Is this your t-shirt

I am happy to take new patients who don’t have insurance.  People without insurance make great patients.  In my estimation, they tend to be a lot more careful and take fewer health risks.

The government would have us believe that that 45 million Americans are without insurance.  I think the number of people without health insurance is a lot higher than that.  I have been practicing about 18 yrs and if you exclude the elderly (who have Medicare), I have seen a lot more people without insurance than those who do have some.  Even with insurance many people have such high deductibles, it might as well be no insurance.

No one knows what the eventual fate of Obamacare will be, but in the mean time, I am still taking new patients — with and with out insurance.

Need a Chiropractor But Have No Insurance? No Problem.

As a chiropractor, I mostly deal with acute and chronic injuries resulting from accidents and bad choices.  The story behind the injury can sometimes be humorous but often, it leaves me shaking my head and asking “what were you thinking?”  Too often the answer I get back is: “it seemed like a good idea at the time.”

The topic for today is the Cinnamon Challenge.  This stunt has been around for a while, but with the growing ease and popularity of Youtube and Facebook, we are seeing a lot more cases.  Teens, who are most likely to try the stunt, will attempt to swallow a tablespoon of cinnamon while friends record a video.  The stunt usually leaves the teen choking and coughing as the caustic cinnamon irritates the throat and causes a hyper gag-reflex.

Cinnamon has been used as a spice for at least 4,000 years.  It is safe for humans to eat, if in small quantities.  Few people are allergic to it.  But if powdered cinnamon is inhaled, it’s fibrous structure can cause serious harm to the small air sacks of the lungs.

During 2011, the US American Association of Poison Control Centers received 51 calls related to the Cinnamon Challenge. Since then, the number of children and adolescents engaging in the practice has apparently increased dramatically: During the first 6 months of 2012, Poison Control Centers reported 178 calls related to intentional ingestion of cinnamon powder.

As teens see the fame that others receive by publicly airing their bravado, they may be tempted to ‘one-up’ the challenge.  Teens are at a real risk for serious lung injury when they engage in this activity.

‘Cinnamon Challenge’ Not Safe for Teens

New research suggests that stress can have a long-term affect on Panic Disorder. Chiropractic care can help reduce the pain that adds to stress. Dr Andrew White, St George UT, chiropractor, has been successfully treating chronic pain since 1995.

Can regular chiropractic care reduce panic disorder?  Recent research from Brown University suggests that there is a way.

Harvard/Brown Anxiety Research Program looked at how Panic Disorder changed over time relative to a stressful life event.  They expected that panic symptoms would spike close to the time of the event, but this was not the case.

They studied patients over time and found that panic disorder symptoms progressively worsened slowly over 3 months following a specific ‘stress life event’, including serious family discord and losing a job.

Since the effects of the stress grew slowly, there is time for coping measures and stress control to have a positive effect.  One very effective tool for stress reduction, is proper body mechanics and pain reduction through regular chiropractic care.  There have been a number of studies demonstrating how chiropractic care reduces pain thresholds and nervous system excitation.   One such study, published in January 2010, looked at pain reduction in the lumbar spine of horses.

You don’t have to be a scientist to know that reduced chronic pain, like pain from low back injuries, whiplash, disc degeneration, can reduce the over-all stress of a person.  Reduced overall stress, and nervousness, can help minimize the long-term effect and increase of panic disorder.  Most chiropractors, myself included, are not treating Panic Disorder itself.  We are treating joint pain and the nervous system which, in turn, helps reduce over-all body stress.

In the 3 month window following the stressful life event, one should do many things to help reduce stress and cope.  Certainly, proper diet, and exercise are important.  So is regular chiropractic care to maintain proper structure and function of the nervous system.  Chronic pain is a stress-event and it can be reduced with proper application of chiropractic treatments.

Innova Pain Clinic, in St George UT, has specific protocols that have been developed, refined, and honed to maximize recovery for patients.  If you have recently suffered a significant stress life event, please call us and schedule an appointment so we can help reduce your over-all stress.

