UPDATE: Congratulations to My Old Friend Anthony Calvillo…

Congrats to the Montreal Alouettes football organization and their quarterback Anthony Calvillo on back to back Grey Cup victories. Sorry Riders fans, better luck next year.

Dr. J

Bright Light Therapy because you don't have to be S.A.D

I thought I'd blog about something topical based on the season that quickly approaches... Winter!  

SAD or Seasonal Affective Disorder is a mood disorder in which people who have normal mental health throughout most of the year experience depressive symptoms in the winter.  It is more prevalent in regions farther away from the earths equator. 

The first line of treatment recommended by many doctors for seasonal affective disorder is bright light therapy. This involves the patient sitting in front of a "light box", an artificial source of bright light, for a certain period every day. This can range from 30 minutes to several hours, either in the morning or afternoon, or sometimes both. Bright light therapy with light boxes has been shown in many studies over the years to be a very effective treatment for most SAD sufferers, providing at least a modest improvement in symptoms in nearly everyone. As such, bright light therapy can be a very important treatment for the SAD patient, especially since it is not always possible to get outside in natural sunlight every day during the winter.

Light boxes have a "lux" rating, which is simply an indication of the intensity of the light they produce. Most studies into light therapy for the treatment of seasonal affective disorder have used light boxes with a rating of 10,000 lux and these are widely available to the public. Light boxes with lower lux ratings are also available but treatment periods will need to be longer to produce the same positive effects as a shorter period in front of a 10,000 lux unit. 

Possible but rare minor side effects include jumpiness/jitteriness (8.8%), headache (8.4%), and nausea (15.9%).  These symptoms are usually very mild and can often be eliminated by adjusting the period of light exposure.

So if you think you may suffer from SAD, talk to your health care professional about the benefits of Bright Light Therapy.

Other options for SAD treatment include the following supplements:

Vit D (deficiency is linked to many health issues including depression

Melatonin (at night to help induce better sleep)

St. Johns Wart (improves mood)

Omega Fatty Acids, 5-HTP and SAMe (natural antidepressants)

Do Skechers' Shape-Ups Really Work (updated)?

update:

Thought I'd add a little to this article as I have done some more probing into the product and it's claims.
For company propaganda from the website check here.

Improves posture (unlikely), improves circulation (exercise of any kind will do this), strengthens the back (how exactly?), firms buttocks and tones thighs and calves(more than regular walking, I think not) are some of the claims.  One that may have some merit is 'reducing knee joint stress'.  A certain group of the population have faulty gait mechanics which cause them to 'slap' their foot on the ground every step they take.  Now the design of this shoe, for those people would help reduce the shock impact of this slapping and as a result might reduce knee and ankle pain. 

Anyway, I'm not saying 'don't wear this shoe' just be cautious in what you expect the shoe to for you.  If you like the shoe and it feels good, go ahead and enjoy them.

Just wanted to throw out my two cents on a growing trend / fad in footwear.  Products like the Sketchers Shape Ups and other MBT (Swiss Masai Barefoot Technology) shoes make some pretty unbelievable claims of toning calves and thighs without increasing your  bodies energy output in any meaningful way.  Hard to believe  there is any truth to it, and I have been unable to find any scientific research to support these claims.  Generally if it sounds too good to be true, it probably is.  

That being said, some anecdotal evidence seems to indicate that many people find them comfortable and enjoy wearing them for short durations / distances.  So, as long as you don’t plan on doing a lot of side to side movements and aren’t going to be walking long distances in them go ahead and enjoy them.  Just don’t expect to have ‘super model’ legs after a few laps around the block.  There is no replacement for hard work!

11 supplements to consider...

A followup to my Consumer Reports blog about potentially harmful supplements.  To their credit they did have a list of 11 supplements worth taking.  The original article can be found here.

Here are their recommendations :

CALCIUM

Effective in combination with vitamin D in preventing and treating bone loss and osteoporosis.   Calcium can decrease the effectiveness of certain antibiotics, osteoporosis drugs, and thyroid drugs.

FISH OIL

(EPA/DHA, omega-3 fatty acids, PUFA) Effective for reducing triglyceride levels. Likely effective for decreasing the risk of heart attack, stroke, and progression of hardening of the arteries in people with existing heart disease.  Might increase the effect of blood-thinning drugs and high blood pressure medications. 

GLUCOSAMINE SULFATE 

Likely effective treatment for reducing symptoms of osteoarthritis of the knee. Might also help slow progression of osteoarthritis. Might increase the blood-thinning effect of warfarin and cause bruising and bleeding.

LACTOBACILLUS

(acidophilus, acidophilus lactobacillus, probiotics) Possibly effective for preventing diarrhea while taking antibiotics. Gas. People with poor immune function should check with their doctor first. 

