Can Chiropractic Help the Post-Surgical Patient?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically! GIVE US A CALL!!!

CTS “Facts” (cont.)

Last month, we covered what Carpal Tunnel Syndrome (CTS) is, its symptoms, causes, who is at risk, and how it’s diagnosed. This month, we’ll center our focus on CTS treatment.

How is CTS treated? For the best success, treatment should begin as early as possible. Unfortunately, most people wait a long time before they get to the point where the symptoms interfere with daily activity enough to prompt them to act quickly and make an appointment. Once the cause or causes of CTS are determined, treatment can address ALL the presenting contributing conditions. The FIRST course of care should be NON-SURGICAL, though this is not always practiced – so be aware! Non-surgical care includes the following:

1. Chiropractic:
• Manipulation: This usually includes adjusting the small bones of the hand, the wrist, the forearm, elbow, shoulder, and/or the neck.
• Soft-tissue therapy: This includes loosening up the overly tight forearm muscles where the median nerve runs through (on the palm side of the forearm).
• Modalities: Such as electrical stimulation and/or laser/light therapy can be very beneficial in reducing swelling or inflammation. In chronic CTS, ultrasound may be helpful as well.
• Nutritional: Nutrients such as vitamin B6 have been shown in studies to be effective in some cases. Also, anti-inflammatory herbs (ginger, turmeric, bioflavinoids) and / or digestive enzymes (bromelain, papain, and others) taken between meals are quite effective.

2. Anti-inflammatory: The first important distinction is that ice can be very effective depending on how long the CTS has been present. In particular, ice cupping or rubbing ice directly on the skin over the carpal tunnel is the most effective way to use ice as an anti-inflammatory agent. When doing so, you will experience four stages of cooling: Cold, Burning, Achy, Numb or, “C-BAN.” It’s important to remember this as you are REALLY going to want to quit in the burning/achy stages when it feels uncomfortable. Once the skin over the wrist / carpal tunnel gets numb (which takes about four to five minutes) QUIT as the next “stage” of cooling is FROST BITE! Most medical practitioners promote the use of NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, aspirin, or Aleve. However, these carry negative side effects including gastritis (burning in the stomach that can lead to ulcers), or liver and/or kidney damage. Try the nutritional anti-inflammatory approach FIRST as they are extremely helpful without the bad side effect potential!

3. Diet: An ant-inflammatory diet, like the Paleo-diet or gluten free diet, serves as a great tool in reducing the inflammatory markers in the body. Though only 7-10% of the population has celiac disease (gluten intolerance), it’s been estimated that over 80% of us are gluten “sensitive.” Reducing systemic inflammation can make a BIG DIFFERENCE in the management of many conditions including CTS!

4. Mechanical: Wrist “cock-up” splints can also be REALLY HELPFUL, especially for nighttime use. The reason for this is because when our wrist is bent forwards or backwards, which frequently occurs when sleeping, the pressure inside the carpal tunnel increases, and over time (minutes to hours), the increased pressure in the tunnel exerts compression on the median nerve which then creates numbness into the thumb, index, third and half of the fourth finger, which can wake you up out of a sound sleep. Keeping the wrist straight at night prevents you from curling your wrist under your jaw while sleeping.

5. Ergonomic Modifications: Changing your work station (computer station, line position, machine controls, pace or rate of repetitive movements, and more) is VERY effective.

NOTE: ALL of the above can be managed through the services offered at our clinic!!!

Fibromyalgia Wholistic Care

Fibromyalgia (FM) is a very challenging condition to both diagnose and treat since there are different clinical signs and symptoms that make each patient with FM unique. Therefore, we usually make the diagnosis by excluding other possibilities. To make matters even more challenging, there are “primary” and “secondary” types of FM, or those who develop FM for no know reason (primary) vs. those whose FM arises from a known condition (secondary). Because of these challenges, there is no single treatment program to apply to all struggling FM patients. Rather, studies often suggest that a multidisciplinary “team” of health care providers be utilized in the management of patients with FM. It is recommended that EACH FM patient have their needs be uniquely treated. This month, we will look a “multimodal” approach to treating FM that incorporates a “team” approach.

