The He-Said-She-Said about NSAIDs
Robert Hayden, DC, PhD, FICC
Question: I have heard a lot said about over-the-counter pain medication and how it might not be safe to take under certain circumstances. What are your thoughts?
A couple of years ago, I was treating a patient that I have known for a long time. She had a friend with her who had a small child. My patient asked me if I would take a look at her friend, Shelley, who was feeling a little woozy. Shelley was sitting in the floor leaning against the wall. I helped her to a standing position just as she lost consciousness and fell into my arms.
Question: A lady's husband was very ill, so she eliminated or removed every toxic product in their household - bleach, harsh cleaners, tin cans of food, anything perfumed, etc. What are the things in our homes that might be harmful or toxic?
There is a list of things that maybe your home, car, workplace, or anyplace else you may want to visit. Most of these things we assume are harmless because they are, in fact, things we encounter everyday. If they do not emit fumes, flames, or radiation, we may not perceive them as harmful. Let's look at some of the things you encounter every day that can bite you.
What if ObamaCare Stands?
Robert A. Hayden, DC, PhD, FICC
We are poised now for the Supreme Court to address the constitutionality of ObamaCare. This signature legislation for the Obama administration will become a central focus of the next presidential election this year.
What will be the consequences for US citizens if ObamaCare survives the legal and political tests ahead? It is difficult to imagine, in part because we have never embraced such a concept before. It is also difficult to imagine the impact of a bill that was passed before anyone could read it.
We might look to the state of Massachusetts for answers. This state was used as a model or ObamaCare. In Massachusetts now, 97% of that state's residents now have health care. This includes a half-million new consumers into a system that was not ready for them. There were unintended and unpredicted consequences of this influx of consumers. Here is a sneak peak at what we might expect should ObamaCare come to fruition in America.
According to the Massachusetts Medical Society, the waiting time for a new patient seeking a primary care physician varies between 36 and 50 days. About half of their internal medicine doctors have closed their doors to new patients. Because the physician population in Massachusetts is much higher than most other states, other states may expect much longer waits for patients seeking care due to massive shortages of primary care doctors.
The Association of American Medical Colleges is predicting a shortage of 46,000 primary care doctors by 2025, just over a decade from now. This is certainly influenced by physicians, nurse practitioners, and physician assistants gravitating toward more lucrative specialties. It may also be influenced by the thought processes of promising young students, who may be looking at dismal prospect for private practice and electing not to pursue a career in healthcare.
Mathematics will produce shortages in another important way. If ObamaCare becomes reality, the federal government will set fees for providers. It is possible that providers will not be able to opt out of the program, so they will be trapped. It is already true for many providers that if they fill their waiting rooms with Medicare patients, they will have to close their doors because Medicare cuts fees routinely sometimes in excess of 90%. Independent practices are small businesses and simply will not be able to make their expenses and will close.
We have seen numerous articles and opinions warning us that physicians will retire or abandon their careers rather than work under the circumstances that will be created by socialized medicine. The trend of independent medical practices being absorbed by business interests is already evident here in Griffin, and the prediction is that two thirds of them will be gone soon.
When sick patients cannot find a primary care doctor to see them, this creates an emergency-- and off to the emergency room many will go. Hospital emergency rooms are obscenely expensive, and this can only increase cost and waiting time for emergency care. The experience in Massachusetts was a 7% increase in emergency room traffic.
Massachusetts is now considering cutting health care benefits to about 30,000 legal immigrants in order to save their system for citizens. Budget cuts now threaten indigent care given to patients in Boston. On a national scale, there may be millions of formerly insureds pouring into the system because the cost of healthcare could not be borne by their employers anymore. Imagine what would happen if ObamaCare floods and additional 12 to 20 million illegal immigrants into Medicaid. The system will simply collapse.