Dr. Andrew White
Chiropractic Physician focusing on chronic pain St George, UT

Reference:
SULLIVAN, K. A., HILL, A. E. and HAUSSLER, K. K. (2008), The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine Veterinary Journal, 40: 14–20. doi: 10.2746/042516407X240456

How Chiropractic Care Is Reducing Panic Attacks

Imagine you are driving down the 4 lane highway during rush hour at 65 mph and suddenly the 4 lanes of traffic turn into 1 lane. All those cars must merge into that one crowded lane. There will be a lot of congestion, exhaust fumes, and overheated tempers. This is what happens in your wrist in carpal tunnel syndrome;  all that traffic is getting squeezed.

There are about 9 tendons and the large median nerve that all must ‘merge lanes’ to make it into that cramped carpal tunnel at your wrist. Generally, there are no problems with the merging. But with heavy traffic flow, or heavy work load for the tendons and muscles (such as typing or writing), there will be some congestion and abrasion of the tissues of the wrist. This can lead to irritation of the median nerve creating carpal tunnel syndrome.

Median nerve irritation can make the thumb side of the hand ache, feel numb, or fall asleep. Often, people shake their hands or rub them to wake them back up.

There are some home therapies and safe treatments available.

1. Take small (1 minute) breaks every 30 minutes to rest and stretch the hand and wrist tendons, especially the flexor tendons on the underside of the forearm.
2. Seek chiropractic intervention early. Chiropractors are specially trained to mobilize the small bones of the wrist to open up that carpal tunnel and free up some room for tendons and nerve. Pain medication does not solve the problem, it only hides it.
3. Strengthen the hand and wrist with putty or therapy bands.
4. Wear a splint at night to help reduce hyper-flexion of the wrist. The splint is called a cock-up.

Carpal tunnel syndrome creates pain in the wrist, and thumb side of the hand.

Remember to see a chiropractor right away. Think about it this way: What do chiropractors do all day? We use our hands and push/pull. Our hands and wrists take a lot of abuse. Our hands are our living. Chiropractors know how to take care of hands and wrists.

Call Dr. Andrew White of the Innova Pain Clinic in St George UT if you are experiencing carpal tunnel syndrome and need immediate results. 435-652-4322

Carpal Tunnel and Chiropractic

I saw this today and thought it was nice to be considered.  I came in at #17.

An infographic by the team at CouponAudit

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Honorable Mention for this blog

The design had four groups to fully test the interactions.

When researchers look at spinal manipulation techniques they tend to use an either-or scenario.  Two modalities are pitted against each other and like boxers in a ring, the strongest survives.  As an example, in my last article, physiotherapy went up against surgery for the undisputed crown of knee pain treatment.  As it turned out, their grudgematch ended in a draw.

This research article used a 2×2 fractorial design.  It looked at two options for treating lower back pain: ultrasound therapy and manipulation.  In this design, there were four study groups:

• Ultrasound and sham manipulation
• Ultrasound and manipulation
• Sham ultrasound and manipulation
• Sham ultrasound and sham manipulation

The methods for the study were well described and follow the pattern of treatment that a person would find in my St George Chiropractic office.

Ultrasound Methods

Ultrasound uses sound waves to promote soft tissue healing.

The US intervention was delivered after the manipulation intervention, using the Sonicator 730 (Mettler Electronics Corp), with a 10 cm² applicator at an intensity of 1.2 W/cm^2 and frequency of 1 MHz in continuous mode. Conductivity gel was used to enhance absorption and produce deep muscle thermal effects. About 150 to 200 cm^2 of the lower back were treated. Sham UST was delivered in the same manner at a subtherapeutic intensity (0.1 W/cm^2).

Manipulation Methods

Manipulation is gentle, safe, and effective.

The manipulation techniques were delivered after a standard diagnostic evaluation at each treatment session. The lumbosacral, iliac, and pubic regions were targeted using high-velocity, low-amplitude thrusts; moderate-velocity, moderate-amplitude thrusts; soft tissue stretching, kneading, and pressure; myofascial stretching and release; positional treatment of myofascial tender points; and patient’s isometric muscle activation against the physician’s unyielding and equal counter-force. Time permitting, optional techniquescould be used if the physician judged 1 or more of the 6 designated techniques to be contraindicated or ineffective.

