Germaphobia Vs. Immunology

Full disclosure, I am a germaphobe and have suppressed my obsessive tendencies since I discovered them as a pre-teen. Like most of us, I was taught about hygiene around the 5th grade. You know, when kids are on the verge of stinking if they don’t shower often enough. Since that time when I learned about bacteria and other germs, I made sure to wash my hands often. Then, one day around 7th grade, I watched an after-school special (Gen X-ers will remember those). It was about a kid who was an obsessive hand-washer due to his OCD. As I watched this kid struggle I had an epiphany. I was that kid! My hands were chapped. I avoided touching things, just in case. I would never drink from someone else’s cup or share a spoon. I was a germaphobe!

A phobia is an extreme or irrational fear. I had taken it to the irrational level thinking everything I was doing could keep me from catching a germ. At the time I realized my folly, I understood that trying to protect oneself completely is impossible. As I have studied, I learned why trying to do so is dangerous. I am afraid that with the response to COVID-19, we are becoming, as a civilized society, germaphobes. The risk of such phobic behavior has the potential to be infinitely more harmful than the novel coronavirus we have been trying to stop.

Immunology is the study of the immune system or how the body responds to foreign substances or infectious organisms. The basic tenets of Immunology concern exposure to a pathogen and the body’s ability to fight it off. There are many weapons against invaders so, keep in mind that I am just touching upon the very basics. B-cells seek out pathogens and attack them. T-cells find infected cells and kill off the cell so the pathogen cannot reproduce. This process can take a week or more. Whenever these types of cells go to work, they create armies of these antibodies and they also record the way they attacked the antigen so that should a person ever be exposed to an antigen again, the body will be ready to the point where the likelihood of another infection is extremely low. This is why when I was a kid and had chickenpox, my parents made my siblings play with me to get it, too. That way, we would all have it and would develop lifelong immunity to the disease. In addition to T and B-cells, and there are many different types, there are also substances that we can ingest that help boost our immune system. This is seen when a newborn, who does not have an active immune system, is given antibodies through her mother’s milk or when people get an immunoglobulin shot.

The key to developing a strong and healthy immune system is to gain exposure to a wide variety of germs and letting our bodies fight off those antigens and build armies against them for the future. If we are never exposed, we cannot develop antibodies to fight off the infection. This is the basis for vaccination, expose a person to a virus so their immune system can develop the antibodies necessary to fight it off if exposed to the virus again. If enough people in a community have developed the antibodies to fight off an infection, herd immunity is achieved and the spread of the disease is negligible.

There are germs on and around us at all times. Most perform a vital function in the balance of life. If a host becomes immunocompromised, germs can proliferate unchecked. We have to keep our immune systems ready to fight off diseases. What we do not exercise becomes weak. If you completely isolated yourself for long enough, you would not be exposed to any new or changing germs. When you entered into society again, you would most likely get sick from some antigen that your peers had already developed immunity against. This is the danger of prolonged social distancing! We need to share our germs to survive as a species. You cannot develop a strong immune system by isolating yourself. Likewise, if we kill off or block the germs we need to maintain ecological balance with copious use of disinfectant wipes, excessive hand sanitizing and washing, and ubiquitous use of masks, we will not only throw off the balance but we will also have a more severe flu and cold season than we have seen in a very long time.

The notion that we need to shelter in place until a vaccine is developed, is preposterous. We are so focused on the virulence of the Coronavirus that we are completely ignoring the fact that now is the time most of us should be sharing and therefore building up immunity to the flus and colds that will hit us later. These are the same flus and colds for which they have never created an effective vaccine. It is shortsighted to focus only on COVID-19, and that is just from an immunological point of view, the social and financial dangers, notwithstanding. Viruses move through communities quickly. If we have not developed herd immunity to COVID-19 at this point, which I truly believe we either have or are close, then let’s fight it head-on. Those with compromised immune systems and others with higher risk factors need not be in the fray. Those are the individuals who should shelter in place. The rest of us need to share our germs. If we remained isolated, there will never be a good time to rebalance.