PSYLLIUM

Effective as a bulk laxative for reducing constipation or softening stools. Likely effective for lowering cholesterol in people with mild to moderately high cholesterol. 

PYGEUM
(African plum tree, African prune, Prunus africana) Likely effective for reducing symptoms of an enlarged prostate.

SAMe
(ademetionine, adenosylmethionine, S-Adenosyl-L-Methionine, sammy) Likely effective in reducing symptoms of major depression, reducing pain, and improving functioning in people with osteoarthritis. 

ST. JOHN'S WORT
Likely effective for improving symptoms of some forms of depression.

VITAMIN D
(Cholecalciferol, vitamin D3, ergocalciferol, vitamin D2) Likely effective when taken with calcium to help prevent osteoporosis.

Happy Halloween Everyone...

I found this interesting post / chart of the time line behind Halloweens history and I thought I'd pass it along.

Link
It may be as old as 800 BC when the Celts would wear masks to ward off evil spirits.
Amazingly Halloween has become a 6.9 Billion dollar industry.

Possibly Dangerous Supplements

A recent edition of Consumer Reports had a section on ‘The 12 Most Dangerous Supplements’  that I found interesting.  Here is a brief summary for anyone interested.  Honestly, half of them I am not familiar with whatsoever.

 NAME (also known as) 

ACONITE
(aconiti tuber, aconitum, radix aconiti) Aconite is the most common cause of severe herbal poisoning in Hong Kong.

BITTER ORANGE
(aurantii fructus, Citrus aurantium, zhi shi) Possibly unsafe. Contains synephrine, which is similar to ephedrine, banned by the FDA in 2004. Risks might be higher when taken with herbs that contain caffeine.

 CHAPARRAL
(creosote bush, Larrea divaricata, larreastat) The FDA advises people not to take chaparral.

 COLLOIDAL SILVER
(ionic silver, native silver, Silver in suspending agent) The FDA advised consumers about the risk of discoloration on Oct. 6, 2009.

COLTSFOOT
(coughwort, farfarae folium leaf, foalswort)

COMFREY
(blackwort, common comfrey, slippery root) The FDA advised manufacturers to remove comfrey products from the market in July 2001.

 COUNTRY MALLOW
(heartleaf, Sida cordifolia, silky white mallow) Possible dangers linked with its ephedrine alkaloids banned by the FDA in 2004.

 GERMANIUM
(Ge, Ge-132, germanium-132) The FDA warned in 1993 that it was linked to serious adverse events.

GREATER CELANDINE
(celandine, chelidonii herba, Chelidonium majus)

KAVA
(awa, Piper methysticum, kava-kava) The FDA issued a warning to consumers in March 2002. Banned in Germany, Canada, and Switzerland.

LOBELIA
(asthma weed, Lobelia inflata, pukeweed, vomit wort) The FDA warned in 1993 that it was linked to serious adverse events.

YOHIMBE
(yohimbine, Corynanthe yohimbi, Corynanthe johimbi) Possibly unsafe for use without medical supervision because it contains a prescription drug, yohimbine. The FDA warned in 1993 that reports of serious adverse events were under investigation.

The article can be viewed here.

Vacations are fun, but traveling is a pain in the neck!

Actually, traveling can be an even bigger pain in the back.

First of all there is the physical stress and strain of lifting bags, dragging them through the parking lots and airport, carrying all those over-stuffed carry-ons.

But the number one complaint by plain, train and automobile travelers—when describing the onset of their back pain—is sitting for too long. Airplanes and even trains advertise that their seats were ergonomically designed by specialists to properly support to low back and neck during travel. But I know the one's I sit in feel horrible. And it's not only me... people complain about them all the time, and their continuous pain gives them fair reason.

Luckily, the pain associated with travel can be greatly reduced, and in many cases avoided, with these simple tips:

• ·  Only pack what is absolutely necessary for your carry on. To avoid the neck and shoulder strain of lugging these around, and of trying to place them into and remove them from the overhead compartment, the lighter the better.
• ·  The poor seating designs of most travel vehicles cause back pain due to incorrect support of the spine, and forward pitching of the shoulders. To avoid this, try using a small pillow and place it behind your low back or neck for support. Seated posture is so important for preventing strain to the spine, and pain to the neck, shoulders and low back that by whatever means... find and use a support.
• ·  Be sure to remain well hydrated during your travel time. One of the most basic, yet common, causes of muscle pain is dehydration. Not having enough fluid in the body to keep the body cool, the blood moving, the muscles supple and the tendons relaxed. Not only must you drink plenty of water, but you should also avoid (or at least limit) coffee, tea and soda during travel, as these all worsen dehydration.
• ·  If you are taking a long drive, train ride or flight, try to get up and move around every hour or so. Simply standing up for a few minutes and doing some light stretching, twisting or bending will help keep you limber, relaxed and the blood moving in and out of the muscles. And when the blood does not move or moves too slowly, the muscles and tendons become tight and painful!
• ·  And lastly, be sure that when lifting bags, holding children and reaching for items that you plant your feet flat for support and bend from the knees. Incorrect lifting or over-reaching for items is one of the most common causes of back pain... and one of the easiest to avoid.