For those less familiar with FM, many patients with this condition have symptoms that include fatigue, “all over” body pain, sleep problems, mood symptoms, and chronic pain. They may also have conditions including irritable bowel syndrome, palpitations, thyroid dysfunction, adrenal dysfunction, gastroenterological symptoms, chronic headaches, and MANY others. Dealing with these and other FM symptoms can have a tremendous negative impact on one’s quality of life and activities of daily living.

So as previously stated, the treatment of FM requires a comprehensive approach where the patient’s individual symptoms are targeted, as there is no “cookie cutter / one size fits all” management approach. Effective management approaches include chiropractic, allopathic, acupuncture, soft tissue therapy, sleep hygiene counseling, nutritional counseling, mind-body therapy, and dietary counciling including nutritional supplementation that target specific deficiencies determined by lab/blood tests and/or are based on the clinical history.

Treatment is centered on the human body’s deficiencies with the most important being the removal of any and all “trigger(s)” that causes inflammation in the body. Use of an anti-inflammatory herb such as ginger, turmeric, boswellia, (and others) can help until the causes are identified. A gluten-free diet is often very successful in reducing the autoimmune reaction that occurs with gluten sensitivity, which is estimated to be as high as 80% of the general population. This is NOT to be confused with gluten intolerance or celiac disease (they affect 7-10% of the general population). Once inflammation is controlled, weaning away of the anti-inflammatory supplements can be done successfully.

The hormonal levels of the body must also be in balance, especially the thyroid, adrenal, and sex hormone levels. Lab tests should include a complete thyroid panel (TSH, T3, T4, T7/free thyroxin), a salivary cortisol test (for adrenal function), and sex hormone levels (DHEA, pregnenolone, progesterone, estradiol, and, free and total testosterone). Assess and eliminate food sensitivities/allergies (gluten and dairy are most common). Nutritional supplementation should include vitamins (a multiple, omega 3 fatty acids, Vitamin D3, and Co-enzyme Q-10; minerals (calcium, potassium, magnesium), amino acids and sometimes others (case dependant)). These keep our organs functioning well, like a finely tuned machine! Care must also be taken not to over-dose as well, so let us guide you in this process – consider chiropractic your “coach” in this team-based approach!

What Kind of Headache Do I Have?

Headaches come in MANY different sizes, shapes, and colors. In fact, if you search “headache classification,” you will find the IHS (International Headache Society) 152 page manual (PDF) lists MANY different types of headaches! Last month, we discussed migraine headaches. This month, we’ll talk about the other headache types. So WHY is this important? Very simply, if we know the type of headache you have, we will be able to provide you with the proper treatment. Headaches are classified into two main groups: “primary” and “secondary” headaches. The “Primary” headache list includes: 1) Migraine; 2) Tension-type; 3) Cluster; 4) “Other primary headaches,” of which eight are listed. One might think that with this simple breakdown of the different types of headaches it should be easy to diagnose a type of headache. Unfortunately, that’s NOT true! In fact, a 2004 study published that 80% of people with a recent history of either self or doctor diagnosed sinus headache had NO signs of sinus infection and actually met the criteria for migraine headaches! So, the more we can learn about the different types of headaches, the more likely that we will arrive at an accurate diagnosis.

Tension-Type Headaches: This is the most common type affecting between 30-78% of the general population. It is usually described as a constant ache or pressure either around the head, in the temples, or the back of the head and/or neck. There is typically NO nausea/vomiting, and tension-type headaches rarely stop you from performing normal activities. These headaches usually respond well to chiropractic adjustments and to over-the-counter medications like Advil, aspirin, Aleve, and/or Tylenol, though we’d prefer you first reach for an anti-inflammatory herb like ginger, turmeric, bioflavonoid, and the like as these have less stomach, liver, and/or kidney related side-effects. These headaches are typically caused by contraction of the neck and scalp muscles, which can be result of stress, trauma, lack of sleep, eyestrain, and more.
Cluster Headaches: These are less common, typically affect men more than women, and occur in groups or cycles. These are VERY DISABLING and usually arise suddenly and create severe, debilitating pain usually on only one side of the head. Other characteristics include: a watery eye, sinus congestion, or runny nose on the same side of the face as the headache. An “attack” often includes restlessness and difficulty finding a pain-reducing, comfortable position. There is no known cause of cluster headaches, though a genetic or hereditary link has been proposed. The good news is that chiropractic adjustments can reduce the intensity, frequency, and duration of cluster headaches!