In my opinion, and I share this with many other professionals who are much smarter and more educated than I, it is now time to ease back into society. It should be a process. Stop wearing your mask unless you are symptomatic, have a high probability of being an asymptomatic carrier, or around people who are known to be susceptible. Ease up on the sanitizing of every surface. Shake hands. Hug. Meet with friends and neighbors. Be social. Obviously, do all of these things with those who do not appear to be at risk or with those who may have been exposed. Staying inside might have been important while we were analyzing the threat and flattening the curve, but now it is time to save lives by not staying in.

Photo by Tai’s Captures on Unsplash

 

 

“Do you accept Kaiser?” “Yes, we do, sort of…”

We get calls every day asking if we take Kaiser patients. Of course, we do! However, we are not contracted with Kaiser so that is a bit of a misleading statement but let me explain. Kaiser Permanente is one of the largest health care providers and insurance companies in California and its innovation has become revolutionary. Kaiser is both an insurance company and provider of healthcare which has given it a unique way of managing the growing costs of healthcare while still providing quality care.

As a provider, Kaiser does not actually provide chiropractic care. They have acupuncturists, physical therapists, and, of course, all of the traditional medical professionals. At least, as far as I know, they do not employ chiropractors to perform chiropractic care. As an insurance company, they have some policies which include chiropractic care. Kaiser does not actually manage chiropractic benefits for their clients. Instead, they contract out chiropractic benefits to a company named ASH or American Specialty Health. If a chiropractor wants to be on the list of providers for the people who have chiropractic benefits on their Kaiser policy, they must be contracted with ASH.

I am not contracted with ASH nor do I have plans to become contracted with them. ASH is an  HMO or health management organization and their model of business is not compatible with mine. HMO’s are willing to cover patients in acute pain who have an injury on their list of conditions suitable for chiropractors to treat. They have models that require justification for care through paperwork. I like more flexibility in treating my patients and I hate extra paperwork. HMO’s have done well in reducing the cost of care for insurance companies. In theory, this means lower premiums and copays for patients.

So, how exactly do I take Kaiser patients? I am glad you asked. First, most Kaiser patients do not actually have chiropractic benefits. So, it makes no difference whatsoever to see an in-network or out-of-network chiropractor. We have a great practice with very affordable fees and super friendly staff. Why wouldn’t you want to see us over anyone else?

For the patients who actually have chiropractic benefits through ASH we can still help. I may not be contracted with ASH and therefore have the privilege of taking a reduced fee in exchange for a policy that will tell me that I can only see a patient six times before having to file another report to get a few more visits until they decide that the patient should be better so they are not paying anymore; then, by the time I get done writing reports and fighting the insurance company, I have wasted enough time and money to make it completely not worth it; but, I can see patients with Kaiser/ASH at no additional cost to the patient.

I routinely accept patients’ regular copays as full payment for care. Compare that to a doc who will take that copay for the six visits the insurance company gives and then charge full price once the insurance company deems their lingering issues resolved. Of course, sometimes patients prefer my monthly care agreement because it works out to be less expensive than paying their copay every time. Either way, it is a better deal for the patient because they are not under the scrutiny of the insurance company but still enjoy the contracted copay or less. In addition, they get great care and it can be completely customized without strict policy guidelines. In that way, we are happy to take care of Kaiser patients and everyone else who has insurance whether we are in-network or not.

***Photo by Miguel Bruna on Unsplash

Thoughts On the Coronavirus and All Infectious Diseases

As with anything that dominates the twenty-four-hour news cycle, the Coronavirus or COVID-19 has a spectrum of concern. Please educate yourself on this virus by checking out the CDC’s website. I am writing to give my thoughts from a holistic healthcare provider and, hopefully, a reasonable perspective to help you navigate the fear while still protecting yourself.