It is likely that such a logjam will increase traffic to nonphysician providers who can address many of the issues that primary care physicians would treat, providing a less expensive and more immediate path to care. Since the 1990s, patients have already been voting with their healthcare dollars for this option, visiting nonphysician providers overwhelmingly more than all medical specialties combined. The most numerous physician-level provider in this category are chiropractors, and they are gearing up for the future.
What can patients do? First, get healthy and stay that way. Second, establish a relationship with the healthcare provider(s) of your choice, while you still have a choice, and maintain that relationship. Third, get familiar with the issues, and vote your conscience.
April 16, 2012
Even though the injury happened when he was a young athlete, Dr. Richard Leone remembers how frustrating it was that the physicians couldn't eliminate the feeling he had that someone was stabbing him in the back with a knife.
"They didn't know what to do with me. They could only medicate me," he said. "I said, 'The medications are not solving my knife. I want someone to get the knife out of my back.'"
However, Leone said his pain ended once he started going to a chiropractor.
Fast forward and Leone now has been a chiropractor for 44 years. He owns Back and Joint Pain Institute in Tacoma. But even after all this time, he is still moved by that pain he felt years ago.
While he doesn't have cutting back pain anymore, Leone has seen patients with the same pain he felt. The problem is that some of these patients can't be healed by typical chiropractic methods.
But rather than just sending these people off to have expensive back surgery, which may or may not eliminate the pain, Leone decided it was time to upgrade his practice with new methods of treatment and new technology.
"The ability to help these people is a new challenge," he said. "There's a tremendous need out there. It kind of breaks my heart when I see some of these cases out there. You only have one time through this life."
The Back and Joint Pain Institute has three decompression tables and Leone plans to add two more. The office also has one MLS Laser, but Leone also plans to add more of these machines in the future.
He said this technology has helped the Back and Joint Pain Institute to reach a 90 percent success rate.
And Leone is not the only chiropractor that has decided to invest in new technology.
"A lot of practices, like mine, are looking toward as much help from technology as they can get because we want to be efficient," said Robert Hayden, spokesman for the American Chiropractic Association and owner of a private practice in Georgia. "We want to get people healthy as fast as we can."
Hayden said that while there are some chiropractors who may have resisted technology, the threat of health care reforms and Medicare requirements have moved things forward.
"That really forced a lot of practices to embrace technology that they really were not comfortable using before," he said.
When doctor Leone started practicing, surgery was the typical method prescribed for fixing a herniated disk.
But now, Leone and other chiropractors, have been able to use decompression tables to move disks back to their normal positions between two vertebrae.
Spinal decompression therapy is able to slowly release pressure inside a disk and create suction to pull the disk back into place.
While it's not necessarily an easy process, Leone said patients benefit from the treatment because it doesn't require any downtime — and it doesn't pose the health risks that come with any surgery.
But perhaps Leon's biggest argument for decompression is that it's improving his patient's health. He said there are many cases in which surgery doesn't address the real problem.
"That's not going to help," he said about trying to find quick fixes through surgery. "That's like, if you have a rock in (your) shoe every day and you take ibuprofen to not feel the pain. When that wears off, you will still have the rock in the shoe."
Hayden said he originally invested in a decompression table to help treat his own spinal stenosis. But he soon found success treating patients.
"Decompression is not a new concept, but the decompression tables have really taken off in the last 10 to 15 years," he said. "That technology has advanced."
The other form of technology Leone and other chiropractors are investing in is laser therapy, particularly the MLS laser.
"The use of (cold lasers) I think is going to proliferate," Hayden said. "That's cutting edge technology a lot of us are using."
Laser therapy is typically used when injured areas often become tight and spasm. Leone said many doctors have worked to find a way to release that spasm.
MLS laser therapy features different wavelengths and different emission modalities, which make it a more effective laser for stimulating parts of the body that have tightened and are spasming.
"Your body heals itself," Leone said. "The only thing doctors do is help your body heal."
Laser therapy also is a useful tool for patients who can't undergo decompression therapy, including those who have had back surgery.
