Health Update: NEUROPATHY

LEARN MORE ABOUT
PERIPHERAL NEUROPATHY

There are more than 100 known types of peripheral neuropathy, each with its own characteristic symptoms, pattern of development, and prognosis.

Approximately 30% of peripheral neuropathy cases are linked to diabetes. Other common causes of neuropathy include autoimmune disorders, tumors, hereditary conditions, nutritional imbalances, infections or toxins. Another 30% of peripheral neuropathies are termed “idiopathic” when the cause is unknown.

Types of Neuropathy
    * Autonomic Neuropathy
    * Cancer-Related Neuropathies
    * Compressive Neuropathies
    * Diabetic Neuropathy
    * Drug-Induced and Toxic Neuropathy
    * G.I. and Nutrition-Related Neuropathies
    * Hereditary Neuropathies
    * Immune-Mediated and CIDP
    * Infectious Diseases and Neuropathy
    * Neuropathic Pain

Peripheral neuropathy symptoms and signs can vary in how they begin.  Some neuropathies come on suddenly; others gradually over many years. There are three types of peripheral nerves affected, and symptoms depend on these nerves and their location:

    Sensory Nerves:       Affect sensation
    Autonomic Nerves:   Affect internal organ functions
    Motor Nerves:          Affect muscles

Many types of peripheral neuropathy affect all three types of nerves to various degrees, but some affect only one or two.

Here are some peripheral neuropathy symptoms and warning signs as described by patients:

Weakness in the Arms or Legs
Legs: Usually caused by damage to the motor nerves, leg symptoms often include difficulty walking or running; a feeling of "heaviness" in your legs; finding it takes a lot of effort just to climb the stairs; stumbling or tiring easily.  Muscle cramps may be common.

Arms: In the arms, you may find it difficult to carry groceries, open jars, turn door knobs or take care of your personal grooming.  A common frustration is dropping things.

Numbness, Tingling and Pain
Sensory nerves, when damaged, can cause various symptoms. Early on, there may be spontaneous sensations, called paresthesias, which include numbness, tingling, pinching, sharp, deep stabs, electric shocks, or buzzing. These sensations are usually worse at night, and sometimes become painful and severe.

You may also experience unpleasant abnormal sensations when you touch something, sensations called dysesthesias because they are caused by stimuli.
Or, you may find yourself feeling nothing at all, in this case experiencing anesthesia, a lessening or absence of sensation.

Impaired Sense of Position
When you lose the ability to “sense” or feel your feet, you may find yourself being uncoordinated because when you walk because you are not sure about the placement of your feet.   Patients may find themselves walking differently without really knowing how or why they are doing so. Chances are they have either widened their style of walking (in an unconscious effort to keep their balance) or they may be dragging their feet.

“Glove and Stocking Sensation”
This phrase describes what doctors call a patient’s odd feeling of wearing stockings or gloves or slippers when, in fact, the patient’s hands and feet are completely bare.

Symptoms of Autonomic Damage
When it occurs, autonomic nerve damage can potentially cause: a drop in blood pressure and, consequently, dizziness when standing up; intestinal difficulties such as constipation or diarrhea; sexual dysfunction; thinning of the skin (with susceptibility to bruising and poor healing), and other symptoms.
If you or a loved one is experiencing any of these neuropathy symptoms, we encourage you to visit your physician as soon as possible and discuss your symptoms and your concerns.

Neuropathy Support Group:  www.neuropathy.org

Health Update: Whiplash Injury Guide

This guide has been carefully prepared to educate those who have suffered-whiplash types of injuries of the neck and spine. The information presented is for general health education only. Individual health concerns should be addressed with a knowledgeable health care provider.

The Severe
“Whiplash Injury Guide”
INCLUDING… The Four
Dangerous Whiplash Myths

Whiplash injury is a very real type of problem that costs communities billions in health care and disability dollars.

Studies have recently shown that about 10-20% of the population suffers from neck pain, and car accidents/traumas are a big cause of this type of pain.

But you've probably wondered how something so minor as a fender-bender to your bumper could be such a pain in neck.

    Maybe your doctor told you, "give it a couple of weeks"..."you'll be fine."

But you're not fine.

Your neck hurts when you work at the computer, when the dog pulls too hard on the leash... maybe sleep has become more difficult with a lot of tossing and turning, or you've become dizzy...or always tired when you used to be full of energy and pep.

Maybe you've noticed how your neck moves differently since the accident. Looking over the shoulder perhaps isn't as easy as before.

Does all of this sound familiar?

