Informed People Make Healthy Choices

Staying Healthy and Well

Many hospitalizations could be prevented by making changes in six main risk factors - Tobacco use Alcohol abuse Accidents High blood pressure Obesity Gaps in screening and primary healthcare Overall, good health is maintained by Proper nutrition Moderate exercise Avoiding harmful behaviors and substances Paying attention to early warning signs Protecting ourselves from accidents

Being an informed patient is an empowering concept.¹ In the modern healthcare marketplace, the doctor-patient relationship has become a two-way street. It's no longer a situation in which the doctor tells the patient what to do. Today, patients can be full partners in managing their care and well-being.²

What does it take to be an informed patient, one who can participate in a meaningful way and not be merely the passive recipient of the doctor's instructions and recommendations?

The first key is to identify a doctor - a chiropractor or family physician, depending on the circumstances - in whom you have confidence. Here are a few essential points to consider

• The doctor has spent enough time with you on the first visit
• The doctor has focused on you, and has not been distracted by all the other things happening in the office
• The doctor has satisfactorily answered all your questions
• The doctor's recommendations are clear, and you understand what the next steps are going to be

The questions you ask are not just to keep talking and capture more of the doctor's time spent with you. An informed patient does some preparation - some homework - before the actual office visit. The Internet offers a lot of valuable information on both chiropractic and medical treatment. And, it's important to remember that not all information is accurate and authoritative - consider the source of the "information".

• Consider the author's background and affiliations
• Consider the potential for bias
• Is the site itself up-to-date - for example, are there "dead links" on the site

Do your best to evaluate the doctor's recommendations. First, what are the expected results? How quickly should you begin to feel better? Are there potential side-effects of the recommended treatment? What are the alternatives?

Alternatives may include other forms of therapy within the doctor's office and may also include consultation with another specialist. The main point is not to be left with a confusing array of choices, but to have enough information to go forward with a treatment plan that makes the most sense, both to your doctor and to you.

If a prescription is involved, make sure you write down the exact spelling of the medication and the exact dosage and frequency. Prescriptions are usually scribbled, and both doctors and pharmacists can make a mistake. Don't let your doctor simply hand you an illegible piece of paper. Insist on ensuring that you understand what is being prescribed, and be sure to ask your doctor about potential side effects, risks, and interactions with any other medicines you may be taking.

As in all relationships, the doctor-patient relationship is based on clear communication and mutual trust and understanding. You can help your doctor help you by being informed and participating in the decision-making process.

Dr. Dave Edenfield, "Your Jacksonville Chiropractor", and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies. Now accepting VA patients. For more information visit:
Lakewood Chiropractic
Jacksonville, Florida 32217
904-733-7020
http://www.lakewoodchiropracticjax.com/
https://www.facebook.com/lakewoodchiropractic
https://twitter.com/AskDrEdenfield

¹Informed Consent. "Ethics in Medicine". University of Washington School of Medicine. http://depts.washington.edu/bioethx/topics/consent.html#ques1
²"Be an active healthcare consumer". Agency for Healthcard Research and Quality. http://www.ahrq.gov/path/beactive.htm

How Safe is Chiropractic Care?

How Safe is Chiropractic Care?

 

Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches, and other neuromusculoskeletal complaints.  Although chiropractic has an excellent safety record, no health treatment is completely free of potential adverse effects.

The risks associated with chiropractic, however, are very small.  Many patients feel immediate relief following chiropractic treatment, but some may sometimes experience mild soreness or aching, just as they do after some forms of exercise.  Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours.¹

In addition to being a safe form of treatment, spinal manipulation is incredibly effective, getting patients back on their feet faster than traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in those patients who have been experiencing the symptoms for one year or less.  In addition, a study published in the July 15, 2003, edition of the journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications.

Neck Adjustments

Neck pain and some types of headaches are sometimes treated through neck adjustment. Neck adjustment, often called cervical manipulation, works to improve joint mobility in the neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and tension. Neck adjustment is a precise procedure that is generally applied by hand to the joints of the neck. Patients typically notice a reduction in pain, soreness, stiffness, and an improved ability to move the neck.

Neck manipulation is a remarkably safe procedure. Although some reports have associated upper high velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, there is not yet a clear understanding of the connection. While we don’t know the actual incidence of stroke associated with high-velocity upper neck manipulation, the occurrence appears to be rare—1 in 5.85 million manipulations²— based on the clinical reports and scientific studies to date.

To put this risk into perspective, if you drive more than a mile to get to your chiropractic appointment, you are at greater risk of serious injury from a car accident than from your chiropractic visit.

