Dementia has been particularly on the mind of our family recently as we are dealing with a loved one in accelerated decline. This has been very puzzling to us since there is no known history anywhere else in the family. This article reminds me that there are a lot of modifiable risk factors for dementia, and diet is a big one. In particular, processed foods diets which are known to be low in some key nutrients for brain longevity have been pretty clearly documented as a risk factor. Current stats showed that the average American is consuming 60% of their diet from highly processed foods. This is alarming in many ways.
Remember that when it comes to dementia risk, inherited genetic factors appear to be making up only 15% of the total risk pool for the average person. The rest is in your camp.
NECK AND SHOULDER PAIN AFTER BREAST SURGERY
I have meant to blog about this for a while, but it always takes a couple of really whopper cases of something to move me in that direction, and last week was no exception. I saw probably one of the worst case of post breast surgery pain that I have seen in a decade.
When I graduated from school 29 years ago. It never occurred to me I would be working on feet and breasts as much as I do. When you consider that 20% of the American adult population suffers from daily impairing foot pain, the foot work should not come to you as a surprise, but the work on the chest wall and breasts associated soft tissues probably will. The reality I encounter in practice is that a lot of women will have breast surgeries for variety of reasons: mostly mastectomies or lumpectomies for breast cancer, breast reconstruction surgeries, and some elective surgeries.
Thankfully, when you consider the sheer number of women having breast surgeries every year, a lot of them will come through the experience with full recoveries and no further issues. However, even with the small percentage of women having complications, that is still an enormous amount of women walking around with daily discomfort in the area of the breast itself, the armpit, the anterior neck and shoulder, and sometimes down the arm.
The most common issues I tend to run into and hopefully address in women post breast surgeries are the following:
– Pain along the anterior neck, upper back, and shoulder blade. This is often the result of generalized shortening of the anterior tissues in the chest wall, post surgery scar tissue, and immobilization, causing some anterior jutting and internal rotation of the shoulder, pulling on the shoulder blade.
– Pain along the breast tissue itself, most commonly along the lateral breast, chest wall, and axilla. This is most commonly associated with scar tissue formation on the lateral aspect of the breast. This is often associated with a phenomenon referred to as "chording", which refers to a form of scar tissue formation that looks like the strings of a musical instrument.
– Pain or tingling, numbing down the arm. This is often mistaken for secondary cardiac complication and leading to multiple cardiac testing and chest CAT scans. The scar tissue from the breast surgery and the immobilization can lead to some strangulation of the neurovascular bundle in the axilla. Patients will often have a shooting tingling pain down the triceps, as well as a sensation of hot and cold in the arm that remains unexplained.
– Continued uncomfortable swelling in the armpit to the upper arm, from lymphedema associated with scar tissue obliterating normal lymph return.
The treatment for these issues boils down to several concurrent interventions including:
– Chiropractic adjustments to the neck, thoracic spine, shoulder blade, and shoulder.
– Rehabilitative exercises to restore normal alignment of the shoulder girdle.
– Intense soft tissue scar manual therapy, to improve normal lengthening and flexibility of the affected tissues. This would include specific nerve to soft tissue manual adhesion release therapy, which often produces lasting relief of chronic breast and arm pain.
– When necessary lymph drainage therapy.
– Home self-care including knowing how to stretch, sometimes self treatment of soft tissue adhesions.
– Sometimes supportive home measures such as sports taping of the breast to improve normal realignment of the breast tissue towards midline and avoiding crowding of the armpit where the neurovascular bundle to the arm is located.
– Picking out the right bra going forward to properly support and shift the breast implant material post mastectomy scar.
Free Online Exercise Resources for Seniors through the Silver Sneakers Program
https://tools.silversneakers.com/
I'm running into senior patients more frequently who have not fully returned to a robust exercise program, primarily because they have opted out of returning to a physical gym facility or group classes. Some of it is driven by various factors, including some very legitimate ones that have to do with difficulty driving and not being able to get away from caregiving duties.
Many seniors are not aware of Silver Sneakers resources at all, and the majority of them are definitely not aware of the online classes that are offered by Silver Sneakers for free. These classes are both live stream classes, as well as on-demand classes from a pretty robust collection of videos that are catering to the needs of some of our seniors, including some balance limitations, arthritis, and people recovering from major illnesses with a lot of deconditioning requiring very gradual ramp-up.
Increasingly I find myself setting up patients to use these online videos and selecting the videos that I feel will be most appropriate for them based on their clinical needs at the time of the chiropractic encounters. Signing up for your free online Silver Sneakers account is ridiculously easy. All you need is your name, your date of birth, the zip code in which you live, and where your Medicare supplement policy is registered. You then have to pick a password and your account is all set up and ready to go.
