What do You Think of Socialized Health Care?

The debate is in full swing over socialized health care. It seems to me that it is only a matter of time before the politicians decide to take control of the rising costs. I can understand both sides. I am not going to even argue between both sides because it seems like the two sides are comparing apples and oranges. I think most agree that whatever we have right now is not a great solution for the masses. My point in witing this article is will it work in the US? 

Now, I know what you are thinking, “It works in Canada and Europe and people are not as antagonistic or supportive as the two camps portray.” I agree. All of the debate is focused on whether it will be right for the people. But, just as in everything there are other parties involved. I have yet to see much discussion about whether the providers are going to go for this. 
You see, the doctors in Canada and Europe have never really known anything different. They went to school with a certain expectation and are working under those circumstances. This will not be true for doctors in the US if we switch to socialized health care. Think about it this way. Most US docs went into healthcare because it is career where one can help and serve others while also enjoying a certain status and income level. Keep in mind there are two sides to this: the ability to practice as one chooses and the money. 
Lets talk money for a bit because that seems to be the major focus (though I will argue that for the majority of docs it is the lesser issue). Going to professional school is expensive. A lot of time and money is invested in the education of a doctor. As of now, the compensation in most cases is satisfactory but not as good as it used to be. I wonder what compensation will be under government regulation?  
The real issue, however, is not money; it is control. Doctors have taken a beating since the onset of HMO’s. Take a poll of any profession and job satisfaction has more to do with the ability to affect outcomes. If HMO’s are bad wait until the government decides to take over. Medicare is the classic example. Medicare dictates very specifically what a doctor can and cannot do. In additon, if you feel a procedure is warranted but the government does not, guess who wins? Accountability is good, but when a doctor spends more time justifying his course of treatment than actually treating people satisfaction starts to wane. 
The question then becomes how many doctors are going to stick around with changes that will limit their ability to treat patients the way they want to and with a cap on how much money they can make? The other question is whether the government will allow doctors to opt out of universal health care and take private pay only? If they don’t, will enrollment at professional schools decrease and will you see more doctors leaving the field for less stressful and more profitable professions? If they can do private pay how many docs will opt out? Either way, what will our access to health care look like? I don’t know the answers for sure but I can tell you as a health care professional I would opt out so as to avoid the pitfalls and the headaches of governmnt controlled “sick care” and if the government doesn’t give us choice… well I guess I will have to cross that bridge when we get there. 

“But Doc, It Feels So Good to Crack My Own Neck!”

Everybody knows that guy that pops his own neck. You know, the guy who is sitting by you who grabs his chin and yanks it from side to side waking up your co-worker or the sleeper in church who suddenly dreams they are being shot with a machine gun. Maybe you are that guy. If you are let me pass on some good advice. STOP!

First of all, you are annoying every one around you. Second, you are doing damage to the ligaments and joint capsules of your neck. 

Here is how it happens. When you get a hankering to pop your neck it is usually because one of the 33 joints in the neck is not moving as much as it wants to, which can cause inflammation, stiffness, and a decrease in proprioception (the sensation that tells us what the joint is doing).

When you try to get that joint moving using your chin as a long lever you apply a very non-specific shearing force to the entire neck which works as a unit. Under force the the most pliable joint will move and pop. Perpetual force over a period of time will cause the joint to be hypermobile.

Because the neck functions as a unit, to compensate for the hypermobility of one joint, other joints will become fixated or hypomobile. Joints that move too much or too little are dysfunctional joints and will degenerate quicker than properly functioning joints. 

Popping your own neck also creates a viscious cycle. You pop your neck because a joint isn’t moving. The joint you pop makes it feel better because of a natural endorphine release but those joints are not the ones that need to move. In fact, the joints that need to move become less mobile because they now have to compensate for the joints that move too much because you keep moving them. Also, the good feeling you get when you pop hypermobile joints only last a short while. 

In addition, the combination of overly hypermobile and hypomobile joints in the neck make it very difficult for your chiropractor to give a specific, effective adjustment because with overstretched ligaments it is very difficult to get the right tension to adjust the proper vertebra. 

