixed, displaced, or are applied to a region where the neurological function may be compromised), exercise training, traction, electrical current, ultrasound, stress and diet management.

We realize 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.

Fibromyalgia - More Tips From Real Patients

Last month, we listed many great "pearls" of wisdom direct from patients suffering with Fibromyalgia (FM), some of which we would like to directly focus on this month and expand as these truly arise from the heart of the experienced and deserve more attention (plus, we couldn't include them all last month and can expand on them now).

1. "Keep a journal every day about what you do and how you feel." Many times when discussing your symptoms of FM with us, it is very hard to remember important details and keeping a journal is REALLY appreciated as it serves as a reminder for the patient of the things that trigger a flair-up. The journal can often save an immense amount of time trying to determine what can be done to help the patient, such as when to employ biofeedback skills, like visualization. This is performed any time or place where you may find yourself in a situation that is totally out of your control and you sense your ability to cope is failing. At uncontrolled times such as this, shutting the eyes and visualizing a calming and relaxing scenario is usually very helpful and can be exercised as often or for as long as needed. Again, write down the most effective visualization scenarios or thoughts so you can refresh your memory from time to time.
2. "Sleep is very important. Try not to nap during the day so you can sleep better at night." One of the biggest complaints from FM patients is sleep disturbance, whether it's getting to sleep or waking up multiple times a night and/or not being able to return to sleep. Many "pearls" were found that dealt with sleep quality and methods for improving sleep. One of the most important issues is stated above - try to avoid napping during the day. Another is to go to sleep at the same time each night, or, to stay on a schedule that is consistent. Some recommended avoiding thoughts about the day that are stressful or situations you can't control prior to going to sleep.
3. "Exercise on a regular basis." This too, was a popular recommendation. Most felt "light exercises" was better, while a few favored strenuous exercises. Some gave specific recommendations like yoga, stretching, or swimming ("...because it's easier on my joints."). Some gave specific instructions like, "...Exercise! Keep those muscles and bones flexed and firm. But do not overdo it!" Another recommended wearing a sweat suit to keep the muscles warm. Most importantly, develop a routine that includes regular exercise doing something you like! This will ensure consistency and flow. Exercise also has the very important ability to reduce stress simply from "working out," and stress reduction and control was mentioned by itself multiple times. Not mentioned is the fact that endorphins and enkephlins are released with exercise that can reduce pain, as they are "natural pain killers," morphine-like substances our body produces.
4. Diet: This too, was popular and frequently mentioned. Some gave very detailed information about what to eat such as, "Balance your meals with a low-fat, high-protein diet. Drink plenty of water." A low gluten diet is anti-inflammatory and very helpful.
5. Miscellaneous: Educate yourself about FM by gathering as much information as possible, reading about FM on a regular basis, starting or attending a support group, choosing a doctor who understands FM were also very common themes. Perhaps most important was, "accept your limitations," and in doing so, don't be afraid to ask for help - create a list of reliable friends and family who are willing to help out when needed.

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

Carpal Tunnel Syndrome: Diagnosis

Carpal Tunnel Syndrome or, CTS, is a common condition that affects many people. The process by which it is diagnosed includes a careful history and examination that includes an orthopedic and neurological exam, sometimes special tests such as X-Ray, MRI, EMG/NCV, and special sensory tests (including vibrometry or neurometry). So, let's discuss this process.

HISTORY: When you first arrive, you will be asked to complete some routine paper work that includes history-based information such as the mechanism of injury (how did CTS start), the onset (when the symptoms started), pain related issues (factors that increase or decrease the pain/symptoms), quality of symptoms (numb, tingling, achy, pins/needles), radiation of symptoms and location, severity (right now, on average past week, at best and at worst), timing of the symptoms (worse at night, in the morning, after certain work or home activities), and past history information. You will also be asked about your current health status such as heart disease, stroke, diabetes, thyroid disease, arthritis, and any other health related conditions that may be present. We will also do an inventory of your systems (cardiovascular-heart, pulmonary-lungs, genito-urinary or, bladder, kidney, sex organs), skin, musculoskeletal (muscles, bones, and joints), and neurological systems. This is all im portant as they can contribute to CTS.

