“Harder than a Half-Ironman,” Dr. Glenn’s Race Report (pic), and the 1-Page Health News (w/video)

My friend and fellow Altitude Multisport club member Justin Chester summed up Xterra Beaver Creek perfectly, “That’s harder than a Half-Ironman!” I don’t know about that since I’ve never done a Half-Ironman. But I do know this: Beaver Creek, for such a posh place, serves up one tough off-road triathlon course. For the record, I did the Sprint version.

I’m never too focused to high-five my kids at the bike-run transition!

Overall, I had a good day. My swim was slower than last year, possibly related to my lack of swim training this year. I guess I shouldn’t have taken 7 months out the pool after last season? The bike and run were about the same as last year (maybe a tad slower). Overall I was only 4 minutes off of last year’s time. I’ll take it! Next up is Xterra Indian Peaks at Eldora ski resort this coming Saturday. That’s right, 2 Saturdays in a row.

Weekly Health Update
Week of: Monday, July 22th, 2013
“A healthy outside starts from the inside.”
~ Robert Urich

Mental Attitude: Obsessed With Forbidden Pleasures.
When individuals are forbidden from everyday objects, their minds and brains pay more attention to them. Obsession is not as strong if others are also denied. When an object is forbidden to a group, the allure of the object drops dramatically. This helps to explain why group diet programs can be more successful than dieting alone.
Cognitive, Affective and Behavioral Neuroscience, June 2013

Health Alert: Kids Poisoned.
Every 10 minutes a child in the United States is taken to the Emergency Room because of poisoning from swallowing a prescription or over-the-counter medicine. The most common drugs associated with children’s poisoning include those used to treat diabetes, high cholesterol (statins), pain (opioids), and cardiovascular diseases (beta blockers).
Pediatrics, June 2013

Diet: Soda, Illegal Drugs, and Teeth.
Drinking large quantities of soda can be as damaging to your teeth (tooth erosion) as methamphetamine and crack cocaine use. Tooth erosion occurs when acid wears away tooth enamel. Without enamel, teeth are more susceptible to developing cavities, as well as becoming sensitive, cracked, and discolored. The citric acid present in both regular and diet soda is known to have a high potential for causing tooth erosion. The ingredients used in preparing methamphetamine can include extremely corrosive materials such as battery acid, lantern fuel, and drain cleaner. Crack cocaine is also highly acidic in nature.
General Dentistry, June 2013

Exercise: Quantity Over Frequency?
A study of over 2,300 Canadian adults found that those who exercised 150 minutes over just a few days of the week received the same health benefits as those who spread out 150 minutes of exercise over the entire week.
Physiology, Nutrition, and Metabolism, June 2013

Chiropractic: Success!
A study compared the effectiveness of manual therapy (performed by a Chiropractor), physical therapy (performed by a Physical Therapist), and medical care (delivered by a Medical Physician) for patients with neck pain. The success rate at 7 weeks was twice as high for the chiropractic therapy group (68.3%) compared to the medical care group. Patients receiving chiropractic therapy had fewer absences from work than patients receiving physical therapy or medical care for their neck pain. Manual therapy and physical therapy also resulted in statistically significant less analgesic (pain relief medication) use.
Annals of Internal Medicine, 2002

Wellness/Prevention: Prevent Stress.
Among women who reported stress, 40% had psychosomatic symptoms in the form of aches and pain in their muscles and joints, 28% suffered from headaches or migraines, and 28% reported gastrointestinal complaints. (Note- I’m sure men would have reported even more complaints, as everyone knows women are the tougher gender.)
University of Gothenburg, June 2013

As always, thanks for reading,

Carpal Tunnel Syndrome – Nutritional Considerations

Carpal Tunnel Syndrome (CTS) is a condition where the median nerve that arises in the neck and travels through the shoulder, arm, and into the hand becomes compressed. Compression of the median nerve results in tingling, numbness, pain and/or weakness that affects the 2nd, 3rd, and thumb-side half of the 4th fingers. It can wake sufferers up in the middle of the night, forcing them to have to shake the hand and flick the fingers to “wake it up.” This can occur multiples times a night, making for a long next day! We’ve discussed chiropractic management strategies such as manipulation/mobilization of the neck, shoulder, elbow, wrist and hand, the use of a cock-up splint (especially at night and at times when driving), but more information regarding the use of nutritional supplementation is lacking; hence the purpose of this Health Update!

