Say you have neck or back pain. How will you treat it? Many people will go to a medical doctor who will look at the symptoms, such as pain, and treat it with prescription or over the counter medications. In some cases, they may recommend surgery to manage the pain or correct the problem. But there is a safe and less expensive alternative. Chiropractic is the better choice over drugs and surgery!
An increasing number of people are foregoing the medical doctor and opting for chiropractic care for pain management � and often with excellent results. So, what is it about chiropractic that people feel makes it a better choice than drugs or surgery for their pain or mobility issues? There is more to the answer than you may realize.
Drug Therapy
When it comes to certain types of pain, particularly neck pain, medication is not the best way to manage it. Studies show that patients who opted to undergo chiropractic treatments and exercise regularly were more than twice as likely to significantly reduce their pain or even eliminate it entirely, compared to those who choose to take medication.
Aside from efficacy though, many medications have unpleasant and even dangerous side effects. Even over the counter medications can cause problems.
For instance, acetaminophen has been linked to serious health issues like pancreatitis and impaired liver function. NSAIDs like ibuprofen can upset the stomach and can cause rebound headaches in migraine patients (studies show that chiropractic is extremely effective in preventing migraines).
Prescription drugs can be highly addictive and lead to overdose. The Centers for Disease Control (CDC) has declared opioid addiction and overdose in the United States to be an epidemic. They have set forth guidelines for doctors who prescribe opioids for chronic pain, but the epidemic continues.
Surgery
Any treatment that can help a patient avoid invasive surgery is an optimal alternative, and chiropractic care provides that. One study shows that patients who saw a medical doctor as their first treatment option when dealing with back pain were more likely to have surgery than patients who say a chiropractor first.
Almost 43% of the medical patients eventually underwent surgery while only 1.5% of chiropractic patients had surgery. This means that if you are a medical patient trying to resolve your back pain you are 28 times more likely to eventually have surgery for it than you would if you went to a chiropractor.
Aside from the obvious invasiveness of the procedure as well as recovery time and probable physical therapy that would be required as part of your aftercare, there are many other downsides. The time and money necessary for the surgery, pre-surgery appointments, post-surgery appoints, recovery, and therapy can be significant.
However, a significant concern in hospital settings is the risk of C-diff (Clostridium difficile). C-diff is bacteria that can cause C. diff colitis, an inflammation of the colon or large intestine that can make you very sick. It can be passed from person to person but can also occur in people who take antibiotics � which are often given when a person undergoes surgery.
Chiropractic Care
Chiropractic care gets to the cause of the problem instead of treating the symptoms like most medical doctors. The whole-body approach also empowers patients to make lifestyle adjustments that aid in their care and healing. It allows them to take ownership of their health and pain management so that they feel more in control.
Chiropractors take a natural, holistic approach to pain management by bringing the body back into alignment if necessary and recommending exercises and other activities to help patients regain their normal range of motion and flexibility while relieving not only the pain symptoms but often correcting the problem that is causing the pain.
Diagnosis of the diseases of the abdomen can be classified into:
Abnormalities of the gastrointestinal tract (esophagus, stomach, small & large bowel, and the appendix)
Abnormalities of the accessory digestive organs (Hepatobiliary & pancreatic disorders)
Abnormalities of the genitourinary & reproductive organs
Abnormalities of the abdominal wall and major vessels
This presentation aims to provide the most basic understanding of general diagnostic imaging approach and appropriate clinical management of patients with the most common diseases of the abdomen
Imaging modalities used during an investigation of the abdominal complaints:
AP abdomen (KUB) and upright CXR
Abdominal CT scanning (with oral and I.V. contrast and w/o contrast)
Upper and Lower GI Barium studies
Ultrasonography
MRI (most used as Liver MRI)
MRI enterography & enteroclysis
MRI rectum
Endoscopic Retrograde Cholangiopancreatography (ERCP)- mostly hepatobiliary and pancreatic ductal pathology
Nuclear imaging
Why Order An Abdominal X-ray?
