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Conservative Care First

By On · Add Comment · In chiropractic adjustments, herniated disk, low back pain, low back surgery, microdiscectomy, pain killers, sciatica

Low back pain is the fifth most common reasons for physician visits in the U.S.  One third of them report persistent back pain of at least moderate intensity one year after an acute episode, and 1 in 5 report substantial limitations in activity.

Sciatica–a painful nerve irritation–can accompany low back pain and can sometimes be present on its own.  Sciatica and low back pain together very often result from disc herniation, predominantly in the lumbar spine.

Several treatment options exist, but which ones are most effective?  A 2010 study set out to determine the efficacy of two of these treatments–chiropractic adjustments or surgery.  Forty patients were chosen through elective referral by primary care physicians to spinal neurosurgeons.  Patients were chosen on the basis that they had already failed at least three months of nonoperative management including treatment with analgesics (pain killers), lifestyle modification, physiotherapy, massage therapy, and/or acupuncture.

The patients were randomly split into two groups: those to receive chiropractic adjustments and those to receive microdiscectomy (surgical removal of the herniated disc–cool video here).  Crossover to the alternate treatment was allowed after three months.

Researchers found significant improvement in both groups.  Hmmm…so, by this study, chiropractic and disc surgery were better than pain killers, lifestyle modification, PT, massage and acupuncture to relieve chronic, stubborn sciatica.  Okay, I’ll buy that (well, I am a chiropractor, you know?).  But which one is better?  We’ve gotta have a ‘better’, don’t we?

The results showed that the two treatments came out exactly the same for all outcome measures for the majority of subjects one year post-treatment.  However, eight patients did crossover from chiropractic to surgery, while three crossed over from surgery into chiropractic.  The three that did not benefit from surgery failed to benefit from chiropractic as well.  The eight chiropractic-didn’t-work-for-me crossovers, however, did benefit from the disc surgery…and get this…they did so to the same degree as their surgery-first counterparts.  Dang–now that’s a good study!

Here’s the take home: When dealing with chronic sciatica due to herniated disc, try chiropractic first, period (authors believe first line should be drugs, physical therapy and lifestyle modification…but I don’t).  If the chiropractic doesn’t work, go ahead and get the surgery (although I still think I would try chiropractic, rehab and orthotics [if foot dysfunction present] seriously for at least one year before making that decision).  If you do it this way, you won’t hurt yourself  (at least within three months) by waiting on the surgery–you will still likely benefit as if you went surgery right away–AND if chiropractic works for you (as it did for a majority in the study), you’ll be better off physically and financially, because remember, you’ll never be the same or better following a surgery, and microdiscectomies aren’t cheap (unless, of course, you are lucky enough to live where there’s socialized medicine, and then somebody else will pick up the tab).

Finally, if you decide to get the surgery and it doesn’t work for you (10-20% failure rate), understand that there’s no going back–chiropractic probably can’t help you then.  Get it?  Good.

More on Brittany Murphy

By On · Add Comment · In Brittany Murphy, congenital disorder, death, drug toxicity, heart attack, natural causes, pain killers, prescription drugs

Some final words on the recent death of actress, Brittany Murphy. According to a forensic pathologist, attorney and medical-legal consultant, the 32-year old actress most likely died of drug toxicity. I know you are all thinking what I’ve already said, but since preliminary reports have the death listed as from “natural causes,” we can all sigh a collective, “No scheiße!”

Celebrity Web site TMZ is reporting there were “large amounts of prescription medications” on the nightstand when paramedics arrived at her Hollywood home, and that Murphy was “complaining of shortness of breath and severe abdominal pain” in the week before she died.

On Tuesday, pathologist Dr. Cyril Wecht (celebrity coroner that has worked on famous cases like Elvis Presley and JonBenet Ramsey) said on CBS’ The Early Show that although it’s possible Murphy died of natural causes, it would likely have been from a congenital heart abnormality (my words exactly); however, most people are aware that they have these disorders. More likely, he said, she suffered toxicity from a multitude of prescription drugs obtained both legally and illegally, a la Michael Jackson, Heath Ledger, and Anna Nicole Smith.

“When you have a 32-year-old person dying suddenly, and especially a celebrity in Los Angeles, you can place your bet down that it’s going prove to be a case of acute combined drug toxicity. And I bet you that this young lady tragically died in the same way that Michael Jackson did, and Anna Nicole Smith, and her son, Daniel Smith, and Heath Ledger — a combination of drugs that had been prescribed for her, prescribed for her husband, for her mother, in some fictitious names, probably by doctors who are very, very quick to make available anything that celebrities want, sometimes using knowingly fictitious names.

“So, even though these drugs are, quote, legal, unquote, they are, many times, illegally obtained. And it’s a tragedy. And it’s being played out everywhere in America every day, and we only come to know about it when it involves celebrities.”

