Rambling Thoughts on the “New COVID Normal” at 424 Mill Street West

The last two weeks have felt like a daily mental whiplash, adapting day by day to a new life and work environment.  I have had just enough time and energy to update the blog and social media sites with a few blurbs as we go. Today is offering me an opportunity to finally put some linear thoughts together.

I am blessed to report that our household is doing fine, with no illnesses and no urgent unmet needs (stocked up on TP 3 weeks ago during a routine trip to the store).  Through a stroke of good luck, Kim also routinely stocked up on hand sanitizer and office TP about 5 weeks ago. Bleach goes a long way (1 gallon makes 15 gallons of strong sanitizer spray!). Disposable gloves by the thousands were readily available from restaurant supply stores, and somehow, we had stocked up on surgical masks in December. The staff has made themselves a little “COVID fortress” at the front desk to keep a 6 foot distance during interactions with patients. They have instructed more people to immediately wash and sanitize their hands upon arrival than a seasoned kindergarten teacher.

Like all health care offices, we have been reassessing daily what we should do, if we should do it, and how to do it safely. After much deliberation and informed by recommendations of various public health agencies, we decided to remain open with restricted hours and strict new infection mitigation procedures (posted on website ).  It is certainly not business as usual but it is services nonetheless. Patients with absolute contraindications to travel outside the home are rescheduled to mid April, patients with wellness concerns mostly opt to defer to April as well. This allows us to maintain staggered appointment times for folks who need to be seen in the next two weeks.

As I constantly second guess myself about any decision I have made in the past two weeks, daily life at the office seems to keep me on track.  Governor Walz’s stay at home order that went into effect on Friday included chiropractic services in the list of essential health care services.  It reminded me that a week ago, I stayed at the  office until 8  pm to treat a PCA who works with disabled young adults and was hurt pulling a double shift since other PCAs were out on quarantine. Her next step was probably the ER or urgent care, and she had nobody to cover her next shift.  Thankfully most appointments last week were not that kind of nail biters, but I have come to realize that for many folks coming in, deferring treatment for a couple of weeks will result in non-regainable deterioration of their condition, difficulty keeping up with their job (think grocery stockers, delivery drivers, and young parents), and increased risk for ending up in an overloaded acute care health system. So for now we plod along with a lot of bleach, and a willingness to adapt every day. 

Before parting, please allow me to share a few insights. The bad: the reality of the situation is that life will not just go back to normal magically after April 10th.  The two week sheltering order is time to plan the next phase, in particular how we emerge from the shutdown to a safe “new normal”.  There is a breadth of non-acute health care services that need to resume (think dental, optometry, addiction treatment, preventive care), before they turn into a heap of acute and late stage problems.  Some of the patients we are deferring now fall in that category and we need to find a way to expand access to those folks before too long.  The good: folks out there (or more accurately in there), seem to finally take the social distancing recommendations to heart and this will pay off in a couple of weeks.  There is more information coming out about what truly transmits COVID in asymptomatic and presymptomatic patients (will post link on site tomorrow) suggesting that outside of aerosol droplets from coughing or sneezing, normal breathing is much less of a vector than contact/touch. So being ruthless about what your hands touch and how diligent you are to keep your hands clean before you touch your face is a great way to prevent infection.  I started wearing disposable gloves anytime I enter a store and discard in the trash as I exit. I wipe down everything I bring in from the store with the 1:10 bleach solution before bringing them in the house.  These measures are annoying and time consuming, but in the scheme of things, a small investment for a great return. 

Many blessings and virtual hugs to all. Know that behind my surgical masks, I am still smiling at all of you. 

Fiona Demel DC

Increasing Food Allergies in Children: What Are Some of the Drivers-

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528619/?fbclid=IwAR0ePaWUz3ZZy1iFc_vSjTOtMz6qnTkUitqh41Ik4sF4zgWQkzKtaD1gDEY

Dr. Alvarez headed out on maternity leave at the end of last week. It was a chaotic time between wrapping up the treatment plan of some of her patients, transitioning those still needing care into my schedule, planning an enhanced infection control plan, etc… However my most important parting thoughts on Friday evening were still to spend a few minutes with Kaila ensuring that we have a good plan of action to check on her before she heads into labor and talk about baby health issues post delivery.

So baby health issues were still floating in my head as I was cleaning out the bowels of my inbox and came across this article that a friend had sent me last year. I had meant to post it ever since then but it must have been buried by another couple hundred emails before I got to it.

Food allergies and intolerances are truly on the rise, not just diagnosed more often. Some are severe and lead to immediate, recognized reactions, and some are slow, chronic, rolling into each other in a way that patients cannot clearly attribute their symptoms to one food or the other (and thus testing becomes really useful). The loss of oral food tolerance is certainly driven by many, many factors in our environment, but today I want to focus on a single one that is not getting a lot of attention: early infancy prescription of antacid for reflux medications.

