Patients often ask great questions with very personal feelings. What I mean is that history and math professors may get great questions but a student is less anxious over what the answer might be. One of the best parts of being a doctor is explaining something to a patient about their body. It can mean encouragement from great fear to relief or bringing comfort and illumination to a challenging outlook of injury. We care about what is happening to our body.
A patient recently told me: "I had a MRI last week and got the results today. I have a herniated disk, and arthritis. I am being referred to a specialist. I guess what is your take on both of those? I was in such shock when they told me the news I couldnt comprehend anything they were saying."
I've spoken about the value of xrays before (http://bit.ly/b0hhcX), and I would speak of MRI testing similarly. These tests are valuable tools when utilized to support an overall clinical picture. They are often misleading and unhelpful tools for pain. As the New York Times recently offered, "magnetic resonance imaging seldom sheds light -- indeed, in many studies the scans have picked up spinal abnormalities in many people who have never reported back pain" (http://nyti.ms/eENwWu). Unfortunately, many physicians will see an MRI report with degenerative changes and refer to a specialist for significant interventions (surgery, narcotic medications, injections) when prevention would be more productive to the patient.
Doctors are often driven to interventions while patients would more often benefit from preventions or restorative care. Our health care system does not incentivize preventative medicine nor is there a reward for saving patient's time and money. Our system promotes number and frequency of treatments, the costlier to the patient, the better for the industry. What would happen if a doctor was paid from the overall health of their patients or how much activity the patients were able to enjoy in a year? What a dream that might be!
When a patient hears "degenerative disc disease", "arthritis", "herniated discs", "misalignment", "subluxations", and other less helpful, common diagnoses, I would encourage a response of "what treatment is best for my body?". A patient needs to ask, "What is most likely to restore my ability to move and live?". The momentum of research indicates for low back pain: surgery, drugs, and bed rest are least likely to help while physical therapy, soft-tissue therapy, chiropractic techniques, and rehabilitative exercises are far more productive, safer, and less costly.
In meeting the reality of our system today, patients cannot change economic forces behind surgery and pharmaceutical medicine, but each can ask their physician, "what is the safest and most productive option for my body?"
Thursday, December 30, 2010
Sunday, October 17, 2010
Value of a physical exam
The physical exam is a dying art in medicine. Patients know this; you may have waited longer in the waiting room or filling out forms than your doctor took to examine your condition. There is much evidence to the value of a doctor taking the time to fully examine your body and talk with you to discover what the best course of treatment might be.
A recent article: http://nyti.ms/aGv0m4, from the New York Times, which shares Dr. Verghese's work at Stanford medical school. As a professor, I encourage my students to spend time and effort with a thoughtful history--making a great effort to listen to a patient. A proper exam requires time not just for talking but also for inspection, palpation, range of motion, orthopedic, and neurologic testing. 'Time' is the key. It is not possible to consider most conditions in 20 minutes.
In practice, at Tri-Synergy Chiropractic, we reserve 90 minutes for new patient visits. We've found the best care we can offer takes between 60-90 minutes. We average 2-3 visits per patient with fully successful outcomes because we take the time to listen to a patient, ask key questions, and examine their body before we conclude how we might help.
The pressure other physicians feel to finish a pt visit in 15-20 minutes leads to higher use of MRI, xray, and other expensive testing, without improved healing outcomes. This also leads to a quick prescription mentality, that encourages patients to "take two of pills and call me in a week" instead of assessing the underlying problem. There is a great value in technology, but it will never replace the importance of a physician listening and touching their patient.
A recent article: http://nyti.ms/aGv0m4, from the New York Times, which shares Dr. Verghese's work at Stanford medical school. As a professor, I encourage my students to spend time and effort with a thoughtful history--making a great effort to listen to a patient. A proper exam requires time not just for talking but also for inspection, palpation, range of motion, orthopedic, and neurologic testing. 'Time' is the key. It is not possible to consider most conditions in 20 minutes.
