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

When Adjusting the SI Joint Isn’t Enough

If you have never had SI joint pain, you are probably wondering where this particular joint is located. If you have had or currently have SI joint pain, you know it can be a pain in the butt, literally. The Si joint or sacroiliac joint is formed by the sacrum, the trapezoidal bone below the lumbar spine and above the coccyx, and the pelvis, or ilia. There are two joints on either side of the sacrum. The movement of the SI joint is called nutation and it is pretty slight. One does not really even notice the movement until it gets stuck and then it is all too obvious.

A chiropractic adjustment can do wonders to relieve the pain associated with an SI joint that is not moving properly. I have found that using the drop table is particularly effective. I usually follow it up with a side posture adjustment. Sometimes, however, that is not enough. On occasion, I find a stuck SI joint even after the adjustment. In these situations, I look to the pubic symphysis.

The pubic symphysis is a tricky joint. It is formed where the pelvis meets in front. It is a cartilaginous joint that is planar. What I find when something is wrong is one of the pubic rami is higher than the other. Because the pubic symphysis is on the opposite side of the SI joint but still the same bone, if it is not moving right, the Si joint will have problems, too. I use an activator to adjust the pubic symphysis. This is a fairly sensitive area so using the activator makes it more comfortable both physically and socially.

So if you are having problems getting the results you need from a typical SI joint adjustment, have your chiropractor check your pubic symphysis. As with all treatment, it can take several visits before you see significant results. Still, you should start seeing some signs of improvement fairly quickly to help you know you are on the right path.

 

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.

3 Types of Chiropractic Care

Not everyone will fall into one of the categories specifically but, in general, there are three types of chiropractic care. The key is deciding what results you want from chiropractic care. From there, we can determine the frequency and mode of treatment.

The first type of care focuses on symptoms. A chiropractor will see you as many times as needed to reduce your symptoms to a level you can manage. This is usually short term care. Some people will stop here, deal with the manageable symptoms, and then come back when they flare up again. Pain, by the way, is the most common symptom but there are many others, as well, including, but not limited to, numbness and tingling, weakness, blurry eyes, tinnitus, heartburn, etc.

The second type of care takes into account the larger picture and seeks to restore function. I call this rehab or functional restoration care. The plan is generally the same for most people because restoring function is more predictable than reducing symptoms. While we restore function, symptoms will reduce naturally but we continue care to reinforce proper function and actual healing. Most people will need about three months of care. The frequency tends to be three times a week for about a month tapering down to twice a week for a month then once a week. By the end of three months, most people have healed enough to the point of feeling better and functioning as best as can be expected. There is variability in this care and some conditions take a lot longer.

The third type of care is maintenance. Once you have put so much effort and commitment into being your best, I feel it is best to maintain through consistent chiropractic care. Once a week is needed for some and some lucky patients can get away with once a month. Less than that and most patients are coming back with symptoms which begs the question if they are actually maintaining or just chasing their tale? We make maintenance a high priority in our office and make sure it extremely affordable.

Your results will depend on what type of care you engage and how consistently you are engaged in that care. You cannot get rehab results from a few visits of symptom care. Likewise, you cannot maintain something you have attained. Sometimes, patients want to negotiate to get rehab results by coming in once a week. I would love to be able to do that but that’s just not how the body works. For me, the ideal way to treat a patient who is injured or has chronic dysfunction is to complete a course of rehab care and follow it up with continuing maintenance care around once a week.

Back Pain and the Hip Flexor or Psoas

 

 

Often times, low back pain is exacerbated by a tight hip flexor, also known as the psoas. Getting adjusted can help reduce the stress on the psoas but sometimes you need a little more work in the form of a stretch. This video demonstrates how to stretch the difficult area. If the problem persists, we can do some myofascial work to break up adhesions. Look for a video of that in the not too distant future.

5 Causes of Sciatica

Sciatic Back Sciatic NerveFirst, let us define what sciatica actually is and is not. Sciatica is, very specifically, pain along the sciatic nerve stemming from irritation of that nerve. The sciatic nerve is formed from a conglomeration of spinal nerves in the low back which binds together into one sheath. This nerve runs under the piriformis muscle in the pelvic area, then runs in between the two parts of the biceps femoris, also known as the hamstrings. It has become common to call any pain in the leg which is suspected to come from the back, sciatica. However, sciatica is a nerve pain which is the same feeling you get when you hit your “funny bone.” Most leg pain, and consequently what most people call sciatica, is actually referred pain. That is a different post. To be a true diagnosis of sciatica, it must be nerve pain that stems from the lumbar spine and runs into the buttock and/or down the backside and middle of the thigh. Now that we have that out of the way, let’s talk about what causes it!

