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Monthly Archives: July 2011

Psoriasis and …Ichthyotherapy?…. What the hell is that.

Psoriasis probably affects someone you know. About 2-3 percent of the worlds population and 2.2 percent of the US population have the skin disorder known as psoriasis. It is the most prevalent autoimmune disorder, and while there are systemic organ failures (especially kidney) for the truly severe cases, here we are talking about the skin lesions rather that arthritic psoriasis (a topic for another discussion).

Anyone who has this disorder knows it’s far from life threatening, but aesthetically it is quite the challenge. People with Psoriasis experience itching and hyperkeratinization of the skin leading to a constant proliferation of skin cells that become flaky and scaly. Psoriasis usually happens in patches on the elbow, arms, scalp, and shins. In moderate to severe cases it can cover the whole of the back, face, and/or legs. Etiology for autoimmune diseases in general is not well understood, and therefore most doctors can’t really tell you why some people get psoriasis and some people don’t, but it is clear that it has some genetic predisposition yet factors, such as food intake, allergic reactions, stress, etc. can cause those hereditary traits to express themselves (70% of identical twins share psoriasis while only 20% of fraternal twins share the condition).

First off, the normal treatments you’ve heard of. Corticosteroid topical creams, steroid injections, pills up the wazoo, is the norm for medical care. Dermatologists may be more specialized and knowledgeable but will offer treatments similar to your family physician. However, there are some alternative treatments may be of some comfort.

UltravViolet light in the form of UVb treatments can be helpful. Sunlight creates Vit amin D in your skin, and this “phototherapy” cancels out all the harmful spectrum that is in normal sunlight. Think of it like a tanning booth that takes away all the wavelengths associated with skin darkening. Phototherapy is becoming very much the norm when it comes to alternative treatments for Psoriasis. They even have home therapy units now, but at $500 for a cheap model they aren’t cheap.

So what the hell is icthyotherapy? Well, pray tell, it is an ancient form of skin therapy utilized by the ancient mesopotamians. Today several southeast asian countries utilize this type of therapy. Imagine if you will getting into your normal day spa jacuzzi, with no bubbles and hundreds of teethless, pinky sized fish nibbling at your flaky plaques and dead skin. Yes Ichthyotherapy means fish nibbling at your body. The fish they use is called Garra ruffa and they grow readily in the Euphrates River. After submerging the body part affected in the water, hundreds of these tiny fish begin to nibble away at the psoriatic plaques. Interesting therapy, and effective, but the patient will need to return to the spa once every so often for maintenance. Also the sloughing off of the dead skin cells can allow for better results from UV light treatments.

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Worker’s Compensation… How does it work

I’m sure many people have been hurt on the job at work and never even thought to file a worker’s compensation claim. And those are the obvious cases like a box falling on you in the warehouse. But what about those conditions that are not as much the result of accidents but maybe bad work office habits such as, not taking breaks, repetitive typing for hours on end, or even stress related psychological disorders such as loss of sleep.

For California, worker’s compensation is well funded, but the process can be consuming for the patient and the doctor, and is needlessly complicated by paperwork and rules. I will go over some of the things that need to be done if you suspect you or a loved one has a work-related injury.

First of all, it is not as easy as saying you have an illness and getting a doctor to help. The company that you work for has 5 days to provide you with a doctor from their list of Medical Provider Network (the MPN rule in california). IF they did not give you a doctor within 5 days you are exempt from the MPN rule and can see the doctor of your choosing to handle the worker’s comp case.

If your doctor is not in network for your particular companies worker’s compensation insurance company (worker’s comp insurance companies are different than your health insurance), your employer will give you a doctor from their list. AFTER 30 days, the patient may tell the company they do not wish to see the company provided doctor for whatever reason. The company will give you the listing of their doctors and the employee may choose to say that they do not wish to see the doctor’s on that list because (and the reason is very important) of the office location being “out of the way”. This will get you exemption from the MPN rule.

Remember that the reason for worker’s compensation in the state of California is so that worker’s cannot sue an employer for negligence or liability accidents. For trading in the right to sue, the state has created a large fund of money to pay worker’s comp claims. Many people think I don’t want to start trouble at the office… Well that might have been true years before worker’s comp where suing your company was a possibility, but now it not a factor as you can see the state funds most of it. In fact, any good Human Resources agent knows that a healthy worker is an efficient worker and should want to help you fix your medical problems.

