Should we be concerned about plastic water bottles?

BPA- the controversy.

There continues to be an interesting discussion regarding Bisphenol-A (BPA).  Should we be concerned regarding plastic wrap, tupperware, and water bottles?

BPA is a chemical contained in some plastics--many of the food-grade plastics we use daily.  I've found this discussion on NPR's science Friday to be extremely helpful in continuing the discussion.  It's important to remember how challenging known toxic substances are to evaluate--unknown (like BPA) are likely to be a point of challenge for years to come.

http://www.sciencefriday.com/program/archives/201001223

My advice:

• limit contact by using glass or metal bottles.  Stainless steel bottles are available everywhere
• avoid reheating food in plastic.  It tastes better on a plate
• use glass or BPA-free baby bottles for infant feeding

Should I use ice or heat?

Benefits of hot vs cold for an injury.

Perhaps you've had a twisted ankle, sore elbows from another day at that desk, or stubbed your toe in the middle of the night.  A bucket of ice is painful and it's just too difficult to sleep under a hot shower.  What should you use to help calm symptoms of pain and swelling while increasing healing time?  Let's look at the physiology of your body:

Ice

Advantages:

• numbs skin sensations by slowing nerve conduction
• overwhelms nocioceptive input from region (part of a pain signal) which limits sensation of pain
• limits inflammation and swelling by constricting blood vessels thus reducing blood flow

Disadvantages:

• limits inflammation--wait, what?--yes, inflammation is part of a healthy immune response to injury.  The body will heal best with optimal amount/timing of inflammation, not a removal of it.
• slows delivery of oxygen and nutrients by reducing superficial blood flow

Heat

Advantages:

• promotes blood flow which increases delivery of oxygen and nutrients
• blood flow to superficial nerves often relaxes and calms pain symptom

Disadvantages:

• may increase inflammation in acute injury
• may aggrivate and increase sensations of pain

Conclusion:

• In general, injuries respond best to ice in the first 72 hours as the initial stages of inflammation are still taking place.  After 3 days, do what feels best to you.  Each persons body may respond differently to heat or ice.
• Restrict either to 20 minute intervals with at least 20 minutes of rest between.  You body needs time to restore normal temperature to superficial tissues.  Avoid ice or heat if it adds great symptom increase.
• Both ice and heat affect maybe 2 cm deep.  They are used to help you feel better, not as a cure all.  Hands and feet are the most affected tissues by ice/heat because they are thin enough to change temperature.  The causes of low back pain are rarely altered by temperature change, though your symptoms may be helped.

All injuries should be evaluated by a medical professional.  Feel confident that ice or heat may be a great part of helping you heal and feel better.

How do I choose a chiropractor?

Finding a Chiropractor

This question was most recently posed to me while lecturing at Wake Forest School of Medicine. M.D.'s are asking; patients are as well. The following are guidelines that I feel are most important to consider.

Interview all physicians, especially your potential chiropractor. There are a wide variety of techniques and attitudes of D.C.'s (Doctors of Chiropractic) as how they approach patient care. Look for one who is:

• Cooperative and competent
• advises treatment based on a diagnosis
• releases patients after improvement
• engages you as a physician, not a technician. This means someone who looks at your experience as a human, not just a machine to work on.
• treats with more than just manipulations or adjustments. Look for a chiropractor who also offers nutritional, soft-tissue, and exercise expertise.

Problem signs:

• focused on "subluxations" or alignment only
• talks about bones out of place
• requires x-rays in order to treat you
• encourages patients to sign a contract or suggests frequent maintenance care

I encourage my patients to have a goal when they visit (e.g. less neck pain, more shoulder motion, less tingling in their fingers). Patients are seeking progress and chiropractors should also. Some chiropractors are willing to treat a patient weekly to maintain health--this has limited and sinking support of scientific evidence. Find a chiropractor who is helping you reach your goals, not someone who is helping pay for their new boat.