Weekly Health Update

Mental Attitude: Depression And Negative Thoughts.
We all have ups and downs (a fight with a friend, a divorce, the loss of a parent, etc.). Most people get over it, while some people go on to develop major depression. People with depression get stuck on bad thoughts because they're unable to turn their attention away... they keep going over their troubles. Even though they know better, they can't stop doing it.
Association for Psychological Science, June 2011

Health Alert: Energy Drinks?
Energy Drinks contain stimulants, such as taurine, guarana and caffeine. Caffeine has been associated with several damaging effects on children's cardiovascular and developing neurologic systems. Energy drinks are totally unsuitable for children and teenagers. In most cases, the main source of hydration for children should be water.
American Academy of Pediatrics, May 2011

Diet: Watch Your Diet, New Super Sticky Cholesterol?
MGmin-low-density lipoprotein (LDL), a form of ultra-bad cholesterol that significantly increases the risk of heart disease, has been discovered at the University of Warwick, England. MGmin-LDL is much stickier than normal LDL and is more common among elderly individuals, as well as those with type-II diabetes. It attaches to the walls of arteries more readily, where it forms fatty plaques that cause coronary heart disease. As the plaques grow, the arteries become narrower, resulting in reduced blood flow. The artery can eventually rupture and blood clots can form, raising the risk of heart attack or stroke.
Diabetes, May 2011

Exercise: PE?
Despite state requirements that middle and high school students get 400 minutes of PE every 10 days, 1.3 million - 38% of all adolescents in California public schools - do not participate in any school-based PE classes. Contributing to the decline are cuts to PE programs and exemptions allowing high school students to skip up to 2 years of PE. The proportion of teens participating in PE drops with age, from 95% at age 12 to 23% at age 17.
UCLA, June 2011

Chiropractic: Workers' Compensation And Chiropractic Care.
A recent study concluded chiropractic care to be more effective for common, work-related low back pain when compared to treatment by a physical therapist or physician. Overall, chiropractic patients had lower medical expenses, fewer disability recurrences and shorter initial periods of disability.
Journal of Occupational and Environmental Medicine, April 2011

Wellness/Prevention: Better Workout Results In Cup.
One way to enhance the effects of your workout and the integrity of your muscle physiology is by consuming a protein drink (containing as little as 20g of protein) after each workout.
American Societies for Experimental Biology, June 2011

Weekly Health Update

Mental Attitude: Personal Experience Makes A Difference.
Decisions involving risk depend on how we get the information about the potential risks and rewards. Researchers found if people experienced wins and losses first hand, like in a casino, they behaved differently than when told the odds.
PLoS ONE, June 2011

Health Alert: Sick Hospital Stats, Stay Healthy!
12% of hospital stays were readmissions within 30 days of a previous stay! 7% of hospital stays were readmissions within 14 days of their previous stay.
Agency for Healthcare Research and Quality

Diet: Pre-Diabetic? Start Eating More Fruit.
79 million people in the US have prediabetes, defined as blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. We would fare better by eating more fruit while reducing grains, breads and refined carbohydrates. Lumping fruit into the category of carbohydrates is confusing. Fruits are loaded with vitamins, minerals, fiber and filled with water that allows better absorption of their natural properties. Glycemic index is significantly altered by the type of food, its ripeness, processing, the length of storage, cooking methods and its' variety. Watermelon has a glycemic score of 100-which is identical to heavily processed and nutrient poor white bread. Since fruit is very high in water and naturally occurring fiber, the digestion time of any naturally contained sugars is slowed significantly. The natural water and fiber content of fruit actually causes a slow release of sugar into the bloodstream, unlike the instant sugar impact of no-fiber, high-chemical, heavily processed white bread.
CDC

Exercise: Exercise and Brainpower.
Exercise boosts blood flow to the brain and helps it receive oxygen and nutrients. The better shape you're in, the faster you may think. So, if math is a problem, you may find that daily exercise helps to solve it!
Mayo Clinic

Chiropractic: Early Chiropractic Concepts.
Displacement of any part of the skeletal frame may press against nerves, which are the channels of communication, intensifying or decreasing their carrying capacity, creating either too much or not enough functioning, an aberration known as disease. The nature of the affection depends upon the shape of the bone, the amount of pressure, age of patient, character of nerves impinged upon and the individual makeup.
DD Palmer (1845-1913)

Wellness/Prevention: A Simple Wellness Exercise.
List 5 things you do that are keeping you healthy. List 5 things you do that you could improve upon to maintain your health.