It has also been suggested that sudden, severe upper neck pain and/or headache, which may indicate a pre-stroke condition, could cause someone to visit a doctor of chiropractic. In addition, some common activities, such as stargazing, rapidly turning the head while driving, and having a shampoo in a hair salon may cause an aneurysm—a widening of an artery resulting from the weakening of the artery walls—of the neck arteries, resulting in stroke. Such events remain very difficult to predict.

It is important for patients to understand the risks associated with some of the most common treatments for neck and back pain—prescription non-steroidal anti-inflammatory drugs (NSAIDS)—as these options may carry risks significantly greater than those of manipulation.  Per a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.³

Furthermore, surgery for conditions for which manipulation may also be used carries risks many times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks, including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and thromoembolism.⁴

If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific about your symptoms.  This will help your doctor of chiropractic offer the safest and most effective treatment, even if it involves referral to another health care provider. If the issue of stroke concerns you, do not hesitate to discuss it with your doctor of chiropractic. Depending on your clinical condition, he or she can forego manipulation, and instead can recommend joint mobilization, therapeutic exercise, soft-tissue techniques, or other therapies.

Research Ongoing

The ACA believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic.  Today, chiropractic researchers are involved in studying the benefits and risks of spinal adjustment in the treatment of neck and back pain through clinical trials, literature reviews and publishing papers reviewing the risks and complications of neck adjustment.

All available evidence demonstrates that chiropractic treatment holds an extremely small risk. The chiropractic profession takes this issue very seriously and engages in training and postgraduate education courses to recognize the risk factors in patients, and to continue rendering treatment in the most effective and responsible manner.

Dr. Dave Edenfield, "Your Jacksonville Chiropractor", and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies. Now accepting VA patients. For more information visit:
Lakewood Chiropractic
Jacksonville, Florida 32217
904-733-7020
http://www.lakewoodchiropracticjax.com/
https://www.facebook.com/lakewoodchiropractic
https://twitter.com/AskDrEdenfield

References

1. Senstad O, et al.  Frequency and characteristics of sideeffects of spinal manipulative therapy. Spine 1997 Feb 15;435440.
2. Haldeman S, et al.  Arterial dissection following cervicalmanipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.
3. Lanas A, et al. A nationwide study of mortality associated withhospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use.

Am J Gastroenterol 2005;100:1685–1693.

4. Lauretti W. The Comparative Safety of Chiropractic. In DanielRedwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p. 230-8.

A Problem of Epidemic Proportions

Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of tens of thousands of people in the United States. According to the Centers for Disease Control and Prevention (CDC), as many as one in four patients who receive prescription opioids long term for non-cancer pain in primary care settings struggles with addiction. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Further, deaths involving opioids have quadrupled since 1999; in 2014 alone, more than 14,000 people died from overdoses involving the drugs. That same year, another 2 million people abused or were dependent on opioids.
Beyond the risks of addiction and overdose, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process…or even permanent injury.

Rising Recognition of the Value of Non-drug Approaches to Pain

There is a growing body of research that validates the effectiveness of chiropractic services, leading many respected health care organizations to recommend chiropractic and its drug-free approach to pain relief. The Journal of the American Medical Association, in a 2013 patient page on low-back pain, suggested patients consider chiropractic treatment before resorting to surgery. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches by adding chiropractic to its pain management standard. Most recently, in March 2016, the CDC, in response to the opioid epidemic, released guidelines for prescribing opioids that also promote non-pharmacologic alternatives for the treatment of chronic pain.

Conservative Care First: A Common Sense Approach

ACA encourages patients and health care providers to first exhaust conservative forms of pain management, when appropriate, before moving on to riskier, potentially addictive treatments such as opioids. To this end, ACA delegates met in Washington, D.C., in 2016 and adopted a policy statement proposing a solution to the dual public health concerns of inadequate pain management and opioid abuse. ACA’s policy statement supports

1. The investigation of non-pharmacologic interventions for pain treatment across a variety of patient populations and healthcare delivery setting
2. The promotion of evidence-based non-pharmacologic therapies within best practice models for pain management
3. The improvement of access to providers of non-pharmacologic therapies
4. Interprofessional education to augment the training of pain management teams
5. And public health campaigns to raise awareness of drug-free treatment options for pain syndromes. 

