North Beach Chiropractic

Rethinking the Mission

Lured out of doors by one of the first sunny days of Spring, my wife, daughter and I were happily chatting and basking on the front lawn when the car pulled into the driveway. As an older couple stepped out of the car—she, wearing a mid-length skirt; he, in a dress-shirt and tie, carrying what we recognized as a Bible—we experienced immediate unease. Before a word was spoken, we knew the couple’s single-minded purpose: to “convert” us.

In response to the man’s request to share God’s message with us, my wife informed him that we already have a faith and a familiarity with the book he was holding. Rather than receiving this news with pleasure at the knowledge that we probably have a common ground and share similar values, the man became a bit provocative, challenging my wife’s understanding of the good book. With increasing urgency, he launched into his script…to convert us.

At this point, I let the couple know that we were happy and secure in our faith and did not wish to engage in a debate. We would not try to prove them wrong, and we were not interested in being converted. Clearly agitated, the couple retreated to their car and left us feeling less than encouraged by the encounter. For our part, we were content to share some common values and beliefs without embracing their entire belief system. For them, it was all or nothing.

Later, I reflected on the experience. What I found most curious was the immediate sense of dread that each of us felt as the car pulled up and the couple emerged. We knew instantly who they were, and why they had come. Their actions did nothing to advance their objective. Instead, the couple reinforced the negative stereotype we had mentally projected upon them.

After further reflection, my thoughts turned toward my profession. When I entered practice 25 years ago, it was common for chiropractors to provide some form of “patient education” at a first or second visit to indoctrinate the new-patient to the chiropractic perspective. Many offices would make attendance to a new-patient orientation mandatory. Some would insist that the spouse or other family member also be in attendance. Perhaps there was some value in teaching patients about the objectives and practicalities of treatments that may have seemed unfamiliar or intimidating, but a clear goal for the practitioner was to convert a patient, who sought only pain relief, into a lifetime chiropractic patient. If you could win over the whole family, all the better.

So many things have changed over the course of my professional career. For me, it has become clear that “converting” patients to the chiropractic perspective is no longer a worthy pursuit, if it ever was. If you have the courage, ask people you trust what it is they dislike about chiropractors. Try asking about unpleasant past chiropractic experiences. You will likely hear some version of a story that begins with: “They always try to get you to…” or “There was this one guy who wanted me to…” In other words, you will hear a story about an attempted conversion. Collectively, these stories have done more to damage the reputation of the profession than almost anything I can think of. These days, there are far too many sources of reliable and accessible information to assume that any single discussion or presentation will convert anyone to your/our way of thinking about something as vast and complex as health and wellness. That is not to say, ours is a flawed perspective; my point is that we have much to offer our patients and our prospective patients without insisting upon or even directly pursuing their “conversion.”

Patients entering my office have specific needs and specific goals. We may have widely divergent views on health and wellness, but the fact that they have sought my services is evidence that we have some common ground and perhaps share some common values. That’s a great place to start. When I abandon my need to convert patients and focus instead on their needs and goals, it is much more probable that I gain their trust and confidence along the way. I love it when my patients experience resolution of pain or a return of lost function. I love it even more, when they gain greater confidence in their physical potential, commit to quitting smoking, start a new exercise program or make some other positive lifestyle change. These shifts in fundamental values occur every day in the offices of thousands of chiropractors who are not afraid to meet their patients where they are. My hope for the future of my profession is that more of us would abandon the “all-or-nothing” conversion mentality, work within the value systems of our patients, lead our patients by example, and ultimately earn the privilege to share wisdom and, perhaps, show them a better way.

Movement Literacy

Through rather unusual circumstances I, at age 52, have acquired a unicycle. Having acquired it, I am now determined to master it or (more likely) die trying. I am finding, as I often do, learning this new skill is much more difficult than I anticipated. Still, there are brief moments when I “feel it” and it’s a bit of a rush. It’s somewhat akin to that experience when, after staring cross-eyed for 10 minutes in front of one of those annoying 3-dimentional pictures, a fleeting image emerges and you momentarily grasp the depth and contours hidden in the picture. You finally “see it.” The physical experience of “feeling it” on the unicycle  calls to mind a trending term that appeals to me: “movement literacy.”

Each of us possesses a certain level of skill when it comes to reading literacy. Intellect, education, environment and personality all contribute to our level of reading literacy. Some of us are fast readers; some are slow. The ability to retain the material also varies considerably. Some of us enjoy fiction. Others gravitate toward history or poetry. Some use reading primarily as a learning tool while others devote most of their reading efforts to entertainment. Parallels certainly exist for movement literacy. Think of the naturally gifted athlete or dancer who performs impressive physical feats with apparent ease and fluidity. Compare this to a person with poor body-awareness who struggles clumsily to acquire even fundamental physical skills. While both types may be able to walk and chew gum at the same time, their levels of movement literacy are quite different. As someone whose work involves regular encounters with people struggling with some form of movement dysfunction, the thing that excites and challenges me is that–no matter the starting point–we all have the ability and opportunity to improve our movement literacy.