 If you will be traveling across multiple time zones, you may want to look into taking a nutritional supplement called Melatonin.   Taking the recommended dosage before bedtime can help 'reset' your biological clock and reduce the effects of 'jet lag' 

Travel does not have to be as stressful or painful as many of us make it out to be. If we plan well, execute well and take care of our bodies while in transit... the trip will be painless. And what better way to relax on vacation or arrive on business after travel, than stress free, hydrated, supple and... pain free!  Happy travels.

Back to School time - Backpacks and Spinal Health

For a larger copy of the image click here

More detailed info on choosing, packing, lifting and carrying packs can be found here

Basics - should have 2 straps at least 2 inches wide and padded

- A waist strap can help distribute up to 50% of the weight

- the weight of the pack should never be more that 15% of the child's body weight

- avoid twisting while lifting and carrying the pack

-  Always wear the pack on both shoulders (never slight the bag over just one side)

What matress is the best for you?

Think about this: You spend 1/3 of your life in bed.  Doesn't it make sense investing in a decent mattress in order to maximize your quality of life? Many people spend a lot of money on a car they spend maybe an hour a day in and yet they skimp on their mattress.

I will be doing a thorough investigation into the latest technology and recommendations in mattresses in the coming weeks, so stay tuned for a detailed blog on my findings.

In the meanwhile, here are a few guidelines on what to look for in a mattress as it applies to spinal health...

You really can't go wrong with a firm mattress that has a pillow top cover.
Don't bother with the cheapest or most expensive mattresses. 
Don't bother with gimmick mattresses (memory foam, intelli-gel, sleep system, motorized)
Shop around for pricing and don't be afraid to 'haggle' - many stores have frequent sales.

Stay tuned.

UPDATE: Congratulations to My Old Friend Anthony Calvillo…

Congrats to the Montreal Alouettes football organization and their quarterback Anthony Calvillo on back to back Grey Cup victories.  Sorry Riders fans, better luck next year.

Dr. J

Nightime jaw clenching / teeth grinding....

I have been seeing more and more patients whom suffer from night time jaw clenching / teeth grinding (called Nocturnal Bruxism).  They are usually unaware that they are grinding their teeth at night, and are surprised when their dental specialist makes them aware of the damage they are doing to the enamel of their teeth.  While no one seems to know the exact cause of the problem or its increased prevalence, rising stress levels seem to be an obvious contributing factor.

Other than stress reduction, what can be done to treat / reduce the effects of clenching your teeth?
 If you have a good extended health plan that will pay for it, by all means talk to your dentist about getting a custom formed 'night guard'.  Prices vary, but they are expensive and I have a somewhat sour experience with one I paid $800 out of pocket for (my dental plan will pay to fix the damage of my grinding, but not for a device that will prevent the damage preemptively????).  Within a year I had worn through parts of it and paid a dental lab more money to repair it.  Contemplating whether or not to shell out for another one, I decided to try a very inexpensive alternative.  It's called the 'Doctors Nightguard' and you can pick one up at any major pharmacy for around $30.  You put it in boiling water and then bite into it to mold to your teeth in effect creating a 'semi custom' night guard for a fraction of the cost.  I've been using mine for over 6 months now with absolutely no problems.  Keep in mind it is a little more 'bulky' than a custom made night guard, but well worth trying before spending lots of money on something that is likely to break anyway.

In addition to protecting your teeth from damage, a night guard relaxes the muscles of the jaw and can reduce tension headaches in some people.

Balms, Creams, Gels, Lotions, Oils and Ointments....

A quick Google search for pictures of 'ointments for sore muscles' came up with some interestingly funny pictures.

In my office, I'm often asked about different 'pain relieving' gels and creams.  Mostly which do I think is best, or do they really work?
The answer is often not exactly what they want to hear ... They do work, sort of.  The ingredients in most products are the same or similar.  Slightly differing concentrations of Menthol, Camphor, and Eucalyptus - sometimes mixed with other compounds such as MSM, glucosamine, etc.

They do work, in that their effect on the skin distracts the brain from the pain and reduce the brains perception of the pain. So if you are looking for something to distract your brain from the pain while the problem heals over time, and with treatment then by all means use whichever product you like.  Just keep in mind the product itself is not ‘curative’ but rather ‘palliative’ in nature.