Dr. Dave Edenfield, "Your Jacksonville Chiropractor", and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies. Now accepting VA patients. For more information visit:
Lakewood Chiropractic
Jacksonville, Florida 32217
904-733-7020
http://www.lakewoodchiropracticjax.com/
https://www.facebook.com/lakewoodchiropractic
https://twitter.com/AskDrEdenfield

Back Pain and Herniated Discs

Back Pain and Leg Pain

Much more commonly, when lower back pain is accompanied by radiating pain, the radiating pain only travels into the buttock and thigh, and doesn't travel below the knee. And, most commonly, the thigh pain is found in the back of the thigh, rather than in the front of the leg. Most of the time, this radiating pain does NOT come from a herniated disc, and does NOT mean the problem is sciatica (caused by an inflamed sciatic nerve, likely caused by a disc herniation). This type of pain that travels into the buttock and the back of the thigh is usually caused by mechanical changes in the sacroiliac joint and the spinal joints of the lower back. These mechanical changes relate to tight spinal muscles and inflamed spinal ligaments and tendons, with resulting loss of full mobility. The good news is such problems are treatable with chiropractic health care. The underlying problems are structural, related to the joints and surrounding soft tissues, and chiropractic treatment is designed to restore balance and function. Symptoms typically begin to improve quickly. In addition to treatment, your chiropractor will likely recommend stretches and exercises to help solve the problem and maintain physical health.

A 30-year-old mom bends over to pick up her four-year-old and feels a sharp stabbing pain in her lower back. A 60-year-old man bends over to pick up his five-year-old grandchild and feels an electrical shooting pain in his lower back. For both, the pain is so severe they need to sit down.

The next day, both the mom and the grandfather notice they now have pain and numbness radiating down one leg, and they are having trouble walking.

What's going on, how did it happen, and what can be done about it?
 First of all, a little basic anatomy is useful. Spinal discs are weight-bearing shock absorbers. They contain a gel-like ball-bearing center, which is surrounded by tough fibrous cartilage, arranged in concentric, criss-crossing circles.¹

As a person gets older, the discs naturally lose some of their water content, and cracks and fissures naturally develop in the fibrous cartilage. If a weight-bearing stress is unusual and unexpected, the gel-like material in the center of the disc can push through one of the fissures and possibly irritate a spinal nerve.

If enough of this material pushes through, the nerve can become inflamed and cause symptoms such as radiating pain and/or numbness, and possibly weakness, in one leg.

Typically, such pain and/or numbness radiates down the leg, traveling below the knee and possibly into the foot.

Such symptoms, with or without back pain, are highly suggestive of an inflamed spinal nerve. In fact, the person will usually say the leg symptoms are much worse and of greater concern than any back pain that may be present.

If the MRI confirms the disc herniation and suggests an inflamed nerve, the diagnosis is complete. What's next?

In the best scenario, conservative treatment may be sufficient and the nerve inflammation improves with time.^2,3 Anti-inflammatory medication may be helpful. Chiropractic conservative therapy may include physical therapeutic modalities and gentle trigger point therapy to relieve associated muscle spasms.

A spinal surgeon should be consulted to provide an additional opinion and input. If pain is severe and there is neurologic loss, surgery may be the best option.

Of course, the best management, as always, is prevention. Pay attention to safe lifting procedures. Exercise regularly and get sufficient rest. Your chiropractor will be able to provide guidance and recommend effective protocols to help you achieve and maintain good health and wellness.
Dr. Dave Edenfield, "your Jacksonville Chiropractor", and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies. Now accepting VA patients.

For more information visit:
Lakewood Chiropractic
Jacksonville, Florida 32217
904-733-7020
http://www.lakewoodchiropracticjax.com/
https://www.facebook.com/lakewoodchiropractic
https://twitter.com/AskDrEdenfield
¹Postacchini F: Lumbar Disc Herniation. Springer, 2004, Chapter 2.
²Rothoerl RD, et al: When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25(3):162-165, 2002.
³Lumbar Disc Herniation. New Engl J Med 347(21):1728-1729, 2002.

RETHINKING OUR APPROACH TO PAIN #Chiropractic1st

 It’s time to change the way we approach pain. The services of doctors of chiropractic, along with other non-drug forms of pain management, can be an important part of the solution to the opioid epidemic gripping the United States. While medication may be necessary for some patients, there are cases—particularly those involving chronic pain—where a more conservative approach may alleviate pain and even lessen or eliminate the need for prescription painkillers.
The American Chiropractic Association (ACA) believes people in pain need better access to drug-free options such as chiropractic services. ACA has worked for years to raise awareness of conservative treatments such as chiropractic as a first line of defense against pain.
 A Problem of Epidemic Proportions
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of tens of thousands of people in the United States. According to the Centers for Disease Control and Prevention (CDC), as many as one in four patients who receive prescription opioids long term for non-cancer pain in primary care settings struggles with addiction. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Deaths involving opioids have quadrupled since 1999; in 2014 alone, more than 14,000 people died from overdoses involving the drugs. That same year, another 2 million people abused or were dependent on opioids.
Beyond the risks of addiction and overdose, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process…or even permanent injury.
The problem of prescription drug overuse and abuse reaches beyond the general population. New research suggests that the rising prevalence of chronic pain and opioid use by U.S. combat military personnel is cause for serious concern. The study, published online as a research letter in JAMA Internal Medicine, is accompanied by an editorial recommending that the goal should be nothing short of a “cultural transformation” in how pain is managed.
Dr. Dave Edenfield, "your Jacksonville Chiropractor", and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies. Now accepting VA patients. For more information visit:
Lakewood Chiropractic
Jacksonville, Florida 32217
904-733-7020
http://www.lakewoodchiropracticjax.com/
https://www.facebook.com/lakewoodchiropractic
https://twitter.com/AskDrEdenfield

