Chiropractic--sometimes just what's needed

About 15 or 20 years ago I developed a muscle spasm in my back near my shoulder blades. It wouldn’t go away and was driving me crazy. I went to the doctor who hadn’t a clue what to do. I tried acupuncture, which didn’t work either. The only thing that worked was gin and ibuprofen, but I couldn’t keep up that regimen. Then I remembered my husband’s cousin talking about a chiropractor who he described as a “miracle worker.” I had never been to a chiropractor and was a bit suspicious, but at that point, I had nothing to lose. Besides, it made sense to me. The problem was probably structural. So I made an appointment.

I remember sitting miserably in his waiting room, feeling really uncomfortable. When he saw me and diagnosed the problem, he said, “I can fix that.” He adjusted my neck and, presto, the problem went away! I’ve never had it again. I have kept going to him with my various aches and pains. The problems don’t typically get fixed instantly the way my first one did. But over time, things eventually get straightened out. Now I go once a month for a “tune up.”

Given the fact that the spinal cord runs through the center of our vertebrae and that all the nerves in our lower bodies connect to the spinal cord, it seems logical that misalignment of the spine can have profound effects on different parts of the body, depending on the location of the problem. What’s more, the discs separating the vertebrae are also affected by a misaligned spine: they can rupture and swell. Setting the spine to rights relieves the pressure on the discs.

Most commonly, chiropractors manipulate (adjust) the spine by applying a controlled force into joints that have become restricted, either because of a single traumatic event or through repetitive stresses. Manipulation of the affected joints and tissues restores structural integrity and allows tissues to heal.

As far as I can see, doctors of traditional medicine don’t have many options when it comes to spinal or misalignment problems. They can prescribe medication or they can operate—fuse the vertebrae perhaps or insert a spacer between vertebrae. Chiropractic seems like the logical choice for structural problems. But, as with other medical professionals, chiropractors are not all the same. I just lucked out and got a good one right off the bat. A couple of times, when my regular chiropractor wasn’t available, I tried other people. One was good; the other not very good.

Next week: Breast cancer: Unnecessary surgeries

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Back pain: the mind over matter approach

Journalist Tony Schwartz cured his back pain by using the methods of Dr. John E. Sarno (now retired). In 1987 Schwartz had spent a year in “relentless pain, visiting orthopedists and chiropractors, osteopaths and acupuncturists, trying yoga, physical therapy and bed rest, all to no avail.” He attended Sarno’s workshop and learned that, with rare exceptions, back pain has no structural basis. Instead, it is caused by feelings, such as anxiety or anger, that you unconsciously shift from your awareness to the muscles in your lower back. It is "almost always a consequence of muscle spasm that prompts pain, which leads to fear, and then more spasm, and eventually creates a vicious cycle of pain.” Essentially, Schwartz learned there was nothing to worry about except the fear itself.

Using Dr. Sarno’s “talking cure,” Schwartz was completely free of back pain for 25 years. Then it came back. It started with a twinge, then kept getting worse. “It lodged in my lower back, and I could feel the sciatica all the way down to my knee. Within a week, I couldn’t walk more than 100 yards without severe pain.” Assuming it was the same as his earlier diagnosis, he thought about current anxieties in his life, trying to remind himself that the pain was “essentially harmless—much the way any muscle spasm is.” But days passed and he became preoccupied with his pain and could feel his fear intensifying. After about 10 days, he went to see Dr. Sarno’s successor who told him, “You’re going to be fine.”

Even though the pain was severe, Schwartz decided to face his fear and started to resume his walking and jogging. He started walking just three minutes on the treadmill, even though it hurt a lot. But he was determined not to quit. Each day, even though the pain was significant, he felt more confident that he could bear it. Each day the pain was excruciating at first, but he found that the longer he ran, the more the pain receded. Even though it would reappear when he tried to walk, “the pain no longer prompted much fear.” After about five weeks, the pain had disappeared.

Schwartz reports that he’s sent “dozens of people to Dr. Sarno, including ones who had suffered from back pain for years, had visible herniated discs on their MRI scans, and in some cases, had gone through multiple surgeries. Nearly all of them had the same experience I did: complete relief.”