It's quite surprising when you look at whiplash research and its global impact-the entire body is affected. You probably didn't think that headaches or fatigue were part of the whiplash bargain, but they are.

Your Bumper Doesn't Tell the Whole Story…

    You can't look at a dent in the bumper and conclude that the neck wasn't injured.

For instance, they're called 5 mph bumpers for a reason-designed to not be damaged in very low speed collisions. 

This is good for the bumper, but not necessarily for your neck!

What researchers have discovered is that when collisions are of enough force, this causes the vehicle to crumple and absorb energy.

Low speed collisions will often not cause the crumple zones to be engaged.

    If you have a rigid fixed bumper (seen on many older cars and trucks), that does not crumple-this can make the whiplash injury even more severe.

For the above reasons, you might be even more injured in an accident below 20 mph than one above that speed.

There are of course limits to this effect. Collisions at very high speeds (above 40 mph) will often cause the occupants to suffer severe injuries, even though the crumple zones are absorbing some of the energy.

You may have heard someone profess skepticism for your whiplash injury.

Maybe they thought you were gaming the system or out to make a fast buck.

Where does this perception come from?

Probably the insurance companies, who seem to have a profit-motive for denying the realty of whiplash injuries.

Some physicians are simply ignorant about whiplash trauma, perform cursory spinal examinations, or offer treatments that have little or no scientific evidence to back them up.

But is there really such a thing as “Whiplash?”

The science says “YES!”

Whiplash- a soft tissue injury to the neck-is also called neck sprain or neck strain.
It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion.
The disorder commonly occurs as the result of an automobile accident and may include injury to the joints of the spine, disks, and ligaments, cervical muscles, and nerve roots.
Symptoms such as neck pain may be present right after the injury or may be delayed for several days.

In addition to neck pain, other symptoms may include:

• Neck Stiffness
• Injuries To The Muscles And Ligaments (Myofascial Injuries),
• Headaches
• Dizziness
• Abnormal Sensations Such As Burning Or Prickling (Paresthesias)
• Shoulder Pain
• Back Pain

In addition, you may be experiencing cognitive, somatic, or psychological conditions such as:

• Memory Loss
• Poor Concentration
• Nervousness/Irritability
• Sleep Disturbances
• Fatigue, or Depression.

Video: Whiplash Injury

Special Thanks to Dr. Nabil Ebraheim, M.D.

But Why Can Whiplash
    Be So Devastating?

Your head and neck is simply not designed to be accelerated three times the acceleration of gravity....or come in contact with an air bag deployed at 190 mph. 

When these injuries occur, muscles and ligaments of the neck cannot resist the force, which then tears tissues apart.  This then sets the stage for degeneration/osteoarthritis years later.

        The basic principal in a rear-end whiplash, is anything that makes your vehicle not accelerate as fast when hit, is going to make the injury less damaging to your neck.

        If your car is small, it will accelerate much more quickly than a larger vehicle.

        If you're hit on a low friction surface such as rain-drenched pavement, or ice, the car will accelerate very quickly…and some of the worse injuries occur when your vehicle is slightly rolling when hit, because it's easier to get a vehicle moving that is not stopped.

Women are more injured by whiplash, because they generally have less neck musculature development. The ratio of their head size to their neck size is much greater than in a man. There's a very good reason why professional football players have those massive necks.

   

The Four Dangerous Whiplash Myths:

Myth #1: Car Damage = Occupant Injury
It might seem intuitive that if a car is smashed, the neck will be badly injured, and conversely if it's a simple fender bender, then the neck was spared. Some low speed collisions can be even more damaging than high-speed accidents, within certain limits.  The kinds of things that may be more important are if your head is turned, or the size of the vehicle that is hitting you.

Before the accident, was the vehicle was rolling or stopped, how was the headrest positioned? Other factors include getting hit from behind vs. a head-on impact.

Research shows that people are not as badly injured from frontal impacts. It could be the airbag, anticipating the collision and tightening up, or the chin hitting the chest. All other factors being equal it's worse to get hit at the side and behind, than at the front.

Airbags have done a lot to save lives from frontal collisions. Unfortunately, side and rear impacts are less protected by an airbag. Seatbelts also save lives by keeping the occupants inside of the vehicle. Although they save lives, they tend to actually accentuate whiplash injuries in low speed collisions where the torso is more restrained relative to the head and neck.

Even car seats can be a factor in how badly you're injured.  Cars with soft thick seats will cause the head to whip more than occupants in a thin firm seat.  If the headrest was placed too low, it will act as a fulcrum and make the neck injury much worse.  That's why your headrest should always be positioned at the very highest level, and just touching the back of the head. 

