Defeat Depression! New Ways To A New You.

Why You Are Sick

Today, more than ever, we live in a disease-ridden society. But that's not because we lack sanitation, hygiene, abundant foods or opportunities for exercise.

We live in a disease-ridden society because we are creating diseases. Or, more accurately, we are having diseases created for us, and through careful manipulation of our fears, we have come to accept these manufactured diseases as real.

Anyone who watches television or reads a magazine has seen (albeit largely unconsciously) how cleverly marketing first creates a disease, ensures that lots of people come down with it, and then offers a "cure" to get rid of it.

As an example: Until Viagra came along, impotence was either an occasional mishap resulting from emotional causes or secondary to other disorders, such as circulatory problems, nutritional deficiencies, and diseases or trauma interfering with nerve function.

Then Pfizer came along, developed a drug that increases blood flow to the male penis, and needed a market to sell it to. Nevermind that Viagra's ability to improve function is limited to a single mechanism that really only works for a few men (those that are producing insufficient amounts of nitric oxide). That market was too small. What Pfizer needed to do was to create a larger market.

First, they created the need, and that was easy: What man doesn't want to be better in bed? Second, they created the disease, i.e., the reason you're not better in bed. They took the old name -- impotence -- and scotched it, because of its negative connotations. The word "impotence" conjures up images of a skinny-armed teen getting sand kicked in his face by the guy with the rock-hard biceps and bosomy blonde in tow. Or the cuckolded husband coming home from his 9-to-5 only to discover his randy wife in bed with the next door neighbor.

No, those are not images with which any man would associate himself. So Pfizer created a new disease -- Erectile Dysfunction -- with an entirely neutral connotation -- and craftily expanded the boundaries of this  created disease. The really, really important thing to note here is that Pfizer took a symptom of several diseases and made it into a disease by itself so that they could sell a drug to "treat" the disease.

It still hasn't reached the point where a man is going to sit down on the bar stool, look over at his neighbor and say, "Damn, dude, I just got diagnosed with ED. Pass the peanuts, wouldya?"

But the reformation of impotence (the symptom), into ED (the value-neutral disease), mainstreamed the concept to the point where healthy young men are now taking the drug for a perceived extra performance edge.

And Pfizer is putting lots of money in the bank.

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Another excellent example of a manufactured disease is osteopenia.

There was a time when osteopenia was an incidental finding on an x-ray, a way you would describe a bone which had gotten more transparent than others. It was an indicator of the loss of mineral in that bone, and a sign that, as a doctor, you might want to be on the lookout for osteoporosis further on down the line.

Or maybe not. Plenty of people experience temporary osteopenia, which reverses on its own. A number of pharmaceuticals cause osteopenia as a side effect, and as soon as the drug is no longer taken, normal bone is restored.  People living sedentary lifestyles, either due to other health problems or simple neglect,  often develop osteopenia which disappears with a return to activity.

But for several years, I had many a middle-aged woman come to my office with the "diagnosis" of osteopenia, for which they had been prescribed Fosamax or one of the other bisphosphonates.

Again, here we have a symptom, or exam finding, that has been carefully recrafted into a disease.

The rebranding of osteopenia came with the development by Merck of a new drug that could increase the mineralization of bone. But this new drug -- Fosamax -- like, Viagra, had a very limited audience. People with osteoporosis, a true weakening of the bone.

But in 1997, Merck hooked up with the developer of a cheap and easy x-ray machine which purported to measure bone density in a way that would predict risk of fracture.  The DEXA scan immediately multiplied Merck's market by creating a new class of disease sufferers, this time people who had the new disease of "osteopenia."

And the market took off. With the addition of standards manufactured by the drug companies themselves, medical doctors started prescribing Fosamax to a huge number of middle-aged women.

The wheels have since come off that cart, at least a little bit. No so much because subsequent research shows that Fosamax does not create healthier bone, nor because Fosamax has also been shown to actually cause bone death and increase fracture risk in certain bones (true). Nor has the fad decreased because research has also shown that the DEXA scan does not adequately -- or even remotely -- predict bone fracture (true).

No, the fad has passed because the patent on Fosamax ended in 2008, and the horde of no-name drugs has reduced the value of Fosamax considerably. With competition, Fosamax is no longer the money maker that it once was.

But the lesson that Merck learned was a valuable one. No, not the lesson about the consequences of releasing a dangerous and poorly-tested drug onto the market.

The real lesson here was that coupling tests which purport to objectively demonstrate the presence of a "disease" with a drug that cures that "disease" is an extremely potent form of marketing.

Today, consultants of pharmaceutical companies are offering week-long seminars on how to couple drug development with tests that will increase the demand for that drug, and then market them to medical doctors and consumers alike.

This development has gone largely unnoticed, and unreported, and the vast (and unwarranted) trust that Americans have in their medical physicians makes such sales easy to make.

Medical doctors, on their side, are seeing pharmaceutical company payouts, in the form of "consulting fees," as a lucrative sideline to offset the continuing pressure on their income. Medical doctors are also paid ludicrous sums for enrolling patients into research programs, to the extent that some practices have hired specialists to sift through the studies available and determine which will be the most profitable to participate in.

And patients, on their side, are manipulated by the fear spread by pharmaceutical companies that previously unheard-of diseases will dramatically affect their quality of life.

But you know what? Most people aren't sick, and most people don't need prescription drugs -- although 50% of the U.S. population are taking them.

In fact, most of the people taking drugs today are not the victims of disease, they are victims of a lucrative marketing scam no more ethical than an email from a banker in Kenya.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Chiropractic Care and Anxiety

Anxiety is a problem which has afflicted us all at one time or another. Fortunately, our anxiety is usually the result of a specific context or situation, and it resolves as we move to meet the problem or it is otherwise solved. Not so for many, however, who have to deal with anxiety on a day-in, day-out basis. Many people experience panic attacks for no reason, where their heart starts pounding, they get short of breath, and they get a feeling of dread. Generalized anxiety, a free-floating sense of worry that is out of proportion to the cause, can last for weeks or months, and can result in insomnia, hyperactivity, headaches, irritability, abdominal distress and other symptoms.

Mainstream medicine, of course, relies primarily on drugs to treat anxiety disorders, but these drugs can create more problems than they solve. Benzodiazepines, for example, interfere so much with mental functioning that anyone who is taking that class of drug is not permitted to have a commercial drivers license, and they are also highly addictive. A common anxiolytic, Xanax, is one of the most frequently-used drugs to treat this condition, despite the fact that there are no long-term studies confirming either it's effectiveness or it's safety.  Overall, the use of anti-anxiety drugs increases your risk of death from a variety of causes, so with all of this in mind, drugs may not be the best answer for this particular problem.

