ANOTHER BAD EFFECT OF ANTI-INFLAMMATORIES? Is it just me, or is the list of side effects of NSAIDs getting longer and longer? And we really all have Merck and Vioxx to thank for this direction of the research after well over 100,000 cardiovascular events were estimated to have occurred as a result of the new blockbuster drug when it was release. As way of comparison, does chiropractic care increase the risk of atrial fib, chondrocyte death, heart attack, kidney dysfunction, liver dysfunction or bleeding ulcers? Funny that adjusting ONLY (which would not include all of the soft tissue work, stretching, lifestyle changes and use of Graston that we do in the office) fares just as well for most conditions as this class of drugs but a handful of misguided critics still feel that chiropractic care is “not worth the risk”…
Natural Pain Relief
Back and Neck Pain Chiropractor Mesa AZ
COMMON OVER THE COUNTER DRUG FAR MORE DANGEROUS THAN ANYONE THINKS
Your back or neck are a little sore after doing some yardwork this weekend. Just pop a few ibuprofen and everything will be fine. Better yet, saunter on over to the neighbor who had back surgery a few months ago and borrow one of his prescription strength ones. They’re safe, right? Sure, they’ve been strongly associated with liver problems, kidney problems, joint problems and recently heart attacks. But my brains’ still safe, right? Not even close. Even the use of ibuprofen under 1200 mg is associated with a 50% greater risk of stroke in this study. The numbers just get worse from there. This is NOT a benign class of drugs and it remains frustrating when opponents of chiropractic care say that chiropractic care is “dangerous” and not worth the “risk.” The risk of chiropractic vs common treatments like NSAIDs is like comparing the person on the ground watching the skydiver attempt to land without a parachute. And let’s not even talk about surgical risks! So, next time you consider just popping that ibuprofen, maybe you should reconsider with a call to your chiropractor instead…
Should I see a Mesa AZ Chiropractor After My Car Accident?
Of course, my biased answer is going to be a solid yes.
Most patients that come through my office as the result of a motor vehicle accident will be discharged from care when I have done everything possible to ensure that they will not be in another chiropractor’s office in Mesa in 10 yrs complaining about neck pain “ever since that accident 10 yrs ago.”
The bottom line is that the number of patients still experiencing symptoms years later is far too high. My advice to anyone who has been in an accident is to seek the care of a chiropractor in Mesa who is going to address the soft tissues as well as the joints in your treatment plan.
Knee Surgery for Torn Meniscus – Best to Leave it Alone?
There are a few things that have managed to make it into “everyday thinking” despite the fact that it is more dogma than reality. Knee injuries are one of these things.
If you injure your knee and tear something, whether one of the supporting ligaments or one of the two meniscus (or is it menisci??), you’re going to have to have surgery.
I was personally one of these back in 1987 when I tore the medial meniscus of my right knee and had a portion of it removed surgically. If only I had known then what I know now…
The problem with evaluating whether or not surgery for a particular condition works is that we just don’t do placebo surgeries—it’s an ethical problem. Kind of like a placebo-controlled trial on whether parachutes are safer while skydiving. We just don’t do placebo surgeries. Or at least we didn’t until 2002 when the Houston VA medical center decided to do a placebo-controlled surgical trial of patients with knee pain who went under the knife for “debridement,” or a clean-out to get rid of damaged tissue hanging around in the knee joint.
Turns out there was no difference between those who had the full surgery and those who had the placebo surgery. Truly ground shaking outcomes considering that this type of procedure is done some 800,000 times per year in the US alone.
But I really don’t think that many surgeons truly changed based on the evidence of this study over a decade ago. From an insurance standpoint, it was pretty easy for the surgeon to just say he was going in to fix a meniscal tear. And this sounded like a good idea because the back part of the medial meniscus (posterior horn) is commonly torn and it does not have a very good blood supply so healing just isn’t going to happen without surgical intervention to go in and remove the torn meniscus.
There are a couple of problems with this thinking.
The first problem is a biggie and has to do with how we determine whether or not there is any damage to the knee using MRI. Many people mistakenly believe that MRI is an exact science and that, if something is “found” on MRI, it’s the thing that is causing the problem.
Study and after has concluded that there is very little correlation to what is found on MRI and a patient’s symptoms. That’s not to say that that torn medial meniscus on your MRI is not causing you pain, it’s just that we can’t know for sure. And I can tell you, from treating hundreds of knees over the years, that a huge chunk of knee pain comes from the soft tissues surrounding the knees (muscles, ligaments, fascia) and not from what is going on inside the knee.
Fix these tissues and the knee pain goes away, regardless of whether or not the meniscus is affected by the treatment. But very few knee pain patients manage to find their way into physician’s offices that are truly competent with addressing these tissues. Part of this may be because they aren’t aware that these types of treatments even exist—It’s the surgeon’s office to MRI to physical therapy and back to the surgeon to schedule the procedure. Kind of circular.