In practice, at Tri-Synergy Chiropractic, we reserve 90 minutes for new patient visits. We've found the best care we can offer takes between 60-90 minutes. We average 2-3 visits per patient with fully successful outcomes because we take the time to listen to a patient, ask key questions, and examine their body before we conclude how we might help.
The pressure other physicians feel to finish a pt visit in 15-20 minutes leads to higher use of MRI, xray, and other expensive testing, without improved healing outcomes. This also leads to a quick prescription mentality, that encourages patients to "take two of pills and call me in a week" instead of assessing the underlying problem. There is a great value in technology, but it will never replace the importance of a physician listening and touching their patient.
Thursday, July 29, 2010
Nagging Injuries
this is a blog I wrote for a great site: www.whywetri.net
the site has some great resources for amateur and professional triathletes
Return from Injury: the missing step
Injuries can be very frustrating. You’d like to train yet your body is letting you down. Diagnosis is the first step. Healing may include therapy, ice/heat, and medication. I hope you’re looking to rehab from the start to expedite your return to activity. We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.
Rehab is crucial for recovery. Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation. For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.
When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.
It’s important not to get ahead of yourself with rehab. Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger. Ankle or knee sprains are not usually caused by weakness but by the control of the joint. Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint. Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.
In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first. Of course, you wouldn’t only rehab a detached biceps tendon. Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening. The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building. Gentle strength improvement is often a gift of chasing stability. Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint. Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.
For any injury you’re looking to move past, focus on full range of motion first. Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage. Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.
the site has some great resources for amateur and professional triathletes
Return from Injury: the missing step
Injuries can be very frustrating. You’d like to train yet your body is letting you down. Diagnosis is the first step. Healing may include therapy, ice/heat, and medication. I hope you’re looking to rehab from the start to expedite your return to activity. We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.
Rehab is crucial for recovery. Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation. For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.
When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.
It’s important not to get ahead of yourself with rehab. Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger. Ankle or knee sprains are not usually caused by weakness but by the control of the joint. Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint. Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.
In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first. Of course, you wouldn’t only rehab a detached biceps tendon. Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening. The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building. Gentle strength improvement is often a gift of chasing stability. Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint. Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.
For any injury you’re looking to move past, focus on full range of motion first. Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage. Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.
Tuesday, June 15, 2010
How do your muscles get stronger?
What happens to our muscles when we get stronger?
Highlights:
A friend, Samantha, recently asked me what the difference is between a weak and strong person's muscles. I think it's a neat question. Especially because of how dynamic the answer may be. An initial guess is that you add more muscle tissue--and this is correct, but there's so much more! When we discover the ways muscles strengthen, we can learn how to maximize our power and health.
Muscle action explained in 30 seconds...go!
Muscles on a functional level are made of overlapping protein fibers (eg actin & myosin). When a nerve signal fires, the muscle tissue is flooded with a watery bath of ions (kind of like gatorade :) which causes the protein fibers to play a game of tug-of-war. The winner is you--and your now contracted muscles. And scene!
An increase in the number of the protein filaments (myofibrillar hypertrophy) is not always shown in thickness or bulk of the individual. This is what I call "dad strength", where my father was always lean yet could battle 2 growing boys with ease. This is also encouraging to women who are looking to add strength or calorie-burning potential without adding significant bulk.
You can add strength, especially endurance without any physical change to the number or size of muscle fibers. Through good nutrition and exercise, you may increase the power plants in your cells that provide muscles with energy to work. The more often you work your muscles, the more you're telling your body to make little energy factories (mitochondria, for you biology buffs). This is like putting a bigger gas tank on your car. You also need calcium to fire muscles, which is a great reason to support healthy bones & muscles with a supplement.