Whiplash: Who Will Recover?

Whiplash, or Whiplash Associated Disorders (WAD), involves a cluster of symptoms and findings that include biomechanical or tissue injury findings, as well as psychological factors that accompany pain and disability. To answer the presenting question, who will recover from whiplash, a task force was set up to investigate this and research over a 10 year time frame was reviewed. They found the initial level of pain after the injury and the associated psychological factors are the two best predictors of whiplash recovery.

WAD results from a neck injury caused by a sudden back and forth movement of the head that often occurs during a car crash. The injury occurs because of the fact that the sudden movement happens in a shorter time frame than our ability to voluntarily contract our own neck muscles. Hence, even if we brace ourselves before the impact, we cannot avoid the sudden "crack the whip" phenomenon that occurs during a crash. It's even worse is if the head is turned at the time of impact! Although most WAD sufferers recover within a few months, many report ongoing pain a year or more later. With about 2 million insurance claims registered per year in the US, the focus is shifting from what causes pain to what recovery predictors exist with the focus on managing those that are manageable.

One of the two predictors reported was the level of pain reported by the patient 3 weeks after a motor vehicle collision (MVC). In a group of over 3000 patients with WAD, this was reported to be, "...the single most important predictor of who recovers in a timely manner." On a 10-point pain scale (10 being the most intense pain), patients with a score under 5 recovered more quickly.

The second of the two strong predictors was the patient's belief or expectation of recovery. Again, at the 3 week mark following the crash, over 1000 WAD injured patients were asked how likely they felt they would recover fully and at 6 months, the disability level was compared to those expectations gathered at the 3 week point. They found a 4x greater chance of being placed in a "more disabled" group if at the 3 week point, the patient reported a poor outcome expectation for recovery. Those who were reportedly prone to "catastrophic thinking" also fared poorly. These are the patients who can't stop focusing on pain - they believe the crash was, "...the worse thing that has ever happened to them."

They also found patients wearing a neck collar to protect and immobilize the neck following a MVC were no better off compared to those not wearing a collar. In fact, in one group of patients, those who wore the collar were absent longer from work and utilized more pain killing medications compared to those who did not wear it.

We realize that 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 presently and, in the future.

Weekly Health Update

Mental Attitude: Thinking With Your Hands.
Being able to use your body in problem solving alters the way you solve problems. In an experiment, the people who were allowed to gesture usually did so-and they also commonly used perceptual-motor strategies in solving puzzles. The people whose hands were restrained, as well as those who chose not to gesture (even when allowed), used abstract, mathematical strategies much more often.
Association for Psychological Science, May 2011

Health Alert: Type 2 Diabetes.
Diabetes is the seventh biggest cause of premature death in America. 1.9 million were diagnosed with diabetes last year. About half of all seniors (65+) have pre-diabetes. In 2010, the CDC predicted that 1 in 3 adults will have diabetes by the middle of this century. The risk of developing type 2 diabetes increases with age, excess weight, a family history of the disease, and with lack of activity. An individual with diabetes has a higher risk of developing hypertension (high blood pressure), amputation of feet and legs, kidney failure, blindness, strokes, and heart attacks. Diabetes carries a $174 billion cost a year, of which $116 billion are direct medical expenses.
US Dept Health and Human Services, May 2011

Diet: Malnutrition In Elderly.
Femur neck fractures are a predominant cause of hospitalization among people over 65. They result in an end to independent living for 60% and death within six months from surgery for 30%. In terms of generally recognized lower limits for sufficient nourishment, 66% fell short of lymphocyte levels, 21% of albumin levels and 10% of protein levels.
European Federation of National Associations of Orthopedics and Traumatology

Exercise: Don't Forget Water.
The more intense your training session, the more heat your body produces. Before you exercise, drink water to help your body compensate for sweating. You can drink more water during exercise if you're thirsty.
Mayo Clinic

Chiropractic: It Starts Early In Life.
"Research indicates that the major cause of spinal subluxation in infants is childbirth. I stress the need for correction from birth so that irreversible subluxation degeneration changes do not occur. Nervous system injury through cervical spine trauma at birth causes abnormal function, abnormal behavior, and perhaps early death (SIDS)."
Abraham Towbin, MD, PhD, Pathologist Harvard University