You are starting to see memes about surviving the latest end of the world. Let’s be honest, every few years the news goes crazy about some infectious disease that could wipe out entire populations. The disease runs its course, many are infected, several die, and the disease gets under control and passes from global consciousness. Some diseases, particularly the ones they create a vaccine for, stay in the public consciousness because of the shot. These are, generally, very nasty viruses. There is definite cause for concern. However, we need to step back and avoid panicking so we can really fight the spread of such diseases.

Many have written articles about how to protect yourself. I would echo those which encourage you to wash your hands often and avoid close contact with potentially infected individuals. However, we still need to live and function in society. The best defense is not a mask, gloves, or boarding yourself up at your house, but a stellar immune system.

Antoine Bechamp in the 19th Century claimed that it wasn’t germs that cause diseases but that leaving our bodies susceptible to disease was the problem. He argued that there are always germs in great supply about and around us and that until we give them a place to thrive, they stay under control. To prove his point he drank a glass of water infected with cholera and never got sick, so the legend goes. He lived into his 90’s so he, at least, had something going for him.

I am not suggesting that anyone take a flight to China, not that there are any available, to prove the superiority of your immune system. However, we can and should do all we can to keep our immune system performing well. I could write a whole article on keeping your immune system healthy. I will sum up some good ways by saying you need to eat well, drink plenty of water, exercise, get enough sleep, avoid sugar and alcohol, and get adjusted.

I know, I am a chiropractor and I always figure out some angle to work adjusting into the solution. The truth is that chiropractic adjustments have been shown to significantly boost one’s immune system.

Right now, the Coronavirus is not really prevalent in our area. There are a few cases that have been quarantined. Health officials are doing a good job of educating people about what they can do if they suspect an outbreak. In our office, we are taking the normal precautions to ensure that we are not a source location. Please, keep up on your care. Staying healthy, like I mentioned earlier, is still the best defense.

 

5 Things to Consider When Looking for a Chiropractor

It can be tough finding a chiropractor that you can trust and who will be the right fit for what you want and need. This list is by no means comprehensive but over the years I have noticed trends that can help you pick the right doctor of chiropractic for you and your family.

  1. What style of Chiropractic do you prefer? Chiropractors have a fairly broad scope of practice and have expertise in many different styles and methods. Do a little research on the doctor before you go in. Read the doctor’s bio. Look at how they practice. Some chiropractors just adjust, which is what we do in our office. Some emphasize nutrition. A lot of chiropractors really want to treat the whole body and have a lot of extra equipment and programs to help improve your health on all levels. Others only focus on pain relief. Every chiropractor has their own individual style but there are also various technique systems. There is Gonstead, Applied Kinesiology, Activator, Sacro-Occipital Technique, and the list goes on. If you know you like a style, look for a doc who practices that way. If you have no preference, in terms of style, look for someone with similar values or who is likeminded.
  2. What type of care do you want/need? There are basically three types of care and some chiropractors do all three and some only do one or two. The three types of care are acute or symptom care, corrective or rehab care, and maintenance. It can be frustrating to see a chiropractor who only wants to do long term corrective care if you only want to focus on your symptoms. Likewise, it can be a problem if you really want corrective care and to rehab from an injury and the doctor only wants to see you when you have pain. On that same note, some patients are put off by chiropractors who recommend nutritional supplements, orthotics, pillows, or other corrective equipment. Other patients want and need a bigger commitment to improving their health. Finally, some chiropractic offices have physiotherapies like electrical stimulation, lasers, ultrasound, heat, massaging tables, and ice packs. Therapy takes longer to utilize. Some patients like the extra time spent in the office. Others just want a quick treatment. The type of care may change based on your symptoms and healing progress so be sure to find a chiropractor who can either adapt or is in line with what you need at the moment.
  3. How far away is the doctor’s practice from where you live or work? This may seem obvious but I see people all of the time who come from a long way away because their friend referred me or they didn’t put in their location in the search parameters before they read my reviews. Most chiropractors will want to see you more in the beginning sometimes as much as every day. Travel time and gas costs add up. It is best to decide early if commuting to get adjusted is worth it. You also need to consider if it is better to find a doc closer to your work or to your home depending on your work hours and the doctor’s schedule.
  4. Do the doctor’s hours work for your schedule? Most people lead busy lives. There is a lot to do in a day. You need to consider whether your doctor’s hours and schedule work for your lifestyle. Does early work for you or do need someone open late? Are they open on the weekend? Further, do they require an appointment or do they take walk-ins? Most doctors prefer to make appointments for new patients and some always require an appointment. You need to decide if it is better for you to have scheduled appointments or not? On that same note, if the doctor only takes appointments, do they run on-time?
  5. Do the doctor’s fees work for your budget? Healthcare these days is expensive. Doctors have a lot of overhead because of licensure, regulation and the cost of rent and payroll. Because of that, doctors’ fees range greatly. A good rule of thumb is to ask how much an adjustment costs. Chiropractic Economics Magazine puts the national average cost of an adjustment at $65. Most docs will charge more for therapies and other services, so keep that in mind. Whatever the fees, make sure you have a way to pay for the cost of the care you need. Most chiropractors have plans that can help save you some money if you pre-pay. Insurance can also help but is not always very reliable. Going in with a fair idea of what it will cost definitely helps you make a good buying decision. If money is a concern, discussing fees with the doctor after they have a good idea of what you care will look like is very important.

