Resurrection in Medical Journal!

An article in the latest issue of Spine, a highly-respected medical journal, is about “Temporary Mortality” (mortality means death).

Before you ask for re-prints and wonder where to send your checks…..temporary mortality actually refers to people dying in a short period (30 days in this case, I think) after surgery. Just an example of the wonders of medical terminology.

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!

Running away from back pain

Running will wear out your back. Let’s get a show of hands. How many of you agree? OK, let’s change the statement just a little. If you have arthritis, you shouldn’t run because it will wear out your back. Hands one more time – a few more.

A group of researchers at Stanford looked at these questions. Let’s see what they found.

They followed 866 mature individuals (i.e. average age in the early sixties) for 14 years. They looked at members of a running association vs. non-members and at ever-runners vs. never-runners. The members of the running association ran about 26 miles per week.

The runners (anyway they sliced it) had slightly less arthritis, 35% vs. 41-43%. But more importantly, they reported significantly less pain.

So, go get your three miles in today and all will be well? No!! At the risk of stating the obvious, consider (rationally) your current state of fitness and start slowly. Don’t expect to pick up right where you left off before the kids, the Carter administration, or what have you.

Now that we have the obvious disclaimer out of the way, one last bit of advice. Pick something fun! If the thought of running is less pleasant than a root canal, DO SOMETHING ELSE!

The real goal is staying active consistently. If you enjoy your chosen method of exercise, you’re much more likely to keep it up and reap the benefits.

Stop Slouching Simply: 5 easy steps

I am on about 400 health e-mail lists, (slight exaggeration) some aimed at patients and some aimed at medical professionals. 9 times out of 10 the advice is silly, stretched or absurd. But, today I got a great one from RealAge.

RealAge.com is the web-site by the authors of the “You” series of books (You: on a diet, You: the Owner’s Manual, etc.) This particular tip is about posture. I know you are concerned about this, because every time I mention this to a patient, they look down at the floor, their shoulders sink and they say, “I know” with a large heaping of guilt.

Without further ado here is a link to the Real Age posture tips.

Reversing Heart Disease

Just in time for Valentine’s day, the Journal of the American Medical Association (JAMA) has released an informative and (somewhat) encouraging article on reversing heart disease.

They measured the size of the cholesterol plaques in the coronary arteries of 1455 people before and after 18-24 months of drug therapy. They also compared the changes in the size of the cholesterol plaques to the changes in the patient’s cholesterol levels.
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In this study the patient’s heart disease began to reverse IF their level of HDL (a type of cholesterol) increased AND their levels of LDL (another type of cholesterol) decreased.

The reason this makes sense is that LDL and HDL have different jobs. Cholesterol is not all the same. LDL brings cholesterol out to the body for use. This is good and important. The cell wall of every cell in your body needs cholesterol to be healthy. However, when you have too much, sometimes the extra gets caked on your artery walls, causing heart disease.

Why this happens to some and not others is not known for sure. Some think that the cholesterol builds up like a scab when the artery wall is injured whether from tiny tears caused by high blood pressure, or an infection.

HDL takes cholesterol from your body to your liver to be processed. Researchers have theorized that HDL does take cholesterol from artery plaques, but this is the first research to show actual physical evidence that it really does happen. The American Heart Association has a pretty good article here on how this all works.

The bad news from this study is that no decrease in “clinical events” was shown. When you double over from a heart attack or stroke, that is a “clinical event”.

This may simply be because changes that are big enough to matter take time. This study only followed patients for 18-24 months.

So, if you are ready to take control of your heart health increasing your HDL, or good cholesterol is a great way to start. Dr. Richard Fogoros has a great article here with some natural ways to do this.

Your Brain on Placebo

A new study from one of my favorite periodicals, PAIN, has shed some light on the placebo effect. I know many of you look with some suspicion on this whole thing. You think placebo is something that crazy, or at least gullible, people make up – certainly not something that applies to a sane, intelligent person like you.

Some researchers have wondered if you might be right. They have theorized that the placebo effect is due to patients remembering an effect from the fake treatment, when in reality nothing happened.

To test this idea, they gave patients a painful stimulation twice. (Don’t ask how they inflicted the pain. But know you don’t want to participate in this kind of research.) The first time they told them they were giving them a painful stimulus. The second time they said they were doing the same thing, but had given them some medicine that decreased pain in many people.

During both of these events, they used functional MRI (f MRI) to look at how active the parts of the brain were that process pain. When they thought they were being treated, not only did they report less pain, but the areas of the brain that process pain were substantially less active.

Hmmm…….maybe there is something to this placebo thingy?

So, throw out the Vicadin and replace them with sugar pills?!! Unfortunately, even as much as your insurance company would love the savings, that’s not the lesson from this study. The take home from this study is that, while what’s going on in your head may not be the cause of your pain, it has a definite effect on how you actually feel.

Massage for neck pain – Results?

If after reading the post below you are still curious about the results of the research review of massage for neck pain, I will share.

For the studies using massage alone as a treatment for mechanical neck pain, they found that “The results were inconclusive.” However, when they looked at the results of studies combining multiple treatments, they concluded that the “results were also inconclusive.” Remember folks, you heard it here first!

Click here for more info.

The Doctor said my neck hurts?

New report out on massage and neck pain. The results are……….actually, I’m not really that interested in the results.

What is interesting is the diagnosis. So, what august verbiage do they use to classify neck pain? (drum roll) The answer is…….mechanical neck pain. That means that your pain is not caused by a tumor or infection or something else that we are comfortable with – treating, they don’t really want you to have those terrible things, but then their job is more straightforward at least.

Sometimes they will call it “non-specific” neck or back pain. That is really the more honest answer, but they are interchangeable.

So, you say, “Doctor, my neck hurts. What is wrong with me?” He takes a look, can’t find much and says, “Well, it looks like your neck hurts.” That is what they are doing in these studies.

This is why treatment for neck and back pain is such a mess. If you don’t have a specific diagnosis, you can’t expect a cure. What do you think would happen if they studied the effect on “car trouble” of changing the battery. Sometimes it would help and sometimes not.

Let’s imagine that we diagnosed chest pain that way. Let’s say were doing a study on the treatment of chest pain.

Hypothetical Chest Pain Study

If you click on the hypothetical chest pain study you will see that if we group these people together and just treat “chest pain”, just less than half will get better with antacids and the same percentage will respond to nitroglycerin. (Costochondritis is a cause of pain in the chest which will go away on its own in time.)

While this hypothetical study is not perfect, it does illustrate the problems of treating without a diagnosis. It ends up looking like nothing works much better than anything else. And not getting treatment does not look that much worse than getting treated.

Good research and good treatment both need to start from a good diagnosis! Fortunately, we do have some answers here, but this information is not disseminated well. We’ll get to that another day.

Where is my pain?

Where does it hurt and what does it feel like? Simple questions, but not simple answers.

Trying to communicate back pain can be as excruciating as the condition. When I ask this question, as I must, patients furl their brow, gaze in all corners of the room and then with a look of frustration and embarrassment finally say: “I don’t know, it just hurts!”

How can something so simple be so hard!

Our brains have a lot going on. (Yes, even that goofball in the next cubicle.) Since the brain can’t deal with everything, it must make priorities. Unfortunately, your back is not high on the list.

Your brain sets aside a portion – actual physical real-estate – of its sensory area for every part of your body. This is called the somatosensory homunculus, or just homunculus to it’s friends. See the diagram below.

From this chart we can see that your thumb has about as much representation as your entire back, chest and abdomen. No wonder it’s hard to tell what’s going on in your back!