DocAltMed

That’s the name of this year’s first podcast, and it is up and available now. The feed for all my podcasts is here.

And, as promised, here are the show notes:

Br J Community Nurs. 2009 Oct;14(10):422, 424-6.
Dietary factors and depression in older people.

Williamson C. British Nutrition Foundation, London. c.williamson@nutrition.org.uk

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression.

Dietary pattern and depressive symptoms in middle age.

Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK. tasnime.akbaraly@inserm.fr

 BACKGROUND: Studies of diet and depression have focused primarily on individual nutrients. AIMS: To examine the association between dietary patterns and depression using an overall diet approach. METHOD: Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: ‘whole food’ (heavily loaded by vegetables, fruits and fish) and ‘processed food’ (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). CONCLUSIONS: In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective. 

If you are interested in more information about diet and depression, contact me by clicking here.

Thanks for listening, and as always, your feedback and comments are very much appreciated!

One of the things I like about being the type of doctor that I am is that patients feel free to speak their mind to me.

As happened today, while I was performing trigger point therapy (a highly effective but admittedly somewhat painful technique for some muscle problems), my patient said to me:

Patient: “Doc, that #$%^&! hurts!

Me: “Yeah, I know, sorry about that.”

Patient: “That’s your bike out front, right?”

Me: “Yeah. Rode it in this morning.”

Patient: “Yeah, well, when you’re done with me, I’m taking care of it. You’re walking home tonight.”

There is some very good news today for parents of special needs children in the Litchfield area. I received an email today from Krizta Moon, a very talented musician, music teacher and musical therapist, which said that she will be offering a music therapy program at the Litchfield community center.

If you are unfamiliar with music therapy, it is  “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program,” according to the American Music Therapy Association website.

Anyone who has fallen in love, lost a loved one, grieved or celebrated — that is, all of us — knows the power that music has to influence our mood and our minds. Amazing, isn’t it, how a few bars from a half-forgotten song bring back to us in 3D living color the gestalt of a period in our lives?

Well, music is capable of far more than that. In the right hands, music therapy can not only help children cope with pain and stress, but also speed their progress in physical therapy programs. Music therapy can reach out and touch the untouchable, engage the unengaged.  In fact, a recent Cochrane Review, largely considered the gold standard of evidence-based medicine, found that “music therapy may help children with autistic spectrum disorder to improve their communicative skills.”

Ms. Moon said that she will be having an introductory “meet and greet” session open to everyone on Sat., January 23 at the Litchfield Community Center.

Music therapy sessions are specifically designed around the child’s age and developmental abilities, Ms. Moon said. Sessions will be held each Saturday between the hours of 9am-1pm. Each session runs for 45 minutes, starting on February 20th and will conclude on April 10th for a total of 8 sessions. Total cost is $150.00. Sign-up for this event will begin at 10am at the Litchfield Community Center. From 11-11:45, be there to participate in a large group session for parents and special needs children ages 4-18.

“An advantage of music therapy,” Ms. Moon’s email said, “is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to address more complex issues such as grief, abandonment or deeply conflicted emotions. As a medium, music therapy has enormous range and scope in targeting multiple clinical needs across the gamut of childhood developmental stages. It can set the occasion for a child to establish a meaningful relationship with an adult through musical play and interaction. Music therapy can also facilitate the development of pro-social skills, trust and feelings of positive attachment. Developmentally, almost all children respond to music. This greatly assists in laying a strong foundation for engaging in deeper therapeutic work. A child’s natural interest in music is enhanced by the fact that they are occupied in stimulating motor and auditory activities more associated with play or fun than work or therapy. The careful and repetitious orchestration of such multi-sensory experiences, in the context of a skillful and nurturing relationship, has a remarkable range of clinical benefits.”

On a personal note, I would just like to add that Krizta Moon has been my daughter’s singing teacher for several years. I know whereof I speak when I say that she is an extraordinarily talented, caring and skilled teacher, and I am glad that she has extended her talents into the realm of music therapy. I have no doubt that she will be of great benefit to many children here.