So please, do yourself, everyone around you, and your chiropractor a favor and stop turning your neck into silly putty for a 30 second high and a cool sound. 

Have We Lost Our Minds Over a Virus?

Are you buying the hype of the Swine Virus? The media is completely outdoing themselves on this one and people are panicking like Chicken Little. I just heard that in Egypt, where there are no reported case, they just slaughtered thousand of, you guessed it, swine.

Please be rational about this. First of all, thousands of people die every year from ordinary viruses. So, it makes no sense to get worked up over a new one; they are all new. Second, we have an immune system for a reason. Keep yours in good working order and you will be fine even if you are exposed. Even if the virus gets a hold of you it will probably just feel like a bad flu. Take care of yourself and your body will fight it off better than any anti-virus medication.

And, if your immune system is compromised then wash your hands frequently and avoid crowded places. But please, stop stressing over this, it will only weaken your immune system.

“Stand Up Straight!” Part II – The Neck and Shoulders

Some could argue that good posture of the neck and shoulders is vital to your health. I agree! Most of the processes of life are controlled by the brain. Information then travels down through the spinal cord or through the cranial nerves. Either way, to get to the body it has to go through the neck somewhere. If there is not an efficient path then communication suffers.

As discussed in Part I, the outer part of the ear should line up with the middle of the shoulder. This has become so rare these days that you almost never see it. If you do, often times the only reason it is lined up is because the shoulders sit forward as well. If you go deeper (like on an x-ray) you should see a nice arc with the vertebrae neatly stacked on top of each other. The arc allows for maximum tensile strength and appropriate loading of the discs, ligament and muscles.

The head weighs about as much as a bowling ball so, in order to support the head all day long the neck should be underneath it. Generally, for every degree the head goes forward of the neck, you add an additional 10% more force. This is based on the pull of gravity and angles etc. With the head carrying forward the mechanical advantage of having an arc and the lever the muscles use start to lose ground. Pretty soon ligaments get overstretched and muscles are working much harder. There is also added pressure to the front of the vertebrae and decreased pressure on the back which creates imbalance. Imbalance leads to altered function which leads to altered nervous system flow which leads not only to poor coordination but also improper communication and disease.

Additionally, as the neck goes so go the shoulders. Shoulder injuries are one of the most common injury complaints. With shoulders you already sacrifice stability for mobility so if they are resting at an even less stable location (ie. rounded forward) then wear and tear is bound to happen. Furthermore, slumped shoulders can affect lung capacity and function. The last time I checked, most of us were already bad at breathing properly and I am pretty sure that oxygen is important to the body.

So what to do? First things first, in order to effectively improve posture, you have make sure that all of the joints are moving properly and coordinated together. Adjustments are very effective for this

Second, you have to stabilize the shoulder blades. The best way to do this is to pull the blades down and back while gently lifting the chest. This will stimulate the usually dormant postural muscles of the neck and upper back and relax the muscle that are carrying most of the work but shouldn’t.

Third, getting back the curve in the neck is tricky but important. I use what is referred to as a traction wedge my office. It is not very comfortable but allowing the head to hang over and edge with a tension band is effective in reshaping the neck.

Obviously, this is a process. It is usually not that effective to just try and stand up straighter. Nevertheless, with effort, results can be visible in less than a few weeks and long lasting results in less than 3 months.

Stay tuned for Part III where we discuss posture of the low back!

Stand Up Straight (Part I)

I know you have heard this from your mother at some point in your life even if you may not have said it to your kids, yet. Posture is becoming an increasing problem. I like to call it the de-evolution of man. You know the pictures where you see the monkey turning into cro-magnon man etc. until eventually walking upright like we are supposed to. Well imagine we add one more picture where we are hunched over a computer like a monkey.

Let me get one thing straight (no pun intended) before I stand on my soap box about posture (actually, I am not standing at all; I am lying on my couch typing on my laptop), I appreciate ergonomics as much as the next guy but there is no perfect position. We were designed to move! How we move and what we do when we are moving is what is important.