Fortunately, there are several ways of managing anxiety that do not require drugs. EEG neurofeedback, a technique which uses real-time electrical signals in your brain to alter its patterns, has been used quite successfully to manage anxiety. Fortunately, Litchfield has an excellent clinical therapist who is also highly skilled in EEG neurofeedback. David Pavlick is a clinical social worker with an office at the Center for Alternative Medicine, and has helped many people overcome their anxiety.

Cognitive Behavioral Therapy, or CBT, is the current darling of psychology, and it, too, appears to be  very effective in treating anxiety. In fact, a variety of talk therapy techniques have been shown to help people with anxiety.

But, as is the case for most chronic problems, a multidisciplinary approach usually results in better results. People with chronic problems, especially mental and emotional disturbances, should also be examined by a primary care chiropractor to eliminate underlying physical and nutritional causes for the anxiety.

Multiple studies have confirmed that balancing the essential fatty acids (EFAs) can reduce the symptoms of stress. Back when I started practicing, I used to hand a patient a bottle of EPA or DHA and have them take it for a month to see what kind of response we would get. These days, however, I can order a simple blood test, covered by insurance, which will show me the patients' levels of the various essential fatty acids, eliminating the guesswork. I can tell without trial and error whether or not such an approach is likely to work, and if so, exactly what kind of dosages of which EFAs I need to make my patients better.

The B vitamins, magnesium and calcium also play a role in anxiety states, and adjusting these levels may help as well. Imbalanced hormones will also often play a role, as an over- or underactive adrenal gland, or an imbalance in the hypothalamic-pituitary axis can be primary causes of anxiety symptoms.

Very often, I find, that in order to correct my patient's nutritional status, we have to begin by fixing impaired digestion, one of the most common -- and most overlooked -- causes of mental and emotional issues that I see.

With all of these conditions, once again, instead of guessing, I test, and use objective measures to tell me if these types of intervention will be useful.

Finally, Traditional Chinese Medicine can be successfully employed to help patients with anxiety. From a TCM point of view, there is no separation between mind and body, and the freedom from that false duality gives us the ability to view anxiety from an entirely different angle.

In TCM, anxiety stems primarily from an imbalance in the Spleen organ system. Because the Spleen, in TCM, is responsible for extracting qi from the food, Spleen imbalances result in qi stagnation or depression.

When qi becomes depressed in the middle jiao, then you start to experience the signs and symptoms of panic attacks, as well as other classical signs of anxiety. Thus, from a TCM point of view, restoring normal Spleen functioning is primary to the treatment of anxiety. (As a side note, I find it very interesting that in both TCM as well as Western alternative medicine, the digestive system is found at fault in mental disorders.)

So, fortunately, for people experiencing anxiety, there are a number of approaches that can be used to assist them. From nutrition to acupuncture to lifestyle and herbal interventions, a variety of forms of alternative medicine can be used as an adjunct to, or even primary means, of helping people deal with anxiety disorders.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

It's in the Bag.

Cycling -- at least the way I do it -- is all about the bags. Rarely do I take off on a jaunt when I don't feel the need to carry a few extra things. Think of your car. Who would use a car lacking a glove box or a trunk? Nobody, of course. Even if you don't treat your vehicle as a beast of burden, that storage space is a necessity for just your normal motoring activities.

When you use your bicycle as your primary form of transportation, the same rules apply. You still need a glove box. You still need a trunk.

So when I completed the transformation of a 1974 Fuji Sport 10 into a retro/commuting/tweed & vest bicycle, I still needed a couple of finishing touches. I needed some place to keep the detritus of daily life; my wallet, my keys, my phone, a jacket, a multitool; a tablet or netbook, and the odd bottle of wine or baguette that is the primary task for which such a bike is created.

My current pannier/briefcase, an Axiom Legacy, was certainly up to the task functionally -- after all, it weathered the winter of 2010 on the side of the trike with nary a complaint. But the briefcase's 21st-century materials and styling was all out of place on a bike with pretensions to the Golden Age of cycling.

Recalling the testimonials of my UK friends, I next looked at Carradice -- a company that brings cotton canvas and a stiff upper lip to the damp, streaky, misty fog that the British sportingly call "weather." And while Carradice certainly had both the style and the quality I sought, I recalled warnings about it's eccentrically English supply chain, which seems to consist of "we'll get it to you when we send it, and thank you ever so much for your order."

In fact, not a single US dealer could be found which actually had any of the bags in question in stock.

I finished my search where I should have started it, specifically on Etsy, and even more specifically at Anhaica Bag Works. Anhaica, which takes its name from the capital of the Appalachee tribe (today known as Tallahasee, Florida), is the home of a cycling needlewoman who combines her experience on bicycles with considerable skills as a seamstress and designer, using waxed canvas to create waterproof bags of considerable durability.

My first purchase from Marina, Anhaica Bags' proprietress, was a custom handlebar bag with pockets for all of the essentials of a Modern Man. Over a few email messages, Marina and I discussed what I would be using it for, what I would be putting in it, and  the size and type of pockets I would need. Marina had the bag finished and mailed to me in less time than it takes Carradice to return an email, and within four days of use it easily replaced my briefcase. By the second week, it had become indispensable, even on the rare occasions that I hop into a car. By the third week, it had become, God help me, a man purse. I don't leave home without it.

I was so impressed with the workmanship of the handlebar bag that I ordered a rack bag to replace my aged Nashbar rack bag, which was developing holes and looking a little too rickety for the 200 miles I was planning to pedal over my upcoming holiday. Again, I looked to Carradice for inspiration (well, mostly dimensions), and asked Marina to make me something like that. Once again, in record time, I had a canvas rack trunk which matched the handlebar bag and which used re-purposed lightweight coroplast to give it shape. It consisted of a single compartment with a rear pocket on the outside. Like the handlebar bag, it was strapped and closed with durable webbing and strong plastic buckles.

My multi-century vacation is now a note in my journal and pictures on my PC, and I've logged a hundred more miles in about-town riding, and all I can say is that the bags produced by Anhaica Bags simply rock. I had no idea that a rack bag, made so simply, could be so unbelievably useful. The two quick-release buckles make accessing the bag a snap, especially compared to the drill I had to go through with my old rack bag: (1) Fold back the weatherproof flap (2) unzip the bag expander by mistake (3) re-zip the expander (4) find the zipper pulls for the real opening (5) open the bag (6) reach in blindly as the flap falls back down...you get the idea.

