LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

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Have You Had Your CT Scan Today? 5 Tips You Need to Know

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Statistically, the answer is probably yes because we are handing these out like candy.  Fill up at Quik Trip and you can have your windshield repaired and a CT scan ordered.

I recently had a patient with a headache that was not responding as expected.  Her PCP ordered a CT scan.  Not an MRI.  When I told her she needed to get him to order a MRI instead, his office noted that they do not order MRIs.  What????  For her situation, there was absolutely no reason for a CT scan over the MRI.  As a matter of fact, the only reason to order a CT over the MRI is when we need rapid information, such as an intracranial hemorrhage after head trauma.  Or maybe if some type of bone growth is suspected.  Also, you can’t do an MRI when any type of metal is in the body such as a pacemaker or spinal fusion.

Other than these limited situations, MRI preferable to CT scans.  Despite this, CT scans are now coming in cereal boxes and kid’s meals in the drive thru.  In an ER setting the argument is usually that CT scanning is much quicker (read = you can make more money off of it), which is why ERs only use CT scanners.  And some will say that the initial cost of purchasing the scanners is much cheaper for the CT scan over the MRI.  This may be a good argument for a hospital, but NOT for a physician ordering from an imaging center with access to both.

So why all the frustration on my part?

Because the radiation associated with CT scans has been estimated to contribute to some TWENTY NINE THOUSAND cancers per year in the US alone.

That makes this discussion incredibly relevant to your long-term health, since it’s highly likely you’ve had a CT scan done before.  The article noted above was published over 5 years ago, so this has been plenty of time for physicians to change their addiction to ordering CT scans.  Heck, you could practically hear the screeching of the brakes immediately after this study was published.

Turns out that the screeching sound was actually the tires squealing as the number of orders for CT scans took off at full speed.  Yup, according to this review article, there were just over one million CT scans order in England in 1996-97.  By 2012-13 this number had jumped to a whopping five million.  Even worse, for 2013-14, there was a 13% increase with no sign of “plateauing.”

How are these numbers even possible???

I know that I often complain that it seems like most physicians don’t keep up with medical literature, but geez-o-Pete.  We’re talking 5 years since the concerns started to rise that one of the CT scan side effects included a large increase in cancer risk.   Despite this, we still have physicians ordering these scans.  Even worse, they are ordering them for situations where an MRI would be an even better choice or (even worse, in my opinion) they are ordering them for situations where they should not be ordered.  This happens an awful lot for conditions like headaches, shoulder pain and back pain.

So what should you do?

  1. Avoid the ER if at all possible.  Try urgent care or find a good chiropractor.  If you do go, make sure they feel the CT scan is absolutely, positively needed and the benefits of obtaining the scan outweigh the increase in cancer risk from ionizing radiation.
  2. If your doctor is ordering a CT, have a discussion with him or her about ordering a MRI instead.  There is no radiation with a MRI.
  3. Just like in the ER, if your doctor is ordering a CT scan, make darn sure the imaging itself is actually needed.  All too often a CT scan is done as a shot in the dark.  Imaging should be done to help confirm a diagnosis, NOT to fish around for ideas.
  4. If you have an ultrasound done, it many cases it is NOT necessary to order a CT scan on top of this just to confirm what the ultrasound found.  It’s ridiculous.
  5. If a CT scan is absolutely determined to be the best option (if you have a pacemaker, for instance). then check with your doctor and the radiologist about ways to lower the radiation exposure for the test (such as imaging ONLY the area of concern).

For a full review of the Committee of Medical Aspects of Radiation’s 16th report you can click here to read more about it.

Knee Osteoarthritis Symptoms: MRI Images of Knee of Little Benefit

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Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?

Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.

We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.

For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.

I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.

This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:

  • osteophytes (also known as bone spurs)
  • cartilage damage
  • bone marrow lesions
  • subchondral cysts
  • meniscal lesions (usually described as a torn meniscus)
  • synovitis
  • attrition (a wearing down of the joint surface)
  • ligament lesions

What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing.  Here’s what they found:

  1. 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%,  followed by cartilage damage in 69% and bone marrow lesions in 52%.
  2. As expected, the higher the age, the higher the prevalence of abnormalities.
  3. The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.

The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).

The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.

It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…

If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?

HOW DO YOU MANAGE ACUTE LOW BACK PAIN? – (02-13-06)

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Physicians’ Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines

This is one of those articles that, as a chiropractor, really gets to me. We are frequently called quacks and non-evidence based. Unfortunately, it appears that no one has the ability to throw any stones.

However, given that many studies have now shown that chiropractic care is a more cost effective approach, we can begin to see why. I know I have patients come into my office with a simple case of LBP that’s pretty clear cut, and yet they have X-rays and MRI in tow when they come in. Talk about expensive care!!!

Read entire article here

LEUKOARAIOSIS – AN MRI STUDY OF THE BRAIN – (02-25-08)

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Significant association between leukoaraiosis and metabolic syndrome in healthy subjects

For those of you not familiar with the term, leukoaraisosis is a finding on MRI that loss of white matter in the brain is occurring. And if that doesn’t sound like a good thing, then you’re right.