Your Computer and You

A Healthy Workstation That Works

Setting-up your computer workstation to be a healthy environment is a key element in avoiding repetitive stress injuries. Monitor position, seat height, and elbow-wrist placement are the main elements of a ergonomically healthy design. Your chair seat height and the keyboard should be aligned so that when your hands are on the keyboard, your elbows are parallel to the floor. In other words, in an ergonomically efficient typing position, your elbows are neither above nor below the keyboard. Your wrists should be in a neutral position when typing, neither flexed nor extended. Chronic wrist flexion or extension will result in fatigue and overuse. Position your monitor or laptop display so your neck flexes slightly and your angle of gaze is directed downward about ten degrees. If you're using a mouse, it should be close to the keyboard, so that good elbow alignment is maintained. You should not have to reach for the mouse. It should be right there.

Windows and Mac users actually do have one thing in common - computer ergonomics issues, namely, pain.^1,2 Beyond the usual hardware and software gotchas we deal with on a daily basis, the real bottom-line question is, "how to play nice with my computer".

Doing computer work is a funny kind of work, a type of activity we're still getting used to. It's not physical work in the sense that there's no heavy lifting going on, no truck-driving, no emergency services heart-pounding decision-making.

But computer work is still an intensely physical activity, although the work is pretty subtle. In computer work it's the small muscles that are getting the workout, not the big muscles we're used to thinking about.

Wrist muscles, tendons, and ligaments. Finger muscles, tendons, and ligaments. Shoulder muscles, Neck muscles. All of these are involved in ongoing repetitive tasks when you sit at a computer and one hour turns into two, two hours turns into three, and suddenly half the day is gone and you notice you've got a killer stiff neck.

Or, one day the tendons on the back of your hand begin to hurt, feeling irritated and inflamed. Or your shoulders and upper back are tight and painful.

Your hands or shoulders feel better by the time you go to sleep. But the next day, as soon as you start to type they act up again.

This is all very uncomfortable, because you've got to do your work.

What's going on?

These various pain patterns in your hands, wrists, shoulders, and neck can be grouped together as a repetitive stress syndrome. Repetitive activities, done over a long period of time, can irritate and inflame the muscles, tendons, and ligaments that are involved in doing the work.

But computer work involves repetitive tasks. How can you avoid these painful problems?

The best approach is to prevent them in the first place.³ If such a syndrome does develop, relative rest is indicated. Reduced computer activity, in smaller intervals, is a good solution. A very useful work-around for right- or left-arm pain is to teach your non-dominant hand to use the mouse or touch pad. This training may take a few weeks - the valuable result is the ability to switch hands whenever you like, distributing the workload between the two sides. Much better.

The most important aspect of prevention is to take a quick, refreshing break once an hour. This is a critical habit to develop. Get out of your chair, walk around, get some fresh air if possible. Change your environment for a few minutes - talk to a co-worker for a moment, get a drink from the water-cooler down the hall, seek out a picture, wall-covering, or landscape you've never seen before.

These activities refresh your body AND your brain, and you're ready to do another hour of productive, creative, healthy work. You'll feel much better, you'll be avoiding repetitive injuries, and your workday will be more enjoyable.

Dr. Dave Edenfield and Lakewood Chiropractic offers the most advanced treatments for back pain, sciatica, neck pain, whiplash and headaches. They also treat auto accident victims with state-of-the-art technologies.  For more information visit:

http://www.lakewoodchiropracticjax.com/

https://www.facebook.com/lakewoodchiropractic

https://twitter.com/AskDrEdenfield

 ¹Keyserling WM, Chaffin DB: Occupational ergonomics - methods to evaluate physical stress on the job. Annu Rev Public Health 7:77-104, 1986.
²Computer Workstation Ergonomics. Centers for Disease Control and Prevention, 2000. http://www.cdc.gov/od/ohs/Ergonomics/compergo.htm
³Robertson MM, et al: Effects of a participatory ergonomics intervention computer workshop for university students. Work 18(3):305-314, 2002.