Sinus Headaches: Sinusitis (inflamed sinuses) can be due to allergies or an infection that results in a headache. This may or may not include a fever, but the main distinguishing feature here is pain over the infected sinus. There are four sets of sinuses. Many people know about the frontal (above the eyes on the forehead) and maxillary (under the eyes in our cheeks) but the two sinuses deep in head (ethmoid and sphenoid sinuses) are much less known or talked about. These two deep sinuses refer pain to the back of the head, and when infected, it feels like the back of the head could explode. Lying flat is too painful so sitting up is necessary. Chiropractic adjustments applied to the sinuses, upper neck, and lymphatic drainage techniques work GREAT in these cases!

We will continue next month with the remaining types of headaches!

Whiplash – Can We Predict Long-Term Problems?

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

Chiropractic and Pregnancy

Chiropractic techniques are applied to MANY patient types, from infants and children to 80, 90, and even 100 year-olds! Obviously, gender is not a factor as both men and women seek chiropractic care and receive similar positive benefits. But, what about chiropractic care for the pregnant female patient? Are there reasons chiropractic should be avoided? What are some special concerns or reasons for considering chiropractic treatment? Let’s take a look!

The American Pregnancy Association defines chiropractic as follows: “Chiropractic care is health maintenance of the spinal column, disks, related nerves and bone geometry without drugs or surgery. It involves the art and science of adjusting misaligned joints of the body, especially of the spine, which reduces spinal nerve stress and therefore promotes health throughout the body.” Regarding safety, they state, “There are no known contraindications to chiropractic care throughout pregnancy. All chiropractors are trained to work with women who are pregnant. Investing in the fertility and pregnancy wellness of women who are pregnant or trying to conceive is a routine care for most chiropractors.”

You may ask, “Why should I consider chiropractic care when I’m pregnant?” During pregnancy, there are biological changes that occur in preparation for bringing a newborn into the world. During this nine-month process, the stresses and stain on the spinal column (as well as the feet, ankles, knees, and hips) occur at such a fast pace that the body cannot always physically adapt and compensate quickly enough and problems in muscles and joints can occur. When this happens, the body compensates movements instinctively, and walking differently and/or moving in a compromised, altered manner, can lead to other issues that may be more challenging to address, especially during pregnancy. Spinal joint dysfunction can include misalignment, movement dysfunction (either too much or too little), and more. Due to the growing fetus, the protruding abdomen increases the curve in the low back, which changes the mid-back and neck curve as well. Changes in the pelvis, especially during the third trimester (last 3 months) of pregnancy in preparation for delivery can affect pelvic alignment and sacroiliac joint function. These postural adaptations often require management that no other profession addresses as directly as chiropractic! Sometimes, pelvic misalignment may reduce the room or amount of space available for the developing baby (called “intrauterine constraint”). This may make it more challenging for the baby to achieve the best position for delivery and possibly affect the birthing process for both the baby and mother. There may also be benefits from simply keeping the spine well aligned and functioning by reducing stress or strain on the nervous system since the spinal cord and associated nerve roots are housed by the spine, and autonomic functions are affected as well. Other potential benefits of receiving chiropractic care during pregnancy include (but are not limited to) maintaining a healthier pregnancy, controlling symptoms of nausea, reducing the time of labor and delivery, relieving back, neck or joint pain, and possibly preventing a potential C-section.