 

Let’s look at what we are trying to accomplish by nutritional approaches for CTS:

  1. Anti-inflammation: Because of stomach, liver, and kidney side effects, NSAIDs such as ibuprofen, aspirin, and others may not be your best choice. Rather, consider Turmeric (300 mcg), Ginger (100 mg), Boswellia (100 mg), Rosemary (100 mg), Bioflavonoid (100 mg), Bromelain (50 mg), Vitamin C (1-3 grams/day), Vitamin E (400 IU/day), Vitamin D3 (2000-5000 IU/day), Vitamin B-complex (especially B6, 9, and 12).
  2. Muscle relaxation: Calcium (1500mg/day), Magnesium (400 mg/day), Potassium, valerian root (vervain), B-Complex, L-Arginine, Rosemary, Catnip, Kava root, Chamomile, Cayenne Pepper, Horseradish, Lavender, Licorice, Devil’s Claw.
  3. Nerve repair: Folate (B9), B12 (cobalamin), Vitamin D3, B1 (Thiamin; minimum: 1.2mg/day), B5 (Pantothenic acid), B3 (niacin; minimum 16 mg/day), B12.
  4. Managing systemic conditions:

a)      Diabetes (dysinsulinism): Chromium (picolinate or choloride), Alpha-Lipoic Acid, Omega-3 Fatty Acids (1000 mg of EPA & DHA), Coenzyme Q10, Polyphenols (dark chocolate, green tea), Botanicals (plant extracts such as garlic, prickly pear, aloe vera, fenugreek, bitter melon and ginseng).

b)     Thyroid dysfunction (hypothyroid): B-Complex (100 mg of B1, 3, 5, & 6 3x/day; B2, 50 mg 2x/day; B12 1000-2000 mcg/day; Selenium and iodine, Anti-oxidants (Selenium, Vit. C, Vit. E) Copper, thyroid extract, organic iodine.

c)      Obesity (BMI>30): Childhood obesity: Vit. D (ages 1-13, 5 mcg/day), B12, Vit. C, Fiber, Calcium (an extra 300mg of Calcium= >2 lb. weight drop); other fat soluble vitamins (Vit. A, E, and K), iron (iron is more commonly deficient in obese children and adults and can lead to fatigue and poor mental health and memory function).

  1. Other considerations: General health: paleo diet, sleep quality, and exercise (see below).

 

You may notice that there is a lot of overlap in many of these vitamin recommendations. If one were to give nutritional recommendations for general health purposes, the anti-inflammatory “big 5” might include 1. A good quality multi-vitamin mineral, 2. Magnesium (often with calcium as a combined supplement), 3. Omega-3 fatty acids; 4. Vitamin D; and 5. Coenzyme Q10. For CTS specifically, the addition of a B complex seems consistently recommended above.  Controlling weight will reduce CTS risk and decrease the risk of acquiring type II diabetes which increases CTS risk by itself. Perhaps an “ideal diet” for everyone might include eating plenty of fruits, vegetables, lean meats, and the elimination of gluten (grains) – referred to by some as the “anti-inflammatory diet,” paleo diet, caveman diet, and Mediterranean diet. Fortifying a great diet with vitamins is the “take-home” concept!

Low Back Pain and Travel Tips

Low back pain (LBP) and the discussion of traveling tips will be concluded this month. Please refer to the last 2 months for other great traveling tips. Keep a copy of these in your travel bag!