Reflux in babies is not uncommon and can be frustrating to deal with. It is usually a diagnosis of exclusion with babies being generally fussy, averse to laying flat on their back, coughing after laying down, and sometime regurgitating a lot after eating. Reflux in babies is really an autonomic neurological issue with poor closing of the valve between the stomach and esophagus, but the mainstay medical treatment is with antiacids. It does offer relief from symptoms of the stomach acid coming up the esophagus, but it does so at a cost.

The mechanism by which acid blocking medications increase the development of food allergies is not completely understood but the theory is that the medicines lead to poor breakdown of protein in the stomach due to lowered acid, and that those larger proteins hitting the small intestine irritate the small bowel lining and can get across the intestine to the blood stream where the baby’s immune system will recognize them as foreign proteins that need to be fought off, much like a virus.

While the acid blocking medication may sometimes need to be used as an immediate short term treatment while you look for other ways to resolve the reflux, the goal should always be to do it for the shortest period of time. Chiropractic can be of help in many babies with reflux by looking at the neurological integrity of the upper cervical spine from birth straining.

Spring Cleaning

With our first baby due in a few weeks our spring cleanup will have to start a little early this year and with the beautiful weekend ahead of us, this is the perfect time to start! Oddly enough, I cannot wait to start cleaning with the windows open and the smell of fresh air! Is this normal or nesting? What is on your spring cleaning “to do” list? How will you be an effective contributor to your household while making sure to keep your body and stay healthy? And of course, how will you enjoy the outdoors this beautiful weekend?! We hope to enjoy a few walks, both for the outdoor, fresh air benefits and to get this baby moving :). Vacuuming our vehicles will be perfect to do too! 

A few tips to remember while spring cleaning:

• Bend at your knees and limit rounding through your low back

• Do you have a bunch of dog poop to clean up when the snow melts?

  • Challenge your kids or siblings to see who can pick up the most dog poop the quickest!

• Open up those windows and allow for some fresh air to sweep through the house!

• ENJOY IT, or try to :)

New Year, Accomplished Resolutions

If you are anything like most people, you have already begun and stopped your New Years resolutions. You tried starting out the new year with a number of goals or one massive goal and by the time February and March roll around they have become too difficult to maintain, not because you didn’t mean well, but because changing too much too quickly can be overwhelming and ultimately leads to failure. So, let’s try breaking that habit now, restart and start small. Create a small goal and expand on that each month. Start now and by the end of 2020 you will have accomplished 10 goals!

Example: 

1. March

   1. Eat an additional 1 cup of vegetables each day.

2. April

   1. Drink another 8 oz of water. 

3. May

   1. Walk outside for 10 minutes a day.

4. June

   1. Eat an additional 1 cup of vegetables a day.

5. July

   1. Get in an additional 3,000 steps in a day. 

6. August

   1. Swim 2 times per week.

7. September

   1. Go trail hiking 1 time per week.

8. November

   1. Drink another 8oz of water a day.

9. December

   1. Limit sugar consumption during gatherings.

      • 1 piece of dessert.

These are just some examples, change these small goals into something YOU want to accomplish.

Meeting Protein Requirements in Athletes: The Type of Protein Matters

https://www.ncbi.nlm.nih.gov/pubmed/31835510

There is a raging debate going on worldwide around our dinner table about where our food should come from. The debate primarily centers around the consumption of animal products and its purported implications with ethical and environmental considerations. This is a heated debate with many facts being tossed around and from the digging I have done over the past 5 + years, with many facts that do not pass the test of scientific scrutiny.

The purpose of this blog is NOT to engage in the debate, which would take thousands of pages, but to highlight a concern that I am more frequently coming in to contact with in my daily practice. Many youngster are opting for a diet devoid of any animal products, and many of these youngsters also happen to be athletes. Their assumption is that they will meet their athletic protein requirements, both in quantity and amino acid quality, from their dietary choice.

Depending upon which source you pick, the daily requirement for an active athlete varies from 1.8 to 3 grams of protein per kilogram of body weight. You don’t even need to be an athlete to at times need a higher protein intake (elderly at risk of muscle loss, obese patients with metabolic syndrome, etc.). Meeting that protein quantity need with a strict plant based diet can be very difficult, and require someone to ingest a very large amount of calories since all plant based proteins contain a fair amount of carbs and/or fats along with the protein. Moreover, the protein quality score and digestibility score of plant based protein (the DIAAS scale, revised in 2013 and the gold standard since), is showing that the highest DIAAS vegan food score is still lower that the lowest animal DIAAS score. Thus getting the right mix of amino acids for muscle and soft tissue building is also limited by the source of protein.

There is an argument that you can still meet the target for protein quantity and amino acid mix by supplementing a strict plant based diet with higher amounts of fractionated/isolated protein such as pea/rice powder. That is thankfully true since a lot of people will still opt in for a vegan diet for personal reasons, however you then need to consider three implications:

• These protein powders are no longer a “whole food”. Their manufacturing require some degree of chemical altering and sometimes quite a bit.