With my Anhaica Bags rack bag, all I do is unclip the buckles, flip open the top, and I have full and unfettered access to the entire contents, organized just the way I want it. There is one large pocket in back for tools and a spare tube, and that's it. Opening and closing it was so simple that, while I was touring, I regularly had to stop and double check that I'd actually closed the lid -- it was that simple.

Oh, yeah. What about the weatherproofness of these bags? If you are used to high-tech fabrics like Gore-Tex, the quaint simplicity of waxed canvas might strike you as somewhat backward and unreliable. Let me be the first to tell you that it is not. As luck would have it, the first day I used each bag, I got caught in severe downpours. When I got back home, I found my contents inside utterly dry. I mean bone dry. Marina makes her own waxed canvas, and strategic flaps and design creates a bag that is as waterproof as I could wish for, while avoiding the mold-inducing hermetic sealing of, say, Ortlieb bags.

I know I'm beginning to sound like a shill for Anhaica, but if I do, it is only because I am so enormously impressed by the level of skill that went into the construction of these cycling bags. As I mentioned before, Marina is a cyclist herself, and her knowledge of how to design and make a bag comes from day-in-day-out experience; the kind of experience that you will rarely see reflected in a mass-market product. And if you are worried about the responsiveness of a single-proprietor business, you needn't. At one point, I mangled one of the pockets on the handlebar bag, and I emailed Marina about getting it repaired. She returned my email the same day, while she was on vacation, and had the repaired bag in the mail to me the day after she got it. Service? Yeah, she's got it.

Anhaica offers other bags besides the rack and handlebar bags I bought. She has tool rolls (and will whip up a custom one for you), backpacks, and hip packs, from a variety of materials. Frankly, I'm thinking about trying to talk her into making a set of panniers for me.

Marina's products are not something you come across often these days, being the product of the experience and skill of a single person who obviously takes great pride in her work. The durability is built in the cloth and the stitching, and the attention to detail makes these bags suitably handsome for any bike, not just my moustachioed retro bike. If you are considering adding bags to your bike, I strongly recommend that you check out Anhaica Bags on Etsy.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

25 Things You Didn't Know a Chiropractor Could Do: DOT Medical Exams

Last week, I attended a seminar with a few hundred other doctors to get prepared for the new federal regulations about DOT medical exams. Anyone who has a commercial drivers license (CDL) knows about the medical exam they have to take every 2 years (sometimes more often) in order to keep it. I've been doing these exams for several years, and over this time, the federal Department of Transportation has been reviewing and upgrading their medical exam program.

The result is that, in 2014, any doctor providing DOT medical exams will have to pass a test and be certified by the agency before they will be allowed to issue medical certificates to drivers. Always one for being on the bleeding edge, I'm one of the first physicians in the country to have undergone the new DOT training, and I will be among the first wave of doctors to be taking the test later this year. The regulations have gotten complex enough so that this has become a bit of a speciality, and can no longer be adequately performed by most primary care physicians.

In order to make it easier for drivers, I've developed my 65-15-24 Guarantee.

65 -- The full cost of the exam is $65. Unlike others, I will not charge for reviewing medical histories, consultant reports, or additional visits that might be required by DOT regulations.

15 -- Once you have completed your paperwork, you will not wait more than 15 minutes to see me. If you do, your exam will be provided at no cost.

24 -- You can get in to see me for your exam within 1 business day.

If you've ever read my previous post on my core principles, you will see how this service fits, and why I've chosen to incorporate this guarantee.

Check your paperwork. If you need to re-up your medical exam, or you know someone who does, have them give me a call at 860-567-5727. Or, go to www.dot-exams.com for more information.

The Ten Deadliest Mythical Diseases, Part 2

The second half of my top 10 mythical disease list is sure to stir up some contention, as I will be taking on some sacred cows of both the mainstream and alternative medical communities. Regardless of the controversy that it might cause, addressing these myths directly will help us -- both doctor and patient -- to arrive at more accurate understandings of the health problems that we encounter and struggle with.

Why do I call these "mythical" diseases? Because they exist only to wrongly describe a phenomenon which we insufficiently understand. Sort of like Zeus chucking thunderbolts about the heavens until we discovered that lightning is only an electrical discharge. Once we knew of lightning's true origins, we became more able to protect ourselves from it, rather than scurrying about in fear of an unhappy god.

The same thing applies with these diseases. So long as we ascribe them to poorly-fitting taxonomies, we will be unable to create effective solutions. If we throw away our distorting glasses, seeing them anew, we can investigate and apply new solutions. My first item on the second half of my top 10 is a perfect example. (I've waited for years to write that sentence.)

6. Chronic Lyme disease. If I ever met a disease that wasn't, this is it. Chronic Lyme has as many possible symptoms as fibromyalgia. What makes it particularly difficult to uproot is that chronic Lyme is bolstered, in the opinion of many, by the fact that the sufferer has already experienced a documented illness. The argument that the the Lyme bacteria hides itself within its host is derived from the same argument in the 1980s which postulated that HIV was actually a form of syphillis, a chronic spirochete infection eventually invading the host's brain and nervous system. However, with syphillis, the patient continues to show signs of active infection, whereas none are found in the chronic Lyme patient.

What better fits the available evidence is that many of the symptoms of chronic Lyme can be traced to gastrointestinal dysfunction induced by the antibiotics used to treat acute Lyme. It is not unusual for a GI tract, denuded by an antibiotic of its beneficial bacteria, to create a constellation of symptoms difficult for many doctors to categorize, from neurological to immunological alterations. This theory does not fit all of the cases of chronic Lyme, but many of those cases that I have seen have been resolved by restoring normal gut function.

7. Celiac disease. Speaking of gut dysfunction, if I had a nickel for every patient who walked in my door having been told that they have celiac disease by their mainstream primary care doctor, I'd be a rich man. The fact of the matter is that what is often mistakenly diagnosed as celiac disease is usually simple gut dysfunction or leaky gut syndrome. There's no need for a life spent in fear of wheat. Simply fix the underlying problem and move on.

8. Osteopenia. This isn't a disease, and never has been. It is only a radiological finding indicating mild decreased density of the  bone. That decreased density does not indicate that the individual is in any imminent risk of a fracture; it only means that the person may, at some point down the road, and not necessarily, develop osteoporosis.

Osteopenia is a normal feature of aging. It did not become a disease until the bisphosphonates like Fosamax hit the market, and they tried to enlarge the population of potential Fosamax recipients by reclassifying osteopenia as a disease that needed to be treated.