Next week: Chiropractic--sometimes just what's needed

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Back pain: try postural changes

Alert readers (my family) informed me about an NPR program that featured an acupuncturist, Esther Gokhale from Palo Alto, who has, she maintains, found a solution for pack pain. She herself had suffered from such pain and had traveled around the world studying back pain in many cultures. She found that many indigenous people, such as the Ubong tribes in Borneo have no back pain.  She also found that these people and others like them have straighter spines than we do. Their major spinal curve is the one at the base of their spines (a J shape), while our spines have an S shape--with an additional curve further up. Watching them move, she contends that their straighter spines account for the regal way in which they move and hold themselves. 

She has worked out a series of posture-improving exercises that have apparently helped a lot of people (including Joan Baez!). Rather than trying to describe them here, I've found that it's really best to check out her many videos, one of which is a TED talk. Just Google Gokhale and you'll find plenty of them.

                          

I attended one workshop locally (she has instructed others in her approach) and am trying some of the new postures. For one thing, you have to let your butt stick out a little, which shifts your weight a bit and makes for the J curve. I'm also trying to change my walk by using my glute muscles and propelling myself from my back foot. It's too early to tell, but I seem to be having less joint pain. 

Next week: Back pain: a mind over matter approach

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Back pain: best to avoid surgery

I don’t have much experience with low back pain, but I have read that it is the number one cause of disability throughout the world. That’s a pretty big deal. I have two friends who have had back surgery: in neither case did the pain go away. In 2007, 27 million US adults reported back problems. More than 1,500,000 opt for back operations each year. The record of success is pretty dismal.

One study looked at the records of 1,450 patients diagnosed with disc problems. Half had two or more vertebrae fused; the other half had no surgery. After two years, only 26 percent of those who had the surgery returned to work while 67 percent who'd not had surgery returned to work. What’s more, 41 percent of those who'd had the surgery increased their use of opiates.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. Between 1995 and 2010, there was an eight-fold jump in this type of operation. For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Dr. William Welch, chief of neurosurgery at Pennsylvania Hospital, admits “We are less successful at treating back pain” than leg pain. The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.” In other words, we all have degenerating disks.

Here are the common types of back surgeries.

Diskectomy: removes the herniated portion of the disk; requires removal all or part of the back part of the vertebra to access the ruptured disk.

Laminectomy: removes the bone overlying the spinal canal to enlarge it the canal.

Fusion: fuses two or more bones in the spine to eliminate painful motion between vertebrae.

Artificial disks: implanted to replace an injured disk; a treatment alternative to spinal fusion.

Next week: Back pain: try postural changes

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Some dermatological rip-offs

I have never felt ripped off by my dermatologist, not even the first one whom I didn’t like. My current dermatologist and dermatological surgeon perform only necessary procedures and are conservative in their approaches. Everything is done in the office.

This is not always the case. The New York Times tells the story of a woman whose dermatologist (actually it was a physician’s assistant) took a biopsy of a tiny white spot on the side of her cheek, which did turn out to be cancerous—a small, slow-growing basal cell carcinoma. After removing the cancer, using the Mohs treatment, the patient was sent across the street to a surgical center to have the wound closed by a plastic surgeon. The patient protested that she didn’t want a plastic surgeon and didn’t care about having a scar, but the doctor told her she had no choice. This patient had to don a hospital gown, was given an IV, and was sedated by an anesthesiologist. Her bill included $1,833 for the Mohs surgery, $14,407 for the plastic surgeon, $1,000 for the anesthesiologist, and $8,774 for hospital charges. Ridiculous!

Because it is more expensive than other techniques and highly profitable, some say that Mohs surgery is overused. The incidence of Mohs surgery increased by more than 400% in 10 years, which may be due in part because of our aging population. In a sample of 100 Mohs surgeries, the cost ranged from $7,594 to $474,000 with the higher costs for hospital-based physicians. When the surgery is performed in different steps by different specialists, each specialist can bill for his or her own procedure, such as the surgery itself, closing the wound, anesthesiology, and facilities fees. This can total more than $25,000 for a single procedure, as in the case of the patient in The New York Times article.

I recently had a basal cell carcinoma removed from my chin (Mohs method) and chose not to have stitches. I now have a bit of a dimple. Because skin cancers tend to be slow growing, I've toyed with the idea of ignoring them. But I don’t have the nerve.

Next week: Back surgery--best to avoid

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.