Wellness/Prevention: Green Tea Please.
A beneficial compound found in green tea, a polyphenol called EGCG, has a powerful ability to increase the number of "regulatory T cells" that play a key role in immune function and suppression of autoimmune disease. This compound has shown to help control inflammation, improve immune function and prevent cancer. Pharmaceutical drugs perform similar roles but they have problems with toxicity. Natural food products may provide a long-term, sustainable way to accomplish this same goal, but without toxicity.
Immunology Letters, May 2011

Neck and Back Pain

When we say to you, "...you have a cervical disk problem," do you know what that means? I didn't think so. As doctors, we talk about these things so often, we sometimes just assume you know what we're talking about. So first, sorry about that! Now, let's clear up the question, what is a cervical disk problem?

The term "cervical" means neck, just like the terms "thoracic" means mid-back and "lumbar" means low back. The term "disk" refers to the shock absorbing fibro-elastic cartilage that rests between each vertebra of the spine. Think of the disk as being similar to a jelly donut. The center of the disk is liquid-like (the nucleus), kind of like petroleum jelly, and the outer part (the annulus) is tough and strong and circles the nucleus center like the rings of an freshly cut oak tree stump. What makes the annulus/outer layer so strong is the type of tissue it's made up of and, maybe most important, the opposing criss-cross pattern of each layer or ring of the annulus. Studies have shown that when the disk is pierced with a knife and then compressed, this criss-cross pattern of the annulus layers self-seals the cut, resulting in no leakage of the liquid center.

So, the question is, how can a disk rupture, herniate or "slip" if it's so tough, strong, and self-sealing? The answer: as the disk ages or when it's injured, tears or "fissures" in the disk fibers occur creating rents or channels for the liquid part to work its way out towards the edge and eventually break through the outer most layer - hence, the term "herniated disk." It's similar to stepping on that jelly donut until the jelly leaks out to the point where you can see it.

Here's the strange part. Research tells us that about 50% of people have bulging disks (not quite herniated through) and 20% of us have herniated disks (that have popped through) but have NO PAIN AT ALL! That makes it tough since an MRI or CT scan may show a herniated or bulging disk but how do we know that's the disk that's clinically important - the one that's creating the pain? That's why we treat patients and not their image (MRI, CT scan or x-ray). Even though a disk may be bulging or herniated, we may not necessarily treat that particular disk if it's not expressing itself clinically by creating a shooting pain down a specific area in a arm, usually below the elbow often into either the thumb or pinky side of the hand, with associated abnormal tests for strength and/or sensation. That's why we check your reflexes, your strength, and sensation for each nerve. We're checking to see if that herniated disk is "pinching " the nerve and if it is, we utilize manipulation, traction, PT modalities, and issue home traction units to try to "un-pinch" that nerve to avoid surgery.

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/arm 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.

Fibromyalgia and Exercise

It is common knowledge that we all benefit from exercise. But, it is especially important for people with fibromyalgia (FM) to exercise as it reduces fatigue, increases energy, improves joint flexibility, and improves sleep quality and mood. In essence, exercise allows FM sufferers to live a more enjoyable and fulfilling life!

With that said, it is important to realize that not all exercises are right for every individual person. Therefore, when introducing new activities and exercises into your routine, do NOT do too many new or different exercises all at the same time as you will not be able to recognize those that may not be right for you. Rather, pick one or maybe two new exercises at the most and incorporate them into your routine so that you can "prove" that they "work for you." Then, if you get worse, you'll be able to confidently identify the exercise that may not be right for you.

The focus of deciding which exercises are "right for you" is usually based on the presence or absence of pain and hence, we should discuss pain. There are "good" and "bad" forms of pain. A "good" pain does NOT feel harmful - that is, knife-like or lancinating or, severe intense pain. Rather, it should feel, "...like a good stretch," or, a pain that, "...hurts good." In fact, sore muscles after exercising prove that you've accomplished something positive. It's usually noticed the day or two after a new exercise or activity is started and then subsides gradually. It will actually "go away" quicker if you perform the same activity or exercise within a few days after the initial session and after the 2nd or 3rd time, it will usually not give you that "post-exercise soreness" type of pain and you can gradually increase the exercise after that point.