Treatment lasted 12 weeks

The patients treated each week and at the end of 12 weeks, the pain was evaluated.  The results of the study demonstrated that the manipulation group had better pain responses than the groups without manipulation.  The results also showed that the group which had manipulation and ultrasound therapy responded the best.

This proves a point I have made for years, that proper chiropractic application should involve three components:

• Inflammation reduction
• Muscle balancing across the joints
• Improved joint mechanics

In our St George chiropractic office, we have a specific physiotherapy protocols to address the soft-tissue component as well as multiple manipulation techniques to restore joint mechanics.  Our office provides the HVLA techniques as well.

Dr. Andrew White

Reference:

Ann Fam Med March/April 2013 vol. 11 no. 2 122-129

Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain

Which is causing the pain?

Manual Medicine, like chiropractic, can help knee pain from arthritis and meniscus injuries.

When a patient presents with a knee meniscus injury as well as osteoarthritis, it can be difficult to determine the causative factor for their pain. Is it pain originating from the meniscal injury or in the arthritis? because of the question surrounding the injury, it can be difficult to determine which course of treatment is best for the patient.  Should they undergo physiotherapy or surgery? A recent study published demonstrated that specific manual medicine techniques were as effective as surgery in reducing the pain from this combined injury.  This is great news for people who have meniscal injuries and knee arthritis. It basically proves that manual medicine can help alleviate their pain without the need for expensive and risky knee surgery.

Research conducted by Brigham and Womens Hospital in Boston

This excellent research article was published by the New England Journal of Medicine.  The study included  351 patients aged 45 and older who had both a meniscal injury as well as osteo arthritis.  The participants were randomly assigned one of the two groups and the interventions were then applied.  The surgery group had an arthroscopic partial meniscectomy performed while the physical therapy group had the following interventions:

• Progressive home exercise.
• Structured program to address
• inflammation,
• range of motion,
• concentric and eccentric muscle strength,
• muscle-length restrictions,
• aerobic conditioning (e.g., with the use of a bicycle, elliptical machine, or treadmill),
• functional mobility,
• proprioception and balance.

Manual techniques help to restore balance to the muscles and joints.

The items that I have listed in bold type are the exact things that one would have done at a chiropractic office.  There is an overlap of treatment modalities in physical therapy and chiropractic.  Both disciplines are complementary.  In this example, we can see the overlap and the mutual benefit.

Manual Medicine as effective as surgery

In the research study there was no significant difference in pain levels after six months and one year.  For those patients who had received surgery they have the same degree of functionality as those who had seen the manual medicine specialist.  It is important to note that the cost of the surgery was significantly higher than was the cost for physical therapy.  We should all look to this great study and learn from it.  If we shift our paradigm away from immediate surgery and more towards long-term structural healing, we can achieve the same therapeutic benefit and save financial resources in the process.

One thing this research article did not point out, but I think it would have been an important criteria for inclusion, is the presence of clicking, catching, popping, or sudden weakness of the knee associated with a meniscus tear.  I think those individuals would probably have a more favorable result with a partial meniscectomy.

What does chiropractic have to offer?

With respect to chiropractic care, I tell my patients that my job is threefold.  Of course I have the obligation to help the patient out of pain.  But in order to do that I must reduce the inflammation machinery which is producing the pain, restore normal muscle tone across the joints, and restore normal biomechanical functioning of the joints.  There are multiple techniques for her performing this threefold mission.  In our office we utilize specific tailored physio therapeutics as well as multiple joint manipulation techniques, some of which are low force and instrument assisted manipulation techniques, and HVLA (high velocity low amplitude manipulation).

Reference:
Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis, NEJM March 19, 2013.

Manual Medicine as Effective as Surgery for Meniscal Tear

Early last week, on the same day, I had two typical cases come into my St George chiropractic office.  Nothing about either case seemed unusual.  But when one juxtaposes the two cases, one can see that we need some divine Injury Karma, something to smooth out the hills and valleys of fairness a little.