The types of treatments you can expect when you visit us include many of the usual chiropractic treatment approaches that you are used to receiving. These include (but are limited to) spinal adjustments, soft tissue technique, massage therapy, exercise considerations, nutritional counciling and more. Special considerations include a method called the Webster Technique, that according to a July/August 2002 JMPT published study, reported an 82% success rate in moving a breach presenting baby to vertex (normal).

Low Back Pain – Is it on the Rise?

As stated last month, the prevalence of low back pain (LBP) is REALLY high! In fact, it’s the second most common cause of disability among adults in the United States (US) and a very common reason for lost days at work. The total cost of back pain in the US, including treatment and lost productivity, ranges between $100 billion to $200 billion a year! Is low back pain on the rise, staying the same, or lessening? Let’s take a look!

In the past two decades, the use of health care services for chronic LBP (that means LBP > 3 months) has substantially increased. When reviewing studies reporting insurance claims information, researchers note a significant increase in the use of spinal injections, surgery, and narcotic prescriptions. There has been an increase in the use of spinal manipulation by chiropractors as well, along with increased physical therapy services and primary care physician driven non-narcotic prescriptions. In general, LBP sufferers who are chronic (vs. acute) are the group using most of these services and incurring the majority of costs. The reported utilization of the above mentioned services was only 3.9% in 1992 compared to 10.2% in 2006, just 11 years later. The question now becomes, why is this? Possible reasons for this increase health care use in chronic LBP sufferers may be: 1) There are simply more people suffering from chronic LBP; 2) More chronic LBP patients are deciding to seek care or treatment where previously they “just accepted and lived with it” and didn’t pursue treatment; or, 3) A combination of these factors. Regardless of which of the above three is most accurate, the most important issue is, what can we do to help chronic back pain sufferers?

As we’ve discussed in the past, an anti-inflammatory diet, exercise within YOUR personal tolerance level, not smoking, getting enough sleep, and obtaining chiropractic adjustments every two weeks are well documented methods of “controlling” chronic LBP (as there really ISN’T a “cure” in many cases). You may be surprised to hear that maintenance care has good literature support for controlling chronic LBP. In the 8/15/11 issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned the article, “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcomes?” Here, they took 60 patients with chronic LBP (cLBP) and randomly assigned them into one of three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have over a one month period; 2) 12 treatments, over a one month period but no treatment for the following nine months; or 3) 12 treatments for one month AND then SMT every two weeks for the following nine months. To measure the differences between the three groups, they measured pain, disability, generic health status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and 10-month time intervals. They found only the patients in the second and third groups experienced significantly lower pain and disability scores vs. the first group after the first month of treatments (at three times a week). BUT, only the third group showed more improvement at the 10-month evaluation. Also, by the tenth month, the pain and disability scores returned back to nearly the initial baseline/initial level in group two. The authors concluded that, “To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.” Other studies have reported fewer medical tests, lower costs, fewer doctor visits, less work absenteeism, and a higher quality of life when maintenance chiropractic visits are utilized. The question is, WHEN will insurance companies and general practitioners start RECOMMENDING chiropractic maintenance care for chronic LBP patients?

CTS “Facts”

WHAT is Carpal Tunnel Syndrome (CTS)? CTS occurs when pressure is applied to the median nerve which travels from the neck, through the shoulder, upper arm, elbow, forearm, and through the carpal tunnel where the “pinch” is located. The median nerve innervates most of the palm of the hand, the thumb, the index finger, middle finger, and the thumb side of the ring finger. The carpal tunnel is made up of eight little bones in the wrist that form the arch and a ligament that forms the floor. There are nine muscle tendons, the median nerve, as well as blood vessels that travel through the tunnel.

WHAT are the symptoms of CTS? The “classic” symptoms include burning, itching, tingling, and/or numbness of the second to fourth fingers with the need to shake or “flick” the fingers to “wake up the hand.” When present long enough, or when the pressure is hard enough on the nerve, weakness in the grip occurs and accidental dropping of tools, coffee cups, and so on can occur. Pressure on the nerve increases when the wrist is bent backwards or forwards, especially for long time frames and/or when the wrist is moving in a fast, repetitive manner with jobs like carpentry using vibrating tools, a screw driver, hand drill, a hammer, line production work, waitressing, and so on. Often, symptoms are first noticed at night, as we tend to sleep with our wrists bent and tucked under our chin or neck. Symptoms can also occur during the day, especially when driving or when performing repetitive work. Difficulties buttoning a shirt, making a fist, grasping small objects and/or performing manual tasks are common complaints of CTS.