The most significant part: Strength gains in the first 5 weeks of exercise is nerve based. Let me say that another way: if you change your exercise program, and start to notice strength gains, the physical physiology of your muscles has changed very little--it takes longer for your body to grow and repair those muscles--what is happening is your brain and nerves are learning how to better coordinate recruitment and firing of muscles. We could talk all day about this. This is where the fun of treatment really begins. When I treat the brain and nerves, I can often change the strength and function of muscles immediately!
Muscle growth, power plant improvement, neurologic development...we haven't even gotten to how we use biomechanical joint advantage (leverage) to add strength. How do your muscles get stronger? One part physiology (muscle fiber & mitochondria increase), 1 part neurology (brain and nerve control), and 1 part biomechanics (leverage & joint proprioception).
Now, If you're looking to strengthen your muscle, you have so many options!
Highlights:
- different ways your muscles get stronger
- evidence for how exercise, nutrition, and activity change your muscles
- learn what you can do today to increase strength, burn more calories and feel stronger
A friend, Samantha, recently asked me what the difference is between a weak and strong person's muscles. I think it's a neat question. Especially because of how dynamic the answer may be. An initial guess is that you add more muscle tissue--and this is correct, but there's so much more! When we discover the ways muscles strengthen, we can learn how to maximize our power and health.
Muscle action explained in 30 seconds...go!
Muscles on a functional level are made of overlapping protein fibers (eg actin & myosin). When a nerve signal fires, the muscle tissue is flooded with a watery bath of ions (kind of like gatorade :) which causes the protein fibers to play a game of tug-of-war. The winner is you--and your now contracted muscles. And scene!
An increase in the number of the protein filaments (myofibrillar hypertrophy) is not always shown in thickness or bulk of the individual. This is what I call "dad strength", where my father was always lean yet could battle 2 growing boys with ease. This is also encouraging to women who are looking to add strength or calorie-burning potential without adding significant bulk.
You can add strength, especially endurance without any physical change to the number or size of muscle fibers. Through good nutrition and exercise, you may increase the power plants in your cells that provide muscles with energy to work. The more often you work your muscles, the more you're telling your body to make little energy factories (mitochondria, for you biology buffs). This is like putting a bigger gas tank on your car. You also need calcium to fire muscles, which is a great reason to support healthy bones & muscles with a supplement.
The most significant part: Strength gains in the first 5 weeks of exercise is nerve based. Let me say that another way: if you change your exercise program, and start to notice strength gains, the physical physiology of your muscles has changed very little--it takes longer for your body to grow and repair those muscles--what is happening is your brain and nerves are learning how to better coordinate recruitment and firing of muscles. We could talk all day about this. This is where the fun of treatment really begins. When I treat the brain and nerves, I can often change the strength and function of muscles immediately!
Muscle growth, power plant improvement, neurologic development...we haven't even gotten to how we use biomechanical joint advantage (leverage) to add strength. How do your muscles get stronger? One part physiology (muscle fiber & mitochondria increase), 1 part neurology (brain and nerve control), and 1 part biomechanics (leverage & joint proprioception).
Now, If you're looking to strengthen your muscle, you have so many options!
- begin with regular hydration and healthy protein sources (building blocks)
- add activity based in real-life movements (functional training). eg. walking, swimming, playing with children, gardening
- exercise regularly and with intensity to challenge your body to need more strength (5 x 40 min/week)
- continue diet & exercise changes for more than 5 weeks to see physical changes
- seek knowledgeable therapists and physicians who encourage you to move for enjoyment!
Wednesday, May 19, 2010
ADHD- Is food to blame for hyperactivity?
"Hey did you hear ADHD is caused by eating pesticides?"
"No, I heard it was from BPA in canned foods...or artificial sweeteners!"
I enjoy observing the way mainstream media presents scientific data. Oversimplification, overstating, and flat out misrepresentation of the evidence is commonplace. However, I feel they mostly do the best they can. It is very difficult to grab reader's attention, sell copy, and remain objective and rational.