If you are not familiar with karma, I’ll explain with a simple expression “What goes around comes around.”

The first case was a young grandmother about 50 years old.  She had been playing with her grandkids while their mother was at work.  During their ‘play-day’ the grandmother injured a disc in her lower back and now she is really tough shape.  She has pain running down the back of one leg.  She can’t stand up straight.  She has to change positions every few minutes or the pain in her lower back becomes unbearable.  Because of the lower back pain, she can’t sit comfortably anywhere, including on the toilette, so that has created some secondary problems for her.  She is still working part-time, but she had to take a few days off in order to heal correctly.  What caused her injury:  playing with her grandkids.

Building a Treehouse should be injury free.

The second case was a teenage boy who had been using a cell phone while driving on St George blvd.  He took his eyes off the road for a moment and rear-ended another vehicle.  There was not much damage to his truck, but the other car had significant damage.  The boy’s injuries were minor; no neck pain, no headaches.  He was being examined as a matter of course and precaution.  He took ownership of the car-crash.  He told me it was his fault, that he knew better than to use a phone while driving.

When I look at these two cases, I can’t help but think that there ought to be a force in the universe called Injury Karma.  This force would mitigate any injury suffered if it occurred during certain altruistic events.  Here is a short list from the top of my head.

Injury Karma – Free Pass List:

• Taking the neighbor kid fishing when you take your own kids out.  If the kid is from a single-parent family, then your karma points should be doubled.
• Playing with children.
• Playing outside physical games with children should even heal an old injury and count as double karma points.
• Rescuing a cat from a tree.
• Building a play-house for your kids.
• Building a community garden space should count as double karma points.

Distracted Driving should count as double negative injury karma points.

If a person was being totally selfish and inconsiderate when they incur an injury, then the karma should probably make that injury more painful.  The universe can teach them a lesson.  I’m not suggesting that they should have a debilitating disease, or lose a finger or anything.  I just think that if the sting were more poignant, then maybe they might try to straighten up a bit.

Here are my top picks for negative Injury Karma.  If you have any suggestions for negative karma, then leave your comments below.

Injury Karma – Negative List:

• Using any electronic device while driving.
• Unsafe lane-changes while driving.
• Merging into a lane currently occupied by a motorcycle.
• If that motorcycle happens to be a blue 250cc cruiser and the rider has an orange backpack then your negative points are doubled.
• Teasing or bullying.
• Teasing or bullying your younger brother to the point of tears should be double negative points.

Injury Karma should work like Santa's List

I suppose we have a concept in our culture about Injury Karma.  But it only seems to operate in December.  You might know it by it’s other name:  Santa’s Naughty/Nice List.  Only in my version, instead of coal, a person gets an extra measure of hurt– just enough to let them know that the Universe is watching.  So be good for goodness sake.

Dr. Andrew White

Injury Karma

"In God we trust; All other must bring data." -Deming

As a population we intrinsically know that surgery has risks.  We especially know that major spinal surgery is very risky.  You don’t have to go far to find someone who had major spinal surgery and suffered a complication.  But talking with individuals about their poor-surgery outcome is not a fair way to judge practice.  In science, there is an expression coined and made popular by W.E. Deming: “In God we trust; all others must bring data.“  It means that anecdotal evidence is great while sharing stories around a campfire, but it does not hold much weight beyond that.  The data, or facts, support the plan of action.

I came across a research article in the Journal Spine.  It details the rate of complications with major back surgery. The research team looked at 942 cases and analyzed the data.  Here are some very interesting points from the research team:

• 87% had a least one documented complication
• 73.5% had a postoperative complication (8% delerium; 7% pneumonia; 5% naturopathic pain; 4.5% dysphagia; 3% neurological deterioration; 13.5% wound complication)
• 39% of those patients had to stay longer in the hospital as a result of their complication
• 14 people died after receiving back surgery
• 10.5% had an intraoperative surgical complication

I share these facts not to scare people away from surgery, rather to describe the options involved with spinal pain.  There are always going to be cases where major surgery is absolutely the answer.  But the majority of lower back pain does not require risky surgery.  One needs to explore other treatment options completely before resigning to the surgeon’s scalpel.