Here are some specific recommendations for implementing exercise safely and successfully. Because FM seems to exaggerate pain, make sure to:

1. Start out slow: Begin with only a few repetitions, move only so far (stay within "reasonable" pain boundaries), and do only 1 or 2 sets, maybe 5 minutes max of a particular maneuver. Remember, if you do too much and really hurt a lot afterwards, you may become afraid to exercise again and that's the WORST thing that could happen!
2. Self-Massage, hot or cold: Consider light self-applied massage with or without moist heat (but no more than 20 minutes / hour - don't "swell it up" by leaving heat on for longer than 30 minutes. If pain is more intense (>5/10 on a 0-10 scale, for example), use ice after exercising, usually for 15-20 minutes (on 15/off 15/on 15/off 15/on 15 = 1.25 hours), so it can act like a pump to remove swelling more efficiently. Talk to us about heat or cool rubs or gels.
3. Personalize: Because you're unique, personalize your program so it becomes "yours." Remember, you are not like the next person and you must design a program that "works" for you. Pick things you like to do so you look forwards to doing it - bike riding, brisk walking, swimming, canoeing, hiking off road, weight lifting (emphasizing low weight/high reps), and so on - PICK SOME ACTIVITIES THAT YOU LIKE TO DO!
4. Aerobic exercises: Consider starting with an aerobic (heart pumping) type of exercise. Many studies have reported that aerobics offer greater benefits compared to stretching, for the FM patient. Start with a low impact cardiovascular exercise like walking. Even sitting on a gym ball and gently bouncing for 5 minutes gets the heart pumping quite nicely and, it's fun! Swimming and bicycling are good, non-pounding types of exercises as well.

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: Treatment Recommendations

Carpal tunnel syndrome, or CTS, is one of the most common causes of pain, loss of work, and work related disability in the United States. It affects approximately 50 per 1000 persons in the general population and the average lifetime cost of CTS (including medical bills and lost work time) is estimated to be about $30,000 per each injured worker. In 2003, there were more than 3.8 million visits made to health care providers for CTS.

The diagnosis of CTS is based on the patient's complaints, the examination findings, and special testing such as electro-diagnostic tests (like Electromyography or EMG). The success or failure of treating CTS rests on the accuracy of the diagnosis. Often, patients with CTS will present after surgery complaining of the same symptoms they had prior to surgery, such as numbness and pain in the index, 3rd and 4th fingers, weak grip, sleep interruptions and so on, only to find that the median nerve is pinched higher up than the wrist, such as in the neck or elbow.

Treatment failure, as well as an increased likelihood of developing CTS, may also result from the presence of other "risk factors." These include (but are not limited to) advancing age (>50 years old), females > males, and the presence of diabetes and/or obesity, which often coincide. Other risk factors include pregnancy (due to hormonal shifts and fluid retention), certain occupations (highly repetitive), strong family history of CTS, specific medical conditions like hypothyroidism, autoimmune and rheumatologic diseases, certain types of arthritis, kidney disease, trauma, anatomic predisposition of the wrist and hand (shape and size), infectious diseases, and substance abuse. The difficult thing in treating CTS is when multiple factors exist - like a female over 50 with a highly repetitive job and who is also obese. Obviously, the "best" treatment here would include weight management, and possibly work station mod ifications, in addition to the in-office treatment approaches. Patient compliance or, following the doctor's recommendations is VERY important such as wearing the wrist splint at night, doing the carpal tunnel stretch exercises, weight management / dietary recommendations, and so on. Therefore, successful treatment for CTS relies on a balance between the patient and provider communicating about ALL the treatment options - surgical and non-surgical so the patient can make an informed decision. Since each patient is unique, the treatment approach must be tailored to that individual and may require, as previously stated, a number of treatment strategies aimed at patient specific issues.

Chiropractic is in a unique position for managing the CTS patient. This is because we look at the whole person, not just the wrist and, we offer the LEAST INVASIVE approach. Many times, there are issues in the neck, shoulder, elbow and forearm in addition to the wrist/hand that MUST BE carefully assessed in order to obtain a successful, satisfying result for the patient. We also consider the many "risk factors" described above and can assess or coordinate services with other health care providers so the many conditions described previously can be properly evaluated. So, the question remains, what do chiropractors do when treating a patient with CTS? Treatment often includes "the usual" such as wrist splinting during sleep, work modifications, and anti-inflammatory approaches (ice cupping, herbal, etc.). Unique to chiropractic are manipulation or adjustments (often to the neck, shoulder, elbow, forearm, wrist and hand), muscle tendon release techniques (possibly using tools to breakup adhesions, scar tissue, and the like), exercise training for the involved areas including the hand/wrist, as well as dietary strategies for weight management, metabolic syndrome (pre-diabetes) and so on.