The second problem has to do with this particular study. In it, researchers looked to answer the question about whether surgery to repair a degenerative meniscus tear (as opposed to one that happens from trauma) actually does squat. Specifically, they were interested in whether self-reported locking or catching would be improved by partial meniscectomy (since it is increasingly well-established that doing the surgery for pain alone is not beneficial).
Seventy patients underwent the real surgery to remove a portion of the medial meniscus and 76 had a sham surgery done. Here’s what they found:
- Thirty-two patients (46%) in the true surgery group reported catching or locking before surgery; after surgery that number was 49%.
- Of the fake surgery group, 37 (49%) reported catching or locking before surgery; after “surgery” the number was 43%.
In other words, some $50,000 later, risk of injection and time off and pain for rehab, there was pretty much no difference between the groups.
Studies like these and the other ones mentioned in this article are blowing open the doors of the dogma that surrounds knees injuries, findings on MRI and the value of arthroscopic surgery. This is not to say that there is not value to the surgical options, but you better damn well be sure you see someone who truly understands how to assess and treat the soft tissues surrounding the knee before you go under the knife.
Should All Patients with a Migraine See a Chiropractor in Mesa?
Ok..given my bias everyone probably knows my answer here when it comes to chiropractic in Mesa.
It never ceases to amaze me when a patient has had headaches for years or even decades that have never been to a chiropractor. Given the evidence, it really should be considered malpractice (lack of informed consent) for a neurologist to NOT refer to a doctor of chiropractic for an evaluation of any headache patient.
And yet the referral to a chiropractor who specializes in soft tissue treatment of the neck almost never happens. It is the migraine sufferer that loses out.
Just how common is neck pain in migraine headache sufferers? This particular article looks at this question in 113 migraineurs, who had headache frequencies ranging from episodic to chronic migraine. These headaches sufferers were examined by headache medicine specialists to confirm the diagnosis of migraine and rule out both cervicogenic headache and fibromyalgia.
For each attack over the next few months, sufferers recorded the whether nausea was present as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe). Here’s what they found:
- There were 2411 headache days, 786 of which were migraines.
- The majority of migraines were in the moderate pain stage.
- Regardless of the intensity of headache pain, neck pain was a more frequently present than was nausea.
- Those diagnosed with chronic daily headache were more likely to have neck pain.
So what does this mean? From a standard migraine approach, this means that, although the presence of nausea is a characteristic of a migraine headache, neck pain (which is not a characteristic) is actually more common.
From my standpoint of almost 20 years of treating migraine patients, we have totally, absolutely missed the ball. Since most headache specialist do not touch the patient and wouldn’t even know how to treat problems in the neck is he or she found them, these patients are mis-diagnosed.
I can’t tell you how many times I’ve had patients come in with a diagnosis of “migraine” only to have the headaches go away with soft tissue treatment of the neck structures combined with manipulation. These were NOT migraines. Migraines generally do not respond as well to manual therapies, but most often need a lifestyle overhaul to manage the headaches.
The bottom line? Neck pain is strongly associated with headaches. If you have headaches, it is absolutely essential for you to find a chiropractor competent in soft tissue treatment to see if this will help.
Natural Treatments for Arthritis Go Head to Head with Dangerous Drugs
There are lots of claims about natural treatments for arthritis, but which ones work?
Without any good answers, all too many of us drop back on drugs for arthritis pain. The list can include drugs like steroids and NSAIDs. These drugs come with a list of side effects that you would not want to experience (if you’re really up to learning all about why NSAIDs are so bad for your health, feel free to check out my eBook on the topic by clicking here).
A few years back, the drug companies were able to come up with a new version of the most common class of anti-inflammatories, the cyclo-oxygenase inhibitors. This NSAID class includes drugs like ibuprofen, and indomethacin. The problem with this class of drugs is that one of the enzymes they block just so happens to protect the lining of the stomach. This is why the big risk with these drugs is bleeding ulcers and why some 20,000 people per year die as a result of taking these drugs.
Because of this tiny little side effect, researchers developed a class of drugs that do not block the one version of the enzyme that protects the stomach lining. Thus was born the selective cyclo-oxygenase inhibitors that rose to the top of the drug food chain to become one of the most financially successful blockbuster drugs of its time.
At least, until it was determined that, while this drug was a wee bit safer on the stomach, unfortunately this drug DID block one enzyme that protected the heart, leading to some 100,000+ heart attacks and who knows how many deaths from Vioxx alone. To make matters worse, Merck hid this data for years until it blew up in their face, resulting in hundreds of lawsuits from families that lost their loved ones.
Luckily (for the drug companies) the public has a short memory and Celebrex is still available on the market and prescriptions are still being written today for patients with arthritis pain who probably forgot about the entire Vioxx debacle.
So, if you happen to be one of those patients whose primary care doctor also has a short memory and wrote you a prescription for Celebrex, there may be an answer.