Tennis Elbow? I Do Not Even Play Tennis!

tennis-elbow-pictureIn a world where we have so much access to information, I find that when it comes to diagnoses, there are some overly-simplified patterns. If there is pain in the foot, it is plantar fasciitis, pain down the leg is labeled sciatica, and elbow pain is tennis elbow. Not that these conditions are not common; just not that common. Tennis elbow is particularly over-diagnosed. Pain in the elbow is common. Tennis elbow, however, is specifically pain resulting from injury to the extensor tendons which insert at the lateral epicondyle causing inflammation and dysfunction. Simply put, to be tennis elbow, the pain must be right around the little knob on the outside of the elbow and get worse when trying to extend the wrist with resistance. It is called tennis elbow presumably because repetitive backhand swings in tennis will cause such a condition. Incidentally, pain on the inner knob is known as golfers elbow.

I have found that neither tennis elbow or golfers elbow are more common than just a regular subluxated elbow. As a hinge that rotates and pivots and is made up of three bones and two joints, dysfunction is easy to come by. Often, the radial head will get stuck farther back than it should be. This will cause a strain on the muscles that insert in that area and mimic or create tennis elbow. The good news is that with an adjustment or a few, the condition typically responds quickly. If it is, indeed, tennis elbow, the best thing to do is to make sure the elbow is adjusted and functioning properly, then focus on the tendons with ice, stretching, and myofascial massage or active release. So, the next time somebody complains of tennis elbow, tell them to see their local friendly chiropractor.

 

The Cost of Waiting

Abraham Lincoln once said, “You cannot escape the responsibility of tomorrow by evading it today.” The same is true for addressing your health concerns. Several times each day I have patients come in who tell me they have been hurting for days, weeks, months, or even years. The story is usually that they just thought it would get better on its own but it never did. Inevitably, they express their remorse at waiting to come in.

The truth is that with any injury, the body starts the healing process immediately. The concern is whether you will heal correctly. The body will compensate in whichever way it can to stabilize. If muscles are tight or ligaments are overstretched, it will alter the proper movement of joints. Such improper movement causes the nervous system to become confused and ultimately desensitized. Consequently, the body will lay down scar tissue that will promote the new and improper movement patterns which leaves the body susceptible to reinjury or to injury of surrounding tissue.