EXAMINATION: The routine exam for CTS patients includes a careful evaluation of not only the hand and wrist, but also all structure from the neck down the arm, including the shoulder and elbow. That's because a pinch of the nerve at any location from the neck down can contribute to CTS symptoms and treatment at these locations is often needed for a satisfying result. Categories of examination include:

• Observation: This includes posture, skin color/texture, and quality of movement such as being slow or careful with or without pain behavior like grimacing or verbal expressions of pain.
• Palpation: Touching areas including the neck, shoulder, elbow, wrist, and hand. We are looking for pain responses, numbness/tingling, temperature & moisture of the skin, muscle tone, joint grinding, and others.
• Orthopedic tests: This will include testing for nerve pinching in the neck, shoulder, elbow, or wrist; attempts to reproduce symptoms in the hands by bending and holding the bent wrist positions for 10-30 seconds, tapping the wrists with a reflex hammer checking for numbness into digits thumb through the 4th finger; stretching the fingers backwards to see how "stiff" they are comparing the two hands, and others.
• Neurological tests: Using various instruments that may include a sharp object like a pin, a dull object, light touch, vibration produced by a tuning or neurometer or vibrometer, a reflex hammer to test the reflexes in the arm (several locations), and possibly a 2-point discriminator which measures whether one can feel 2 points the same on the two sides or down to at least 6mm (1/4 inch). Testing muscle strength in the arms as well as grip strength is also commonly done.
• Special tests: These are less commonly performed but can include: blood tests (diabetes-sugar, thyroid, arthritis tests, Lymes Disease, others), EMG (electromyography), NCV (Nerve Conductance Velocity - these tests measure the speed at which a nerve transfers an impulse from point 1 to 2 such as neck to hand, elbow to wrist, across the wrist to the 2nd finger), X-Ray and/or MRI (Magnetic Resonant Imaging).

The bottom line, make sure your health care provider is thorough and checks everything from the neck to the hand as often, many other conditions above the wrist frequently contributes to CTS symptoms.

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.

Low Back Pain: The Importance of Patient Education

It's been reported that educating the patient about their condition reduces unnecessary anxiety and fear, which in turn, allows a more swift resolution of their condition. The intensity of low back pain (LBP) can sometimes be so severe, the patient can hardly move without getting a sharp, knife-like pain that stops them in their tracks. When one experiences this kind of pain, it's very easy to assume what's causing this, "....must be lethal!" Or perhaps, "how can anything hurt this bad and not be cancer?" These types of thoughts can lead to unnecessary (and frankly, inappropriate) behavior including fear of activity (including work), anxiety, depression, and poor coping skills. In this regard, all LBP guidelines include the important recommendation of offering appropriate reassurance and advice through patient education as it is KEY to reducing this unnecessary fear and anxiety. This includes educating the patient as to what hurts them (anatomical tissue damage), why it hurts so badly (the inflammatory cycle), and what they can and should do to get out of the acute, painful stage as quickly as possible ("RICE" or, Rest, Ice, Compress, Elevate).

Education is related to experience. Stop and think about how a child manages pain. When they fall down and skin their knees, the intensity of their crying can be deafening! It's obvious the child's the reaction is exaggerated, as exemplified by that blood curdling scream. The reason for this heightened reaction is due to the lack of experience or, "knowledge" about this type of injury - they don't realize the pain will dissipate with a few minutes and as a result, they over react. As we age, skinning our knees is more irritating mentally than it is painful - we look at it, after muttering a few words under our breath (which won't be repeated here), and then we go about our daily routine, knowing fully well that it will hurt for a while and eventually get better. Studies have shown that people who have graduated from high school or college have a higher pain threshold than those who have not. This may be because, through learning about the body in science class, they understand the anatomy and physiology (structure and function) behind a cut on the skin. As a result, there is no overreaction, just a "reaction."

So, when can this educational process start? The answer is simple - as soon as possible; and actually, before we become patients! A recent study published in the journal "SPINE," found 8 year old school children were capable of out-performing a similar aged "control" group that were not educated on management and prevention of low back pain. Tests were administered initially, at 15 days and at 98 days after beginning the education process. They used a comic book as the method to educate the 266 member group of 8 year olds while a "control" group of 231 kids did not receive the comic book educational tool. Initially, the 2 groups scored similarly (about 73% correct answers for both groups). The comic book was given to the 266 kid group at day 8 and both groups were retested again at the 15 and 98 day time points. The results showed the group receiving the comic book education about LBP scored significantly higher at 15 days and retained the information at 3 months. Though no one will know if the educated kids will be less prone to develop chronic pain due to this gain of knowledge, the increased likelihood certainly exists.

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.