Category Archives: public health

Sitting at a Desk is a Pain

balance-ball-chairWe sit a lot.  Most people sit at work.  We sit for recreation or entertainment.  We sit to drive, and we sit to eat.  Many people ask me the question, “what kind of chair should I get for work?”  Unknowingly they are asking the wrong question.  They really want to take care of their back and they’ve probably heard the fad news of the day that “Sitting is the New Smoking” or that standing or treadmill desks are the way to go.  There are kneeling chairs, exercise balls for sitting.  Balls mounted on chairs, reclining chairs and setups that you can climb inside.  Most of these devices are great, but I haven’t found a single one that you can’t sit poorly in.  You can even slouch on a ball.  The key is not what we sit in, though it can help to get good sitting furniture.

There are really only two ways to avoid the problems that come with sitting, the first way is to sit properly with good posture, however posture is supported by our muscles.  No one, no matter how well trained can sit indefinitely without those muscles getting fatigued.    Most of us are poorly trained and return to poor sitting posture after less than 20 minutes.  I highly recommend core training and exercises to improve our postural endurance, but like the different chairs it is not enough by its self.

tr800-dt7_fullviewThe only method that is manageable and within the reach of almost everyone is to sit for shorter periods of time.  That doesn’t mean to rush out and buy a standing desk or a treadmill work station.  You just have to limit your sitting to the period of time that your muscles and joints can handle at any given time.  For most people that means standing up 2-3 times per hour just to stretch or move.  You could walk to another cubicle to deliver a message, go get a drink, do 5 jumping jacks, or just stretch for 30 seconds and then get back to proper sitting.  Try it for a day.  Set a 20 minute timer and every time it goes off, pause what you’re doing, get up and move for 30 seconds.  You’ll be amazed at how you feel and how much more productive you can be even though you are taking more breaks.

Fevers

Image: Ambro / FreeDigitalPhotos.net

Mom, almost instinctively, checks your forehead for a fever to see if she should keep you home from school.  That’s a good plan.  If your body is ill, one of the proper responses is for it to develop a fever.  The fever is not the problem however; it is part of your body’s solution. 

A recent question by a parent of a child with an ear infection brought this up.  Most parents get scared when their child gets sick and this is perfectly normal.  They should.  This information may help to calm you down.  Our bodies were masterfully designed to be able to combat illness on their own.  Sometimes they need a little help, but often are capable if we just provide the right environment for health.

When it comes to temperature normal is not 98.6° F (37° C).  That is a number for the text books, but anything from 97° F to 99° F may be normal for you.  A normal fever (in a person greater than 3 years old) is between 102.2° F and 104.5° F (39° C and 40° C). This temperature is not bad and should be considered beneficial; it is being regulated by the body and is still under control.  It’s ok.

A fever above 104.5° F (40° C) is not going to cause damage, but does indicate more seriousness and you should see a doctor if you have a fever that gets to this level or a low grade fever for more than 5 days.  Damage to the body or brain is not going to occur until temperatures of 108° F (42° C) or higher.  So don’t panic.

Over the counter fever reducing drugs are not even recommended by the American Academy of Pediatrics.  In the case of home medication for children with fevers they suggest and I agree that treatment should be provided to “improve the child’s overall comfort rather than focus on the normalization of body temperature.”  If a child can’t sleep due to pain then they will have more difficulty getting well.  Care should focus on proper fluid intake and comfortable rest and not on reducing the fever.  For additional information please see this article by Claudia Anrig, DC.

Menier’s Disease: New Research

Patients doing their own research on conditions occationally bring me something that they find interesting to get my opinion.  This recently happened with an article on MÉNIÈRE’S DISEASE AND JOINT INJURY.  The full title is “The Potential Role of Joint Injury and Eustachian Tube Dysfunction in the Genesis of Secondary Ménière’s DiseaseI thought I’d just share that review with you.

Meniere’s Disease is a disorder of the inner ear causing many different symptoms from vertigo to ringing in the ears to hearing loss.  The article really seems to be just an idea that the authors have been pondering and sought to find evidence to back up their idea.  Not very scientific in my opinion.  What they’ve really done is see if there is any validity to their hypothesis so that they can do further studies.

The ear has 3 sections, inner, middle, and outer.  The inner ear is sealed off and in your skull and is what does all of the work you might associate with the ear, hearing and balance.  The middle ear is simply a cavity with facilities to allow the outer ear to “talk” to the inner ear and is drained by the eustachian tube into the back of your throat.  The middle ear is usually where ear “infections” occur.  The eustation tube becomes blocked and can’t drain the middle ear so fluid builds up or an infection may grow.  If this occurs frequently, medical doctors sometimes, (instead of fixing the tube that your body has) insert additional tubes that drain to your outer ear.

The bones in your neck join the skull right behind your ear.  If you put your finger right there you feel a soft spot between the bump of your skull your jaw and your ear.  Those are the joints that the article talks about, the upper cervical spine and the TMJ.  The close proximity has always caused people to justify a relationship between those joints and the ear. Neurologically there has been no direct connection found that I’m aware of. These authors are proposing an indirect nerve connection in order to explain why TMJ or neck injuries can lead to Menier’s disease. 

From a chiropractic perspective their hypothesis also implies the reverse, that patients with Menier’s Disease might benefit from chiropractic management.  To be determined…

Informed Consent

In Connecticut there is a debate over chiropractic and the topic of informed consent.  (News Article) The debate is not over whether there should be informed consent.  In fact, in the United States, informed consent is already mandatory for all health care providers.  Informed consent is supported by chiropractors.  It is in the best interest of our patients .  No!  This debate is over whether chiropractors should be forced to inform every patient of a risk of stroke.