As a chiropractor, if I can help move the joints in a proper manner before inflammation and scar tissue sets in, then the healing process is a much easier ordeal. If you wait until scar tissue repair has set in when you come in to see me, the first step will be for me to tear down most of that process so the healing can start over. As with remodeling kitchens, the demolition can be ugly. The old adage of getting worse before it gets better is often in play and can lead to a few days of discomfort.

Another caveat to waiting is establishing movement patterns that can be difficult to retrain. Old habits are harder to change than simply making new ones in a fresh environment. Chronic conditions can take years to correct for this very reason. Muscles and joints have memory locked in to the nervous system. In my experience, it typically takes around three months of consistent treatment to change that memory.

Finally, with altered movement, the the body will degenerate quicker. At a joint level that means that tissues will dry up and bone spurs will form. Once a bone spur has formed, everything changes. No amount of adjusting, taking supplements, acupuncture, or whatever is going to remove that. Tissues can be rehydrated but they are never as good as they used to be. This is mortality. However, we can help slow down the degenerative process. At the end of the day, if we just improve the function it is worth it.

All conditions will change over time. The body will strive to compensate but that compensation can lead to issues down the road. If you have an injury or if dysfunction has been brewing for too long, get in! Better yet, come consistently and do your best to maintain good health and function.

 

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Momentum of Healing

It is always interesting when a new patient who has never seen a chiropractor before,  and knows very little about it, asks what it will take to get better. When I explain that we are going to start off adjusting them three times a week, their eyes usually get very big and the eventual question is, “Why so often?” My answer is always the same, because you need consistency and momentum to heal.

Healing can be like climbing up a sand hill. When you first start out, the sand is the thickest and you are very prone to getting stuck or sliding back down. Likewise, if you are not concentrating on healing correctly, you can start going sideways and waste a lot of energy but not get anywhere. Heading in the right direction with enough momentum to gain traction is the only way.

Getting adjusted three times a week in the beginning of care provides the momentum necessary to progress up the sandy hill of healing. A little higher up on that hill it does not take as much energy so twice a week is sufficient to keep healing. However, stopping or slowing too much can make it difficult to get started again and complete the healing process.

Preventative Health Care?

For you football fans out there, you will get this analogy. Your team is up by 2 with just over a minute remaining in the game. Your offense has done just enough to be up but your defense has played lights out. Now they start playing “prevent defense” and everyone drops back. What are the odds the other team drives down the field and kicks a field goal despite your screaming at them through the television to keep playing aggressively? Prevent defense stinks!

Likewise, preventative health care in most forms either does not work or does not exist, no matter how popular the term is. What exactly are you trying to prevent anyway? In chiropractic we mostly treat injuries either from a one time big traumatic event or cumulative trauma. How does one prevent that? In medicine they talk about preventing disease. Besides the fact that most of their tools are designed to fight existing disease, the premise is wrong. What is disease other than the body not functioning the way it is supposed to? Shouldn’t we then focus on health rather than disease? If we focus on health, then what we are really saying is that we want to maintain good health. In my opinion, “maintenance health care” is a far superior term.

When we maintain good health we focus on the positive. Instead of trying to create scenarios where the possibility of injury or becoming sick is prevented, shouldn’t we put our energies into helping our bodies work the best they can? In this way, when pathogens or traumas come around, our bodies will be better equipped to either fight or heal in an efficient manner. We cannot live in a protective bubble!

Let us focus on attaining and maintaining proper health. If we improve function and keep making the healthy choices that helped us achieve better health, we will avoid all of the issues that so called preventative health care seeks to treat. Let’s make maintenance care our priority and get rid of the term prevention care.

Strengtheining the Core Through Coordination

When we talk about “the core” of the body, we are typically referencing the musculature around the abdomen and low back. These muscles consist of the abdominal muscles (rectus abdomini,  internal obliques, external obliques, and transversi) and the muscles of the back (lattisimus dorsi, serratus posterior inferior muscles, erector spinae, multifidi, interspinalis muscles, lateral intertransversi muscles, quadratus lumborum, and to some degree the iliopsoas).