Myth #2: No Pain = No Injury
I don’t feel pain so I’m ok. Most people who get in an accident will feel flustered and shook up. In low speed collisions, it is more rare to have pain right after accident. Usually symptoms develop over days, and it is not uncommon for the pain to come on two weeks post trauma. Conversely if you feel immediate pain, then substantial tearing and damage has occurred.

Another thing to consider is that the spine can be injured and yet may not cause much neck pain.  However, these patients usually have tender spines to the touch, even if there are no outward symptoms.  Less than 20% of the nerves that come through bundles between your vertebrae carry pain signals.  That means it's important to examine for more than just pain, such as neurological and muscle function. A doctor needs to carefully palpate the tissues of the neck, check range of motion, and examine the flexibility of individual spinal joints.  With this type of comprehensive exam you will be able to know if you've been injured. 

Myth #3: Kids Don't Get Whiplash
Kids aren’t injured in whiplash. Maybe you thought little Johnny wasn't injured in the car seat, or since kids tumble around when they play, they couldn't possibly be injured. This couldn't be further from the truth. Infants and young children have very undeveloped spines with much less muscle strength. This makes their ability to resist the forces lessened. You have to also consider the size of the head compared to the size of the neck. This difference is greatest in young children. When infants are injured they can show behavioral changes such as irritability and disrupted sleep patterns or nursing difficulties.

Myth #4: X-rays Always Show Whiplash Injury
If you've had a severe whiplash, you may have taken a trip to the emergency room where an x-ray was taken. If you're like many patients, the x-ray was read as normal. The problem is the x-ray you received, probably taken with you in one position, does not show injuries to the soft tissues such as ligaments and muscles, unless massive injury has occurred. Only if motion x-rays are obtained, can you see how the joints are moving in the neck. Since the injury is a sprain of ligaments, and x-rays show only bones-they do not give the complete picture.

Unfortunately for some whiplash victims
neck trauma will lead to arthritis of the spine

Don't be too alarmed, but concern is helpful.

People hear the word arthritis and think of rheumatoid arthritis and crippling joints.

What I'm talking about is osteoarthritis, or degenerative joint disease. 

Osteoarthritis is one of most common diseases afflicting humans, more common in people over age 55 than any other health condition.

Billions of dollars are spent each year on drug treatments that really do nothing to prevent degeneration of the joint.

In fact, some scientists suggest that injuries do not heal properly when patients take NSAIDs such as ibuprofen. 

This is in addition to the known rare side effects such as stomach bleeding, liver, and kidney problems.

    Arthritis occurs in spinal joints that have damage to the ligaments and disks. As degeneration progresses, the mobility of vertebrae are altered. The stretched out ligaments will allow excessive motion and after injury, scar tissue develops. Over months and years, the scar tissue contracts and the disk size decreases. This will make the mobility of the neck abnormally low (more stiffness). This scar is also not as elastic as tissue that has not been injured. Persons who have pre-existing degeneration and arthritis at the time of impact, will suffer whiplash more frequently (lower threshold) and with more severity when it does occur. Since older adults are most likely to have this type of degeneration arthritis, they are put more at risk in whiplash accidents.

_________________________________________  

    Hello.

    My name is Dr. Cilea, D.C.,


    One of the mainstays of medical treatment of whiplash is to immobilize the neck with a collar. Except in rare cases, it is something that I never use in practice.

    While good in theory, it just weakens the muscles and fails to preserve movement, which the neck needs to heal properly. 

    I am glad to see that many medical physicians are using them less and less, and promoting more active rehabilitation. Neck collars/braces are needed for fractures or dislocations, but strains/sprains are generally made worse with this treatment.

    I have spent years studying the mechanics of neck problems, and effective treatments, and I've successfully cared for many patients over the years, getting their quality of life back and reducing pain. But I'm still surprised by how many still take the medical approach-hot packs, collars and pain pills.

    Treatments ideally should be mechanical, not chemical, and not just cover up or mask the pain.

    I'm not saying my approach is scientifically proven to be the best...or that I have all the answers.

    But I do think there is a general lack of appreciation for the seriousness of these types of neck injuries, and that people are often convinced by insurance companies and others, that no injury occurred.

    This can sometimes result in no examination, no professional treatment, or the patient self medicates with various over-the-counter drugs or maybe you were required to see a "gatekeeper," that didn't appreciate the complexities of whiplash injuries and never referred you to the appropriate doctor.

    In any case, I'm not surprised if you're going through a health care maze-most of my patients do so.