 

BE PROACTIVE WITH THE AIRLINES: 1. Get an aisle seat. Request an aisle seat out of “medical necessity.” By stating it this way, the airlines will go out of their way to find you an aisle seat. It is easier to exit the seat in case you have to use the restroom or an emergency occurs. It also allows you to get up and walk around for exercise, which can reduce the irritation of LBP and reduce the chances of blood clots. We can provide a letter to travel with stating that you have LBP, which can help you get special considerations. 2. Request a wheelchair. Make sure the airline knows you would like a wheelchair. They will handle your carry-on, get you through security quicker, and get you to and from the gate in a safe, timely manner. Typically this request is done at the time you make your reservation, but you can also tell a flight attendant prior to landing and they will have it arranged by the time you de-plane at your arrival site. Since there is no way to know how long the security line will be or how long the distance will be between gates or to baggage claim, having a wheel chair pre-arranged is wise. 3. Request a row of seats. Typically, if the plane isn’t full, you can ask for a row of seats that are empty so you can put the arm rests up and spread out, lay down and be much more comfortable. 4. Recline your seat. Depending on your type of low back condition, you may feel most comfortable either in a vertical upright position or reclined position. Some seats, such as in the exit row or last row, do not recline so ask when booking your flight or when you check-in to make sure your seat is adjustable. 5. Stay stretched. Prolonged sitting has many negative effects on muscles, joints, and circulation. Performing stretches from sitting or standing can help a lot, especially on long flights. Ask us to show you some easy-to-perform exercises that can be done in confined spaces! 6. Pre-board. This option allows you to board the plane first and gives you extra time. 7. Handicapped parking sticker. Consider this if walking is challenging for you. We can assist you in this effort and it will allow you to park close to the entrance at the airport. 8. Get a seat assignment. Getting “bumped” is common practice these days due to airlines purposely over-booking. If you do not initially obtain a seat assignment, call the airlines immediately to obtain a seat. Getting bumped can mean a delay for a couple hours up to a couple days!

 

SIT WITH SUPPORT: 1. Back Support. Using a special back support (if possible) or even a rolled up towel, pillow, or airline blanket between your back and seat can really help decrease low back pain. A small water bottle (tighten the cap!) is also a good option. The “bottom line” is comfort. If it feels good and relieving, it will be of benefit and help you. 2. Sit “supported.” Sitting with your knees bent at a right angle (90°) pushing your feet into the floor can be relieving and offer good support, especially during take-offs and landings. Also, stretch your legs out straight periodically under the seat ahead of you. You may have to place your briefcase or carry-on behind your legs, in front of your seat to open up the space so you can stretch out. Lastly, drink plenty of water, slip your shoes off at times, get up and walk periodically, carry a note from us for special needs, and most importantly, ENJOY YOUR FLIGHT!!!

Common Questions about Cervical Disk Herniations

Last month, we discussed the topic of neck pain arising from cervical disk herniations. The focus of this month’s Health Update is common questions that arise from patients suffering from cervical disk derangement.

1. “What can I do to help myself for my herniated disk in my neck?” The mnemonic device “PRICE” stands for Protect, Rest, Ice Compress, and Elevate is a good tool to use in the acute stage of many musculoskeletal conditions.

  • Protect your health by NOT placing yourself in an environment that is likely to harm you, such as playing sports or doing heavy yard work. That is, think about what you do BEFORE you do it and if sharp, radiating pain occurs, STOP and assess the importance of what you are doing. Use the concept, “…don’t pick at your cut.” This means if you want the injury to heal, don’t keep irritating it!
  • Rest is similar. Limit your activities to those that can be done without increasing symptoms, especially radiating pain.
  • Ice – The use of ice reduces swelling/inflammation, which reduces pain and promotes healing. Alternate it every 15-20 minutes (on/off/on/off/on) several times a day. You can also use contrast therapy (Ice/heat/ice/heat/ice) at 10/5/10/5/10 minute intervals to “pump” out the swelling.
  • Compress – The use of a collar worn backwards, if it’s more comfortable that way, can literally “take the load off.” the neck and disks. There are even inflatable collars which are pumped up with air to traction the neck. Other forms of traction will be discussed further.
  • Elevate – The concept of raising the ankle to the height of the heart so swelling can drain out of the ankle is the classic example of “elevation.” In the neck, the traction concept may apply once again.

