Smoking hurts….your knees?

A new study at the Mayo clinic shows that smoking makes arthritis worse. They followed a group of patients with arthritis pain in their knees for 2 1/2 years.

The smokers in the group were younger, skinnier and had more worn out cartilage. They also had more pain. This is bad all the way around. Their pain started earlier, hurt worse and we cannot just blame their weight (which is a typically overblown cause anyway).

Does this make sense? Or, is this just researchers picking on smokers again? Unfortunately, for the smokers, it does makes sense and the research is pretty good.

To understand how this works, let’s use an analogy of a coal-fired furnace. This furnace (in our analogy) makes the energy that powers the rebuilding of our bodies.

So, when you damage the cartilage in your knees, which we all do from time to time, your body fires up the furnace and mends the damage.

However, your body does not use coal. Your body uses oxygen to make energy.

When you breathe in, the oxygen from your lungs is put into hemoglobin molecules. You can think of these hemoglobin molecules as semi-trucks. These semi-trucks (the hemoglobin molecules) then take the oxygen to the rest of your body where it can be used to make energy needed to repair damage to your body.

One component of cigarette smoke is carbon monoxide (CO). The problem with CO is that it fills up some of the semi-trucks (hemoglobin molecules). So when they go make their deliveries, they have nothing useful to drop off.

If the CO fills up too many of these semis (hemoglobin molecules), you die. We saw this in the news recently when some local (pacific northwest) folks ran generators in-doors during the windstorm and associated power outage.

In a less dramatic case, as we see with smokers, it slows down the healing process. In fact, if a surgeon tries to fuse the spine of a smoker, the body won’t heal well enough for the fusion to work. On a side note, if the smoker quits for six weeks, the fusion will heal, but the patient won’t get pain relief.

One more reason to kick that habit.

Pounding Your Headache

The American Council on Headache Education web-site is another health site that is worth spending some time on.

Here is a link to an article of their’s on physical and alternative treatments for headache.

Dental X-rays for Osteoporosis Screening?

In the future will your dentist be checking you for osteoporosis? A new study in the journal, Bone, looks at the idea of using dental x-rays as a screening test for osteoporosis.

Don’t throw the DXA scanner just yet. While the technology may improve, in this study just less than a quarter of bone density changes were explained by the dental images.

So, back to the drawing board – or, at least to your local DXA scanner.

Positive brain changes from chiropractic care?

Chronic pain (pain lasting longer than three months) causes changes in the brain. A new study shows that adjusting people with chronic neck pain has some effect on these areas of their brains. A control group doing neck motion exercises showed no changes.

The researchers looked at somatosensory evoked potentials (SSEP) from the median nerve (the nerve that goes through the carpal tunnel). SSEP’s are a measure of the brain activity from a particular area. In areas with chronic pain, the brain tends to be overactive. So less SSEP’s is good.

In the group that got neck adjustments, they had lower measured SSEP activity. The group that did range-of-motion exercises showed no change. They only looked at these patients after one treatment. The effect lasted about 20 minutes.

This is great news for chiropractors everywhere. No more three times per week treatment schedules – we need to see you every 20 minutes (at least during office hours). : – P

This study adds to our understanding of how adjustments, or spinal manipulation (the technical term), work. However, many questions still need to be answered.

What’s really going on here?

Ok, so we know that we don’t know for sure, blah, blah, disclaimer, disclaimer. What’s really going on here? (Editors note: The following is opinion – a good one, though.)

I think it boils down to (mostly) motion. What we are trying to do when adjusting a neck or back is get a joint that has dysfunctional movement, to move normally. Joints that are not moving normally cause problems. We have studies showing that joints start to degenerate quickly when they are not allowed to move.

The lack of normal motion causes different information to be sent to the brain (for nerds only: less mechanoreceptor input, stopping the spinal gating theory from helping out). This contributes to changes in our movement patterns and keeps the pain around longer, even without anything still broken, or torn or obviously inflamed.

Increasing the motion with a spinal adjustment (or manipulation for those terminology sticklers), reverses these changes. After one treatment the changes only lasted for 20 minutes.

I don’t think this means we need to treat patients 72 times per day. After an adjustment, you get lots of extra motion for about 20 minutes or so. This is partly related to some muscular reflex relaxation and the gas bubble that pops (that’s what makes the “crack”).

To provide meaningful change, we need to keep this motion normal. Having a course of treatments along with some specific exercises and postural advice can accomplish this.