Fortunately, since all of the lawsuits hit as a result of Fosamax & Friends causing bone death instead of bone strength, I've been seeing a lot fewer patients in my office carrying the weight of this imaginary disease.

9. Chronic Fatigue Syndrome. This is just another way of a doctor saying "I don't know what's wrong with you except you appear to be very, very tired." Like fibromyalgia, it's a wastebasket diagnosis that stands in place for many other disorders, from subclinical hypothyroidism to hypothalamic-pituitary-adrenal axis dysfunction to Vit. B deficiency. If a doctor tells you that you suffer from CFS, just go find another doctor who is willing to dig a little deeper. I really dislike this diagnosis, because it unnecessarily burdens people with what they believe to be an incurable disease.

10. Gastro Esophageal Reflux Disorder. The only reason we have GERD on such a wide scale is because of that little purple pill. Until then, it was heartburn, and readily fixed by not eating junk, not eating too late, not drinking too much alcohol and keeping your gut healthy. And before the purple pill, cider vinegar and baking soda seemed to take care of most cases of GERD. Yes, there are a few people with valves in their GI tract that aren't working properly; however, the vast majority of GERD is not GERD at all but just crummy eating habits.

Frankly, it says everything to me that the medical "cure" for this "disease" is to inhibit the proper functioning of the stomach, impairing both your digestion and your immune system in the process. If you have to fix a problem by breaking something else, you probably don't know what you're doing.

I could go on, and I may do so in another post. But I hope that in reading this list over, you've recognized the common denominator in all of them. These "diseases" are actually dysfunctions that stem from either improper medical intervention or inappropriate lifestyle choices. And that concept is what lies at the heart of much of my approach to treatment. The sooner we learn that we control our diseases -- not the other way around -- the sooner we can become healthy.

Cycling Renaissance

In a previous post, I mentioned the Golden Age of Cycling, which occurred at the beginning of the 20th century. And from the most current numbers, it looks as if we might be poised for a second Golden Age.

Rutgers University professor John Purcher has crunched the most recently available cycling data, and his numbers are pointing to a renaissance in cycling. Here are the highlights:

• Bike commuters doubled between 1990 and 2009.
• Transportation cycling (going to work, shopping, running errands) is outpacing sport cycling (fast guys in lycra). 54% of all cycling trips in 2009 were for transportation, an increase of 11% in 8 years.
• Cycling fatalities fell 21% between 1998 and 2008 (Remember my post about cycling safety?)

(Source: "Bicycling Renaissance in North America?," Pucher, J., et al., 2011, Transportation Research A, Vol. 45)

What does this mean to you? Well, if you are thinking about jumping into cycling -- particularly transporation cycling -- it means that you are beginning to see a variety of bicycles and gear designed for this purpose. When first lived car-free, as a dazzling young urbanite in Boston, there was no such thing as a "commuter bike." I had to make do with a faux-racing bike with its drop handlebars and uncomfortable-but-speedy design.  Now there are dozens of brands that make commuters, from Jamis to this fine selection, including a very classy Pashley.

It also means that your safety, which is already pretty good, will get even better. Because multiple studies have shown that the more cyclists there are on the road, the safer it is for all cyclists (there is also some evidence that suggests that more cyclists make the roads safer for motorists as well).

For me, cycling makes a wonderful transition from work to home. Instead of remaining compressed and tense behind the wheel of my automobile, my ride home is now filled with sunsets, stars, the smells of the seasons and the gentle hiss of my tires on the road.

And that is what makes my daily commute a daily pleasure.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

I *Would* Ride, Except It's Too Dangerous!

This is the most common reason I hear from people who otherwise might take my advice, dust off their bikes, and go for a spin.

While it might seem dangerous -- being on the road next to the 2,000-lb behemoths that can crush us like a bug on tile -- in fact, the opposite is true. Cycling is *so* safe that the average cyclist actually lives several years longer than a non-cyclist.

Let me repeat that, with flair: Cycling is so safe that the average cyclist lives several years longer than a non-cyclist.

Sure, lots of cyclists (in this country, at least) wear those silly foam hats, and talk about all of their close calls with motorists, potholes and dogs, but these should be viewed for what they are -- campfire goosebump stories. The fact that the cyclist in question is around to tell the story should give you a clue that perhaps, just perhaps, the danger value has been cranked up a notch or two.

So let's look at some cold, hard (and rather pleasant) facts about cycling:

• According to several studies, cyclists live longer than non-cyclists; in one study, the cycling lifespan advantage was almost 10 years.
• Motorists are *far* more likely than cyclists to suffer from serious head injuries.
• Cycling is safer than: Fishing, horseback riding, swimming, athletic training, football and tennis.
• Cycling is safer than riding in an automobile.

Let's compare lifetime risks. Your risk of dying from:

• Heart disease              1 in 5
• Automobile accident    1 in 84
• Pedestrian accident     1 in 626
• Bicycle accident           1 in 4,919

The simple fact is this: Cycling is a very safe activity. It is safer than every other form of transportation except flying, and orders of magnitude safer than riding in a car.

The problem with cycling safety is one of perception, not reality, so fear not, hop on your freedom machine and roll down the road.

Don't forget to wave at the folks in the gas station. I always do.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

This Road Belongs To The Bicycle

In today's installment of Bicycle Month posts, I am going to ever-so-briefly mutate from being a physician and bon vivant to (very) amateur historian.

You know that road out in front of your house? The (probably) paved road that takes you and your resource-hogging, squirrel-killing automobile to work, to school, and to the grocery store?

Well, you can thank this country's cyclists for that road.

You see, back during the turn of the century, cycling was an enormously popular activity. By the 1880s, the "safety bicycle" design, essentially the same shape as the modern bicycle, had replaced the dangerous penny-farthing, and John Dunlop had invented the air-filled tire. These two advances converted the bicycle from a silly toy for the young, adventurous and rich, to a useful transportation and recreational device for the masses. The use of the bicycle exploded among the middle class, and what is now known as the Golden Age of Cycling began.

(I cannot go further without noting that the bicycle was an enabler of the nascent feminist and suffrage movement in the U.S. In fact, Susan B. Anthony called the modern bicycle the "freedom machine." But we'll get back to that later this month).

As the American populace became truly mobile for the first time, they found the conditions of our dirt roads somewhat less than adequate for their speedy new machines. And, as Americans tend to do, they banded together to advocate for improved cycling conditions. The most prominent face of this social force was the League of American Wheelmen (which continues to be the largest voice for cyclists today as the updated League of American Bicyclists). The League successfully lobbied both local, state and federal government to engage in a massive upgrade of the nation's rutted roads.

