MRI’s… What are they good for?
Absolutely nothing! Or at least that’s what it seems when it comes to identifying what’s causing back/sciatic pain related to disc herniation identified on MRI, according to the study below.
This is not ground breaking news. Other studies have indicated similar conclusions, that, in the absence of nerve root compromise (pinching or compression of the nerve root), identifying a protruding or even extruded disc on MRI has little to no relevance to symptoms of leg pain.
As one of my high school football coaches (Mark Matheny) used to say, “What’s a mother to do”?
I think what you must understand about these conclusions is that you should not “make a mountain out of a mole hill” when it comes to disc herniation findings. Some physicians will make a big deal about it and that’s just wrong.
Most, and I mean most, disc herniations can be treated successfully without surgical intervention.
We utilize two protocols to conservatively treat disc herniations. The one that works the best, in most cases, is the McKenzie protocol, and the other is Cox’s distraction protocol. The McKenzie protocol is effective for cervical disc herniations a well.
So, if you have arm or leg pain associated with a disc problem, we can likely help! If you have questions about this topic, please don’t hesitate to call and discuss the issues with me.
For more information on McKenzie or Cox work, go to my website and look under disc herniation or McKenzie: http://www.greathousechiropractic.com
Magnetic Resonance Imaging in Follow-up
Assessment of Sciatica
The Hague Spine Intervention Prognostic Study Group*
N Engl J Med 2013;368:999-1007.
Copyright ˝ 2013 Massachusetts Medical Society.
One reviewer wrote: “A recent systematic review concluded that even in the acute setting of sciatica, evidence for the diagnostic accuracy of MRI is not conclusive.”
Discussion: In summary, in patients who had undergone repeated MRI 1 year after treatment for symptomatic lumbar-disk herniation, anatomical abnormalities that were visible on MRI did not distinguish patients with persistent or recurrent symptoms of sciatica from asymptomatic patients. Further research is needed to assess the value of MRI in clinical decision making for patients with persistent or recurrent sciatica.
“I had headaches for the better part of forty (40) years. At one point my internal medicine doctor told me they were caused by three thing; stress, hormonal imbalance and heredity. His answer was pain pills! Over the years I have tried acupuncture, herbal remedies, massage and various other things. Until Dr. Greathouse discovered the use of laser treatment, I’ve lived my life around terrible headaches. Now I have a life and am so excited about this treatment. I highly recommend it for anyone suffering from headaches!”
Thanks for the testimonial Anne!
Health neuroscience is still in its infancy with regard to headaches. Some drugs are very effective and some are not. Some drugs come with unwanted side effects as well as long-term use ill effects. So, it’s nice to find an alternative form of care that has no side effects. Even better, it’s nice to find how to prevent or self treat your headaches!
There are natural alternatives out there!
Anne was a patient, who used to treat with me for headache relief by means of manual therapy, and this helped, but we found she obtained longer lasting relief with the combination of manual therapy and the application of cold laser.
Another much younger patient with chronic recurrent headaches recently benefited with a simple neck exercise that commonly relieves headaches. His initial care began with passive movement provided by means of manual therapy and quickly evolved to active care (self treatment). Nothing beats the liberating experience of not having to use a medication or see a healthcare provider.
Some of the alternative treatments for headache care that we utilize include:
- Manual therapy (mobilization & massage)
- Cold laser
- Electric stimulation
- Ultrasound (therapeutic)
- McKenzie MDT (very effective & geared toward self care)
- Diet assessment
- Supplements, herbal, homeopathic
We can ascertain if you will be responsive to care in relatively short order. There’s never a charge for an initial consult. If you are suffering from headaches and are looking for a viable alternative to medication, please give us a call.
*Imaging Boom Raised Radiation Exposures*
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: June 12, 2012
Advanced diagnostic imaging has increased substantially over the past 15
years, bringing an increase in radiation exposure, researchers found.
CT imaging roughly tripled and MRI use nearly quadrupled from 1996 to
2010 across the six large integrated health systems studied by Rebecca
Smith-Bindman, MD, of the University of California San Francisco, and colleagues.
How Dangerous Are CT Scans?