  1. Disc Injury. Disc injuries are the most common back ailment. When a disc bulges or herniates, it can occupy the space where the spinal nerves exit from the vertebral column. If a disc bulges too far it can push against the nerve root causing pain to travel down the sciatic nerve and beyond. Sometimes, the bulge will hit the nerve and then pull back enough so that the sciatic pain is not constant. If the disc is in constant contact with the nerve, one can experience pain, numbness and tingling, weakness, and other symptoms. Chiropractic can help, but these can take a long time to heal and consistency makes the difference. Traction, rehabilitation exercises, physical therapy, and stretching can also help if done properly. If it comes to it, cortisone injections and surgery may be last resort options.
  2. Inflammation. With injury comes inflammation. Though the disc is the most common injury, there are several other structures in the area of the nerves that make the sciatic nerve that can be injured. Inflammation is toxic and can cause its own set of issues. Nerves are especially sensitive to inflammation. Icing, NSAIDs like ibuprofen, Chiropractic, and steroids can all help reduce inflammation. When the inflammation is in check, the back and sciatic pain will diminish. When the area with the sciatic nerve or nerve root is inflamed. The symptoms will remain constant.
  3. Sacro-Iliac (SI) Joint Dysfunction. The sciatic nerve crosses the SI Joint just after it forms the large nerve. If the pelvis shifts or is not working properly, it can irritate the Sciatic Nerve through direct pressure, inflammation, or by causing muscle tightness or spasms from the imbalance. Adjusting the SI joint will help reduce inflammation and muscle guarding, as well as move it away from contact with the nerve if that is the case. Chiropractic is by far the best thing for this case but a clever physical therapist can help, too. Exercise, stretching, and icing may help but can irritate it, as well.
  4. Piriformis Syndrome. This diagnosis has become pretty popular. I find that it is misdiagnosed more often than not. The piriformis is a little pear-shaped muscle (hence the name, piri means pear), that spans the SI joint. The Sciatic Nerve runs underneath it in most individuals. If this muscle tightens, it can compress the sciatic nerve and cause sciatica. The piriformis can tighten for various reasons including any of the above-mentioned maladies. Usually, I find the piriformis is a secondary issue. Sometimes, however, it can take on a life of its own after the other condition has resolved. If it is, truly, piriformis syndrome, the best thing to do is have a specialist perform a muscle release on it. Active release, myofascial release, Bowen, Rolfing, massage, etc. can all help if done right. Be aware that if it only helps for a little while, then there is probably another issue that is still causing the muscle to tighten or guard.
  5. Direct Contact. Because the Sciatic Nerve runs through the buttock and down the back of the leg, the way one sits can cause sciatica. The most common cause is a wallet in the back pocket. Additionally, a seat that curves upward along its lip can put pressure on the legs and irritate the nerve. Unfortunately, I have seen this most often in vehicles.  The solution for these is obvious. The trick is to figure it out before it causes problems more difficult to remedy.

There you have it. Probably not a comprehensive list but definitely the most common causes. Sciatica is actually rarer than it seems. When you have it, however, it is very painful and can be difficult to treat. If you are experiencing sciatica or any type of pain or other symptoms down the leg, chiropractic can help. And, like all conditions, being prompt and consistent makes for better and quicker healing.

5 Things to Do When a Rib “Goes Out”

Rib HeadsRib pain can be miserable. I cannot tell you how many patients have come in to see me after visiting the Emergency Department because they suspected a heart attack or something serious. Pain in the chest, shortness of breath, radiating pain down the arm, nausea, etc. Sounds like a heart attack but all of the tests are negative. So what do you when the emergency docs send you home and tell you it is nothing? Most likely you are dealing with a rib that is either stuck or not moving in the way it is supposed to. Here are five things to do, and not to do, to help.

  1. Heat and Ice. One of the biggest complaints, when a rib is out, is muscle spasming. Heat will help you endure a muscle spasm. There is a caveat, however. Heat brings blood to an area and if that blood is not flushed out, it will cause more inflammation. So, use heat for 20 minutes and then walk around for a while or ice it. Ice drives away inflammation. Ice for 20 minutes maximum. Always end with icing. For more information on heating and icing, go here.
  2. Massage, but be careful. As mentioned, muscles are often tight when a rib is not functioning properly. massage can really help to calm down the muscles. Here again, a word of warning. Often times, the person giving the massage will feel a good sized bump and mistake what is really the head of the rib for a muscle knot. Rubbing this bump will not only be painful but can increase symptoms. Working on the areas around it can be quite helpful. Massaging after the rib is moving again is great.
  3. TENS or Electric Stimulation. A great, non-drug option for killing a spasm and managing pain is to use e-stim, TENS or something similar. These are basically devices that send electrical pulses through wires and patches over muscles. There are several options of machines and can be purchased at various locations or from Amazon. Price and quality range drastically but I have found that the inexpensive units work pretty well.
  4. Get it adjusted! At the end of the day, until the rib starts moving properly it will cause problems. Not all chiropractors are great at adjusting ribs as they can be difficult. Likewise, you really need to have the specific rib adjusted and not just do a general spine adjustment. Even after you get it adjusted it may still feel out. Remember that the muscles have most likely tightened around it and formed a knot. Symptoms can take a while to settle down.
  5. Mind your posture and quit trying to stretch it. Typically, ribs go out because of a forward head and shoulder posture. So, why do we always try and stretch that same way to get it to feel better? Likewise, stretching spasming muscles does not really work. It drives me crazy when I adjust a rib and the first things my patient does is check to see if stretching forward still hurts. That is like separating a wound to see if it has healed yet. If you keep doing it, it will never heal. Instead, look straight ahead and pull your shoulder blades down and back. Here is the vintage YouTube video I created to demonstrate. If you do this exercise and it is still really painful, chances are the rib is out again.