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: Why Is It So Common?

This question has plagued all of us, including researchers for a long time! Could it be because we're all inherently lazy and don't exercise enough? Or maybe it's because we have a job that's too demanding on our back? To properly address this question, here are some interesting facts:

1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5. About 2% of the US workforce receives compensation for back injuries annually.
6. Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped - that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain. Other risk factors include psyc hosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990's, it has been strongly encouraged that we as health care providers utilize a "biopsychosocial model" of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.

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.

Win a Free Dinner for Two at Arturo's!

Exclusively for Oakland Spine and Rehab friends and family - visit us on Facebook and click the "Like" button to be entered to win dinner for two, a $100 value, at Arturo's Restaurant in Midland Park. Anyone who has already "liked" us is automatically entered to win.

On August 1st, we'll have a drawing from our fans who have "liked" us on Facebook and then notify the lucky winner!

In order to maintain a proper treatment schedule, we would like any patients normally having treatment on Mondays to please reschedule those appointments for Tuesday.

Click the like button below (or on our Facebook page) to be entered to win.

Watching your back,
Dr. Brad
201-651-9100

Weekly Health Update

Mental Attitude: Suicidal Teens And Eating Disorders.
Teens 13-18 years old suffering from anorexia, bulimia and other eating disorders are more likely to suffer from suicidal thoughts, anxiety disorders and substance abuse. 0.3% of the teens surveyed reported suffering from anorexia nervosa and 0.9% from bulimia nervosa. A full 1.6% suffered from binge eating disorder. One third of those with bulimia actually attempted suicide. 15% of those with binge eating had and about 8% of those with anorexia had attempted the same. 55-88% of teens with eating disorders also reported such problems as anxiety, depression, or a behavioral disorder.
American Journal of Psychiatry, May 2011

Health Alert: Uninsured Unable To Pay Hospital Bills.
50 million Americans are uninsured. Most uninsured people have virtually no savings, half with less than $20 net worth. Half of families with income at 400% of the Federal Poverty Level, or $89,400 a year, have financial assets below $4,100. Every year, 2 million uninsured Americans are hospitalized, with 58% of these hospital stays resulting in bills of more than $10,000.
US Dept Health and Human Services, May 2011

Diet: Weight Management Tips.
1.Fruit. Fruit contains vitamins, antioxidants and fiber. Consumption of fiber is associated with lower body weight and gives a feeling of fullness. 2. Keep hydrated. Feeling tired or hungry? You may just be thirsty. Drink at least 6 glasses of water a day. Water helps your body transport nutrients and eliminate toxins. 3. Close the kitchen. When you finish a meal, clean the dishes and turn off the lights. Tell yourself the kitchen is now closed.
Family Features, April 2011

Exercise: Exercise and Colds.
Regular exercise helps jump-start the immune system, thus helping to reduce the number of colds, flu and other viruses.
Mayo Clinic, May 2011

Chiropractic: The Nervous System Connected To The Immune System?
The neurotransmitter norepinephrine is present in sympathetic nerve fibers that innervate lymphoid organs and act on the spleen. Norepinephrine in lymphoid organs plays a significant role in the regulation of the immune system. Stressful conditions lead to altered measures of immune function, and altered susceptibility to a variety of diseases. Many stimuli, which primarily act on the central nervous system, can profoundly alter immune responses. The two routes available to the central nervous system are neuroendocrine channels and autonomic nerve channels.
The Chiropractic Research Journal, 1994

Wellness/Prevention: Minutes Of Exercise A Day Can Keep The Pain Away.
As little as 2 minutes of exercise a day can reduce pain and tenderness in adults with neck and shoulder problems. After 10 weeks, the 2-minutes-per-day exercise group experienced significant reductions of neck and should pain (decreased 1.4 points out of 10) and tenderness (decreased 4.2 points out of 32). The 12-minutes-per-day exercise group had slightly larger reductions in pain and tenderness (an extra .5 and .2 points, respectively).
American College of Sports Medicine, May 2011