It used to be that is was honorable and manly not to complain about accidents at work, but if you think about this: the main drama and tragedy of 21st century America is that people get sick and/or hurt and the medical burden turns into a financial crisis leading to the ruin of many families. Today, if you don’t take care of your health it can be a great burden to the rest of the family. Chronic pain is frustrating, depressing, and life-draining. Why allow those conditions to worsen when the state has an institution in place to help get you treatment.

 
 

Frozen Shoulder? Sounds like my last date….

Also known as Adhesive Capsulitis is a form of connective tissue inflammation that it affects the ligamentous capsule of the the shoulder joint, where scapula meets humerus.The shoulder is a very complex joint in order to attain the full six degrees of motion (the knee for instance only has 2) and to keep ball and socket joints (think of G.I. Joe figurines) from constantly dislocating from the socket, a heavy ligament capsule is needed to hold the arm in place. The causes are unknown, but physiologically speaking there is abnormal scar tissue build up as a result of inflammation of the capsule.

Prevalence is higher among the 50+ age groups and athletes that repetitively over use the shoulder joint. So in other words, non-use and overuse of the joint can predispose the joint to adhesive capsulitis.

Sufferers of this condition cannot raise their arm in flexion and abduction and the range of motion of the shoulder overall is greatly decreased with sharp, motion restricting pain, when the patient tries to move the shoulder. Because of this great motion limitation, patients have serious problems putting on clothing, brushing their teeth, or even opening doors. In many cases sleep is affected because laying on their back and turning over in their sleep can cause pain.

Symptoms include non-radiating sharp pain around where the deltoids meet the acromion, inability to move arm in a full arc of motion in all ranges of motion (typically frozen shoulder only affects one shoulder), great inflammation without proportional amount of swelling and redness, and the constant pain may also cause headaches and depression.

Common non-surgical therapies include, ultrasound therapy (to reduce the scarring of the tissue), hot and cold therapies, electronic muscle stimulation, active physical rehab, and later strengthening exercises when range of motion is restored.

Warning! This is a condition that can last for years if untreated, and even with fairly aggressive rehab, it may be months before pain symptoms (inflammation) reduce and maybe years before full motion is restored. Frequency of treatment is an important factor and patients with this condition should see their chiropractor or PT at least 2-3 times per week.

There is a common notion in our country that everything bigger is better and more is always more welcome, but in certain medical cases less is more and adhesive capsulitis can be one of those. Because of the great amount of inflammation and pain, highly aggressive treatment plans can sometimes backfire and progress may through range of motion can be lost if the therapy is creating further inflammation. However this is contradicted in the fact that the patient needs to break the scar tissue build up within the capsule and so movement and muscle techniques are mandatory. So the great difficulty in treating these patients is knowing when the threshold has been reached and being careful not to overdo the therapy.

Anti-inflammatory and antioxidant diets are important when dealing with this kind of injury. Although studies are inclonclusive on how adhesive capsulitis comes about, what is known is that it is an inflammatory condition much like bursitis. Ice and heat can have some palliative affect, but while only go so far and will not break down the buildup of scar tissue. The inflammatory conditions that result in pain can be reduced over time by increasing your intake of anti-inflammatory products. This may sound very scientific, but in reality it is about knowing your body and making common sense choices. For instance, when a person consumes great proportions of meat and disregard all the carbs (the AtKINS diet) you are creating an environment in your body that acidic and difficult to heal. Inflammation in this environement is more common. When you eat more fish and less meat, and supplement with unprocessed unrefined complex carbs (like whole grains), and you stop drinking all those sugary acidic drinks, and eat more alkaline foods like vegetables it creates a more amenable conditions in your body for healing. Peanuts are decidely inflammatory and should be avoided while cashew, almonds, and walnuts are a great way to get the right kinid of fatty acids in your body.  Another great strategy for along the anti-inflammatory route is to ingest great amounts of fish oils (EPA/DHA) as their is no toxic level and omega-3-fatty acids are important overall health and healing. Anti-oxidant foods like fruits and vegetable can also help the healing process.