    Not seeking proper treatment when indicated can lead to more problems down the road.

I WANT TO OFFER YOU ANOTHER WAY, AN APPROACH

BASED ON EVIDENCE AND THE MECHANICS OF THE BODY.

The most crucial point I want you to get from this Guide, is that it may be important for you to get a Comprehensive Whiplash Examination to determine if you've been injured.
Call our office at 732-719-8148 and schedule a FREE* consultation.



Don’t forget…it is important for your treatments to make your spine more flexible where it is not, and restrict movements where it is unstable.

Conventional MRIs immediately after the accident will not show these mobility changes and X-ray cannot show the disks of the spine. Only tests of mobility can show you where mechanical treatment is needed.

I strongly recommend that you have me evaluate your condition. There is ABSOLUTELY NO OBLIGATION for care. It is merely a chance to document any injuries and to find out if you need additional treatment.

*The free consultation offered here does not apply to patients who participate in a Federal program such as, but not limited to, Medicare.

Health Update: Fibromyalgia

Fibromyalgia Challenges

Fibromyalgia (FM) is a condition that usually affects different organ systems in the body, causing a number of symptoms. Some of these include:

1. The muscles (the musculoskeletal system): tender, achy, stiff, tight muscles, trigger or tender points all over the body
2. The nerves (the nervous system): headaches, light headedness, sleep disruption, depression, anxiety, numbness/tingling (overlaps with the cardiovascular system)
3. The stomach and intestines (the gastrointestinal system): diarrhea, constipation, irritable bowel, leaky gut, heart burn, lack of appetite, abdominal cramping
4. Breathing (the respiratory system): hyperventilation, rapid / shallow breathing patterns; 
5. The heart (the cardiovascular system): racing heart rate – palpitations, feeling cold all the time, numbness/tingling (overlaps with the nervous system)

Because of the multiple systems involved, there are many challenges to managing Fibromyalgia.  Studies suggest a balance between several approaches works best.  Some of these approaches include biomedical treatments, organ-specific treatments, and cognitive interpersonal treatments.  Within these categories, the following can be broken down further:

1. General – those treatments directed at the whole body such as anti-inflammatory measures.  These include (but are not limited to) medications (corticosteroids, NSAID’s – such as Advil, Aleve) and nutrients (ginger, turmeric, boswellia, Vitamin D, and others).  Other anti-inflammatory measures include diet, such as the Paleo Diet or “caveman diet.”  This diet eliminates grains or flour-based products from the diet.  That means no more breads, pastas, crackers, cookies – anything made with flour.  This approach emphasizes consuming fruits, vegetables, grass-fed lean meats and fish.  The main ingredients in grains that are of concern in the Paleo Diet are gluten and lectins
2. Central – those treatments directed at the chemical factors in the brain that control mood, depression, anxiety and so on.  These include (but are not limited to) medications (tricyclic antidepressants, muscle relaxers like Cyclobenzaprine, SSRI, SNRI and Trmadol) and certain nutrients (neurotransmitter support such as 5-HTP – tryptophan, DHEA, phenylalanine, and others).
3. Psychotherapy and active behavioral therapy – treatments that are supportive of nervous system such as cognitive behavior therapy, aerobic exercise, patient education, multidisciplinary therapy, hypnotherapy, biofeedback, and strength training.
4. Passive physical intervention – chiropractic therapy, massage therapy and other forms of manual therapy, and acupuncture.

The goal of this article is to look at fibromyalgia from a holistic perspective so that those struggling with FM and similar conditions can better appreciate the concept of multidisciplinary treatment, of which chiropractic care plays a significant role.  Coordination of care and finding the “right” health care providers cannot be over-emphasized.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION CALL (732) 719-8148

WEEKLY HEALTH UPDATE

Courtesy of:
Advanced Wellness in Marlboro, New Jersey
(732)984-9597

Mental Attitude: Exercise May Ward Off Anger. Before and after 30 minutes of moderate-intensity cycling, male participants viewed a slideshow known to evoke anger mixed with images designed to induce fear, pleasantness or no emotions. After exercising, watching the pictures didn't make the men more angry, while after rest, the pictures did so. An exercise class or weight lifting can take your mind off things. The distraction offered by exercise can have a calming effect, as well.
Michael R. Bracko, EdD

Health Alert: Are School Wellness Policies Implemented? The Child Nutrition and WIC Reauthorization Act of 2004 requires all school districts have a Wellness Policy if they participate in federally funded school meal programs. Part of the Wellness Policy should include nutrition education activities. 58% of the teachers thought they did not have adequate classroom time to include nutrition competencies. 64% thought they had the skills to incorporate the wellness policy, but only 30% are including nutrition competencies into their lesson plans.
Journal of Nutrition Education and Behavior, July/August 2010