Reading-speed and reading-retention can be developed through practice and training. Interest and enthusiasm for reading can be greatly enhanced by seeking out reading material that has a fundamental appeal to the reader. Similar opportunities exist for developing movement literacy. As I am settling into middle age, I have come to terms with the fact that I will never be as fast, strong or flexible as I once was. Thank goodness speed, strength and flexibility are not the only “books” in the movement library. By taking a creative and imaginative approach to physical activity, I have learned that it is possible to not only maintain a high level of physical fitness with age, but to expand movement literacy by obtaining new skills or recovering lost skills through persistent and innovative training.

If you feel like your level of physical competence is shrinking, I would encourage you to take bold steps to expand your level of movement literacy. Get out of your comfort zone. Learn a new game. Take an exercise class. Buy a DVD on introductory yoga or Tai Chi. Get a trainer. Get a unicycle! You won’t improve your reading skills if you have only one book on your bookshelf. Neither will you improve your movement literacy without bringing new tools into play.

Happy reading!

TREATMENT FOR BULGING DISCS

Bulging discs are frequently seen on spinal magnetic resonance images, or MRIs. Whether due to trauma or age-related wear and tear, these specialized cushions situated between the bones of the spine often start to pooch out into the area occupied by sensitive spinal nerves. The severity of the bulge and the degree to which the disc encroaches upon the spinal nerves largely determine the severity of the related symptoms and the most appropriate course of treatment.

In a study published in 1994 in the “New England Journal of Medicine,” researchers identified disc bulges on 52 percent of MRIs of the lower backs of asymptomatic adults. Outside of research, it is unusual for an asymptomatic person to have an expensive MRI performed, but the high prevalence of disc bulges in the asymptomatic people in this study suggests that the condition may not always require treatment. At the very least, an otherwise healthy person who has been given a diagnosis of a mild disc bulge need not pursue aggressive treatment for the condition.

Besides discs, there are many other potential sources of pain in the back. The authors of the “New England Journal of Medicine” study warned that the presence of a disc bulge may be an incidental finding on an MRI and may not even be the cause of pain. A disc bulge discovered in a person with pain that remains localized to the back requires no additional treatment measures than those utilized to treat most other types of back pain. The most promising treatments, according to the Agency for Health Care Policy and Research, include nonsteroidal antiinflammatory medications, such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Naprosyn, Aleve), spinal manipulation, rest and traction.

Authors of a study published in 2010 in the “Indian Journal of Orthopaedics” determined that the presence and degree of disc bulging is less significant than the location of the bulge in terms of symptoms. Bulges that crowd the space where the spinal nerves must pass to exit the spinal column are much more likely to irritate or compress the nerves and cause pain. The resulting pain often radiates along the course of the sciatic nerve into the buttock, thigh or leg. Cases with radiating pain can often be successfully treated in the same way as those with just localized pain. In unresponsive cases, epidural steroid injections may be considered.

Severe disc bulges sometimes cause enough nerve compression that the result is not only localized or referred pain, but loss of function to the nerve and the parts served by the nerve. This is usually experienced as numbness or weakness in a leg, but can sometimes it may even affect bowel or bladder function. These cases often necessitate surgical treatment to relieve pressure on the nerve in order to avoid permanent deficits. Expert guidelines published in 2001 in the Journal of General Internal Medicine recommend reserving surgical treatment for cases with these types of deficits. In the absence of nerve deficits, surgery should only be considered after at least 4 to 6 weeks of failed conservative treatment.

Thoughts On Thinking

As a recreational runner, I have experienced the the tedium and discomfort of building up an endurance base. Runners, like everyone else, do not enjoy pain. So, we take measures to distract ourselves from the pain. This is one reason so many runners put on headphones and crank up their i-pods before hitting the road. People afflicted with chronic pain often try various means to distract themselves from their pain as well. These may include seemingly harmless strategies such as work, hobbies or video games. More destructive strategies might include smoking, over-eating, drug abuse or alcohol dependency. Each of these methods is an attempt to take the mind off the pain. While trying to ignore pain through distraction may be a good strategy for dealing with the temporary discomforts of exercise, it may not be the best strategy for dealing with chronic pain.

Lately, I have been doing a lot of reading about the clinical applications of “mindfulness”. Mindfulness is the antithesis of distraction. The practice of mindfulness involves focusing your attention on the here and now–experiencing the present moment completely, as it unfolds. For a person in pain, that means actually focusing on, rather than ignoring, the pain experience. When in a quiet, restful mode, allowing oneself to passively “observe” the pain can actually provide insight into gaining some measure of control and perspective over the condition. While exploring the location, quality, intensity and other aspects of the pain, the observing mind may achieve a certain independence from the pain itself. To discover that you are not your pain can be empowering even if this may only be a fleeting experience at first. Further, relaxed breathing and intentional focus can help the person in pain discover what sorts of positions, movements, activities or invading thoughts may influence the pain experience in a positive or negative direction.