Some physicians are raising concerns about the safety of such procedures — most notably, an increase in cancer risk. A CT scan packs a mega-dose of radiation — as much as 500 times that of a conventional X-ray. If your doctor orders a CT scan for you or your child, should you think twice? Absolutely, say researchers behind two recent studies that sound the alarm about the increased cancer risk associated with multiple CT scans.
“Our focus is to bring awareness to the fact that people are getting large doses of radiation and it’s not innocuous,” says Timothy Bullard, the study’s lead author and chief medical officer at Orlando Regional Medical Center. “We want people to use the technology appropriately.”
“Appropriate” is the key word — especially since a review study published last November in the New England Journal of Medicine determined that as many as one-third of all CT scans performed in the United States are unnecessary.
Chiropractic: Too Little Too Late?
See Medical Inc. links below!
If you haven’t guessed it already, I’m a bit of a chiropractic heretic. Don’t get me wrong, chiropractic manipulative therapy works wonders on mechanical problems of the spine and extremities but the other health claims to fame are not responsibly or professionally addressed by the profession as a whole and thus many field doctors fail to address informed consent for treatment of what is called somatovisceral disorders. Somatovisceral in the chiropractic sense means treating other illnesses or symptoms such as infantile colic, heartburn, hypertension, etc…, by means of spinal manipulation. While there’s anecdotal evidence of good results along these lines of thought, the scientific evidence of such forms of care is far from valid & reliable.
Chiropractors will argue that the medical establishment does the same thing and on a grander scale but this argument fails to support the fact that what we are doing is right.
The following trailers look good and I’m sure will expose some extraordinary issues within the medical profession. Hopefully there’s some introspection within all health care disciplines as well.
I haven’t seen the DVD in it’s entirety as of yet but did want to get the information out there.
Medical Inc. (links below)
Staying Healthy with Nutrition
Elson M. Haas, M.D.
Niacin (Vitamin B3)
Information on this site is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your medical health care provider.
What got my attention about this vitamin was some information I came across where vitamin B3 was being used for severe depression with great results. I see so many patients today who are on mood altering medication. The above book “Staying Healthy with Nutrition” by Dr. Haas, is a wonderful resource on how food and supplements affect our health. Below is info from his book on vitamin B3. Many health experts attribute our ill health issues, physical and psychological, to the lack of nutritional value of our food. Niacin is used to support a variety of metabolic functions and to treat a number of conditions. Nutritional therapy is a viable alternative to drugs in many cases. As you learn to connect your health issues with food deficiencies, find an expert to help guide you through these alternative treatment pathways.
Niacin plays a key role in glycolysis (extracting energy from carbohydrate and glucose), is important in fatty acid synthesis and in the deamination (nitrogen removal) of amino acids, and is needed in the formation of blood cells and steroids, and is helpful in the metabolism of some drugs and toxins. It is a vital precursor for the coenzymes that supply energy to body cells. Basically, the coenzymes of Niacin help break down and utilize proteins, fat and carbohydrates.
Vitamin B3 also simulates circulation, reduces cholesterol levels in the blood of some people, and is important to help the activity of the nervous system and normal brain function. Niacin supports the health of skin, tongue, and digestive tract tissues. Also, this important vitamin is needed for the synthesis of sex hormones such as estrogen, progesterone, and testosterone, as well as other corticosteroids.
Niacin helps increase energy through improving food utilization and has been beneficial for treating fatigue, irritability, and digestive disorders such as diarrhea, constipation, and indigestion. It also stimulates extra hydrochloric acid, helps in the regulation of blood sugar (as part of glucose tolerance factor) and gives all of us a greater ability to handle stress. It’s helpful in treating anxiety and possibly depression. Niacin has been used for a variety of skin reactions and acne, as well as for problems on the teeth and gums. It is sometimes helpful in the treatment of migraine headaches and arthritis, probably in both cases through stimulation of blood flow and capillaries. This vitamin has also been used to stimulate sex drive and enhance sexual experience, to help detoxify the body, and to protect it from certain toxins and pollutants. For most of these problems and cardiovascular related ones mentioned below, the preference is to taking the “flushing” form of Niacin, or Nicotinic acid, not niacinamide. This includes cholesterol reduction.