This particular article pits the natural combination of glucosamine and chondroitin up against Celebrex in 606 patients with knee arthritis and severe pain (Kellgren and Lawrence grades 2–3 knee osteoarthritis and moderate-to-severe pain based on the Western Ontario and McMaster osteoarthritis index-WOMAC-score ≥301 an a 0–500 scale).
Patients received either 400 mg chondroitin sulfate, 500 mg glucosamine combination three times a day or 200 mg celecoxib (Celebrex) every day for 6 months. Here’s what they found:
- The natural arthritis treatment group dropped 50.1% (WOMAC score).
- The drug-known-to-kill group had a matched 50.2% decrease.
- At 6 months, 79.7% of patients in the natural arthritis treatment group and 79.2% in the toxic arthritis drug (Celebrex, in case you’re not following along) group fulfilled OMERACT-OARSI criteria.
- Both groups had more than a 50% reduction in joint swelling and effusion.
Sounds like a pretty even match, right? Yeah–except that neither glucosamine nor chondroitin, in the history of its use, has been associated with even a single death (that I’m aware of–I’m sure there’s a patient or two who choked to death taking the supplements…), while Celebrex is in a class of drugs that is so bad for the heart that cardiology recommendations now state that NO heart disease patients should be on NSAIDs.
Oh..and it’s WAY cheaper. So which one are YOU taking?
How to Prevent Osteoarthritis After Injury
The more astute of us are rightfully concerned with developing arthritis as we age. Luckily, this is not a foregone conclusion.
Most people incorrectly think that injury to a joint is the only major factor that leads to the later development of arthritis in that joint. While any injury to a joint is an important player, there are other factors at play.
(I also have patients who state that his or her left knee pain is just from old age. At this point I ask how much older it is than the other knee…)
For arthritis of the spine related to disc degeneration, we have known for a long time that a lifestyle that is pro-heart disease will also increase your risk for disc degeneration and spinal arthritis. The reason for this is simple—discs do not have their own blood supply. Instead, they are fed indirectly by small blood vessels. If these small blood vessels become filled with plaque, they can no longer deliver needed nutrients to the discs. With normal use, these discs will break down because they can’t meet the demands of daily life.
The surfaces of your joints are not too much different. Poor blood vessel health will lower the ability of your joint surfaces to get the nutrients they need to respond to day to day demands.
This means that a lifestyle that is designed to protect your heart will also protect your joints. Pretty cool. NOT killing two birds with one stone, so to speak.
This particular study may give us even more insight into how we can protect our joints. In it, researchers looked at the ability of different types of fats (specifically saturated fats, omega 3 and omega 6 fatty acids) to protect against damage to the medial meniscus of the knees of mice.
They found that saturated fats and omega 6 fatty acids did not protect against the later development of osteoarthritis and even increased the amount of arthritis that resulted, they increased extra bone formation around the joint (a hallmark of osteoarthritis) and increased scar formation.
Let me put this more plainly: The dietary choices you make WILL absolutely increase the damage to your joints that occurs with an injury, leading to more osteoarthritis in your joints years later.
Luckily, the omega 3 fatty acids were a different story.
The omega 3 fatty acids were able to enhance wound repair as well as lower the risk of later development of arthritis. Pretty cool that diet can play this powerful of a role.
In case you need a refresher on which fats to avoid, here’s some help:
- The main source of saturated fats include fats contained in our society’s poorly raised livestock.
- Omega 6 fatty acids are found in certain oils like corn, sunflower, soybean and peanut oils.
- Omega 3 fatty acids are found in nuts, seeds (such as flax), wild caught fish and game, certain grains (salba, quinoa as examples) and grass fed beef.
Just by making smart dietary choices combined with maintaining an ideal body weight and staying active you can go a long way towards protecting your joints for years to come.
Is would also seem that, just in case all the other things that they are good for has not been enough, fish oils supplements would play a role in preventing osteoarthritis, especially after injury.
Osteoarthritis is NOT something that has to happen to your joints. Think about that the next time you reach for that bag of chips…
Should I See a Mesa Chiropractor for My Chronic Migraine Headaches?
Why am I even asking this (it was rhetorical, by the way)? The answer is unquestionably yes.
It never ceases to amaze me how many new patients come into my office that have been having headaches for years and have never been to a chiropractor in Mesa. Many of these patients begin to feel better in as little as a week. The caveat here is that you need to find a Mesa chiropractor who addresses the soft tissue (muscle, ligaments, tendons, fascia) aspect of your problem and not just adjusting. Many times the soft tissue aspect has been present for so long that just adjusting, just exercising, just ultrasounding, just interferentialling (is that a word??), just strengthening or just adjusting is not going to be enough.
This particular study just supports this link, finding close associations between tenderness in the trapezius muscles and chronic tension headaches as well as migraine headaches that were present only on one side of the head.