If you would like to attend, please call 860-484-9080 to confirm. You can also contact Ms. Moon via email, at lunazsoul (at) hotmail.com.

In a classic set-up, the Hartford Courant published an online poll asking readers if chiropractic patients should be required to sign special consent forms, as I mentioned in a previous post.

The poll question was placed directly across from a Rick Green anti-chiropractic screed, in which Mr. Green manages to disclose both an appalling lack of understanding of scientific research as well as feeble rabble-rousing skills in his attempts to mislead the public about this topic.

I wouldn’t mind so much about the anti-science bent of his column if Mr. Green was at least able to generate some fire underneath his supporters.

But, alas, he could not even do that. Normally, the placement of a survey as the Courant did in this situation virtually guarantees that the results are skewed in favor of the opinion of the columnist. Not so in this case. Here are the most recent poll results:

I’m sorry, Mr. Green, but it looks like the public has spoken.

And they think you, and the proposed regulation, is wrong.

That fount of modern female wisdom, Cosmopolitan magazine, inadvertently highlighted the fundamental problem with modern healthcare in its recent online article, Hairstyles Men Love.

Next to this picture of an undeniably-photogenic Anna Faris:

The article notes that “From an evolutionary perspective, guys subconsciously like hair that looks clean and healthy, like Anna Faris’s blond locks. “Hair that’s in top condition shows that you have a balanced diet and good health — signs of an ideal mate,” says biological anthropologist Helen Fisher PhD.”

So far, so good. Sociobiology, or the description of human behavior from a evolutionary perspective, has come a long way since its introduction 40-odd years ago, and is now a widely accepted (if oft-misused) theory. It is quite probable that in matters as fundamental as procreation, we are hard-wired to respond in certain ways just as much as the female Western Tanager will always go for the guy with the big red top.

But then Cosmo blows the lid off of the secret behind looking healthy:

“Work a silicone-based straightening serum through damp hair before blow-drying,” Cosmo advises. “Clip locks in 4-6 sections depending on how thick your hair is. Then tackle one at a time with a paddle brush and a blow-dryer equipped with a nozzle pointed straight down. Finish with a light shine spray.”

Ok, let me see if I’ve got this right. The secret to attracting guys, Cosmo says, is to develop that healthy glow, which presumably indicates a fecund future of healthy, bouncing babies to carry the genetic line forward. And the secret to attaining that health is a silicon-based straightening serum?!?

Not a word about the things that I associate with good health, like, maybe, good nutrition, exercise, sanitation — all that stuff that actually does give a person that healthy glow, instead of simply imitating it.

In the same way, mainstream medicine mistakes appearing healthy for looking healthy. Instead of looking at the person, they look at the numbers:

Cholesterol low?                   Check.

Thyroid hormone normal?     Check.

BMI “normal”?                      Check

All well and good. But the fact of matter is, manipulation of the numbers does very little to change a person’s health. You can have a normal body mass index and still be highly prone to cancer and heart disease. You can have normal thyroid hormone levels, yet still have a thyroid that is dysfunctional. And don’t even get me going on cholesterol. Cholesterol levels are no indicator of any kind of health whatsoever.

So, by manipulating the numbers, the modern MD thinks they are creating health in their patients. But, like the two ounces of straightening serum, they are only creating the appearance of health.

Reducing your cholesterol level has no effect on your overall lifespan. None. Zero. Zip.

Normalizing your thyroid hormones does not mean your “thyroid” symptoms will go away.

A normal BMI does not mean you are fit.

Just like two ounces of straightening serum will give the appearance of health without the reality, the statin drug or the synthetic hormones will make pretty pictures — but, in the long run, won’t change your health for the better.

I’ve just been selected as one of the on-line experts at MDinfo.com.

Don’t be confused by the name. There are a lot of smart doctors on there handing out good advice.

If I do say so myself.

I am writing regarding the hearings in Hartford on the requirement for chiropractic physicians to disclose to patients the risk of harm from cervical manipulation.