2. “I don’t want to have surgery if I can help it. What can you do as a chiropractor to help me?” This is one of our primary goals, and in fact, the goal of ALL health care providers, even surgeons! Chiropractic offers anti-inflammatory measures: ice, herbal anti-inflammatory agents (ginger, turmeric, bioflavonoid, curcumin, bromelain, Rosemary extract, Boswellia Extract, and more), digestive enzymes taken between meals, muscle relaxant nutrients (valerian root, vitamin D, a B complex, chamomile, magnesium, and others) as well as other non-pharmaceutical options. Treatments consist of manual manipulation, mobilization, traction (for home and office), modalities such as laser and low-level laser, electrical stimulation, magnetic field, ultrasound, and others.

Most important is having a “coach” guide you through the stages of healing by first addressing the acute inflammatory stage (first 72 hrs), the proliferative or reparative phase (up to 6-8 weeks), followed by the remodeling phase (8 weeks to 1 or 2 years) and finally, the contraction phase (lifetime – includes the natural shortening of scar tissue). If manual traction reduces neck and arm pain, the use of home traction is very effective. Options include sitting over-the-door traction, laying down versions, and mobile traction collars (discussed previously).

Exercises to stretch and strengthen the neck are also very important in reducing neck pain as well as preventing recurrences. If in spite of all the best efforts of this non-surgical care approach should ongoing neurological loss and relentless symptoms continue, we will coordinate care with physiatrists for possible injection therapy and pharmaceuticals, with neurology for further testing (such as EMG/NCV – a nerve test), and/or neuro- or orthopedic surgery – THE LAST RESORT!

We realize that you have a choice in where you receive 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 presently and, in the future. 303.300.0424 office@denverback.com

 

Car Accidents and neck pain (a.k.a. Whiplash)

Whiplash refers to an injury to the neck resulting from a rapid movement, usually associated with a motor vehicle collision (MVC). However, it can occur with a slip and fall injury, a bar room brawl, during a sports event like being tackled in football, among other things. For the sake of this discussion, we will stick with the classic example of a rear-end MVC.

 Mechanism of injury: So what really happens during the MVC that causes injury? The answer centers around movement of the neck which exceeds the normal tissue’s stretch limits, sometimes referred to as “the elastic barrier.” When the MVC occurs, during the first 100-200 milliseconds the trunk supported by the back of the car seat rapidly moves forwards leaving the head unprotected in its original position resulting in a backward glide or motion of the head and neck. Next, the head (which weighs about 12-15 pounds) drops back (HOPEFULLY) into the headrest stopping the motion, but if the head rest is too far back (>1/2 inch) or too low, then the head keeps going backwards until the tissues in the front of the neck stretch to the point of either stopping the motion or tearing (or both).

Next, the highly stretched front of the neck muscles, ligaments, disks, and tendons (in a “crack the whip” like manner) propel the head forwards to the point of over stretching the tissues in the back of the neck, which similarly stops the movement &/or tears. The degree of injury depends on many things, but is notably worse in the long-necked, skinny female where the “crack the whip” reaction is the greatest. Several factors determine the degree of injury, including the “G-Force,” or the amount of energy produced during the impact. The greater the G-force applied to the head/neck, the greater the potential for injury.

The G-force affecting the occupants inside the vehicle is related to many things: the speed of the crash, the size of the two vehicles (worse if a large automobile hits your smaller car), the angle and springiness of the seat back, the amount of energy absorbed by crushing metal vs. no damage to the vehicles (worse when there is no damage as all the energy is transfer to the occupants), whether the head was rotated or looking straight at impact, and more. The KEY to all of this is that we cannot voluntarily contract our muscles quicker than 800-1000 msec and the whiplash process is over after about 500 msec, so we can’t effectively “guard” or protect ourselves against injury even if we try by bracing ourselves before the MVC!

            Type of injury: The classic injury is called a sprain (ligament tear) and strain (muscle and/or muscle tendon tear) to either or both the front of the neck and/or back of the neck. Sprains and strains come in 1st, 2nd, and 3rd degree tears, getting progressively worse as more tissue is torn. Please refer to previous issues of the Whiplash Health Update where the anatomy is reviewed so you can “picture” this properly.