Recently, a company offered samples to me at no charge to try on my patients.  I’m always open to trying a product offered by a company at no charge because it means that they genuinely believe in their product.  Initial response has been very good and I am leaning towards using the product in my offices.  It’s called ‘Cryoderm’ and if you are interested in trying some, come on into the office and ask for a free sample, while they last.
I like the product because it has a very strong cold sensation that seems to last much longer than similar products, as well as being non greasy and having a milder (less offensive) odor.  
The same company also sent a 'warm' sensation cream called "Thermoderm" and I can't recommend it.  It was definitely 'hot', but felt more like a sunburn than a soothing heat (and it lasted a  long time - more than one day later it was still burning).

Cryoderm Info

Custom Foot Orthotics, Can They Help You?

What do custom foot orthotics do?
Depending on the design, orthotics can cushion and support your foot by redistributing the pressure areas on your feet. They can also be designed to support and improve the alignment of the bones in your feet and legs. Improper foot alignment can lead to a wide variety of foot, knee, and lower back problems.

By improving the alignment the body is able to function more efficiently with less stress on the muscles and ligaments that hold you together. Many different styles and types of orthotics can be designed in order to alleviate various types of pain in the feet, knees, hips and lower back. These can range from soft flexible types to very rigid types. It is important to have your foot and shoes properly evaluated prior to getting orthotics. Beware of companies that provide only one type of orthotic-it may not be right for you.

I Have Flat Feet, Does This Have Anything To Do With Why I Have Lower Back Pain?
Flat feet cause the leg bones to rotate inwards when you are standing and walking. This will affect your hip and pelvic positions, thereby altering the amount of back curvature and leading to pain. Previous injury, activities, and upper body mechanics will also play a role in lower back pain.

Do My High Arch Feet Have Anything To Do With My Knee Pain When I Run?
A high arched foot lacks adequate shock absorption. When there is not enough cushioning at the foot, shock is transmitted upwards, placing added load on the knee and hip joints.

Can I Wear Orthotics With Any Shoes?
Orthotics can be designed for virtually any shoe type but are usually designed with a particular shoe type in mind, depending on your needs, and as such should work well with shoes of similar style. If an orthotic is designed for running shoes, it will not fit properly into a heeled shoe. Sandals also restrict orthotic use, as the orthotic is not secure without a closed shoe.

The bottom line is that if you have any foot pain, or even unresolving knee, hip or low back pain, custom foot orthotics may be the answer to your problem.

If you have extended health insurance, it is likely that the majority of the cost may be covered by your plan.  Check with your employers HR department to find out the exact coverage your insurance provides and in some instances a prescription is required from your family physician.

A biomechanical foot analysis will reveal whether or not you are a candidate for corrective orthotics.  Give my office a call today and setup an appointment to have your feet checked.

 

 

New Study Refutes Glucosamine for Arthritic LBP......

Study

Well here are my thoughts on this:
1) The study was funded by the medical (aka medicinal) community
2) The patient study was very small (250 people) - this is the first thing they (MD's) use to refute studies published by 'Natural' Health-care practitioners.
3) Their outcomes were based on very subjective measures and conclusions may have been reached using 'leading' questionaires.
4) The study is B.S.

While time and further investigation, may show Glucosamine suplementation does not help individuals with advanced lumbar spine arthritis, and resultant low back pain, they may not have ended up with the arthritis in the first place had they started supplementation years prior to the diagnosis.

My previous blog about joint supplementation still stands, and I recommend all of my patients continue supplementing glucosamine along with a healthy diet to slow / prevent early onset arthritis.

RX For Low Back Pain: Stretch Your Hip Flexors

With all the sitting we do as a society, virtually anyone who doesn’t already perform a habitual flexibility program (like Yoga or Pilates) has tightness in the muscle group known as the hip flexors.   For those interested their names are the Psoas, Iliacus, Iliopsoas, Sartorius and Rectus Femoris. 

Luckily their names need not be memorized and they can be stretched collectively as a group.  When this muscle group gets tight, it pulls the lower back (lumbar spine) forward and causes a shift in body weight distribution to the back of the spine.  Over time this causes excess wear and tear to the small joints, called facet joints, at the back of the vertebra.  The result is lower back pain and, if left long enough wear and tear arthritis (degenerative joint disease or osteoarthritis).

The good news is that stretching out the hip flexors can alleviate a lot of lower back pain and reduce your chance of being diagnosed with early onset arthritis of the spine. 

Try to do this stretch regularly and reduce your chance of having lower back pain due to tight hip flexors:

If you are ambitious enough you can add these two stretches to balance out your 'core' flexibility.

and

 If you feel and 'bad pain' or increase in symptoms from these stretches, consult with your Chiropractor immediately to ensure they are appropriate for your condition and that you are doing them properly.

Another good one, stretches the 'Hip Rotators'