I am troubled in two ways by the legislation. First, I am concerned that the legislation is based on unsubstantiated fear and rumor rather than established science. Second, I am troubled by the way in which it singles out one medical provider among all others for this invasion into the doctor-patient relationship.

Stroke due to cervical manipulation is an exceedingly rare event. In fact, the most in-depth examination of this topic, a study published in the journal Spine in 2008, concluded that stroke due to chiropractic manipulation may be a non-event. The authors of the study reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in stroke risk with chiropractic.

Even if you argue that spinal manipulation can result in injury, it is exceedingly rare. Another study, reviewing 10 years’ worth of malpractice claims in Canada, concluded that the risk of stroke following chiropractic treatment could be only 1 in 5.85 million cervical manipulations. Another way of looking at this number is that it would occur only once in a chiropractor’s lifetime if he were in practice for 1,430 years. And even then, the study did not find that chiropractic manipulation caused stroke.

Thus, I must ask the question: Will the government require that chiropractic physicians lie to their patients about the risks of chiropractic-induced strokes, when, in fact, the best science available shows that none exists?

Any good doctor, whether chiropractic or medical, cares sufficiently for his patients to inform them of the significant risks and consequences of their chosen course of treatment. This is simply good patient care, respectful of the patient and his rights and the doctor and his responsibilities. And any therapeutic intervention carries with it some degree of risk, although, as in the case of cervical manipulation, it may be extremely small, and the injury typically limited to a pulled muscle.

There is no need whatsoever for the legislature to involve itself in this process and begin the micro-management of the doctor-patient relationship, nor should it single out one single provider for its intrusiveness. The legislature would never even consider mandating that every medical specialty disclose in writing specific but rarely occurring abreactions to their treatment.  Why then would chiropractors be held to a different standard? 

Or, if a 1in 5.85 million risk of injury is sufficient to require specific notification, will the legislators also require an MD to obtain specific written consent every time he tells a patient to take an anti-inflammatory? That is not a low-risk treatment. Anti-inflammatory medications are the 15^th leading cause of death in the country today.

Will the thousands of other procedures conducted by medical doctors with much higher risk of serious injury or death also come under the scrutiny of the legislators?

After all, during the two days in which your hearings were held, 4,296 people died as a direct result of their medical care.

Who provided the informed consent for that?

Very Truly Yours,

Avery L. Jenkins, D.C.

Probably the best thing about this holiday, in my mind, is that it gives us all the opportunity to be grateful. As a friend of mine recently pointed out, when you spend your time being grateful, you don’t have a lot of room in your life for stuff like anger, or fear, or jealousy. It’s hard to be grateful and angry simultaneously. Try it. See? Weird, it just can’t happen.

So I’m feeling really grateful today, as I sit and type this beside a wood stove cranking out the heat and eating a clementine. I’m grateful for the warmth of the stove. The children upstairs still sleeping. The deliciously healthful food made possible by a civilization which, for all of its many faults, gives me the capability to eat an orange in the middle of a cold New England winter. And I’m very grateful to the patient who brought me the fruit.

It is always somewhat surprising to me, when holiday season comes around, and patients bring such wonderful gifts to share with Teresa and me.  Diets be damned, they say, and bake with abandon, creating the most  delicious concoctions enticing me to keep my energy up with a quick midday sugar fix. Or two. Or three. (Hmm. I’m pretty sure I’ll be doing the Center’s New Decade - New Me weight loss program in lead-by-example format!). I am touched by these gifts, as I know that they signify my importance in their lives. And when I realize that, I am immediately humbled and awed by the trust which my patients place in me.

There were two gifts this year which particularly moved me.

One of my patients, whom I know is no stranger to philanthropy, took her largesse to an entirely new level this year. In honor of me, she said, she gave the gift of a cataract operation (through Seva, a charity devoted to restoring sight and preventing blindness in the developing world)  so that another person might see again. When she told me, it brought tears to my eyes. To be the inspiration for such magnaminity is overwhelming. Thank you, Joan.

Another gift came in the form of an email from a grateful patient whose holiday was brightened by a new addition to the family — whose presence, she said, was the result of the care which I provided.  I was deeply moved by her thanks as well, and reminded of the joy I experienced many years ago when my first child arrived.