Lastly there is always the option of surgery and corticosteroid injections. Though the injections can reduce the pain it will not reduce the scar tissue build up and gives just enough relief until they can be injected again. You may only have up to 4 injection in a year and 6 over a lifetime (many doctors will not tell patients this) the reason is that thought the injections reduce pain, the corticosteriod also eats away at the cartilage structures of the joint and eventually will lead to bone on bone contact. Injections are good for the pain, bad for the function. Surgery may be an option, but realize that after the surgical procedure, your rehab time may be just as long and as painful as if you had let the condition run its course. Some conditions can reoccur under the certain circumstances and post surgical trauma may lead to a greater probability of re-occurrence at some point in the future.

 

 

 
 

Once upon a Time in America….

The story usually starts with an immigrant arriving and picking himself up over the poor and destitute to become rich and powerful. This was the real American dream, Streets of gold meant opportunity and the promise of freedom from tyranny. And if those fleeing immigrants suffered a poor and unglorified life their children or their children’s children would be able to experience what America has to offer.

Times have changed. America is no longer like those time period movies, we are not a nation of Gatsbys, if that ever was a compliment. All the new money we’ve made as the dominant imperial power of the 2nd half of the 20th century has gone to health care. We are no longer worried about feeding the homeless and starving people of other countries. Consider yourselves lucky as a family if you don’t have a family member who has had a costly surgery, diabetes, an autoimmune disorder, or god forbid, cancer. Each of these conditions is like a high roller slots machine. Furthermore, it seems wrong to blame an individual doctor for the state of health care in this country as it would be shameful and unthinkable to blame a soldier for a war they fight in but didn’t start.

Is it any wonder that many of the popular American dramas begin with a malady that isn’t covered or can’t be afforded. When the patriarch or matriarch of a family goes down with a condition, it isn’t unheard of to have the whole family help out be it driving them around, taking them to dialysis, or just figuring out how to pay for the massive medical bills. And that’s if you have insurance, if you don’t then the family may take the brunt of the eceonomic hardship. There is no surety in insurance. My mother’s latest knee surgery, a full replacement, cost her beyond 80,000, and she had to pay 20%. May seem worth it to get a $100,000 operation (including hospital stay, physical therapy, pain management) for the price of a cheap car, but consider that she has had 3 operations, pre and postoperative rehab, pain drugs, and hospital bills for over 6 months and it can strain any well implemeted budget. God forbid you didn’t plan for someone getting hurt.

Lots of people think they have insurance, but don’t know the ins and outs of their policy. That means they haven’t used it for seeing the doctor or physiotherapist or chiropractor… which means they are paying a company money either off their paycheck for insurance that will probably only cover the major traumas like surgery and expensive “medically necessary” operations. That is all good and well but what about the family that has a $10,000(ind)/$20,000(family) deductible. They are persuaded by the limits of their policy away from preventative, maintenance care medicine and therapies.

So the morale of the story of America now reads… Don’t get sick or hurt. It’s cheaper to die… Pay up the yinyang for a policy or several insurance policy that will cover all forms of care…. Or wait til your 65 to get the base minimum health care other free countries take for granted (which may not even be there by time we are all 65).

No critical article should end on despair, so you ask my solution: Don’t expect free health care. Expect to pay for what you get and demand quality health care from your doctors and believe me the prices for healthcare will drop drastically. Don’t trust insurance companies to cover everything and take care of yourself with preventative medicine, especially in middle age where different maladies may begin to present themselves. An ounce of knowledge yields a pound of life.

 
 

Decompression. If you’ve heard this word in a doctor’s office then…

You might have had or currently have a herniated disc. Herniation is the general term describing the protrusion or bulging or an organ invading a space that is not physiologically normal. There are many different types of hernia, many of which are invaginations of a certain organs, as in a hiatal hernia involving invagination of the stomach into the lower portion of the esophogus leading to gastric reflux or heartburn. There is also sports hernias, that usually involves a weakening of the abdominal wall. The kind of hernia that involves “decompression” is most likely a herniated disc. Intervertebral discs are considered shock absorbers for the spine. But though they are analogous to the rubber on the soles of your shoe, they are more important than that.

Besides protecting the spine from bone on bone contact, they can also affect nerve function as the dorsal roots exit the spinal cord. When a disc herniation (bulge, protrusion, or expulsion; the last being a possible surgical candidate) weakens it allows the two vertebra above and below to approximate. This obviously leads to reduced function and movement as well as irritation and inflammation at that level of the spine.