Nicotinic acid works rapidly, particularly in its beneficial effects on the cardiovascular system. It simulates circulation and for this reason may be helpful in treating leg cramps caused by circulatory deficiency; headaches, especially the migraine type; and Meniere’s syndrome, associated with hearing loss and vertigo. Nicotinic acid also helped reduce blood pressure and very importantly, acts as an agent to lower serum cholesterol. Treatment with about 2 g a day of Nicotinic acid has produced significant reductions in both blood cholesterol and triglyceride levels. To lower the LDL component and raise the good HDL cholesterol, people usually take 50 to 100 mg. Twice daily and then increase the amount slowly over two or three weeks to 1500 to 2500 mg. Generally, for those with high cholesterol levels it has been used to help reduce the risk for atherosclerosis.
Because of its vascular stimulation and effects of lowering cholesterol and blood pressure, vitamin B3 has been used preventatively for such serious secondary problems of cardiovascular disease as myocardial infarction (heart attacks) and strokes. Also, some neurological problems, such as Bell’s palsy and trigeminal neuralgia have been helped by Niacin supplementation. In osteoarthritis, to help reduce joint pain and improve mobility, niacinamide has been used in amounts beginning at 500 mg twice daily up 2000 mg 3 times per day along with 100 mg of daily B complex.
Niacin has been an important boon to the field of orthomolecular psychiatry for its use in a variety of mental disorders. It was initially demonstrated to be helpful for the neuroses and psychosis described as the “dementia of Pellagra,” the Niacin deficiency disease. Since then, it has been used in high amounts, well over 100 mg per day and often over 1000 mg per day (up to 6000 mg), to treat a wide variety of psychological symptoms, including senility, alcoholism, drug problems, depression, and schizophrenia. Niacin has been helpful in reversing the hallucinatory experience, delusional thinking or a wide mood in energy shifts of some psychological disturbances. Though this therapy has its skeptics, as does all applications and nutritional medicine, some studies show promising results in treatment of schizophrenia with Niacin and other supplements. Other studies show little or no effect. More research is definitely needed on Niacin’s effect and mental disorders.
People on high blood pressure medication and those who have ulcers, gout, or diabetes should be very careful taking high doses of of Niacin because of its effects of lowering blood pressure, it’s acidity, its liver toxicity, its potential to raise uric acid levels, and its effect in raising blood sugar; though recently Niacin has been shown to have a positive effect on glucose tolerance (is part of glucose tolerance factor) and, thereby, on diabetes as well. Exercise and Niacin are helpful for people with adult diabetes through their positive effects on blood sugar and cholesterol.
Deficiency & Toxicity
As with other B vitamins, there are really no toxic effects from even the high doses of Niacin, though the “Niacin flush” previously described may be uncomfortable for some. However, with the use of high does Niacin in recent years, the occasional person experiencing some minor problems, such as irritation of the gastrointestinal tract and/or the liver, both of which subside with decreased intake of Niacin. In addition, some people taking Niacin experience sedation rather than stimulation.
Deficiency problems have been much more common than toxicity, and for a long period of history, the Niacin deficiency disease, Pellagra, was a very serious and fatal problem. Characterized as a disease of the “three D’s,” Pellagra causes its victims to experience dermatitis, diarrhea, and dementia. The fourth D was death.
The classic B3 deficiency occurs mainly in cultures whose diets rely heavily on corn and where the corn is not prepared in a way that releases its Niacin. One of the first signs of Pellagra or Niacin deficiency, is skin sensitivity to light, and the skin becomes raw, thick, and dry (Pellagra means “skin that is rough” in Italian). The skin then becomes darkly pigmented, especially in areas of the body prolonged by hot and sweaty with those exposed to the sun. The first stage of this condition is extreme redness and sensitivity of those exposed areas, and it is from the symptom that the term “redneck,” describing the bright rednecks of 18th and 19th Century Niacin deficiency field workers, came into being.
n general, Niacin deficiency affects every cell, especially in those systems with rapid turnover, such as the skin, gastrointestinal tract, and nervous system. Other than photosensitivity, the first signs of Niacin deficiency are noted as decreased energy production and problems with maintaining healthy functioning of the skin and intestines. The symptoms include weakness in general, fatigue, anorexia, indigestion, and skin eruptions. These can progress to other problems, such as sore, red tongue, canker sores, nausea, vomiting, tender gums, bad breath, and diarrhea. The neurological symptoms may begin with irritability, insomnia, and headaches and then progress to tremors, extreme anxiety, depression; all the way to full-blown psychosis. The skin will worsen, as will the diarrhea and inflammation of the now in intestinal tract. There will be a lack of stomach acid production (Achlorhydria) and a decrease in fat digestion and, thus lower availability from food absorption of the fat soluble vitamins, such as A, D, and E. along with other signs, symptoms and deficiency syndromes associated with these fat soluble vitamins.