The drugs in question? Ativan, one drug found in the Michael Jackson case, Klonopin, a drug involved in the Anna Nicole case, Hydrocodone, a common pain killer found in OD cases, and Vicoprofen, a form of Vicodin.

Another truism disclosed by Dr. Wecht, “I guarantee you that, if the pathologists at the Los Angeles coroner’s office had found something dramatic, like a heart attack, like a stroke, or like something of a definitive nature, would you have heard about it. The fact that they say that they’re going wait for toxicology tests and it will take a couple of months, you can be sure that this is going to prove to be a case of acute combined drug toxicity.”

Agreed. Either way, heartfelt condolences go out to Brittany Murphy’s family.

*Brittany Murphy was laid to rest this evening at twilight. RIP.

More Drug Deaths

By On · Add Comment · In acupuncture, alternative therapies, chiropractic, drugs, exercise, health, pain, pain killers, pharmaceuticals, prescription drugs, yoga

When we think of drug related deaths, don’t we all assume it’s heroin, barbiturates, or even alcohol that is involved? What if I told you that the fastest growing drug killer in our medicine cabinets today are painkillers – would you believe me? Well you’d better. A recent U.S. study has found that deaths or injuries related to drug treatments have more than doubled between 1998 and 2005 in the United States, with painkillers and immune-system boosters accounting for most.

Ouch. This further hurts a medical industry that increasingly relies on pharmaceutical treatments for every ailment, no matter how minor. Shame that it has even gotten so far as to make non-medical conditions “easily treatable” with drugs (hear my Podcast Episode 3 on lifestyle drugs to get a glimpse of this travesty). When there is a drug for every situation – forget illness, it’s gone way beyond that – then expect death and disability to rise.

The biggest shame is that there are so many “alternative” solutions for pain – like chiropractic, massage, acupuncture, exercise, yoga – yet so many people refuse to try them or give them an honest chance. Making matters worse, far too many medical doctors, and the medical institution as a whole, are slow to accept these alternative therapies as a part of mainstream care. And they certainly aren’t making a habit of referring their patients to these other useful and effective therapies.

Is it fear? Is it a desire to remain the cultural authority on all things health that leads to this sort of negligence? I think it’s both, with a little bit of arrogance tossed in. The general consensus regarding alternative therapies among medical practitioners is, “There is no proof – no scientific evidence.” This concept is such malarkey that it’s almost painful (excuse the pun) to bear. Take chiropractic for example. There is plenty of research on its effectiveness, but the doors need to be opened for serious dialogue to occur between the professions. Furthermore, chiropractic has been helping people remove pain and maintain health for over one hundred years, and has survived attempts to bury it, discredit it, and even outlaw it. How would this be so if scores of people were not being helped by it? Like, get with it, man. When are you going to accept chiropractic’s validity? When are you going to think first of your patients and steer them toward a non-drug option?

The bottom line is this: Keep prescribing drugs like there is no tomorrow, and see death rates soar. It won’t last forever because the public is getting smarter and more savvy (like my readers). Thanks to the Internet, information is easily shared and the position of physician as absolute authority is being severely challenged. Doctors are guides; they are teachers. Teach the truth and people will listen. There is no truth in the excessive manipulation of body chemistry to maintain health. You heard it hear first, so pass the word. And be diligent and cautious when seeking treatment. What you don’t know can kill you.

Baby Takes What Mama Takes

By On · Add Comment · In breast milk, breast-feeding, codeine, cough syrups, episiotomy, morphine, over-the-counter medications, overdose, pain killers, prescription drugs, ultra-rapid metabolizers
The FDA has warned that breast-feeding mothers who take prescription pain killers containing codeine may put their babies at risk of a morphine overdose. Officials became concerned last year when a breast-fed 13-day-old baby died of just that. Following a routine episiotomy, the mother took a very small dose of pain medication that was rapidly converted to morphine in her body and passed on to her child through her breast milk.

Codeine, a narcotic, is apparently converted to morphine rapidly in the body in a small number of women. Codeine is a common ingredient in prescription pain relievers and some over-the-counter cough syrups. Women who convert codeine to morphine quickly are called ultra-rapid metabolizers. Their prevalence within the population varies between 1-28% depending on who gives the estimate, but it is believed that rates are highest among North African, Ethiopian and Saudi Arabian women.

This is just another reason why new mothers should be cautious of what they take. Drugs are routinely prescribed, but it does not mean they are without risk. You are always safer minimizing the chemical substances you ingest. This does not mean you shouldn’t have help if you need it, however, less is best. And knowing the latest in health information is crucial.

Now that you know that some women are ultra-rapid metabolizers of morphine, you can obtain a laboratory test through your doctor to determine if you fall into this category. Otherwise, ask your prescribing doctor what’s in the drug they’re recommending. If it contains codeine, ask for an alternative. And remember, sometimes it pays to just deal with the discomfort.

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