Thus, the paving of American roads began long before the mass-produced automobile was even a gleam in Henry Ford's eye. The paved road that you drive on today exists because the cyclists of the early 20th century demanded the infrastructure needed for middle-class mobility.

Next time you get angry at some bicycle who is blocking "your" road, remember this. It was originally his road. And in law, custom and practice, the cyclist has the same rights to use the road as you do.

In fact, instead of honking at him, you should thank him, for making your passage possible.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Welcome to National Bike Month!

Welcome to National Bike Month! To celebrate this most worthy steed and its versatility, economy and pure fun as a transportation device, I will, each day in the month of May, post a useful tip or fun fact about biking.

Here's today's tip: We all know that bike riding saves money and improves health. But all too often, we find it difficult to find a way to work cycling into our daily routine.

So try doing this. Pull out a map of where you live. draw a one mile diameter circle with your house at the center. Then, just one day per week, use your bike to run any errand that falls within that circle.

For me, that circle will include the grocery market, post office, library and several stores where I regularly purchase goods. You'll be surprised at the number of places that will fall within your circle. Try it and see!

If you follow this program while we have comfortable cycling weather -- just one day per week for 4 months -- you will have saved about $60 simply by leaving your car in the driveway for those trips.

If you want to, you can use that $60 to take yourself out to dinner. Your waistline can certainly afford it, because you will have burned an extra 2,000 kcal.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Your Friends May Be the Death of You

Patients have frequently come to me saying that previous doctors have told them that their illness is "all in my head."

My response has always been, "Absolutely!"

Virtually all diseases -- from allergies to cancer to heart disease -- have a mental or emotional component. The only diseases which are free of this association are those which are directly traceable to inherited genetic malfunction. One of the core principles of Traditional Chinese Medicine is that all disorders manifest themselves both physically and emotionally, and the doctor who diagnoses or treats only the physical manifestations of an illness is failing his patient. The distinction between mind and body is a false one. They are merely different faces of the deeply intertwined functions of life.

Western medicine is slowly catching up to this 3,000-year-old concept, as a growing body of research demonstrates that what influences the emotions influences physical health. The most recent article to joint this corpus is this study, which shows that among primates, immune system functioning is closely tied to social rank. Female macaque monkeys lower on the social scale had lower-functioning immune systems; but most importantly, when the monkey moved up or down the social hierarchy, their immune system followed.

If you look at all of the research on illness and social environment, I don't believe it would be too much of a stretch to conclude that  changing one's friendships and social organizations can have a dramatic effect on health. But it goes beyond the old bromide "those who lie down with dogs are going to get fleas." In other words, it is not simply exposure to noxious organisms and toxins that will determine our health, but the entire social milieu in which we exist which determines our health.

So what does this mean to you and your health?

Take a look around you. Who are your friends? Is your social circle based on mutual respect? As is the case for many men, their peers and friends are also often their competitors in their games of pleasure, but winning and losing can be grounds for either contempt or camaraderie. Women similarly compete, sometimes in sports, but more traditionally through more subjective measurements than game scores or race times, and sometimes through surrogates such as their children. "Winning" and "losing" in this environment is amorphous at best.

Examine the formal social structures to which you belong. Is your church, synagogue or temple one in which the beauty of the person is celebrated? Or is personal esteem torn down in obeisance to a vengeful, demanding cosmos? Similarly, how respected do you feel by the other members of your book club, health club, or guild?

If, in any of these realms, you do not feel respected, it may be time to change venues. The respect others have for you not only influences your own self-esteem, but may be part of the cause of health problems you have been having.

To change your health, maybe you first need to change your friends.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Springtime and the Yellow Emperor

Encouraged by a recent conversation with a patient, I purchased a new translation of the Yellow Emperor's Classic of Medicine, or Neijing Suwen. The Neijing is the fundamental text of Chinese acupuncture, written in the second century BCE, and continues to have relevance in its exposition of the guiding principles of Chinese medicine. Interestingly, much of its analysis is also congruent with a more modern understanding of physiology.

As I re-read this classic, I was once again struck by the importance that the Neijing places on both environment and mental health as a component of disease.  Western medicine is only today beginning to catch up to where Chinese medicine was over 2,000 years ago. The idea that the healthy individual adjusts his habits to suit the season contradicts our modern way of life, where we use technology to create an environmental bubble in which we believe we can live without having to change ourselves, even while our surroundings go from freezing to sweltering and from desert to swamp.

It is a false belief, of course, as our technological bubble has as many holes as a piece of swiss cheese; and furthermore, evolution has not adapted us for a static, pasteurized environment. We need our cold and hot, our wet and dry, even our bacteria, in order to be healthy. Indeed, the Chines doctors of the Han period were probably the first environmentalists of humanity.

Living in harmony with one's environment is stressed as an important health measure throughout the Neijing. Environment and season dictates the healthy person's sleep schedule, type of work and foods to be eaten. And so it is with the season we now entering:

"The three months of the spring season bring about the revitalization of all things in nature. It is the time of birth....During this season it is advisable to retire early. Arise early also and go walking in order to absorb the fresh, invigorating energy. Since this is the season in which the universal energy begins anew and rejuvenates, one should attempt to correspond to it directly by being open and unsuppressed, both physically and emotionally."

These words were written over 2,000 years ago, but are no less true today. Research published this month has found that our very genes work in synchronicity to the seasons, and this is the very same effect that the Neijing refers to as "universal qi." With the seasons of the earth encoded in our DNA, genes are turned on and off in accordance with the time of year. Not only are our wake/sleep cycles altered, but our bodies are attuned to the type of nourishment that we should be receiving at that time of year, and genes are turned on or off accordingly. The authors of this study conclude that a "loss of rhythmicity or a change of phase may alter the physiological array or rhythms...leading to metabolic derangement and disease, i.e., chronopathology."

Diseases currently linked to chronopathology include cardiovascular disease, depression, pancreatitis, ulcers and other gastrointestinal disorders.

So how does the Neijing suggest that we respond to the changes wrought by spring?

"On the physical level," it suggests, "it is good to exercise more frequently and wear loose-fitting clothing. This is the time to do stretching exercises to loosen up the tendons and muscles. Emotionally, it is good to develop equanimity."

Nutritionally, the book recommends reducing our intake of sour flavors, and increase sweet and pungent flavors. Good spring foods include onions, leeks, leaf mustard, Chinese yam, wheat, dates, cilantro, mushrooms, spinach and bamboo shoots.