Change from “A-B-C” to “C-A-B.” A major change in basic life support is a step away from the traditional approach of airway-breathing-chest compressions (taught with the mnemonic “A-B-C”) to first establishing good chest compressions (“C-A-B”). There are several reasons for this change.
- Most survivors of adult cardiac arrest have an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and these patients are best treated initially with chest compressions and early defibrillation rather than airway management.
- Airway management, whether mouth-to-mouth breathing, bagging, or endotracheal intubation, often results in a delay of initiation of good chest compressions. Airway management is no longer recommended until after the first cycle of chest compressions — 30 compressions in 18 seconds. The 30 compressions are now recommended to precede the 2 ventilations, which previous guidelines had recommended at the start of resuscitation.
- Only a minority of cardiac arrest victims receive bystander CPR. It is believed that a significant obstacle to bystanders performing CPR is their fear of doing mouth-to-mouth breathing. By changing the initial focus of resuscitation to chest compressions rather than airway maneuvers, it is thought that more patients will receive important bystander intervention, even if it is limited to chest compressions.
Basic life support. The traditional recommendation of “look, listen, and feel” has been removed from the basic life support algorithm because the steps tended to be time-consuming and were not consistently useful. Other recommendations:
- Hands-only CPR (compressions only — no ventilations) is recommended for the untrained lay rescuers to obviate their fears of mouth-to-mouth ventilations and to prevent delays/interruptions in compressions.
- Pulse checks by lay rescuers should not be attempted because of the frequency of false-positive findings. Instead, it is recommended that lay rescuers should just assume that an adult who suddenly collapses, is unresponsive and not breathing normally (eg, gasping) has had a cardiac arrest, activate the emergency response system, and begin compressions.
- Pulse checks by healthcare providers have been de-emphasized in importance. These pulse checks are often inaccurate and produce prolonged interruptions in compressions. If pulse checks are performed, healthcare providers should take no longer than 10 seconds to determine if pulses are present. If no pulse is found within 10 seconds, compressions should resume immediately.
- The use of end-tidal CO2 (ETCO2) monitoring is a valuable adjunct for healthcare professionals. When patients have no spontaneous circulation, the ETCO2 is generally ≤ 10 mm Hg. However, when spontaneous circulation returns, ETCO2 levels are expected to abruptly increase to at least 35-40 mm Hg. By monitoring these levels, interruptions in compressions for pulse checks become unnecessary.
CPR devices. Several devices have been studied in recent years, including the impedance threshold device and load-distributing band CPR. No improvements in survival to hospital discharge or neurologic outcomes have been proven with any of these devices when compared with standard, conventional CPR.
- Patients with VF or pulseless VT should receive chest compressions until a defibrillator is ready. Defibrillation should then be performed immediately.
- Chest compressions for 1.5-3 minutes before defibrillation in patients with cardiac arrest longer than 4-5 minutes have been recommended in the past, but recent data have not demonstrated improvements in outcome.
- Transcutaneous pacing of patients who are in asystole has not been found to be effective and is no longer recommended.
Advanced cardiac life support. Good basic life support, including high-quality chest compressions and rapid defibrillation of shockable rhythms, is again emphasized as the foundation of successful advanced cardiac life support. The recommendations for airway management have undergone 2 major changes: (1) the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement is now a class I recommendation in adults; and (2) the routine use of cricoid pressure during airway management is no longer recommended.
As they did in 2005, the AHA acknowledges once again that as of 2010, data are “still insufficient …to demonstrate that any drugs improve long-term outcome after cardiac arrest.”
