Lifecare Chiropractic
1830 S. Alma School Rd
Bldg 7, Ste 135
Mesa, AZ 85210
(480) 839-2273

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disc problems

WHAT HAPPENED AFTER YOUR MRI?

It doesn’t happen all the time, but it is not uncommon for a patient to call our office to cancel an appointment because they went to their PCP, the PCP ordered an MRI and now they have to see a specialist. Sound reasonable?

There are multiple layers of “wrong” in this scenario. First and foremost is that, in most situations, we have already identified whether a disc bulge / sciatica was present based on talking to the patient and our exam finding. At this point, without any type of red flags, it is never, ever recommended to order an MRI this early in the treatment. Happens all the time, but apparently, those ordering the MRI are not reading the studies.

Not only is this a tremendous waste of resources, but it is well documented that this starts the patient on a MRI to epidural to surgery pathway, despite evidence that this is not the best pathway for the patient.  It is also far too common for the PCP to steer the patient away from chiropractic care to a specialist–when chiropractic care is exactly what they need.

So what about the epidural’s effectiveness in the case of chronic (>12 weeks) radiculopathy (leg pain)? This particular study finds it worse than worthless—actually giving a small injection of saline was massively more beneficial than the steroid injection (Oswestry change after 52 wks– saline 14.3 points improvement, epidural 1.9 points worse). So basically, the epidural clearly made the patient worse as time went on.

The bottom line is that chiropractic care, for all musculoskeletal complaints, is the best place to go to get the best outcomes for your pain. Let the chiropractor decide if an MRI and epidural is appropriate.

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DID YOU HAVE AN MRI FOR LOW BACK PAIN?

There are definitely times when knowing less is a good thing.  It occasionally happens where a patient who has signs and symptoms of a disc herniation presents to our office.

Based on an exam and the history given by the patient, disc involvement (bulge, herniation, rupture, etc…) can be diagnosed and treatment started.  A full blown disc bulge may take several days to start to show a response, but the outcomes are usually very good.

Sometimes, it is not a disc problem that is causing the patients’ low back and leg pain.  Sclerotogenous referral from the hip (I really love the word “sclerotogenous”–makes me sound smart) or involvement of the fascia is also notorious for causing leg pain.

Sometimes, it may take a few days to be able to tell the difference.  Certainly an MRI would be helpful, right?  Not so fast…

You see, there is a large chunk of the population that has disc abnormalities on MRI (we can argue about the percentages, but let’s just agree that not all disc abnormalities on MRI cause problems).  We have also seen that MRIs done before and some time after a patient has a disc bulge don’t change much, even though the pain may be gone.

This particular study contributes to what any chiropractor can probably tell you.  MRIs increase the risk of having surgery.  Sounds strange…I mean–how could having an MRI affect your back?

It’s the mindset and the potential diagnosis of a disc problem, even if the disc problem is not what is causing a patient’s pain.

In this study, when the primary care doctor or orthopedic doctor had a financial incentive to order an MRI (usually because the unit was installed in their clinic) the number of MRI for low back pain went up.  In addition, in the orthopedic surgeon’s office, the number of patients getting surgery went up 34%. 

Just something to consider the next time you THINK you need an MRI… 

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May 10, 2001 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Novel Common Genetic Risk Factor for Lumbar Disk Disease

With the completion of the human genome project there seems to have been this burst of wanting to blame genetics for the chronic diseases of today’s society. With diseases such as heart disease, cancer and diabetes, it is shown consistently that environment plays a much larger part in disease determination than genetics. In addition, all these diseases are multi-modal, meaning that, if genetics do play a part, it is a series of multiple genes all contributing to an end result and not likely to benefit from genetic manipulation towards a single gene. My thoughts on a genetic factor for LBP are based on what I see in my office. Most patients have experienced some event that created an initial injury and they never completely healed from that injury. Future episodes of LBP are just extensions of that initial injury. There may be some genetic factor contributing to the condition in a small percentage of the population, but money would be better spent promoting chiropractic for LBP than discovering some pharmaceutical to fix the underlying genetic problem. Identification of a Novel Common Genetic Risk Factor for Lumbar Disk Disease http://jama.ama-assn.org/content/285/14/1843.full

Biomechanical activation of vascular endothelium as a determinant of its functional phenotype I know the title is a little technical, but this article is one of the most staggering that I have come across in awhile. Basically, this article reviews the findings that the genes associated with vascular endothelium (the lining of blood vessels) can change their expression based upon stresses placed upon it. This article reviews biomechanical stresses, but be assured that if this article or a future one focuses on biochemical factors the results will be the same. We are not talking about genetic hardwiring here. We are talking about the plasticity of the body to adapt to changes it is placed under using the same genes. PNAS — Abstracts: García-Cardeña et al. 98 (8): 4478 http://www.pnas.org/cgi/content/abstract/98/8/4478