Ribs can definitely be tricky. Sometimes they stay in after one adjustment and sometimes they take several adjustments. Usually, the longer it is out the more adjustments it will take. The rib joints at the front where it connects to the sternum can go out, too. These are also very painful and can be adjusted, although it is a different method. Please remember that although rib pain is brutal, it is not that damaging. Stressing about it will only complicate the healing process. If you have pain to one side of the spine by the shoulder blades, in the front next to the sternum, radiating along the ribs, or all of the above, just come in and we can either help you or, at least, point you in the proper directions.

Decompression and Traction for the Intervertebral Discs

Decompression Vacuum EffectLife tends to be really hard on the discs between the vertebrae in our spines. Discs are made of a flexible cartilage with a thick fluid and a hard nucleus in the middle. Discs are designed to improve motion and provide shock absorption which makes them the most abused structure in the spine. When we bend forward, the disc bulges backward. This can cause weakness due to wear and tear on the inner posterior aspect of the disc. Likewise, placing too much strain on the top can make the disc bulge all the way around. This is seen when someone is overweight, does a lot of high impact exercises, or loads the body with too much weight like with squats.

Each time a disc bulges farther beyond its normal borders, micro-tearing occurs. Tears heal with scar tissue which is, by its nature, not as pliable and can tear again. It is possible to train scar tissue into flexibility and help it act like regular disc tissue but it takes time and training. Too often the more rigid scar tissue will tear and recreate the original problem. This is where traction or decompression comes in.

I may offend some docs who are big into decompression therapy but to me, it and traction are the same thing. I think they started using the fancier word “decompression” because they developed more sophisticated and expensive equipment and needed a word to match. I must confess, though, as a linguist, decompression does portray a clearer and more concise picture of what we are hoping to accomplish. But, I digress. With decompression or traction (and from here I will use the words interchangeably) the goal is to take away pressure from the disc. When pressure on the disc is lessened, the disc can reshape and heal.

Traction can be accomplished in a number of ways. The method I am asked about most is about home-unit to hang upside down. In this case, one straps their ankles into a clamp and then leans backward to a specified angle. Some units will allow a person to hang completely upside down. I recommend 45 degrees to start. That is usually enough to open the disc space without getting a head rush that will shorten the traction time.

There is a host of other traction devices. Most of them can be found on late night infomercials. All of have some legitimacy but some are definitely better than others. The one I have seen a lot recently has the person lying down with their heels resting on a moveable piece that pulls and moves the legs side to side. I am not sure how much traction is occurring but movement is always good. One of the better ones I have seen in the past looks like a big cushy loop that hangs in a doorway. The person is situated so that their upper back is on the ground and their pelvis and legs are parallel with the doorway. Again, the end result is the same and usually positive.

Some providers have very nice decompression machines that are extremely effective in separating the vertebrae thus decompressing the disc. With severe disc bulges and herniations, these machines can be lifesavers. The only downside is the expense which can be significant. In our office, we have available a more hands-on form of traction called flexion-distraction. The table we use flexes at the lumbar level and is spring loaded. The doctor puts one hand on the spine holding a specific level in place and uses the opposite hand to push the table down. The spine separates then accommodates as the spring pushes the table back up. If the chiropractor knows what they are doing, this a very effective form of traction and can make a big difference in the disc.

All of the forms of traction that I mentioned above address the low back. There are, however, various units for the neck, as well. There are three main types of cervical traction. One way uses a harness around the chin and base of the skull attached to a rope and pulley. These units either have a counter-weight, usually a water bag, or a tension spring. The other devices look like a collar between the shoulders and the chin/skull that expand when pumped full of air. Both are effective and mostly utilized at home. The third combines traction with an attempt to restore curvature. This unit is a wedge whereupon a person lies with their head hanging over the tall side of the wedge. Often times there is an elastic strap or a weight that pulls down from the forehead.

Whatever method you choose or whichever method is the most effective for you, the key to success, as with most things, is to apply it consistently over a significant length of time. I have a cervical traction unit that I use when my neck is hurting and I routinely have Dr. Wagnon adjust me on the flexion-distraction table. Discs, just like people, sometimes just need a break from the pressures of everyday life, traction or decompression is a great way to accomplish this.