Strengthening the core has become a fairly popular mantra these days. Many of us are walking around with poor posture and a fair amount of dysfunction as a result of poor core stability. A weak core leaves one susceptible to a host of joint and disc injuries as well as overly tight butt and leg and muscles. In contrast, a strong core can prevent a host of back injuries.

The word strength, however, needs some clarification in the context of strengthening the core. When most people think of strengthening muscles, they picture muscles moving against significant resistance like lifting weights or power movement against gravity or some other force. These type of exercises can actually be detrimental to the core muscles and increase the risk of injury to the spine. Coordinating the movement of all of these muscles is what is most beneficial.

I mentioned in my last article that postural muscles are slow twitch, white fiber muscles designed for endurance. They need to be strong enough to hold you up all day. Strength, in this case, does not come from bigger muscle fibers but from having all of the muscles firing in a controlled and proper order. For example, if you lift a box, ideally your abdominal muscle and your spinal muscle would contract at the same time to stabilize the body so the shoulder and arms and hips and leg muscles can utilize their power to lift it. What often happens is that core muscles lay dormant until a significant strain forces them to respond. So, when you lift a box, you first engage your back muscles until you are upright then, if you go past vertical, the abdominal muscles will engage. Then, they will fire back and forth while they try to find a semblance of stability.

I bring this all to your attention to encourage you to strengthen your core appropriately. Exercises that promote coordinated movement like yoga, pilates, and modified exercises from yoga can make a huge difference. It can take time to build coordination and it takes a consistent effort. In the following videos, I demonstrate four very useful exercises for coordinating core muscles and therefore, strengthening it.

Cat/Cow

Bird Dog

A Safe Crunch

Side Bridge

Photo by bruce mars on Unsplash

ObamaCare and Chiropractic

How does ObamaCare affect chiropractic care in my office? That is a great question! I will tell you honestly, it doesn’t, at least not on my part. Say what you want about the Affordable Care Act, I do not need the Federal Government or anyone else to tell me that people are struggling with paying for healthcare insurance let alone healthcare.

However, for me the crisis in America is less about affordability and more about health. Don’t get me wrong, I know how expensive health insurance premiums, deductible, co-pays, and non-covered services can be. When all is said and done this year, between surgery on my knee, my son’s broken arm, my wife’s pregnancy and my daughter’s eye surgery, I am going to be out a large chunk of money before the insurance company that I faithfully pay $600 a month to contributes a dime.

Setting aside the debate about how insurance should be regulated, the truth is that Americans are among some of the least healthy people in the world. Contrarily, we spend more than every other country on health care. Timeout while I clarify something. We are not really talking about healthcare. Healthcare is cheap! No, we are talking about sick care. That is where the money is. Compare the cost of a healthy person over a lifetime with one who is in and out of doctors’ offices and hospitals and there is no comparison. OK, now that that is out of the way, my question is how can a highly developed country who spends a ridiculous amount of money on doctors, hospitals, medications, and technology, have a higher infant mortality rate than… anyone? The answer is simple. Money doesn’t make you healthy; doing things to improve or maintain your health does!

At the end of the day, the healthier you are, the less you will have to spend on medical bills. In theory, if everyone made a concerted effort to be healthy, insurance premiums would drop as they would not have to shell out so much for expensive procedures and tests. This is where chiropractic comes in. If you believe as I believe (and I am assuming that as my patient you agree with me on some level), then chiropractic is a powerful health promoting tool.

Because I know and you know that chiropractic is effective at helping improve and maintain your health, it makes sense that getting regular adjustments helps to reduce your overall healthcare costs. Furthermore, I am committed to making sure that everyone who walks in my office can afford the care they need. This is why ObamaCare will not change anything here. If you are desirous to continually work on your health and I am here to help with your chiropractic needs, you have the start of a pretty good team to not only reduce your healthcare expenses but, more importantly, keep you healthy.