Non-surgical Approaches:

Drug Therapy

Rarely a cure for mechanical back pain.  I have written many articles on that topic.  Pain meds mask the mechanical pain.  They don’t fix it.

Massage

Tends to work well for mechanical lower back pain.  The biggest two complaints I hear about massage therapy is the length of treatment sessions (at least an hour), and insurance does not pay for it.  I completely understand the insurance issue.  It seems unfair that a therapy which works is not covered by insurance so the patient has to pay the $70 out-of-pocket visit.  If you need to see the massage therapist 4 or 5 times, that $70 can add up quickly.  The one-hour time commitment can be a bit hard to manage with our busy work schedules.  But I think massage therapy, rendered by the right professional, is worth it.

Chiropractic

Hands-down, my vote for the best choice.  Chiropractors focus on the mechanical sources of the injury and address those specific causative factors.  Most chiropractors in St George are really good at what they do.  There are some crazy ones, just like in every profession, so make sure you choose the right St George chiropractor to fit your lifestyle and condition.

Acupuncture

Has also been shown to be safe and can be effective for certain types of lower back pain.  I am not an expert on acupuncture.  We do have some great acupuncturists in St George and I make referrals to them often.  There is a great one just a couple blocks from my house.  There is a very good one in the middle of town, right on Tabernacle.

Medical Pain Intervention

There are medical procedure options available as well.  Patients can receive some benefit from low-invasive procedures such as Facet Injections, TENS, RF Ablations, percutaneal nucleotomes, and many others.  We have some well trained pain specialists in town.  There are three offices that I work closely with and we send referrals back and forth.  If one of my patients needs to have some additional pain management, I call and coordinate the treatment.

When you have mechanical back pain, often your best option is to be examined by a chiropractor first.  He can recognize your diagnosis and formulate an appropriate treatment plan.  That plan might include other professionals as well.

Dr. Andrew White
Spinal Trauma and Back Pain Chiropractor

Reference:
Spine J. 2012 Jan;12(1):22-34. doi: 10.1016/j.spinee.2011.12.003. Epub 2011 Dec 29. Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients.

Risks of Spinal Surgery Detailed in Research Study

Thankfully, the state of Utah has PIP, or Personal Injury Protection.   That is an excellent benefit on your car insurance.  PIP protects you  in case you are ever injured during the maintenance or operation of your  vehicle.  That means that (up to a certain dollar limit) all your  chiropractic expenses are covered.  This is an excellent benefit because  it protects you against expensive bills if the other guy does not have  insurance.

Compare a normal (left) neck x-ray with the whiplsh neck (right). The person on the right suffered a whiplash injury and never saw a chiropractor to get it corrected. Note the chronic injury to the discs and joints.

You don’t have to be in a multi-car pile up to use your PIP.  If you  are injured while operating your vehicle, you are still protected, no  matter how many vehicles are involved or whomever was at fault.

The PIP is already in place for your long term protection.  You already  have the coverage, use it.  There are many chronic spine and soft  tissue injuries that can be helped with prompt chiropractic management.   Most of those injuries won’t even show up until a few weeks after the crash.  Do not delay, visit your chiropractic doctor today.

The PIP minimum is $3,000.  But you can ask your insurance agent to increase it.  It’s a pretty good idea to do so.  For most of us, the riskiest thing we do in life is drive.  The cheapest insurance you can buy to cover that risk is PIP.  I recommend you increase your PIP to at least $10,000.  That level of protection will cost about $7 per year.  That is an amazingly good bargain.

If you have been injured in your car (passenger or driver), please call  us and let us explain how your expenses can be covered.  Our  office has 18 years of experience in dealing with insurance companies.   In almost all cases, the patient never pays out of pocket.

Dr. Andrew White
Whiplash and Spinal Trauma Chiropractor St George Utah

See a Chiropractor After an Auto Injury