This is good advice for any time of year, frankly, but it particularly makes sense in the spring, as we transit from our cramped and immobile winter selves to our more active summer selves.

The need to keep oneself physically and mentally in harmony with our environment is why I have many of my patients return at each solstice or equinox. These astronomical events, representing the change from one season to the next, are good markers for us to take stock in our health and adjust what needs to be adjusted. Sometimes the adjustment is needed in the spine, sometimes in the diet, and sometimes in the acupuncture meridians. But it just makes sense to prepare yourself ahead of time for the challenges -- and joys -- of the upcoming season. Once again, the Neijing offers us wisdom on this:

"Treating an illness after it has begun is like suppressing revolt after it has broken out. If someone digs a well when thirsty, or forges weapons after becoming engaged in battle, one cannot help but ask: Are these actions not too late?"

It is always my goal to be the doctor who treats the illness before it appears.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

A Meditation on Spirituality and Health

Self-appointed "skeptics" frequently point to practices such as mine, claiming that I'm engaging in nothing but voodoo witchcraft, preying on those so ill and so without hope that they will grasp at any straw proffered them, ante up any outrageous fee desired, and dearly pay for the false hope which I and my colleagues allegedly peddle.

My patients, of course, know the reality is far different. They know me as a hard-headed pragmatist, whose foremost rule is "Find it, fix it, and get out of the way." They know me as a doctor who will rather unflinchingly -- though I hope not unkindly -- point out how they have contributed to their own ill health, while also finding ways they can repair the damage. And they know that my fees are modest; I am unlikely to bathe in gold coin anytime soon from the revenues of my practice.

What they don't know, unless they ask, is that each discipline that I practice, whether it is chiropractic, acupuncture, or herbal/nutritional therapy, is supported by a wealth of scientific research that supports every modality that I use.

When I have used acupuncture to treat children with Tourette's syndrome -- usually successfully, I might add -- I can point to not just one, but several studies that support and guide my intervention.

When I blend a custom herbal formula for a patient suffering from a cold or urinary tract infection, I am relying on studies which show me that the herbs in question are more effective than anything in the MD's formidable arsenal. Though of course, the FDA would have the fantods were I to be so foolish as to make the claim that herbs can actually kill the bacteria causing the infection, even though studies exist demonstrating that very fact. So I won't make the claim that herbs can help cure the common cold, even though substantial research exists supporting that statement.

And when I explain to an acupuncture patient that Qi is a life-force running through their body, and that the flow of this Qi can be altered by placing needles at certain points along that flow, I know that I am using a time-tested analogy for a phenomena that we are only beginning to touch upon in Western science. It is likely that this Qi is actually a form of intercellular communication, and that acupuncture alters the nature of that communication. When you begin to change the body's command and control systems, your results are going to be powerful and intersystemic, which is why both acupuncture and chiropractic have such profound effects on people. Chiropractic adjusting, through its influence on neural communication, and acupuncture, through its alteration of intercellular ionic flow, are both acting on a meta level, thus their widespread effects.

With all of that said; with all of my adherence to the logical discrimination of disease and therapeutics, and my hard-headed emphasis on results, I cannot ignore the power of my patient's spirits, nor their immeasurable will to survive, improve, and in some cases achieve a level of health they never thought possible. Where does this will come from, and how does it manifest its results? Most importantly from my perspective, how can I help my patient harness that power?

Multiple studies have shown that intercessory prayer have little effect on disease outcome. Nonetheless, it is often through their religion or spiritual beliefs that people harness that powerful exercise of volition which dramatically alters the course of their disease.

Despite increasingly frequent forays into this domain, the realm of the spirit remains largely opaque to the otherwise piercing lenses of science. There is some evidence that  our brains are hardwired, as it were, to engage in spiritual practice; to "believe" in unquantifiable, unmeasurable forces which help to direct our lives. And those familiar with the work of Carl Jung and subsequently Joseph Campbell will recognize the hero myth as the unifying essence of almost all religions. Neurological research has shown how the regular practice of meditation, independent of the specific religious tradition of the meditator, can create long-term alterations in our brains. Nonetheless, these scattered breadcrumbs only beg the question of how these beliefs unlock such potent personal power that the course of a disease can be radically altered.

This is a question worthy of consideration, particularly today, when much of Christianity celebrates the birth of its central figure. And as I drove home from a family gathering last night, I could not ignore the beauty and tranquility exuded by the churches I passed, all decked out for their celebrations and lit with candles for their midnight services. There is a compelling power there, not just in Christianity, but in any religion as it expresses the majesty of its office in our affairs. From the miraculous birth of Jesus to the transcendental satori of Gautama Shakyamuni to the revelations of the cave-dwelling Muhammad, there is a common thread from which has emerged some of the most beautiful expressions of art, literature and music of which humans are capable.

To that I would add religion's ability to give us the power to manifest our ideal selves in the physical realm as well as the sphere of ideas. While I cannot explain it, I would be a fool to ignore it, though it is clearly not in my scope to harness it. That is more truly the realm of the priest, the roshi, the imam. As a doctor, I must remain ecumenical to best serve my patients.

To me, this day marks both a beginning and an end. It is the end of the work year for me, and over the next week of "vacation," I lay the foundations for beginning the new year. I am looking forward to the changes I hope to bring about, both personally and in my practice. And I know that this question, the role of spirituality in health, will be one which will invite me back to ponder its challenges throughout this year. I am looking forward to the conversation about to ensue.

And I am also, as always, incredibly thankful to my patients who continue to be my most influential teachers. Thank all of you for your trust in me, and thank you for permitting me to join you down the short segment of your path that we are traveling together. I hope my guidance has not led you astray, but assisted you to become more of who you want to be.

And to all of the readers of my blog, thank you for your attention and your feedback. You encourage me to continue these public musings and consider new topics and new approaches.

Happy Holidays to all! I look forward to seeing you in 2012.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

There is a better way to manage your depression and anxiety. Find out how.

Paralysis. Suicide. Fatigue. Heart Attack. Birth Defects. Liver Disease. Weight Gain.

Is This Any Way To Treat Depression and Anxiety?

These are just some of the side effects of antidepressants. At the same time, research has shown that these drugs are not much better than placebo at treating depression and anxiety.

Please join me on Nov. 9 for an exploration of the dangers of medical treatment for depression and anxiety, and a look at alternative management strategies.

At this seminar, you will learn:

• What are the long-term effects of using drugs for mood disorders?
• What really causes depression and anxiety?
• Can acupuncture help people with depression?
• Which herbs are most effective for people with depression? Can herbs really reduce anxiety?
• What is the research behind alternative management strategies?