            Prognosis: The length of time to recovery or maximum improvement varies by the amount of tissue damage. A “prognosis scale,” first introduced in 1995 and validated by 2001, showed that in Type 1 injuries pain without loss of neck motion healed the quickest. Type 2 injuries where neck movement was reduced after the MVC (but no neurological findings occurred) healed next quickest. Type 3 injuries, which included BOTH motion and neurological loss, healed the slowest and had the worst long-term outcomes. Other factors enter into this, of course.

We will continue this “Whiplash 101” discussion next month…

We realize you have a choice in where you receive 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.

Hippocrates and chiropractic care

Chiropractic may only be 114 years old, but spinal manipulation has been around for thousands of years. Massage and manipulation are two of the oldest remedies known to man. In fact, the first pictures depicting spinal manipulation were discovered in prehistoric caves in Point Le Merd in southwestern France. These drawings depicted crude, non-specific attempts to manipulate the spine that date back to 17,500 bc. The ancient Chinese were using manipulation in 2700 bc. and James Cyriax, in his Textbook of Orthopedic Medicine, included a picture of a Buddhist temple with a statue over 2,000 years old showing manipulation of the lumbar spine.

More recently, Hippocrates (460-377 bc), the father of Greek medicine said, “Get knowledge of the spine, for this is the requisite for many diseases.” He wrote over seventy books on healing and was a proponent of spinal manipulation. This great physician was also the first to deal with the anatomy and the pathology of human spine. In his books, he provides a precise description of the segments and the normal curves of the spine, the structure of the vertebrae, the tendons attached to them, the blood supply to the spine, and even its anatomic relations to adjacent vessels. Hippocrates devised two apparatuses, known as the Hippocratic ladder and the Hippocratic board, to reduce displaced vertebrae.

Hippocrates believed only nature could heal and it was the duty of a physician to remove any interference preventing the body from healing. Hippocrates taught that the essence of life and the ability of the body to heal was the result of a vital spirit.

How to get rid of elbow pain

Denver Chiropractic Center Weekly Health Update

“If you want others to be happy, practice compassion.
If you want to be happy, practice compassion”
~ Unknown
.
Mental Attitude: The Elderly and Facebook.
Elderly adults who learned to use Facebook on a daily basis scored 25% better on tests measuring their cognitive abilities than their peers who did not.
University of Arizona, February 2013

Health Alert: Baby Boomers Vs. Preceding Generation!
As each generation grows older, they believe they are healthier than the previous generation. However, the baby boomers are unable to make this claim. Compared to the preceding generation at the same stage of their lives, fewer have “excellent” health (13% vs. 32%), more have high blood pressure (75% vs. 35%), and more are obese (36% vs. 25%).
JAMA Internal Medicine, February 2013

Diet: The Southern Diet and Stroke.
People from the American South are 20% more likely to have a stroke than those from other parts of the country, and the Southern diet may be to blame. People who eat Southern style food high in fat, sugar, and salt at least 6 times a week were at 41% higher risk for a stoke. People whose diets consisted of fruits, vegetables, and whole grains at least 5 times a week were 29% less likely to have a stroke.
American Stroke Association, February 2013

Exercise: Tai Chi?
Tai Chi may reduce falls among adult stroke survivors. Tai Chi is a martial art dating back to ancient China that includes physical movements, mental concentration, and relaxed breathing.
American Stroke Association, February 2013

Chiropractic: Recommended For Back Pain.
The Royal College of General Practitoners’ 2009 recommendation for treating non-specific low back pain advises doctors to advocate exercise and manipulation (such as chiropractic care) before pharmacological (drug) therapies and more invasive treatments (like surgery).
National Institute for Health and Clinical Excellences, 2009

Wellness/Prevention: Sunshine and Rheumatoid Arthritis.
Routine exposure to the sun, especially ultraviolet B (UVB) rays, may decrease the risk of rheumatoid arthritis. Those with the most elevated rates of exposure were 21% less likely to develop rheumatoid arthritis than who had less exposure.
Annals of the Rheumatic Diseases, February 2013

This week’s 1-Page health News from Denver Chiropractic Center

Health Alert: High Fructose Corn Syrup and Type-2 Diabetes. Researchers found a 20% higher proportion of the population has diabetes in countries with high use of High Fructose Corn Syrup (HFCS), like the United States, compared to countries that do not, like the United Kingdom. The United States has the highest consumption of HFCS at 55 lbs (~25 kg) per year per person. The United Kingdom consumes 1.1 lbs (~.5 kg) per year per person.