Not so obvious, is that this approximation of the two vertebrae lead to a smaller opening created by the bony effects of the superior facet over the inferior facet. This smaller opening called the intervetebral foramen or IVF is crucial to the electrical output of the nerve fibers that fire at a rate that makes the blinking of an eye seem stuck in slow motion. The reduction in nerve firing is like closing three lanes of a four lane highway… on a Friday…in rush hour. There are messages trying to be sent to the muscles, but are unable to get where they are supposed to go on time and so begin to irritate the surrounding musculature and pain fibers.

A slightly herniated disc may not affect a person at all, but the same size protrusion can lead to intense pain in another person, so size of the bulge only tells us so much. What is more revealing is the patients sysmptoms, how much pain they are feeling and the quality. A good pain management doctor or chiropractor can tell what ails a person just by how the pain is described because bone pain, muscle pain, and nerve pain are all different in the nature in which they are percieved, but the right kind of questions will pin point the answer right away.

If you have had an accident recently, the herniated disc may be the result of trauma. If you didn’t have any corresponding accident then the condition possible may be called chronic (which just means that the problem is ongoing for several months, and has not healed up properly leaving residual pain, aching, and soreness).

Decompression is the act of taking away (if only for a moment) the stress of gravity on the spinal structure and reversing the constant downward pressure of the weight of the upper torso and head. This pulling motion on the spine can help to reintroduce much needed fluids into the vertebral discs (which are kind of like sponges that soak up nutrients in the form of fluid, and expel fluid when compressed).

Having an active lifestyle helps to protect you from these types of injuries, as well as having a proportionate torso to your lower body (think Mike Tyson). Decompression is a much safer option when dealing with herniated discs than drugs and surgery (with exceptions being a fully blown or expulsed disc). It can help to take the pressure off those nerves that are affected, much like taking your foot off the water hose.

There are many types of of decompression and hundreds of products and companies. Choosing one that suits you is the job of your chiropractor.

 
 

Past 50? Take care of your health because…

Shingles aka Herpes Zoster… Also known as chicken pox to children. We all know about the all-over itching vesicles that cover a child’s body but what isn’t as commonly known is that the same virus can affect adults who have never come into contact with chicken pox when they were younger. Of course this particular virus is more dangerous when caught at as an adult (hence the pox parties where parents take their kids purposefully to infect them). Even less known is that herpes zoster remains dormant in your system and may express themselves as shingles later on in life. So even if you’ve had chicken pox as a kid, you may still get a flare up of shingles when your immune system weakens as a result of old age.

Shingles are differentiated from other skin lesion in that the vesicles (unlike the child chicken pox version) follow a distribution corresponding to a specific peripehral nerve or dermatome. In other words, the skin lesions are in a pattern that follows the length of a nerve typically on the midback or face, but also commonly along the arms. The virus attacks the length of the particular nerve usually starting with itchiness followed by a skin lesion that is obviously different than a mosquito bite (they may be clustered together and scar and heal at different rates). As the virus travels down the length of the nerve, you may feel swelling, and sharp pain upon touching or movement of the area (especially if the virus has went down to the hands) in addition to the skin lesions.

If the pain persists over a month then you may have developed one of the side conditions associated with Shingles, called Post Herpetic Neuralgia/Neuropathy. This condition results in extreme pain and swelling, not just of one joint but the total infected area with the highest degree of pain where the virus has last traveled to (this virus like to go from one end of a nerve starting in your spinal cord and dorsal root ganglion to the distal ends, like the ulnar innervations of the hand).

The importance of this blog is that as the baby boomers reach past 60 there will be more and more cases of Shingles as they currently occur to approximately 50% of the population at one point in their lives. As you age the ability of your immune system to combat the various bacteria, viruses, and oxidative aging becomes less effective leaving you vulnerable to conditions such as pneumonia. Herpes zoster is one of those conditions that one would not know about unless you are a doctor or you had them, and if you’ve had shingles and the more painful after-effects of PHN then you would know that it is a condition to be feared and should be an impetus for to take better care of ourselves in our older age.

If you suspect you have Shingles, please note that it can be contagious to the touch to others with slightly compromised immune systems or who have never come into contact with the chicken pox virus. Please see your family physician and take the anti-viral medication as prescribed before seeing a chiropractor about alleviation of the pain symptoms.