Example: Monday's AP article regarding evidence linking pesticides and ADHD (Attention Deficit Hyperactivity Disorder). http://www.usatoday.com/news/health/2010-05-17-pesticides-adhd_N.htm
A friend commented to this news, "of course", which is to point the wise idea "you are what you eat". ADHD is a complicated clinical diagnosis with likely complex triggers and causes. This article is encouraging news for parents who have felt helpless with their child's development. The evidence of research continues to point to the power of nuture in helping young minds focus. Healthy behavior role modeling, balance of freedom/structure, and yes, healthy diet are all contributing factors for optimal health. Organic food producers should feel especially encouraged with the research strongly suggesting a change to organic (non-pesticide) fruits and vegetables may reverse or halt this particular ADHD trigger.
What intrigues me is how readers will often take this information to an end point of assumption: "ADHD is caused by non organic food". I feel media is complicit in this dysfunction as they often use "prove" or elude to conclusion in presentation of evidence. Biologic science is a gathering of evidence. Proof in that arena is a majority agreement of interpreters. There is often confusion and dissenting viewpoints from reasonable people. We should be cautious anytime we're referencing an article to prove a recommendation for healthy living.
As far as food is concerned, the current government subsidy (im)balance is tilted sharply towards meat and grains, perhaps this will be one more straw for a public push to promoting healthy diet backed by healthier government policy--one that promotes fresh vegetables and fruits. Though when that happens, there will be so much more for the media to present incompletely.
"No, I heard it was from BPA in canned foods...or artificial sweeteners!"
I enjoy observing the way mainstream media presents scientific data. Oversimplification, overstating, and flat out misrepresentation of the evidence is commonplace. However, I feel they mostly do the best they can. It is very difficult to grab reader's attention, sell copy, and remain objective and rational.
Example: Monday's AP article regarding evidence linking pesticides and ADHD (Attention Deficit Hyperactivity Disorder). http://www.usatoday.com/news/health/2010-05-17-pesticides-adhd_N.htm
A friend commented to this news, "of course", which is to point the wise idea "you are what you eat". ADHD is a complicated clinical diagnosis with likely complex triggers and causes. This article is encouraging news for parents who have felt helpless with their child's development. The evidence of research continues to point to the power of nuture in helping young minds focus. Healthy behavior role modeling, balance of freedom/structure, and yes, healthy diet are all contributing factors for optimal health. Organic food producers should feel especially encouraged with the research strongly suggesting a change to organic (non-pesticide) fruits and vegetables may reverse or halt this particular ADHD trigger.
What intrigues me is how readers will often take this information to an end point of assumption: "ADHD is caused by non organic food". I feel media is complicit in this dysfunction as they often use "prove" or elude to conclusion in presentation of evidence. Biologic science is a gathering of evidence. Proof in that arena is a majority agreement of interpreters. There is often confusion and dissenting viewpoints from reasonable people. We should be cautious anytime we're referencing an article to prove a recommendation for healthy living.
As far as food is concerned, the current government subsidy (im)balance is tilted sharply towards meat and grains, perhaps this will be one more straw for a public push to promoting healthy diet backed by healthier government policy--one that promotes fresh vegetables and fruits. Though when that happens, there will be so much more for the media to present incompletely.
Monday, April 26, 2010
How a Monk Solves Back Pain
What can St Francis of Assisi teach us about alleviating back pain?
A highlight on Standing Desks--A new option for back pain sufferers
Standing desks are a new idea for some, and an old, old idea for others. Notice in Bellini's depiction of St. Francis of Assisi in the Desert (http://en.wikipedia.org/wiki/File:Giovanni_Bellini_St_Francis_in_Ecstasy.jpg).
Not only is St. Francis in an amazing extended position (we'll come back to that), but look in the lower right hand corner and you will find a standing desk! He is able to stand, move, write, read, and think without the tired stance of a chair. In your most energetic state, what position would you want to be in? Likely, it is standing. I've never had a patient tell me, "I was so excited, I had to sit down and slouch."