In contrast to research on long-term use of pain medication, research on mindfulness approaches to chronic pain is very encouraging. Mindfulness strategies tend to result, not only in a lessening of pain over time, but also improvements in abilities to perform activities of daily living and engage in recreational activities. This is a much more desirable outcome to the alternative of achieving a temporary distraction from the intrusiveness of pain through more traditional avoidance methods. The word “rehabilitation” comes from a French verb “habiter”, which means “to dwell” or “to inhabit”. So, to rehabilitate is to re-inhabit the body. This is a profound concept that stands in sharp contrast to a view of chronic pain as part of a broken down body that should be ignored, numbed, or cut out of the body. Our bodies and our minds are incredibly complex and are designed to be fully engaged and working in harmony. For those afflicted with chronic pain, a mindfulness approach offers hope for a brighter future. 

For further information on mindfulness, I can recommend the book: Full Catastrophe Living by Jon Kabat-Zin.

"GETTING RID OF TOXINS"

After nearly 120 years since the founding of the profession, chiropractic finds itself in the unique position of straddling the line between conventional health-care and alternative health-care. Recognizing that much of conventional health-care doesn’t pass scientific muster, I’m comfortable with the conservative, non-invasive emphasis of alternative approaches for many conditions. But, as an analytical person, I’m much more comfortable shifting more weight onto the foot that rests on the conventional side of the line. The skeptic in me is very uncomfortable when it comes to things like “energy work,” “auras” and terminology such as “synergy” that finds its way frequently into promotions of various alternative methods. It’s not that I dismiss these practices or terms out of hand; it’s just that I’m not comfortable embracing them as a part of my practice.

One concept that is frequently touted in claims for alternative practices is “getting rid of toxins.” You’ll see claims of “rids the body of toxins” about everything from colonics to supplements to yoga twists. There is usually no reference to the specific makeup of these so-called toxins; they are just “toxins.”

To be sure, our bodies are exposed to chemicals that can reasonably be categorized as toxins. These enter our bodies in the air we breathe and in the food, beverages and medications we ingest. They are also present as byproducts of our own metabolic processes. Some of these chemicals are neutralized by our livers. Other impurities are filtered out through the kidneys to leave the body in the urine. Some are removed in perspiration and others are retained in the bowel to be naturally eliminated.

While the abilities of various nutritional supplements and alternative practices help the body “get rid of toxins” are certainly debatable, the body can and does rid itself of toxins every day.

The degree to which the liver and the kidneys are capable of purifying the blood is largely dependent upon healthy circulation. The more efficiently and frequently the blood passes through these organs, the faster and more thorough is the purification process. Essentially, anything that facilitates perspiration, accelerates the rate of circulation and improves bowel function will help your body get rid of toxins.

Sounds a lot like exercise doesn’t it?

Diabetes and Diet Soda

http://www.livestrong.com/article/426528-diabetes-diet-sodas/

The “evils” of sugary sodas are fairly universally accepted. But what about diet soda? Controversy exists over the potential benefits or harms of choosing artificially sweetened beverages. There is even some question about whether diet soda may be associated with increased risk for diabetes. The linked article discusses the current state of research on this controversy.

Sweat

                       

Lately, I’ve been reading a lot about “sedentarism” and inactivity. The numbers of sedentary and inactive people in our society have increased dramatically in fewer than two generations. This trend predictably coincides with an increase in “lifestyle” illnesses, such as obesity, type 2 diabetes and hypertension. According to the CDC, one in three adults in the U.S. has high blood pressure. These Americans are at increased risk for heart disease, kidney disease and strokes. As we age, a number of changes occur in the body that can contribute to the onset of hypertension. Some changes are inevitable, while others are absolutely within our control. It’s interesting to me to that the curve of declining activity with age coincides with the curve of blood pressure elevation observed with age.

When hypertension is diagnosed, one of the primary remedies is a prescription for a diuretic medication. A diuretic alters your physiology in such a way that you eliminate body fluids in an accelerated manner–you pee more. Less fluid in the system equals less pressure in the plumbing; hypertension cured.

While researching an article on proper hydration for endurance sports, I learned that it is not uncommon for people to lose more than 1 litre of sweat per hour. A liter of fluid is quite a lot. That 60 minutes of sweat is probably roughly equivalent to the average 24-hour increase in urine production that is so annoying to the person who has just been prescribed a diuretic and is trying to get a full night’s sleep or take a long drive. Also interesting is that the 60 minutes required to produce that sweat coincides with the amount of daily activity that the CDC recommends for children and adolescents. More and more experts feel that there is no justification for modifying these recommendations downward for adults.

Preventing hypertension for many may boil down to a simple choice: sweat or urine. I have to believe that when you factor in the potential negative side-effects of the chemical trickery of a diuretic, along with the numerous known beneficial side-effects of exercise, the scale tips clearly in favor of exercise. But, you knew that’s where this blog was going didn’t you? Happy sweating!