Retroviral RNA in the CSF and brains of individuals with schizophrenia

Just thought I would throw this article into the mix. Psychiatrists and counselors today give little credence to the idea that physiology places a role in mental health. Granted, I am biased because of my studies, but I feel that physiology may indeed be the major player in many forms of mental health. Which would, of course, mean that any patient with a mental health problem, be it depression, anxiety or schizophrenia, would benefit greatly if not entirely from nutritional and lifestyle modification. PNAS — Abstracts: Karlsson et al. 98 (8): 4634 http://www.pnas.org/cgi/content/abstract/98/8/4634

Markers of cumulative biological risk: studies of successful aging

This article reviews the use of allostatic load (AL) to determine biological risks of aging. AL is an index that uses 10 parameters of biological functioning to give an overall level of risk. I have seen computer programs that attempt to give a biological age to the patients. I have very little faith in these because they do not address real questions (they ask for seat belt use, check BP and cholesterol, exercise levels…). Ironically, none of the 10 factors in AL are used on these questionaires. I have to mention one more thing for those of you that just read my comments…6 of the 10 factors are associated with Syndrome X. Go figure…a disease state that most of the medical profession is unaware of, a disease state that is highly modifiable with nutrition and natural medicine, and one that contributes to 60% of aging? And we wonder why medicine in the US is ranked so poorly. PNAS — Abstracts: Seeman et al. 98 (8): 4770 http://www.pnas.org/cgi/content/abstract/98/8/4770

Bile salts and aliphatic ionic surfactants on lymphocyte proliferation

Another big long title and the overall article is not much clearer. Overall, bile salts are produced by the liver and stored in the gallbladder until released by stimulation from a fatty meal. BIle salts have traditionally only been viewed as substances used to emulsify the fats and aid in digestion. That view has been expanding and now includes the findings that bile salts have some immunosupressive effects. Synergy : European Journal of Clinical Investigation 31 (4), 367-373 http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2362.2001.00778.x/abstract

Circadian Cortisol in Response to a 72-hour Fast in RA Patients

Fasting has long been a tool used in functional medicine and this study does show one aspect of why this is beneficial. An increase in cortisol, the body’s own natural anti-inflammatory hormone, is increase in patients while fasting. A few things to consider here before you go on a 72 hour fast. First, one of the main goals of a fast is to halt the insulting of the body with foods that the patient may be allergic to while giving the liver a chance to eliminate backlogged toxins. Next, I always recommend therapeutic fasting–replenshing the body with substances needed for healthy detoxification (supporting both phase I and II). Finally, cortisol can be a very damaging hormone if the body is exposed to it for extended periods. It is designed to be produced in response to stress to help our bodies get through the stressful period and then be gone. Proper attention to adrenal funciton is essential for maintaining a healthy, balanced cortisol response. Springer LINK: Clinical Rheumatology – Abstract Volume 20 Issue 2 (2001) pp 85-87  http://www.springerlink.com/content/ek2g512lhxjfm4bk/

The tightening grip of big pharma

This is a very important article to read for those of you living life with blinders on. The most disturbing news article appeared last Sunday in the AZ Republic as the front page story. The Valley of the Sun is experiencing a severe shortage of pharmacists. It was made out to be a serious situation. To me, the story was sickening to the effect that we as a population are not getting the message. Pharmaceuticals are dangerous. The drug companies control the research and many doctors are unwilling to report obvious side effects as what they are. You are a guinea pig each and every time you take a pharmaceutical drug. Remember that. And, please, read this commentary. The Journal : Back Issues http://thelancet.it/journals/lancet/article/PIIS0140-6736(00)04363-4/fulltext

 

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DO NOT DO THIS FOR A WORK INJURY!!

As a chiropractor, I can tell you that taking advantage of more complicated and “high tech” treatments for many, if not most, musculoskeletal complaints is bad news.  Study after study shows that things like getting an MRI leads to higher chance of receiving an epidural.  Receiving an epidural leads to a higher chance of having surgery.  It becomes a cascade effect.

Most studies looking at chiropractic care for musculoskeletal complaints find that our care is at least as effective and definately cheaper.  Especially when you focus on less medication, less imaging and certainly less surgery.  Which always makes it difficult when someone tries to cut out chiropractic benefits to “save money.”  Math wasn’t my strong point, but sure seems to make sense to keep chiropractic in the picture.

This particular study, while not looking at chiropractic care, did look at the opposite end of the spectrum.  Researchers looked at patients with a herniated lumbar disc diagnosed in a hospital setting.  Almost 42% of them did not return to the workforce full time.  42%!!  The odds were worse if surgery was performed.

The bottom line is to seek chiropractic care FIRST.  Care will be simpler, less costly, and your odds of returning to work will be highter.

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