Diet: Special Delivery. Eating high-fiber foods ensures timely digestion and elimination of wastes (whereas overconsumption of animal fats and low-fiber foods leads to colonic inactivity and constipation). Foods high in saturated fat also can contribute to plaque buildup in the arteries, reducing the ability of blood to move through the body and potentially causing a blockage - leading to a heart attack or stroke.
Peter W. Crownfield, To Your Health

Exercise:  Stretching Exercises At Your Desk For Your Back And Shoulders (The "Leg Hug"). Sit on the edge of your chair. Put your feet together, flat on the floor. Lean over, chest to knees, letting your arms dangle loosely to the floor. Release your neck. Now bring your hands behind your legs, right hand grasping left wrist, forearm, left hand grasping the right. Feel the stretch in your back, shoulders and neck. Hold. Release your hands to the floor again. Repeat three times or as often as it feels good.

Chiropractic:  Brain Energy Output. 90% of the energy output of the brain is used in relating the physical body to gravity. Only 10% has to do with thinking, metabolism and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism and immune function to deal with abnormal gravity/posture relationships and processing.
Dr. Roger Sperry (Nobel Prize, Brain Research, 1981)

Wellness/Prevention: Keep Breathing! How important is oxygen and lung capacity? The surface area of a human lung is equal to a tennis court. Unfortunately, without exercising your lungs (slow deep breathing -- 5 to 10 deep breaths every hour and exercise), your lung capacity will shrink as you age.

Quote: “Oh, the powers of nature! She knows what we need.” ~ Benvenuto Cellini

Health Update: Low Back Pain

What Can I Do To Reduce My Risk For Low Back Pain?

Low back pain (LBP) can have many causes such as genetics, acquired abuses, body type (especially obesity – body mass index or BMI greater than 30), gender, as well as cultural aspects that predispose one to acquire low back trouble.  So, the question remains, “what can I do to reduce my risk for developing low back pain?”

The answer, like the cause is – you guessed it – multifactorial.  Since we can’t change our genetics, we’ll have to accept that one.  But, we can change our BMI by keeping our weight to a reasonable amount.  In an April 2010 study from Norway, 60,000 men and women provided BMI information and 20.9% of the men and 26.3% of the women indicated they had chronic low back pain. The authors found a direct relationship to a high BMI and an increased prevalence of LBP.  Similar results attributing obesity to LBP were also reported in a meta-analysis published in January 2010 in the American Journal of Epidemiology (2010; 171(2):135-154).

So, what is, “…a reasonable amount of weight?”  When using the BMI, a BMI of 18.5 to 25 is considered “normal,” while 25-30 is described as overweight and greater than 30 represents obesity.  We should also mention anything LESS than 18.5 is considered underweight and that’s not good either as many nutritional needs of the body are compromised and too little weight can negatively affect bone health leading to osteoporosis and a myriad of other problematic health issues.

You may be wondering what a body mass index or BMI is, as its quite important and is quickly gaining respect in the medical world.  In fact, it has been suggested to include the BMI along with the other “vital signs” pairing it up with blood pressure (BP), pulse, breathing rate, height, weight, and temperature.  The BMI is a formula of height and weight and it’s a rough calculation of our total body fat, which is related to the risk of disease and death.  However, according to the National Heart, Lung and Blood Institute (NHLBI) it’s a little more complicated than that as people with greater muscle mass (such as a body builder) will have a higher BMI, suggesting they are overweight. At the other end of the spectrum, older individuals who have lost muscle mass may be still be overweight but their BMI will not reflect that.

The NHLBI reports 3 factors of importance when defining obesity and its many negative health effects, including the increased prevalence of LBP.  The 3 factors are: 1) The BMI; 2) The waist measurement; 3) The presence of other negative health factors including: high BP, high LDL-cholesterol, low HDL-cholesterol, high triglycerides, high blood sugar, a family history of heart disease, physical inactivity and smoking cigarettes.  If you have a waist size greater than 35” for woman, greater than 40” for men, AND 2 or more risk factors, simply put, you MUST lose weight!  Even a small weight loss of 10% (such as 30# if you’re 300#), will help lower your risk of developing diseases associated with obesity such as heart disease, high cholesterol related diseases, stroke, certain types of cancers and type 2 diabetes.

We also realize you have a choice in who you choose for your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.                            
                                                                              
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597