WHAT are some causes of CTS? CTS is most commonly caused by a combination of factors that result in swelling of the tendons that travel through the carpal tunnel. This includes over working the arm and hand in any of the jobs described above, but it is more likely to happen when conditions that create generalized swelling occur. Some of these conditions include trauma (like a sprained wrist), hypothyroidism, an over-active pituitary gland, during menstruation or pregnancy, menopause, rheumatoid arthritis, diabetes, mechanical wrist problems, repetitious work (work stress), or the repeated use of vibratory hand tools. It is also possible to develop a cyst (like a ganglion) or a fatty tumor within the tunnel. CTS is also more common with obesity, but sometimes, no logical cause can be identified!

WHO is at risk of developing CTS? Women are three to four times more likely to develop CTS. This may be because of the hormonal aspects described above and/or the relative smaller wrist, which results in a smaller carpal tunnel. There’s also an increased risk of CTS in people over the age of 50. Other at risk individuals include diabetics, people with hormonal imbalances (taking birth control pills, pregnancy, hypothyroid, etc.), and people who work on assembly lines.

How is CTS diagnosed? EARLY diagnosis and treatment is KEY to a successful outcome! The physical exam includes assessing the structures of the neck and entire upper extremity, as the pinch is often in more than one place. A blood test for thyroid disease, diabetes, and rheumatoid arthritis is also practical. Other tests that may help us diagnose CTS can include and EMG (nerve test) and/or x-ray/MRI. Next month, we’ll discuss treatment and prevention!

Fibromyalgia and Nutrition

Fibromyalgia (FM) is truly a challenging condition to manage, as anyone with this condition will attest to! In the past, we’ve discussed many management strategies, including dietary suggestions. Although much of the nutritional information available about FM management is not supported by a lot of “scientific study,” the National Institute of Health through the NCCAM (National Center for Complementary and Alternative Medicine — formed by Congress to evaluate and appraise alternative treatments) provides information on dietary recommendations and supplements. They also provide dietary guidelines and define the benefits and effectiveness for FM patients and us doctors to follow. This month, we will dive deeper into nutritional considerations as this can REALLY make a huge difference for the FM patient!

Since fatigue, sleep quality, and muscle pain are three VERY common FM complaints, the FM patient can track their response to different dietary approaches as they add, modify, or delete various foods and/or supplements from their diet. We recommend “grading” these three symptoms daily on a 0-10 scale (0=good and 10=bad) as this can REALLY help the FM sufferer keep track of various changes that are made in the diet and is extremely useful for future reference.

FOODS: Since many FM sufferers have “sensitivities” to certain foods (reported to be as high as 42% of all FM patients), eliminating these foods makes GREAT sense.

First, it is REALLY IMPORTANT that you KEEP A FOOD JOURNAL for future reference (using the 0-10 scale) as it is impossible to remember all the reactions or responses to various foods even a day or two later, but especially a week or month later! Some common food offenders include MSG (commonly found in Chinese food – simply ask for the MSG to be NOT included when you place your order), certain preservatives, eggs, gluten (grains like wheat, oats, barley and rye), dairy, as well as other common allergens (such as chocolate, nuts, shellfish, and others). Common symptoms may include headaches, indigestion (irritable bowel syndrome), fatigue, and sleep interruptions. When using an “elimination diet,” it is important to make sure you’re getting the essential nutrients in your diet, in which supplementation can help.