If you would like set up a Silver sneakers account and need a little bit of help, let the staff know before scheduling your next appointment so they can give us a few extra minutes, and bring in whatever device you'll be using to life stream the videos.
Chiropractic Adjustments For Patients With Cervical Degenerative Discs: Latest Research
https://www.chiro.org/Chronic_Neck/Does_Cervical_Spine_Manipulation_Reduce_Pain.shtml
For some reason China has been putting out some great recent research on manual manipulation. This latest systematic review tackles a topic on which there is not a lot of published research: do patients benefit from manual adjustments for neck pain that is medically diagnosed as being primarily degenerative in origin? And even more interestingly, if the degeneration is causing pain into the arm? The answer is a resounding yes, and in relatively short period of time, a factoid that surprised even the researchers. So don’t let a diagnosis of cervical spine degeneration stop you from getting a chiropractic evaluation.
What is a disc bulge?
We recorded this short video recently to give people a visual of what a disc bulge is and is not. There is a lot of confusion about some of the MRI reports that our patients are bringing in, not understanding the difference between some normal changes in the shape of the disc margin associated with aging in degeneration, versus the true traumatic injury to the disc.
https://studio.youtube.com/video/shqZXi5C3bA/edit
WHAT PART OF MY CORE EXERCISES KEEP HURTING MY BACK ?
I've had several back-to-back patients who seem to be stuck in a perpetual cycle of reinjury, forced rest, and forced deconditioning. When we started to pick apart the reason for their reinjury, it became apparent that the patients were doing a whole core strengthening routine, and were not able to really identify which part of their workout may be the problem, and which one may not.
I find it pretty vital to make sure that people are able to keep up with some sort of normal conditioning program regardless of what issue they are dealing with. That will require a much more customized approach than simply releasing them back to their normal routine when they got hurt in the first place. To that effect, I will often spend 10 minutes with patients putting them through 12 simple maneuvers, to watch if any of them cause loss of form and pain. What the patient and I are finding out is that out of the 12, there are usually only one or two that are problem causing, while the rest can be safely done. With alternate maneuvers, modified maneuvers, or striking down that one maneuver altogether, the patient could go back to exercising without reinjury and with a sense of confidence that they can rebuild core strength and stamina. Don't let your fear of your normal exercise program prevent you from staying strong.
Tylenol during pregnancy: clearer links to autism and ADHD
https://birthinjurycenter.org/tylenol-link-to-adhd-autism/
I recently received an email from a nonprofit organization dedicated to the education about risk of birth defects and injuries, who somehow had stumbled upon my blog from a year ago in regards to new research on the risk of taking Tylenol during pregnancy. They forwarded me a link of new research on the risk of prenatal Tylenol use in regards more specifically to the increased incidence of ADHD and autism spectrum disorders in affected children.
The research is much more clearly seeing the correlation, and the 2019 NIH funded study was using objective measurements of Tylenol in utero exposure by measuring umbilical cord level rather than using self-reported measures, historically flawed.
This is bad news as so many women are being directed to use Tylenol for a variety of ailments during pregnancy, under the impression that is safe. There is likely to be a dose-response, meaning that taking one or 2 Tylenol during 9 months of pregnancy may not have an impact. But, I know plenty of women who use it almost daily to manage pain and headaches in particular.
Pregnancy is hard enough, and for some women the idea of not having any sort of pain rescue medication to make it through can be daunting, but I encourage every mom to read this article, pass it along, and try very hard to reach for nonpharmacological alternatives until after the baby is born. Many women still seem to be unaware that chiropractic care is readily available during pregnancy .
https://www.nih.gov/news-events/news-releases/nih-funded-study-suggests-acetaminophen-exposure-pregnancy-linked-higher-risk-adhd-autism
Cluneal Neuritis: A Pain in the Butt that Starts Much Higher
I had a patient last week who got a little testy with me because they thought I was not listening. And for once, I could plead not guilty.
At stakes was an acute episode of pain along the right upper buttock, just above the iliac crest. The patient was upset that I was working higher up in the lower midback, close to the last rib. She thought I did not correctly hear her out when she described her pain.
Pain along the iliac crest, just lateral to the lumbar spine, can be tricky to diagnose because a lot of structures reside in the area, and several neurological structures refer to the area as well. Most of the time, the pain is indeed coming from a local problem (upper sacroiliac, QL muscle, L5), but there is a pesky little sensory nerve bundle that travels all the way down from the lower midback and can cause mischief in the area. The distribution of the cluneal nerves is quite lateral, typically a vague achy sensation that patients have a hard time pinpointing, and sometimes associated with a tingling sensation. Cluneal neuritis will only respond to treatment in the area of origin, which is much higher than the area of pain. That is probably why I most often see it in its chronic stages, when patients have unsuccessfully tried various local therapies.