So has it been a good Christmas? You bet! New eyes, new life, tasty treats and fruits and honey. My cup runneth over.

I hope your Christmas has been equally  joyful.

I’ve been saying this for years!

I had a conversation with a patient the other day, one that I’ve had all too frequently in the past.

The patient, someone with chronic neck pain, had gotten impatient with the length of time it was taking her to heal, and had discontinued care. Now she was back in my office, after visits to the MD, PT, and the radiologist.

“I finally found out what was wrong with my neck,” she said.

“That’s great,” I replied. “What is it?”

“I have arthritis!” she said. “My doctor took x-rays.” She pulls out a manila envelope and hands it too me. “Maybe if I’d known a little sooner, I could have gotten this fixed.”

I left aside for a moment the concept, always a little odd to me, that somehow I wasn’t her doctor. I know, it’s a chiropractic thing.

“Yeah, you probably do,” I said. I ignored the manila envelope. “Doesn’t really make any difference, though.”

“What do you mean?” she said.

“Look, Sarah, you’re 50 years old,” I said. “Of course you have arthritis, everybody does by 50. Arthritis is just a medical term for wear and tear on the joints, and if after 50 years you don’t have any wear and tear, that would be the surprising thing.”

She just looked at me, clearly upset that I didn’t share her enthusiasm for her newfound diagnosis and her (real) doctor’s “discovery.”

“Here’s the thing of it,” I said. “Those of us who treat a lot of this stuff know that there is often very little correlation between what an x-ray or MRI tells us and the pain and symptoms patients experience.

“Heck, studies show us that 30% of the population is walking around with a bulging disk in their lumbar spine, but most of them have no back pain. I’ve seen x-rays that showed massive amounts of ‘arthritis’ and disks that are virtually missing in action, but those findings had absolutely nothing to do with the patient’s pain,” I said.

“That’s why I rarely bother with x-rays or CT scans or MRIs unless I see a red flag when I examine you. In most cases, it’s not worth the radiation exposure or cost, because the ‘arthritis’ isn’t the source of your problem.”

“That’s not what my doctor said,” Sarah replied.

“I know,” I said. “Let me ask you this — what did your other doctor do after he found the arthritis?”

“He prescribed some painkillers for me, and I’ve been going to see the physical therapist.”

“Great,” I said. “How’s it working out?”

“Well, sort of ok,” Sarah said. “The painkillers were giving me a stomach ache, so my doctor put me on a different pill, but they aren’t really much better than Tylenol. The physical therapy really helped at the beginning, but it’s not been doing so much lately.”

“Ok,” I said. “Here’s the thing. The wear and tear you’ve got isn’t really the problem. Chronic pain like yours rarely comes from a single source. It’s usually 2, 3, or 4 things all going on at once. If you don’t tackle all of them at once, you won’t really find a solution.”

From that point, I went on to describe a suggested treatment plan — one that I would have implemented a couple of months ago, had the patient not withdrawn from treatment prematurely.

The problem with this treatment plan is that it requires some lifestyle changes. Regular rigorous exercise, not a few lifts and stretches under the supervision of a mildly bored PT aide. Changes in diet, giving up some favored foods.

These protocols do work for chronic, degenerative conditions. But for so many people, the mental/emotional pain of change — even healthy change — is greater than living with physical pain.

By the time I was finished, I could tell Sarah was still unsatisfied with me and my answers. I understand her reluctance. It is much easier to hang your hat on a simple diagnosis — “I have arthritis” — than it is to tell your friends “I have a metabolic/muscle movement pattern dysfunction with inflammatory overlays.”

Despite my 30 minutes of explanation, Sarah left that day without making any further appointments. I don’t know if I’ll see her again, but it’s likely that if I do, her condition will be that much more farther advanced and more difficult to treat.

Over the years, I’ve had many patients like Sarah. And sometimes they do come back, and often, with committed efforts on both of our parts, we make inroads.

Sometimes, it’s just too late.