How many treatments do you need? It really depends a lot on your spine and how well you do your home-exercises, etc. It could be 4-6 or 12 or 20.

As we saw in this study, changes were made in one treatment. If you need spinal manipulation you should see some change, not perfect or permanent – but some definite relief within 4 treatments.

LA Times article on the wonders of back surgery

Read the article (click here).

Good Health Web-Sites

The internet is awash in health information. As you know much of it is trash. Sometimes it is absurd enough to be funny; so, not a complete loss. But finding quality information is difficult.

Besides this blog, you should also check out www.medlineplus.org. It is put on by the National Library of Medicine. For mainstream health information, this is an excellent site. You should run your questions by them. They are weak on alternative medicine, though.

For alternative medicine you should read The CAM Report. This site discusses research on all sorts of CAM (Complementary and Alternative Medicine). I don’t think the author is always right. However, his analysis is usually very good. His mind is open, but not enough to let his brain fall out. (That’s a compliment.)

Both links are listed in the “blogroll” to the right of the page. Happy health information hunting!

Do I have fibromyalgia?

How do we diagnose fibromyalgia….mri, x-ray, blood test, ouija board? Answer: none of the above.

Usually fibromyalgia is a wastebasket diagnosis – meaning if you have pain that lasts a long time, that’s is over a large area and we can’t find anything: you’ve got fibromyalgia. It is, in common practice, a diagnosis by exclusion.

Given that, it should not be too surprising that a recent study found that fibromyalgia is diagnosed incorrectly two times out of three. (That’s not to say that the 2/3 without fibromyalgia were faking it or head cases. They just had a different diagnosis.)

Fibromyalgia is notoriously difficult to diagnose and treat, but this poor performance is unacceptable.

Fibromyalgia is more than just some back pain that doesn’t go away on it’s own. Classically fibromyalgia commonly presents with many symptoms including: headache, sleep disturbances, anxiety, depression, irritable bowel, memory problems and more. Researchers argue back and forth about specific items on this list.

But, researchers DO agree on one thing. Fibromyalgia patients have pronounced and widespread allodynia. Allodynia is when something that shouldn’t be painful, causes pain. An example would be poking someone lightly with a finger. This is not painful in healthy people, but can be very painful to someone with fibromyalgia.

Studies have shown that fibromyalgia sufferers are extra sensitive to pain from heat and electrical stimulation as well. In case any of you are wondering, this has also been confirmed with functional MRI studies. When fibromyalgia patients complain of pain to mild pressure, heat or whatever, the pain part of their brain lights up. They aren’t just making it up.

So, where is this coming from…..what’s going on? More next time.

Fibromyalgia: Introduction

What is fibromyalgia? What causes it? Does it even exist? How is it treated? Does anything work?

With fibromyalgia, there seems to be no shortage of questions. Answers, however, are a different story. Many, including most physicians, know nothing about it – or worse yet, they know things that aren’t true.

The good news is that we are starting to learn about fibromyalgia. There are over 4000 research articles that discuss fibromyalgia. Some of it has to be good. It is.

The bad news is that there is no cure; magic, or otherwise. But most cases can be managed effectively – not perfectly, though. And to really benefit you need to be patient and sometimes it takes hard work. You also need to educate yourself. Many practitioners claim to treat fibromyalgia. Some of them can even help. But, many helpful treatments will be less effective on their own.

The question is not: what treatment do I need? The question is: what mix of therapies do I need. So, how do I find a good doctor to help me through this? Honestly, I don’t know.

That is why you need to take responsibility for your treatment. The first step is understanding fibromyalgia. Finding an effective treatment mix is the second step.

Over the next few articles we will discuss what fibromyalgia is, what it isn’t and then discuss treatment options. I look forward to this. Please leave comments or ask questions! (click here to send a question)

Harvard to pregnant women: eat fish!

Click here for a summary of their recommendations

Presidential back pain – JFK

When we think back on John F. Kennedy, we tend to think of idealism or charisma, maybe his inspiring speeches, or the tragedy of his early death. Few think of back pain. But health problems, including severe back pain, followed him throughout his short time on earth.

Clearly he got the best medicine had to offer, at the time. In fact, one of his spine doctors, Janett Travell, did much pioneering work on back pain that is still referenced by doctors today.

But the point of his story is not to learn anything about our bodies or specific conditions. The story of his accomplishment in spite of his suffering is an inspiration.

The Atlantic online has written this story better than I could. Take some time, on this President’s Day and read his story. (click here)