Hayden said there are a several technologies available to chiropractors that weren't on the market just a few years ago, including new forms of electric therapy, digital X-ray machines — and even a device that can take an X-ray of a finger and from that calculate the bone density in the person's spine.
With technology advancing so quickly, both Hayden and Leone have their sites set on devices that will hit the market during the next few years.
"Some of this is driven by a desire and a need to keep patients happy," Hayden said.
One of the problems facing chiropractors is the stereotype many people have about chiropractors' limitations.
"Chiropractors have been affected by the explosion of technology like every other business has been," Hayden said. "People still have an image of a chiropractor adjusting a spine and extremity by hand, which we still do. But I think they are totally unaware of the adjunct therapies we use and how we do them."
This is not to say every doctor needs every device on the market. Rather, Hayden believes it depends on the chiropractor's practice and patients.
Hayden said that when he was starting out, he needed to distinguish himself from the rest of the chiropractors in his area. So, he began investing in particular equipment.
"That helped to define my practice, not only to separate it from other practices in my area that weren't using that technique, but it also defines the patients I will see," Hayden said. "I'm saying to myself, from a business standpoint, I need to toot my own horn that we have these technologies and treatment modalities."
The problem for Leone is that he doesn't have time to meet with medical doctors to tell them about the treatment methods which are available at his institute. But because education is key, Leone decided to hire a new employee to specifically meet with other doctors.
Leone also hosts two open houses a month to make the general public aware that there are more options than the traditional chiropractic methods.
However, Hayden said it's important that when chiropractors are investing in and using new technology, they don't get caught up in the "quick fix" mentality.
"We live in a fast paced society where there is kind of an aspirin mentality," Hayden said. "People want to take an aspirin and have it go away. Sometimes these things take time."
Back injury can be a pain in the… Sacroiliac
Robert A. Hayden, DC, PhD, FICC
Question: I recently hurt my back while lifting my child from the backseat of my car. The pain is mostly in the back of my pelvis about 2 inches to the right of the base of my spine. What is the likely source of this pain, and how can I treat it?
The location of your pain sounds like a sacroiliac joint. This is very common. While 80% of the population suffers from low back pain at some time in their lives, sacroiliac joint dysfunction (SJD) accounts for likely 15 to 25% of these cases. SJD can be painful, bothersome, and debilitating, but it is usually easily treated conservatively and does not require surgical intervention.
The sacroiliac joints are the largest joints in the spine. If you look at someone's back, you will find two small dimples on each side of the lower back at about the level of the belt. This is the location of the sacroiliac joint. As the name implies, it is the joint between the sacrum, that triangular bone on which you sit, and the Ilium, the large bone on each side of the sacrum that hold up your pants and contains the hip joint lower down. These joints are richly supplied with nerves and supported by large, broad ligaments that provide stability. The joint is designed to move in a way that absorbs shock as you walk, which relieves stress on the spine and hips with weight-bearing.
SJD presents with low back pain, typically at the belt line, sometimes radiating into the buttock or thigh. It is most common in adults, but can happen in teenagers with athletic activity. It is sometimes associated with leg length inequality, abnormalities in the gait, prolonged exercise, or more serious conditions, such as fracture, dislocation, infection, or inflammatory arthritis. This condition is very common in pregnancy because there are hormone induced changes in the sacroiliac ligaments during the third trimester which caused this joint to loosen in preparation for childbirth.
My experience with SJD is that the frequent cause is unknown. There are minor movements that can be very stressful to this joint, such as getting into or out of your car, which involves placing all of your weight on one foot, twisting, and leaning as you aim yourself to a car seat. Certainly, bending and twisting to lift a child is enough to cause SJD.
Diagnosis of SJD is made with a combination of a good history, a physical examination that includes orthopedic and neurological testing, gait analysis, and sometimes imaging to rule out any serious pathology. It is usually successfully treated by adjusting the sacroiliac joint or joints. Occasionally the adjustment is augmented with physiotherapy, such as ultrasound, to decrease swelling of the sacroiliac ligaments, or electrotherapy to control reactive muscle spasms. During the acute phase (first 72 hours), ice compresses are better than heat, and will ease the soreness. Your chiropractor may also suggest some stretches to keep these joints moving and supple.