Secondly, make it easier to eat in a healthful way! Have fruits and vegetables cut up and ready to eat so when you’re hungry, you can QUICKLY satisfy that urge. Lean meats or proteins are also VERY important! Remember, a well balanced diet gives you the “ammo” needed to fight fatigue, hurt less, help you sleep more deeply, and give you energy. By doing so, you will be able to stay more active and productive. Accept the fact that unless you pre-prepare the foods, you will instinctively reach for pre-packaged, no prep time, “fast food” options that most likely have poor nutritional content. Look for healthy foods that do not require a lot of preparation such as buying pre-washed, pre-cut vegetables. Some deli sections have pre-prepared foods like beet salad or quinoa that can be purchased in small quantities to add variety to your diet.

Third, plan for WHEN you eat. It is well known that eating small meals frequently during the day helps increase energy levels, such as at 9-10am and 2-3pm, especially if you’re feeling tired. Make sure the word “SMALL” is understood or else you’ll gain weight and not be hungry for the next meal! ALSO, DON’T SKIP BREAKFAST, AND DON’T EAT LATE AT NIGHT!!! Our metabolic rate (which regulates how efficiently we digest and breakdown our food) is highest in the morning and slowest at night. Try to include some protein and whole grains with your breakfast such as a boiled egg and oatmeal as this keeps the blood sugar from spiking and provides energy that lasts longer. Next month, we will look at supplementation including vitamins, minerals, and herbs that GREATLY help as well.

Is it a Migraine?

There are MANY different types of headaches, of which migraines are a common type. This discussion will concentrate on some unique characteristics that are associated with migraine headaches. This information may help you understand what type of headache you’re having. A unique feature of migraine headaches is that prior to the start of the headache, there is often a pre-headache “warning” that the migraine is about to commence. This is often referred to as an “aura,” and it can vary from a few minutes to a few hours, or in some cases, two days prior to the start of the migraine. Here are some of the more common “warning signs” that you are having, or are about to have, a migraine:

• Neck pain. In an online survey, the National Headache Foundation found that 38% of migraine patients “always,” and 31% “frequently” had neck pain accompany their migraine headache.
• Frequent urination. This can precede the migraine by an hour or as much as two days.
• Yawning. A 2006 article in the journal Cephalgia reported that about 36% of migraine sufferers describe yawning as a common pre-migraine warning. This can occur quite frequently, such as every few minutes.
• A “sensory aura” may occur on half of the body, moving from the finger tips through the arm, across the face, or elsewhere and usually includes a temporary lack of feeling as if the body region is “half asleep.”
• Nausea and vomiting. This is a common aura. According to the American Migraine Study II (a mail survey of more than 3,700 migraine patients) 73% reported nausea and 29% vomiting. Another study reported that migraine sufferers who have nausea/vomiting usually have more severe migraine headaches and get less relief from migraine medications compared to those who do not get nausea or vomiting.
• Other common auras or “sensitivities” during the migraine include bright light, noise, and/or smells (like perfumes), and many migraine sufferers seek refuge in a dark, quiet room and try to sleep.
• Physical activity. Routine activities such as walking, climbing steps, running, weight lifting, or sexual activity can trigger a migraine and/or increase the intensity of an existing migraine headache.
• Trouble speaking. Difficulty “getting the words out” or formulating thought (staying on task) can be another warning sign of an impending migraine. Obviously, if this is the first time this symptom has occurred and it’s “…out of the ordinary,” we’ll have to make sure it’s not something more serious (…like a stroke)!
• Weakness. This may occur in an arm or leg or entire half of the body (left or right side) and also could be a more serious sign of a stroke, but it is also a fairly common pre-migraine aura.
• Visual aura. This can include double vision and / or vertigo (balance loss with a spinning feeling). This often occurs in a special type of migraine called a “basilar-type migraine” and symptoms can include dizziness, double vision or loss of vision. The balance loss is often associated with a “bad migraine” and occurs when the migraine is stronger or more intense than usual.
• “Headache hangover.” This usually occurs after the migraine has passed and people describe a feeling of being “wiped out.” Symptoms can include fatigue, difficulty concentrating, weakness, dizziness, lightheadedness, and extreme energy loss.

In many cases, adjustments applied to the neck and upper back, especially when delivered BEFORE the migraine, can reduce the intensity and in some cases STOP the migraine from even starting!