Several important changes in recommendations for dysrhythmia management have occurred:
- For symptomatic or unstable bradydysrhythmias, intravenous infusion of chronotropic agents (eg, dopamine, epinephrine) is now recommended as an equally effective alternative therapy to transcutaneous pacing when atropine fails;
- As noted above, transcutaneous pacing for asystole is no longer recommended; and
- Atropine is no longer recommended for routine use in patients with pulseless electrical activity or asystole.
Post-cardiac arrest care. Post-cardiac arrest care has received a great deal of focus in the current guidelines and is probably the most important new area of emphasis. There are several key highlights of post-arrest care:
- Induced hypothermia, although best studied in survivors of VF/pulseless VT arrest, is generally recommended for adult survivors of cardiac arrest who remain unconscious, regardless of presenting rhythm. Hypothermia should be initiated as soon as possible after return of spontaneous circulation with a target temperature of 32°C-34°C.
- Urgent cardiac catheterization and percutaneous coronary intervention are recommended for cardiac arrest survivors who demonstrate ECG evidence of ST-segment elevation acute myocardial infarction regardless of neurologic status. There is also increasing support for patients without ST-segment elevation on ECG who are suspected of having acute coronary syndrome to receive urgent cardiac catheterization.
- Hemodynamic optimization to maintain vital organ perfusion, avoidance of hyperventilation, and maintenance of euglycemia are also critical elements in post-arrest care.
The AHA 2010 guidelines represent significant progress in the care of victims of cardiac arrest. Most important is the stronger emphasis on post-cardiac arrest care. Induced hypothermia is underscored, and perhaps the most important advance is the recommendation for urgent percutaneous coronary intervention in survivors of cardiac arrest. The wealth of data thus far indicate that post-arrest percutaneous coronary intervention may be the most significant advance toward improving survival and neurologic function since defibrillation was first introduced decades ago.
In reviewing these guidelines, I must admit, however, that I was disappointed that AHA hesitated to adopt the concepts of “cardiocerebral resuscitation” (CCR). CCR also promotes the “C-A-B” approach to resuscitation, but it fosters even further delays in airway intervention — withholding any form of positive pressure ventilations, in favor of persistent chest compressions, for as long as 5-10 minutes after the cardiac arrest. The current guidelines recommend withholding positive pressure ventilation for a mere 18 seconds. First described in 2002, CCR has been studied more recently as well and demonstrated marked improvements in rates of resuscitation and neurologic survival.[2-4] I think that CCR should be incorporated into basic life support protocols for victims of primary cardiac arrest as quickly as possible to further improve outcomes.
Optimal management of cardiac arrest in the current decade can be summarized simply by “the 4 Cs”: Cardiovert/defibrillate, CCR, Cooling, and Catheterization.
Attorneys as back pain doctors…
Yes! At least they would get to the bottom of things. I’m sure you’ve all heard on TV “Your honor, I object! That’s irrelevant.” The same holds true for back and neck problems, especially now with MRI, which identifies all kinds of abnormalities, few of which are the cause of or relevant to the painful experience the patient is suffering from. Many patients are labeled with surrogate diagnoses followed by treatment that results in wasted time and money.
Evidence based research & study is now bringing to light the fact that we are failing miserably when it comes to treating benign back and neck problems; which, by-the-way, accounts for 80 to 90% of all back & neck problems. Unfortunately there’s nobody to object to or to sustain/overrule whether the findings are relevant or not. This is kind of like the fox in the henhouse, so to speak, in some situations.
Subsequently, cost has sky rocketed and outcomes and disability are actually worse. We keep coming up with bigger and better ways to diagnose and treat but we’re not getting better! Attorneys would at least determine what’s relevant and what’s not before further addressing the problem.
Probably the biggest issue with spine pain is the disc herniation; likely the scariest and most worrisome of findings. While in fact, it’s very common and not relevant in most cases. Studies are now revealing we commonly have degenerative disc disease, degenerative arthritis and disc herniations but don’t have back pain or leg pain.
See my website for some answers on disc herniations.
Am J Med. July 22 2011
Longer Lengths of Stay and Higher Risk of Mortality among Inpatients of
Physicians with More Years in Practice.