Speaking of slouching: did you notice St. Francis' excellent, extended posture. As infants, we adapt well to curling up, and we often return to this position as we age. Full extension (back, arms, hips, and shoulders) is rare, even for mature adults. Yet, our bodies were made for extension. Perhaps we could include more of this each day.
It would be valuable for us to consider a standing desk. We could read, write, email, and even blog from an energetic position--one that allows us to move and work.
Want to dig further?: http://www.nytimes.com/2010/04/22/technology/personaltech/22basics.html
A highlight on Standing Desks--A new option for back pain sufferers
Standing desks are a new idea for some, and an old, old idea for others. Notice in Bellini's depiction of St. Francis of Assisi in the Desert (http://en.wikipedia.org/wiki/File:Giovanni_Bellini_St_Francis_in_Ecstasy.jpg).
Not only is St. Francis in an amazing extended position (we'll come back to that), but look in the lower right hand corner and you will find a standing desk! He is able to stand, move, write, read, and think without the tired stance of a chair. In your most energetic state, what position would you want to be in? Likely, it is standing. I've never had a patient tell me, "I was so excited, I had to sit down and slouch."
Speaking of slouching: did you notice St. Francis' excellent, extended posture. As infants, we adapt well to curling up, and we often return to this position as we age. Full extension (back, arms, hips, and shoulders) is rare, even for mature adults. Yet, our bodies were made for extension. Perhaps we could include more of this each day.
It would be valuable for us to consider a standing desk. We could read, write, email, and even blog from an energetic position--one that allows us to move and work.
Want to dig further?: http://www.nytimes.com/2010/04/22/technology/personaltech/22basics.html
Thursday, April 8, 2010
Do I need x-rays to see a chiropractor?
FAQ: Do I need x-rays to see a chiropractor?
Answer: No. For the great majority of our patients, x-rays are not needed.
At Tri-Synergy Chiropractic, we are focused on evidence-based medicine. We will recommend tests (eg xrays, CT, MRI) only when clinically necessary.
As a physician, I am interested in diagnosing the cause of your symptoms. I'm able to do this by providing a thorough physical exam, including appropriate neurologic and orthopedic testing. We look at muscles, bones, nerves--all of your anatomy. Not just your spinal alignment. Imaging--including x-ray, CT, MRI--may be helpful for your diagnosis, but for most of our patients, it is not needed. I may recommend treatment that I can provide or refer you to another specialist.
We do not depend solely on one form of testing to diagnose or predict treatment. We may not need any x-rays at all to help you feel better. We are more likely to recommend specific exercises for your back pain, rehab for an ankle sprain, or gentle muscle release for your neck pain.
If you are near the High Point - Greensboro, NC area and looking for a chiropractor who will solve your problem, without a lot of visits, find us: Tri-Synergy Chiropractic
Answer: No. For the great majority of our patients, x-rays are not needed.
At Tri-Synergy Chiropractic, we are focused on evidence-based medicine. We will recommend tests (eg xrays, CT, MRI) only when clinically necessary.
As a physician, I am interested in diagnosing the cause of your symptoms. I'm able to do this by providing a thorough physical exam, including appropriate neurologic and orthopedic testing. We look at muscles, bones, nerves--all of your anatomy. Not just your spinal alignment. Imaging--including x-ray, CT, MRI--may be helpful for your diagnosis, but for most of our patients, it is not needed. I may recommend treatment that I can provide or refer you to another specialist.
We do not depend solely on one form of testing to diagnose or predict treatment. We may not need any x-rays at all to help you feel better. We are more likely to recommend specific exercises for your back pain, rehab for an ankle sprain, or gentle muscle release for your neck pain.
If you are near the High Point - Greensboro, NC area and looking for a chiropractor who will solve your problem, without a lot of visits, find us: Tri-Synergy Chiropractic
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