In this study, those patients with Metabolic Syndrome had triple the risk of having leukoaraiosis. This adds further weight to the concept that neurodegenerative disorders like Alzheimer’s and Parkinson’s are actually a form of Type 3 diabetes resulting from insulin resistance.

Read entire article here

STEROID INJECTIONS FOR LOW BACK PAIN? DID YOU GET AN MRI FIRST?

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Medicine has somehow managed to create a culture around low back pain.  Maybe it was unintentional.  Maybe it was ignorance.  Maybe it was willfully done to support the “system.”  Whatever the reason, it costs society massive amounts of money on waste.

Usually not a month goes by when some patient is told by their PCP that they should stop seeing a chiropractor (sometimes after only 1 or 2 visits) and see a PT or get an MRI or both.  Worse, there are many times that a chiropractor does not even become a part of the equation.  The costs when a chiropractor is NOT involved skyrocket.  Here in AZ, a patient seeing their PCP first may end up costing some 30% more.  If they manage to self refer to a PT, the costs are almost TRIPLE.

The reasons for this are multiple, but the bottom line is that we are experts at low back pain and are very good at controlling care.  This means that we infrequently order X-rays and rarely order MRIs.  I know that, in our office, if the patient’s low back pain and leg pain looks an awful lot like sciatica from a disc bulge, why the heck would I order an MRI if I already have a very good idea of what is going on?

This particular study has some interesting findings.  Researchers looked at patients getting an epidural for low back pain with leg pain (lumbosacral radiculopathy) and whether or not they actually needed an MRI before the procedure.  What???  Of course you need an MRI before someone sticks a very long needle into the most sacred of regions in your spine!!  Or do you..

Here are the findings when comparing 2 groups of patients, one group where the MRI was used to guide the epidural procedure and a second group where the MRI was NOT used:

  • Slightly less leg pain in the MRI group at 1 month
  • No differences in pain or function at 3 months
  • After 3 months, only 35% in group 1 and 41% in group 2 showed improvement
  • In non-MRI patients who received a different injection than that proposed by an independent physician (basically a 2nd opinion, but this doctor did actually look at an MRI of the patient), the outcomes were not quite as good as those whose procedure matched that the MRI findings
  • Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an epidural after the MRI was reviewed

So, the bottom line is that MRI made very little difference in the outcomes of the epidural.  Further, a little under 2/3 of the patients received no long term benefit from the whole process.  All for the price tag of around $10K.  Give a good chiropractor $10K to work with and we’ll have the vast majority of patients competing for the Ironman Triathlon in 6 months….

EFFECT OF BUPIVACAINE ON INTERVERTEBRAL DISC CELL VIABILITY

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EPIDURALS DESTROY THE DISCS?  There’s some convincing evidence that have epidurals (for neck or low back pain) actually increases the chance that someone will have surgery.  At first thought this sounds strange, and I have usually considered the association as one more of a trajectory of treatment–taking the more invasive path (that actually begins with MRI or CT far, far too early in the game) leads ultimately down to surgery.  Strong data supports a huge cost savings if a chiropractor is the first point of entry for any musculoskeletal complaint, and we’re just not prone to ordering advanced imaging, epidurals, medication or surgery until it’s absolutely needed.

This study, while not done in humans, finds that the anesthetic commonly used in epidurals (and this DOES include the ones used for giving birth) actually causes the cells of the disc to die off.  Generally not a desirable outcome.  The answer?  Always, always see a chiropractor first for any type of musculoskeletal complaint.

Read entire article here

IS THE ARTHRITIS IN MY SPINE THE CAUSE OF MY PAIN?

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IS THE ARTHRITIS IN MY SPINE ON MY MRI THE CAUSE OF MY PAIN?  This article finds little correlation between arthritis on CT scan and pain.  The concept of arthritis causing pain is something I deal with every day.  Having a patient tell me “my doctor said I have arthritis” is common.

The problem is it that just because you have arthritis (spinal or otherwise), it does NOT mean you have to have pain or that the arthritis is even causing the pain.  Can’t tell you how many times an “arthritic knee” was completely pain free in 3-4 visits.  Did the arthritis get fixed?  Of course not–it just wasn’t what was causing the pain in the first place.  Before anyone has anything done because they “have arthritis” I would strongly recommend they find someone adept at soft tissue manipulation work on the problem spot.  You might be surprised at the results.

ARE CT SCANS RESPONSIBLE FOR CANCER RISKS?

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CT scans & cancer? It is estimated that the # of CT scans done in 2007 will be responsible for 29 THOUSAND additional cancers due to radiation exposure. I can’t tell you how often I’ve had patients come in that had a CT or MRI (no radiation exposure w/ MRI) and there was no need.

This article does not even go into the # of patients that end up having epidurals & surgery for incidental findings on advanced imaging that are not the cause of a patient’s pain. Bottom line? Most of a doctor’s decision should be based on info that get from you. Labs, imaging should not be done blindly because there ARE risks.

Read entire article here