There are many problems with this.

CAUTION: there are risks to drinking water!

The most obvious is that chiropractic is not known to cause stroke.  The only evidence even remotely related does not show that it causes stroke, but that there is an association.  The same association that exists with medical doctors (oh, and hair dressers).  So if it’s not known to cause it why would you force chiropractors to inform people of the risk.  I think I know the reason.

If it is required for chiropractors then it should also be required of all health care practitioners that have equivalent risks. Can you imagine walking into every doctor’s office and having to sign a paper that says that if you came to that office to see them for neck, head or upper back pain there is a possibility you could have a stroke after seeing this doctor. Either no one would go to doctors for those conditions or it would become so prevalent that the warning would become like the boy who cried wolf, useless.

Another problem is the actual risk level that we are talking about. The risk of having a stroke after seeing a chiropractor is somewhere in the region of 30-300 times less likely than you dying in a lightning strike.  Should I have to also warn my patients that they may aspirate  and die from that water I recommended they drink.

Defining what must be included in informed consent adds loopholes for dishonest people and destroys the purpose of informed consent, that of an honest and open conversation between a doctor and a patient.  Please doctors share the likely and serious risks with your patients.  Inform them, by all means.  Don’t get ridiculous.

Back to School

It’s that time again.  Students are getting ready for the new school year.  They and their parents are school shopping, and one of the key items on the list is a backpack.  Whether starting kindergarten or finishing your senior year of college your backpack is going to be heavy.  Backpacks are a concern of chiropractors because we see the damage from them in our offices.  Unsurprisingly studies have found a link between backpacks and back pain, and it seems to be increasing in our youth.  (Seriously, have you seen the size of some of their textbooks lately?)  Despite our great access to information online or in digital forms students are often still asked to haul sometimes massive weight.

There are many things that you can do to reduce the stress on your self, your children or your students.

  • Make sure the backpack weighs no more than 5 to 10 percent of body weight.  That’s about 5-10lbs for most elementary school kids.
  • The backpack should never hang more than four inches below the waistline.
  • Buy a backpack with individualized compartments  to positioning the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your back.
  • Smaller backpacks will not allow you to overload your body, and they will fit children better.
  • Wear both shoulder straps. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
  • Wide, padded, and adjustable straps are very important to ensure proper fit and comfort.
  • Be actively involved in your school and community.  Encourage schools to adopt policies that limit backpack weight, such as using workbooks, books with DVD content, provide assignments online discuss options with teachers and administrators.  Be creative, and understanding.

Hot or Cold Water?

My brother was doing dishes with me when he asked why we used hot water to wash dishes and our hands rather than cold water.  I had never really thought about it.  The answer that every Mom I know of has given is that you use hot water to kill germs.  But that’s not true.  Water hot enough to kill the majority of germs would also give you massive burns.

The shock that I got when I did a search online was that people didn’t know this.  There were people saying you should wash with cold to kill germs, hot to kill germs, warm, not hot, because it kills better, etc…  Washing your hands with soap and water is the number one way to avoid disease transmission, but people don’t know why.

So why do we wash in hot water?  I thought about the idea for some time and came up with two reasons for my brother.  The first and probably most important is that the heat helps melt grease or fats and allows the soap to be more effective.  The second is comfort.  I’d rather put my hands in hot water than cold.  Washing has nothing to do with killing germs, but washing them off.  The point of washing your hands thoroughly is that you wash the germs off, not kill them, and if you don’t scrub every area with soap and rinse thoroughly they stay, especially in crevices like your nails.

As for antibacterial soap, just remember that the purpose of washing hands is to wash off bacteria not kill it.  Antibacterial soap is not any more effective at washing, and has to be left on for 2 min in order to be effective at killing. Also there is merit to the idea that using antibacterial soaps and detergents contribute to “super bugs.”

Proper hand washing is effective for disease control.  Practice it your self and teach it to your children.  If you do not have soap and water, the next best thing is an alcohol based hand sanitizer.  For tips on how to best wash your hands here is the Center for Disease Control (CDC) and another great site.

http://health.howstuffworks.com/question692.htm

Are You…In Good Hands

Now, insurance it’s self isn’t evil.  It’s a great idea at it’s core, spread the risk so that you Ins3aren’t wiped out by disaster.  Even at bad companies there are good people trying to do what is right or just earn a living, but as consumers it is our duty to vote with our wallet.  It is up to all of us to get companies to change by showing them we will not support bad practice.  Unfortunately many people are not informed when they cast their vote.  It is in that vein that I present this information.  The next time you go to vote on insurance companies you will be able to do so armed with information.

I present to you the ten worst insurance companies in the USA as determined by the American Association for Justice:

TEN WORST INSURANCE COMPANIES

1. Allstate

2. Unum

3. AIG

4. State Farm

5. Conseco

6. WellPoint

7. Farmers

8. UnitedHealth

9. Torchmark

10. Liberty Mutual

Ins2This list is a part of a document they have produced and put out (Find the full document here).  They took their time and did their research, after all they are lawyers.

“To identify the worst insurance companies for consumers, researchers at the American Association for Justice (AAJ) undertook a comprehensive investigation of thousands of court documents, SEC and FBI records, state insurance department investigations and complaints, news accounts from across the country, and the testimony and depositions of former insurance agents and adjusters. Our final list includes companies across a range of different insurance fields, including homeowners and auto insurers, Ins1health insurers, life insurers, and disability insurers.”

As a chiropractor I deal with insurance on a regular basis and have written on this topic before.  The more people we can educate the better systems will be demanded.  Pass it on and help change insurance, not through the federal government, but through the power of the people.