Global Public Health, November 2012

Diet: Food Advertising. Childhood obesity has tripled in the past 30 years. Food companies spend $10 billion a year marketing in the United States, and 98% of that is on foods high in fat, sugar, or sodium.

Journal of Pediatrics, November 2012

Exercise: Walk Much? The more moderate physical activity (like brisk walking) you do, the better. Compared to doing nothing at all, seventy five minutes of vigorous walking per week was linked to living an extra 1.8 years. Walking briskly for 450 minutes or more per week was found to provide most people with a 4.5-year longer lifespan. The longer people spent each week being moderately active, the greater their longevity. Heart, November 2012

Chiropractic: Keep Your Disks Healthy. In normal healthy disks, the nerves (sinuvertebral) only sense pain on the periphery or outer regions of the disk. In grossly degenerated disks, nerves may penetrate into the center (nucleus) of the disk and be more vulnerable to degeneration and/or inflammation. Lancet, 1997

Wellness/Prevention: Cell Phone Addiction. Cell phone and instant messaging addictions are driven by materialism and impulsiveness and can be compared to consumption pathologies like compulsive buying and credit card misuse. Cell phones may be used as part of the conspicuous consumption ritual and may also act as a pacifier for the impulsive tendencies of the user. Impulsiveness plays an important role in both behavioral and substance addictions.

Journal of Behavioral Addictions, November 2012

Fibromyalgia and Neurotransmission

Neurotransmission is the method by which nerves “speak” to each other so impulses can be sent from one part of your body to the brain and back. For example, when you touch a hot plate by accident, it doesn’t take long before you quickly let go of the plate. The reason you let go quickly is because of neurotransmission. Certain types of neurons or nerves (called afferents) bring information to the central nervous system where the information is processed and then signals are transferred back to the target site (such as your hand touching the hot plate) by different nerves (called efferents) telling you to immediately let go of that hot object.

It’s like the flow of traffic into a city during rush hour. People work all day and then drive in the opposite direction on their way home (afferents in the morning going in the city or “brain” and efferents in the evening bringing new information home). This “give and take” process of information coming in, being processed and going out helps coordinate our bodily functions. This allows us to constantly adapt to surrounding changes in temperature, stress, noise, and so on.

Each neuron has as many as 1500 connections from other neurons, but they don’t actually touch one another. Rather, there are “synapses” where nerve impulses stimulate the release of calcium and neurotransmitters, which either inhibit or excite another neuron and each neuron may be connected to many other neurons. If the total excitatory stimuli are greater than the inhibitory stimuli, that neuron will “fire” and create a new connection resulting in an action (like dropping the hot plate).

Okay, sorry for the enthusiastic description and details of neurotransmission. More importantly, how does all this relate to fibromyalgia? A new study (published May 14, 2012 in NATURE by scientists at Weill Cornell Medical College) discovered that a single protein (alpha 2 delta), “…exerts a spigot-like function controlling the volume of neurotransmitters and other chemicals that flow between the synapses of brain neurons.” This study shows how brain cells “talk to each other” through these synapses relaying feelings, thoughts, and actions and how this powerful protein plays a crucial role in regulating effective communication in the brain. They found that if they added or decreased this single protein (alpha 2 delta), then the speed of neurotransmission increased or decreased by opening or closing the calcium channels that trigger neurotransmission release.

The relationship between calcium and neurotransmission has been known for 50 years, but how to “turn on or off” the volume is a new discovery. They hope this finding will help in the design of new medications that will help regulate the neurotransmission in the brain, thus help reduce the increased pain perception found in people suffering from fibromyalgia.

Our aim in sharing this information with you is to keep you informed with what is on the cutting edge of research as we’ve said many times before, a “team” of health care provision is the BEST way to manage FM including chiropractic and primary care!