Inpatient care by physicians with more years in practice is associated with higher risk of mortality. Quality-of-care interventions should be developed to maintain inpatient skills for physicians.
Copyright © 2011 Elsevier Inc. All rights reserved.
- [PubMed - as supplied by publisher]
The article below discusses the psychosocial element of posture pain. Let me assure you there’s a direct cause & effect associate with the mechanics of poor posture as well. Be mindful of your posture!
Public release date: 12-Jul-2011
Contact: Amy Blumenthal: email@example.com, 213-740-5552, University of Southern California
Your mother was right: Study shows good posture makes you tougher
Study co-authored by USC Marshall professor examines the link between posture, effectiveness and pain tolerance
Mothers have been telling their children to stop slouching for ages. It turns out that mom was onto something and that poor posture not only makes a bad impression, but can actually make you physically weaker. According to a study by Scott Wiltermuth, assistant professor of management organization at the USC Marshall School of Business, and Vanessa K. Bohns, postdoctoral fellow at the J.L. Rotman School of Management at the University of Toronto, adopting dominant versus submissive postures actually decreases your sensitivity to pain.
The study, “It Hurts When I Do This (or You Do That)” published in the Journal of Experimental Social Psychology, found that by simply adopting more dominant poses, people feel more powerful, in control and able to tolerate more distress. Out of the individuals studied, those who used the most dominant posture were able to comfortably handle more pain than those assigned a more neutral or submissive stance.
Wiltermuth and Bohns also expanded on previous research that shows the posture of a person with whom you interact will affect your pose and behavior. In this case, Wiltermuth and Bohns found that those adopting submissive pose in response to their partner’s dominant pose showed a lower threshold for pain.
Fake it until you make it
While most people will crawl up into a ball when they are in pain, Bohn’s and Wiltermuth’s research suggests that one should do the opposite. In fact, their research suggests that curling up into a ball may make the experience more painful because it will make you feel like you have no control over your circumstances, which may in turn intensify your anticipation of the pain. Instead, try sitting or standing up straight, pushing your chest out and expanding your body. These behaviors can help create a sense of power and control that may in turn make the procedure more tolerable. Based on previous research, adopting a powerful, expansive posture rather than constricting your body, may also lead to elevated testosterone, which is associated with increased pain tolerance, and decreased cortisol, which may make the experience less stressful.
Keeping Your Chin Up Might Really Work to Manage Emotional Pain
While prior research shows that individuals have used pain relievers to address emotional pain, it is possible that assuming dominant postures may make remembering a breakup or some distressing emotional event less painful.
When it comes to back or neck pain many times mechanical therapy is the only answer to the problem!
Science tells us pain basically comes from three sources: thermal tissue damage (hot or cold), chemical irritation from inflammation and mechanical load or stress on tissues.
In the spine, mechanical pain is all too common and commonly overlooked!
A high percentage of the time back pain is mechanical in nature and requires mechanical intervention to improve the problem. A kidney stone is a good example of mechanical pain. The stone is lodged and irritating the tissue. Medication may lesson the pain but the mechanical factor must be remove to get better. many times spinal problems are the same. If the internal component of the joint is displaced it must be reduced. If the joint is painfully stiff or stuck it must be mobilized or manipulated to get better.
There are two valid & reliable classifications of mechanical spine pain; disc derangement, better known as a bulging disc, and joint dysfunction, which is a stiffening of the joint(s). Both forms are common but disc derangement can be the most problematic and disabling. Both can be corrected or improved upon but the derangement classification, although typically more painful and disabling, usually responds to appropriate care more rapidly. Sometime as quickly as one visit an individual can improve from severe pain from the back/leg, neck/arm, to complete abolishment of symptoms and improved function after reduction of the derangement.
Even chronic pain patients respond and should attempt mechanical therapies!
- Physical Medicine: We Offer…
- Mechanical care such as manipulation, mobilization, and therapeutic movement.
- We also offer inflammation & pain-modulating modalities such as electric muscle stimulation (interferential/HVG), ultrasound and cold laser.
- Muscle massage techniques such as myofascial release, trigger point work etc…
- Rehabilitative physical therapy.
Go to GreathouseChiropractic.com for more information on services.
For Appointment Call:
« Previous entries Next Page » Next Page »