• Isolating the protein portion of a plant food also eliminates some of the beneficial nutrient of the plants (fiber and some of the vitamins). It creates a secondary waste byproduct of the non-protein portion of the plant that has to be dealt with.

• The manufacturing of a protein powder is an energy intensive process, which can negate the whole idea of a low carbon and low energy foot print of the plant.

The idea is not to force anyone to change a deeply held personal belief about how they eat, but to consider all of the implications of the choices that you make. My main concern is to make sure that our youngsters do not put themselves at risk of athletic injuries because of protein quantity/quality deficiency. They can achieve that by mixing and matching animal and plant protein sources, or supplement a strict plant based diet with a robust amount of protein isolates.

Free Online Yoga Video Resources

https://www.youtube.com/user/yogawithadriene

I have had a lot of follow up questions from our winter exercise workshop and thought I would more broadly share this resource. Due to a change in schedule at my gym, I can only attend one yoga class a week in person and have been supplementing with one at home routine. The series above is totally free, the classes are well balanced for beginner to more robust options, there are duration options ranging from 10 min to 45 min, and the classes tend to be fun (anyone who brings their dog to the yoga practice can easily get my vote). Lots of great resources out there but for those of you who don’t have time to look this is a good starting place.

Upper Neck Alignment and Its Domino Effect on Brain Circulation and Long Term Brain Disease

https://www.hindawi.com/journals/nri/2015/794829/

For the past three weeks I have mostly been buried under the administrative tasks that come with the annual accounting cycle of a small business (after hours, of course, the office days have kept us hopping). This year has been a little worse than usual with the re-platforming of some software on the cloud , some very icy and slow driving conditions, and the residual paperwork of adding two new staff members, Anne and Dr. Kaila (although the latter is clearly the only bright spot of the trio).

I finally decided to treat myself this morning to a brief “nerd safari” through a big backlog of research podcasts that have been displaced by the admin work, and boy, I was in for a real treat! A colleague had recommended a book by the late Dr. Flanagan, a bit of a chiropractic genius that did research well ahead of his time and with late recognition. His book “The Downside of Upright Posture”, is on my reading list once I finally emerge from my administrative dog house, but in the meantime I still had a chance to peruse his fantastic research paper published in 2015. Dr. Flanagan’s research focused on the little explored relationship between the transition of humans from the four legged stance to the upright two legged posture, and how this shift of the head and neck in gravity has been the source of much problems as the design of our lower brain stem and upper neck junction is very vulnerable to compression and backflow with minor injuries. The venous backflow in the largest vein of the neck, the jugular, can be measured on MRI imaging.

While this excitement may seem irrelevant, there are some profound implications for the chiropractic profession, with focus on upper neck post trauma intervention. In his paper, Dr. Flanagan points to research showing that some of the most life altering chronic residuals from neck and head injuries can be autonomic symptoms (POTS, dizziness, anxiety, arrhythmias, fainting etc…), and in the long term, an increased rate of neurodegenerative disease (Parkinson’s, ALS, dementia). Those residuals may be the results of the venous backflow cascade to the brain, and may be improved by specific manual interventions to the upper cervical spine with a “draining” effect on the venous backflow. Obviously, there is a lot more research to be done to quantify that correlation, but the take home message for now is that chiropractors should really pay close attention to signs of upper neck trauma residuals in individuals with presenting autonomic symptoms and address them.

Already Thinking About Movement as Part of your 2020 Resolution???

Dr. Alvarez and I have some rather hilarious discussions about patient management, which get even weirder by the end of our very busy work weeks. When contemplating the topics for our first quarter monthly education series, the topic of continued exercise routines during the winter months was a natural choice, but what to call it wasn’t so easy. After tossing around some very boring headlines ( 5 tips for winter wellness, bluh ), we decided that we needed something with a little more bite without getting too insulting. Hence the title Winter Couch Potatoes 101, which, we hope will be a good happy medium (you be the judge).

https://fiona-demel-ara5.squarespace.com/config/pages

At any rate, I hope that in spite of your post Christmas blues you will brave the cold on January 13th at 5:30 to join us for a 70 minute hands on presentation of an assortment of half hour workouts that can be done at home with little equipment and little to no cost. After 25 years of practice I see a real alarming trend in patients who get extremely deconditioned in the winter months since they find it difficult to leave the house in the cold and dark, are justifiably concerned about walking on icy surfaces, have scheduling challenges, or lack funds for a gym or group exercise classes. The half hour workouts will include a variety of options that can match a variety of physical abilities including: yoga, light aerobic routine, strength routines, etc… We will use multiple online resources that are free or have minimal costs, and demonstrate the very basic needed equipment needed to effectively exercise at home. Come with your sweatpants and be ready to have a little fun.