Let’s start deep, shall we? The spinal column from the side should be curved. There should be a nice arc with the apex at the front of the neck, another at the back of the mid back and another at the front of the low back. The shoulder joints (ball and socket or glenohumeral if you want to be technical) should rest slightly down and point out about 20 degrees. Likewise, the hips and knees should rest at a slight angle called the “Q angle.” The feet should then rest hips width apart point straight. This is the foundation. It is structurally sound and can carry the greatest load.

If the foundation is good then everything else will follow suit. Muscles will rest at their strongest point, ligaments will have less stress, joints will maintain acceptable pressure, and the intervertebral discs will be situated such that they are fairly even from front to back in resting position.

Ligaments hold joints together and muscles dictate motion with proper signals from the nerves. The problem is that trauma can cause weakness, nerve irritation, and muscle spasm (see earlier posts) and gravity can be considered a slow moving trauma. When you consistently place a strain on the above mentioned structures with gravity things start to change for the worse.

The ultimate resting posture looks like the picture with a straight line going through the ear, the shoulder, the hip, back of the knee and ankle. Stay tuned for more specifics on proper posture of the neck and shoulders, feet and legs, and the low back and core!

“It’s Never Just a Muscle!”

Back Pain

I hear it just about everyday. I don’t know how or why people think it. There is no known conspiracy about it. It may be because it is the only explanation people can think of. It drives me crazy and takes all of my energy to control my emotions when I hear, “I think it’s just a muscle.”

Let me explain why it is never just a muscle when you are talking about back and neck pain. The muscles in the back and neck are slow twitch muscle fibers. They are designed for endurance. They are not fast twitch, speed muscles. In addition, there are three layers of muscles with a ton of overlap amongst the muscles of each layer. For this reason, it is nearly impossible to tear or “pull” one of these muscle without doing damage to a much more susceptible structure first. 

The most common tissue to receive damage in the spine is the disc which can bulge, herniate, mishape, and swell when over worked or over loaded. Then there are the joints and ligaments of the spine which will sprain long before a postural muscle reaches tearing status. Finally, you have the nerve roots which if irritated even slightly will cause a muscle spasm which essentially protects the muscle. Herein lies the issue. 

When a muscle spasms it can be a lot more painful and noticeable than the underlying cause. Don’t be fooled. Muscles don’t just decide to spasm on their own. It is a protective measure. 

There can be occasions where a muscle due to overuse, usually because of postural strains, will form a knot (the technical term being a trigger point). When this happens it is commonly like asking, “which came first the chicken or the egg.” If there is a trigger point it will immediately affect the joints, discs, and nerves. There will also be a good argument that the trigger point only developed because of a lack of motion or subluxation of the joints. Either way, it is never just a muscle. 

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The Most Pressing Issues Regarding Healthcare!

I joined a group on LinkedIn for healthcare providers who want to discuss issues regarding health. The title of my blog is essentially one of the topics that was raised. It was interesting to read that most of the people discussed the issue of reimbursement for healthcare. My response was a lot different and set up in a way that hopefully, the others ranting about money will see the forest despite the trees. Here is my response:

In my humble opinion, the problem with so called healthcare today is that it is, in fact, rarely health care. I would argue that all of our healthcare problems are because we, as a society, focus on symptoms. This is true with the cause of disease and administrative woes. Although we are making strides towards some early detection studies we as patients, providers, administrators and insurers mostly give lip service to the underlying causes of disease. Instead, as patients we rarely give a thought towards our health unless there is a symptom bad enough to warrant an appointment with a doctor. Most doctors are not interested in seeing someone who does not have significant symptoms and administrators know that there is nothing to bill if there is no diagnosis based on symptoms and less if there is no medication or procedure that can be done. Symptoms, symptoms, symptoms and not how can I climb the ladder of improved health everyday of my life.

This focus on symptoms is perpetuated by the percieved notion that someone besides the individual is in charge of healthcare. Concern for one’s health should first and foremost rest on the shoulders of the individual. When there is a sincere desire to be healthy then the rest of us are there to show the way.