If you or someone you know suffers from anxiety or depression, call today to reserve your seat.

Wednesday,  Nov. 9, 2011 Litchfield Community Center 7 p.m.

Call 860-567-5727 and ask for Teresa, or email to depression@averyjenkins.com

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

The Lenses We Look Through

Page A13 of today's New York Times has an article about St. John's College, a rather unique Great Books program. The thrust of the article is to illustrate how St. John's professors -- referred to as "tutors" -- are expected to teach every discipline, regardless of their own specialty. As an example, the article features Dr. Sarah Benson, an art historian, who is currently teaching mathematics -- via Euclid.

The Times article says "students who attend St. John's...know that their college experience will be like no other. There are no majors; every student takes the same 16 yearlong courses, which generally feature about 15 students discussing Sophocles or Homer."

I mention this article for two reasons. My daughter is a freshman at St. Johns College, and is finding the experience to be uniquely mind-expanding.

I can already hear the changes in her thinking; for example, in a recent telephone discussion about how her younger sister's classmates feel that American imperialism is in all cases justified, daughter #1 bursts out indignantly: "But what about Virtue? Don't they even consider that?"

In my mind, I laughed, then applauded.

The second reason is that this article brought back memories of my own undergraduate education, the School of Interdisciplinary Studies at Miami University (of Oxford, Ohio, thankyouverymuch). Cloistered on its own campus (the former Western College for Women, at which my mother was an assistant dean), the School of Interdisciplinary Studies taught us in much the same way that St. John's College trains my daughter today. Frequent, small discussion classes, only barely run by the professors, punctuated by more formal seminars, at which the academics of the College presented insights from their own disciplines, viewed through interdisciplinary lenses.

There was one class, however, which became for me an intellectual satori. I spent a semester studying the relationship between Picasso's Cubism and Einstein's theory of relativity.

It was team taught by a physicist and an art historian, and we all learned together, studying the works of Picasso and Georges Braque, and reading Einstein's original works. And somewhere, through the heat of that challenge, I emerged a changed man. Somehow, my lenses had shifted, and I never looked at the world in the same way again.

The School of Interdisciplinary Studies is long gone, replaced by a sub-department within a department, but I am glad to see that schools such as St. Johns College continue to educate men and women who will be capable of gazing out onto the landscape of culture and ideas and see things to which others are blind.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Time For Your Flu Vaccine? No.

I'm going to talk to you about the flu vaccine. Now, before you dismiss me with a hand-wave and think to yourself, "Oh my god, another anti-vaxxer idiot," let me make a few things clear.

I'm not anti-vaccine. I'm pro-science. I believe that public health policy should be firmly based on the best available research. And what the best available research says, according to the top researchers in the world, is that the flu shot is useless.

But I'm pretty sure that nobody involved in mainstream medicine wants anyone to actually think about whether you need the flu vaccine.

They just want you to line up and get the shot. You see, everybody in medicine makes money from the vaccine, from the Semi-Registered Nurse's Assistant's Aid's Best Friend (i.e., part-time CVS employee who just washed her hands) who actually injects you, to the stockholders and executives at Novartis and Glaxosmithkline, who make the vaccine, to the CDC, which gets lots of money indirectly by pimping the flu vaccination each fall.

The trouble is, it's bad medicine. And bad science.

Don't believe me? Then believe the Cochrane Collaboration. This is an independent organization which performs analyses of medical research, and one of the sources that evidence-based doctors, such as myself, use to guide their recommendations to their patients (of course, I'm absolutely *not* making any recommendations to any of my patients, and if any of my patients are still reading this, I want you to stop immediately).

According to the Cochrane review, the advantages of vaccinating healthy adults are virtually nonexistent. This recent study found that the flu vaccine:

• Did not reduce the number of days lost from work;
• Did not reduce the number of people hospitalized;
• Did not reduce the number of complications due to secondary infection (pneumonia, etc);
• Was effective in only 1 out of 100 people;
• Paralyzed 1 out of every 1,000,000 people who were vaccinated.

Furthermore, the study's authors hedged their conclusions even more. The authors said "Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions" (Emphasis mine).

For those of you who are not familiar with reading scientific studies, this is a researcher's polite way of saying they think the data is trash.

This conclusion was reached by Cochrane researcher Tom Jefferson, in a 2006 analysis published in the British Medical Journal. Dr. Jefferson concluded that there is an "absence of evidence" that vaccinations have any effectiveness at all.  "In children under 2 years inactivated vaccines had the same field efficacy as placebo," Dr. Jefferson said, "and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications."

But what about our aging American population? The elderly is a group heavily targeted by influenza vaccine marketing, but that is primarily the result of easy and profitable Medicare reimbursement more than any evidence that flu vaccines actually help this population.

In fact, the evidence is so bad that Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy has suggested that those who recommend the flu vaccine for older people are at best ignorant and at worst disingenuous.

"These 36,000 deaths that we keep talking about with the flu, that we want to get people vaccinated for so they don't happen, really is not going to occur. And we have to be honest about that," Osterholm told NPR last year. "I know that some people are going to find it very challenging to basically understand that much of what we've probably done has had little impact on deaths," he said.

Nor is the Cochrane Collaborative silent on this issue. This study, first published in 2006 and reviewed again in 2009, concluded that "the available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older." The study went on to note the "low quality" of the research, as well as "likely presence of biases, which make interpretation of these data difficult and any firm conclusions potentially misleading."

Some of the research backing Osterholm's claim includes research by Dr. Lisa Jackson and published in Lancet. Dr. Jackson's study -- which spanned 3 years and included over 3,500 people -- concluded that vaccines don't really help, particularly in the area of secondary infection prevention. Specifically, " influenza vaccination was not associated with a reduced risk of community-acquired pneumonia," her paper concluded.

What other studies seems to show is that, far from aiding those with weak immune systems, flu vaccines either fail to help or overtly damage people with already-compromised immune systems.

The Cochrane Collaborative's persistent claim that the data regarding flu vaccine research is compromised has been bolstered recently. A paper authored by researchers at the British Columbia Centre for Disease Control found that data from several Canadian hospitals reported peak vaccine effectiveness before the flu season had even started. They concluded that this created a "bias tending to over-estimate vaccine protection," which as other research has shown, is marginal at best.

However, there are research-proven ways of significantly reducing your risk of contracting the flu this winter, and the best ways of avoiding the flu involve no vaccines, no doctors, and don't cost you any money.

• First of all, according to the CDC itself, washing your hands is one of the best ways to prevent the acquisition of most infectious diseases.
• Exercise has also been proven to prevent death from the flu as well as other infectious diseases.