Occasionally, SJD is stubborn. There is a special belt, a trochanteric belt, that can be used to augment the adjustment. It holds the sacroiliac joints together by applying pressure just above the hips. I have used them on occasion with good results. I have also had significant success in correcting the underlying cause of SJD with customized orthotics, which I use to correct gait problems and leg length inequality.
The sooner you get appropriate care for your SJD, the better your prognosis. Don't wait and let it become chronic, because it might be harder to treat. However, for the vast majority of people, while it is a pain in the "sacroiliac," it is easy to control.
Deadly Skin Cancer Rises with Use of Tanning Beds
Robert A. Hayden, DC, PhD, FICC
Yesterday I had a conversation with the patient who suffers from fibromyalgia. Heat helps her pain. She is young and attractive in appearance, and likes to look her best. She has helped her pain and her appearance by lying in a tanning bed. This young lady is one of a growing cohort at risk, as women under age 40 are most frequently affected by the rising incidence of melanoma, according to a Mayo Clinic study published in the April issue of Mayo Clinic Proceedings.
This study examined decades of records in a single county in Minnesota. It focused on first-time diagnoses of melanoma inpatients from 18 to 39 years of age from 1970 to 2009. The long period of time strengthens this study's findings, so it is very significant that melanoma cases increased eightfold among women and fourfold among men during this time.
We live in a society that rewards physical attractiveness. Over and over we see people, mostly women, engaging in behaviors that sacrifice health to have the "right look." We see it in fad diets that sacrifice nutrition. We see it in high impact exercise programs that lead to early arthritic degeneration in knees and spines. Now this trend that results in a life-threatening cancer appears to be linked to the use of tanning beds. The authors of the Mayo study note, "Young women are more likely than young men to participate in activities that increase risk for melanoma including voluntary exposure to artificial sunlamps."
The literature on this topic describes the "Jersey Shore" effect. Characters portrayed on that television program are seen as attractive and healthy because they tend to have deep tans. Young people seek that look in order to make themselves feel attractive. It is unfortunate that peer pressure can lead to such a deadly disease. The effect of culture is all the more apparent in light of another government-funded study released this week that shows that cancers generally are trending downward, while melanoma is trending upward, despite a lucrative sun block industry.
I have pointed out health behaviors before in this column that have generated controversy or backlash, and this one likely will from one or more owners of tanning bed establishments. As you can imagine, the Indoor Tanning Association, an organization that promotes this industry, strongly contends that there is no relationship between ultraviolet light exposure from the sun or a sun bed and melanoma. This assertion, however, runs contrary to objective evidence.
Some exposure to sunlight is actually healthy. Vitamin D, which is required for bone health and many other physiological processes, is manufactured by skin in response to ultraviolet light exposure. What, you might ask, is the difference between sunlight and a tanning bed?
When I talk to patients about this issue, I point out that exposure to natural sunlight in moderation with appropriate sun block is healthier than a tanning bed in my opinion because sunlight is filtered by the atmosphere. There is no filtering effect from a tanning bed. This is a matter of individual judgment. Every time someone chooses to use a tanning bed, the chance of melanoma is increased. That risk is real with sunlight as well, but it was the use of tanning beds that showed up as a strong risk factor in the Mayo study.
Melanoma is a very serious life-threatening condition. The man who installed my x-ray unit was claimed by this disease. I knew a dynamic young pastor who felt to this disease and left his family and his congregation too early. Everyone should take it seriously. If you have a suspicious mole or skin lesion that does not heal, go to a doctor and get it checked. If it looks dangerous, you will be referred to a dermatologist. You may think that a visit to the doctor is expensive, but that expense will pale compared to that of an undiagnosed melanoma.
My advice to teenagers and young adults is simple: find a way to get comparable in your own skin!