Today we argue about the fact that the government does too much or too little for healthcare. In addition, we blame insurers for not covering enough and doctors for being too busy to really help. This is all wrapped up in a ridulous sense of entitlement by individuals who, for the most part, have mostly themselves and their poor choices to blame. We assume people are not going to change so we have to change everything else to accomodate them.

Granted accidents happen and ill health is not always a function of unhealthy living, but if every individual felt responsible for his/her own health then the paradaigm completely shifts 180 degrees. In this scenario people reduce risky behavior because there is true risk involved. Loss of life, lifestyle and livlidhood is potentially on the line. They seek providers whom they trust can help in a manner that is cost effective and know that proactive healthy habits are also less expensive in the long run. If the majority of people thought and acted this way they would be healthier. Doctors would educate and coach and occasionally treat individuals with disease which would significantly decrease the taxing burden they bear. Insurance rates would be reasonable because fewer people would need to utilize the extreme measures to extend life that cost so much. In this way, insurance would be utilized as it is intended, to reduce the risk of losing everything in the face of an unfortunate circumstance; not benefits that we hope to use because we paid so much for them. Finally, the government would keep the hell out of the arena in which it has no business.

Complacency in the absence of symptoms and entitlement in the presence of is the disease of what we call healthcare today. Personal and individual responsibility to improve one’s health on a daily basis is the cure.

What A Day!!!

On Saturday I had my annual Patient Appreciation Day and Anniversary party. We had a fantastic turnout. The party went from 10-2:00 pm and in that time I adjusted a little over 100 patients. My awesome massage therapist gave 40 chair massages much to the delight of all who were actually able to receive one. The place was packed and the food was stellar! In all, I cannot think of too many better ways to spend a Saturday then helping that many people improve their health.

The week before I saw new patients at no charge. That included the x-rays. I am actually going to continue the promotion informally this week, as well.

I want to express my appreciation to all who helped and all who came. I am grateful to have so many patients that I can call my friends!

“Nothing Helps My Mid Back Pain!”

At least once a week I get a person in here who presents with mid back pain that is dull and achy but can go really sharp. It is a stabbing pain that feels like a knife going right through to the front. Taking a deep breath is difficult and forget about sneezing, coughing or laughing. Often times they feel like they are having a heart attack because of the tightness, the altered breathing and because it can even refer pain into the arm.

That, my friends, is a rib subluxation. The worst part about it, besides the unbearable pain, is that unless you address the concern directly, it can linger for a long time and go chronic. It is also something that doctors, including chiropractors, don’t always look at and don’t always know how to handle.

Luckily for me (insert tongue into cheek), I have a rib that subluxates quite often and have had it since I was 20. It was the cause of of miserable pain and some nasty heart burn (another topic of conversation that we can address later). When I finally found a chiropractor who figured out that it was, in fact, a rib and not my neck or a thoracic vertebra that had subluxated, then adjusted it properly, it was heaven. Since then, I make sure to educate my patients that have a history of rib subluxtions to let me know if it is acting up before I get too far into adjusting the spine. Otherwise, we can keep adjusting and never quite see full improvement.

Does This Frustrate You?

I was talking to a patient the other day about the problems she was having with her feet. The symptoms didn’t seem to be consitent with any musculoskeletal trauma and the presentation was a little vague (generalized pain but in the joint line, kind of achy, hurt at random times, etc.) At the same time, she has also been complaning  that her psoriais is acting up. This sparked a thought in my brain that she may be suffering from psoriatic arthritis. 

I told her to look up some information and also to talk to her MD about it to see if he woul do any follow up testing. She reported back later that when she mentioned it to him he said, without even examining the foot, “I dont’ think it’s that.” To which the patient replied, “What do think it is then?” The doctor said, “I have no idea.” 

WHAT? How can you say it is not something but also say you have no idea what it is? Does this make sense? If it were completely out of the range of possibilites like, “Hey doc my ankle hurts do you think I may have been bitten by a cobra while in bed last night (assuming you don’t live in India)?,” then I could see answering the way he did. But please, give the patient a break! At least tell her why you don’t think it is psoriatic arthritis. Better yet, try diagnosing for real before you rule out something. Frustrating!