Those are probably the two most important ways to prevent the flu. And the research is unequivocal at this point that nutritional status has a profound effect on immune function, which determines how likely you are to get the flu. But then again, how many doctors actually test your nutritional status to make individual-specific recommendations for improving your immune function during the flu season?

Actually, I do know of one.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

An Aging Martial Artist Returns to the Fray

After a multi-year time-out from training in the martial art of aikido, I returned to the  dojo a few weeks ago. I will confess to some anxiety about resuming training, as I am no longer the young, seemingly indestructible force of nature that I was when I began training in earnestness 20-odd years ago. As one of one of my older dojo mates told me several years ago, at 50 years you have reached the age when if you wake up in the morning and nothing hurts, something is seriously wrong.

Between my last visit to the dojo and this one, I crossed that cryptic half-century borderline, and in addition to the miraculous and immediate attainment of great wisdom, I also acquired the aforementioned aches and pains. I think, in general, these are the dues paid by anyone who has led a fairly active life -- and, of course, the gains in terms of health, longevity and mental outlook far and away offset the intermittently achy knee or shoulder which will never be exactly pain-free.

But my prior years of training had left their mark. While aikido is generally considered one of the "softer" martial arts, anyone who has watched or participated in an aikido class can understand how injuries might arise. At any given point in time, you can be thrown in the air,  have joints torqued in entirely unnatural directions or get whacked upside the head by failing to correctly implement a technique. While largely safe, aikido remains an effective martial art, and a certain level of injury must be tolerated, just as with any other martial art, or many sports, for that matter.

Which is not to deny that my tenure on the training mat has been a little more injury-prone than most. I count among the dents I accumulated over the years a broken rib, a separated shoulder, two concussions, a broken toe and a nose so thoroughly smashed that for a time I resembled a cubist painting. All of which led me, some time after I had been awarded my shodan (first level black belt) degree, to take a break (so to speak) from training. I was just too dinged up to continue, and a few off-the-mat injuries thoroughly doused whatever remaining fire I had for training.

But the call of the dojo never fully left me, and has gradually been growing stronger. So I decided it was time to put feet to mat, but before I went, I wanted to know what -- if any -- research had been done on injured athletes returning to their sports. There is, in fact, not much.

One article in the Clinical Journal of Sport Medicine had this to say:

"Sport psychology research, however, reveals that athletes may be physically healed and rehabilitated but not necessarily psychologically prepared to return to competition. Discussing his return from injury, Earvin Magic Johnson commented, 'But I had lost a lot of confidence during the long layoff. And for a long time after I returned, I still held back. All I could think about was protecting my knee from another injury.' As Johnson's comment suggests, making the transition from rehabilitation to training and competition may not be an easy one for injured athletes. Until recently, the psychologic aspects of returning to sport from injury have unfortunately been largely neglected."

What little research does exist, shows that there are typically four major concerns of returning athletes: Competency, autonomy, relatedness and re-injury.

Competency is your ability to perform, and for any athletic person -- even when you are in a non-competitive environment, such as an aikido dojo -- one's abilities are going to be paramount. I know that I questioned whether I would have the cardiovascular stamina to participate in a hard class and the flexibility needed to perform the techniques fluidly and with less risk of injury. While my time away from the dojo had included a lot of miles on the bicycle, I knew that aikido would tax my systems in a different way.

Autonomy was not so much an issue for me, as I had no coaches or sponsors pushing me into returning. Nonetheless, this is a very real issue that many athletes do face, and not just in the pro leagues, either. For youth athletes, one's parents can be considered as your sponsors, and the pressure from parents and family to return to play can be forceful and unrelenting.

Relatedness is an important factor, for even those involved in solo pursuits. Athletes sidelined by injury may acutely feel their disengagement from their team or the rest of their sporting fraternity. Loss of membership in that group, and alienation from it, can serve as both a spur and a hurdle to returning. One may seek to become part of that elite group again -- yet fear that you will no longer be accepted because of your absence, or your impaired competency.

A final concern is the fear of re-injury. Particularly when a severe injury takes one out of participation, the fear of being injured again can cripple an athlete's ability to perform, regardless of their physical state.

So how can these handicaps be overcome?

First, if you have a coach, good communications about what you both see in store for the future is necessary. In my case, I had a discussion with my sensei of the past dozen years. We talked about why I left, and what some of my concerns were in returning. I was reassured by this conversation that a return would be possible -- though it was equally clear that the nature of my practice would have to change.

A second task is to find a role model. Search out other athletes who have done the same thing you are attempting, and learn from their experiences. Love him or hate him, cyclists have a phenomenal role model in the form of Lance Armstrong. In the martial arts, one cannot ignore the story of George Foreman, who returned to boxing after retirement, and captured the world heavyweight title for the second time nearly 20 years after he first won the belt.

Another important step to take is to get very, very clear on your motivations for returning. If it is to regain a championship or title, or match an older personal best, an honest personal inventory may save you from re-injury. It is best to be clear in your understanding, as I was, that you will be bringing a different game than you had before.

For my part, such introspection proved invaluable, as it gave me a good understanding of how my practice would change, and what I could expect from myself.

So far, this approach has worked well. I was -- shall we say -- a bit tender after my first class, but I quickly got used to the aches and pains of regular training. There have been a couple of interesting surprises, though.

First was the recognition that I hadn't lost as much as I thought I had, mentally, at least. The throws and other techniques still flow nearly naturally, to the extent that they ever did. Interestingly, a few times, my brain kicked into a weird overdrive where, instead of doing the throw that I intended, or was instructed to do, I went into an entirely different technique without consciously intending to. Perhaps I was responding to some subtle variation in the attack which made the alternative technique more attractive; or, perhaps, my mind just slipped a cog. The jury is still out on that one.

More expected was the sensation of trying to do things that my mind knew how to do, but that my body had simply lost the physical capacity to perform. This is most notable when being thrown, as I knew how I wanted the roll to go -- I just couldn't get my body to do it. I know I'll get there eventually; I just need more time on the mat.

Other factors have been playing a role as well, particularly nutrition. Getting my nutrition back to spec to aid my return has also been a priority. Again, the nutritional approach that served me well before The Great Divide is not the same nutrition which is working now.

I would encourage anyone who is considering returning to their field of dreams to give me a a call. Together, we can help smooth the transition from reformed couch potato to athlete.

And if you get the sudden urge to train in Aikido -- there is no better place to go the Litchfield Hills Aikikai. It is blessed with an excellent sensei, and a helpful and welcoming group of students.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.