Include a preliminary evaluation of bowel gas in an emergent setting. For example, a negative study in a low probability patient may obviate the need for a CT or other invasive procedures
Evaluation of radiopaque tubes, lines, and radiopaque foreign bodies
Post-procedural evaluation intraperitoneal/retroperitoneal free gas
Monitoring the amount of bowel gas and resolution of postoperative (adynamic) ileus
Monitoring the passage of contrast through the bowel
Colonic transit studies
Monitoring renal calculi
What to Note on AP Abdomen: Supine vs. Upright vs. Decubitus
Free Air (pneumoperitoneum)
Bowel obstruction: Dilated loops: SBO vs LBO (3-6-9 rule) SB-upper limit-3-cm, LB-upper limit-6-cm, Caecum-upper limit-9-cm. Note loss of haustra, note dilation (presence) of valvule conivente (plica semilunaris) in SBO
SBO: note different heights air-fluid levels on upright film step ladder� appearance, typical of SBO
Note paucity of rectal/colonic gas (evacuated) in SBO
Abdominal CT scanning -modality of choice during the investigation of acute and chronic abdominal complaints especially in adults. For example, abdominal malignancy can be successfully diagnosed and staged providing clinical information for care planning
Abdominal, renal and pelvic ultrasound can be performed to help the diagnosis of appendicitis (esp. in children), acute & chronic vascular pathology, hepatobiliary abnormalities, obstetric and gynecological pathology
Use of ionizing radiation (x-rays & CT) should be minimized in children and other vulnerable groups.
Diagnostic Imaging of Major Diseases of the Gastrointestinal System
1) Esophageal disorders
2) Gastric carcinoma
3) Gluten Sensitive Enteropathy
4) Inflammatory Bowel Disease
5) Pancreatic ductal adenocarcinoma
6) Colorectal carcinoma
7) Acute Appendicitis
8) Small bowel obstruction
9) Volvulus
Esophageal disorders
Achalasia (primary achalasia): failure of organized esophageal peristalsis d/t impaired relaxation of the lower esophageal sphincter (LOS) with marked dilatation of the esophagus and food stasis. Obstruction of the distal esophagus (often due to tumor) has been termed “secondary achalasia” or “pseudoachalasia.� Peristalsis in the distal smooth muscle segment of the esophagus may be lost due to an abnormality of Auerbach plexus (responsible for smooth muscle relaxation). Vagus neurons can also be affected
Primary: 30 -70s, M: F equal
Chagas disease (Trypanosoma Cruzi infection) with the destruction of the Myenteric plexus neurons of the GI system (megacolon & esophagus)
However, the heart is the M/C affected organ
Clinically: Dysphagia for both solids and liquids, in comparison to dysphagia for solids only in cases of esophageal carcinoma. Chest pain and regurgitation. M/C mid esophageal squamous cell carcinoma in approximately 5% due to chronic irritation of the mucosa by stasis of food and secretions. Aspiration pneumonia may develop. Candida esophagitis
Imaging: �Bird -beak� on upper GI barium swallow, dilated esophagus, loss of peristalsis. An endoscopic exam is crucial.
Rx: difficult. Calcium channel blockers (short -term).Pneumatic dilatation, effective in 85% of patients with 3 -5% risk of bleeding/perforation. Botulinum toxin injection lasts only approx. 12 months per treatment. May scar the submucosa leading to increased risk of perforation during subsequent myotomy. Surgical myotomy (Heller myotomy)
10 -30% of patients develop gastroesophageal reflux (GERD)
Presbyesophagus: used to describe the manifestations of degenerating motor function in the aging esophagus >80-y.o. Due to interruption of the reflex arc with decreased sensitivity to distension and alteration in peristalsis.
Patients may complain of dysphagia or chest pain, but most are asymptomatic
Diffuse/distal esophageal spasm (DES) is a motility disorder of the esophagus that may appear as a corkscrew or rosary bead esophagus on barium swallow.
2% of non-cardiac chest pain
Manometry is the gold-standard diagnostic test.
Zenker diverticulum (ZD) aka pharyngeal pouch
An outpouching at the level of the hypopharynx, just proximal to the upper esophageal sphincter, known as the Killian dehiscence or Killian triangle
Patients are 60-80 y.o and present with dysphagia, regurgitation, halitosis, globus sensation
May complicate with aspiration and pulmonary abnormalities
Patients may accumulate medications
ZD- is a pseudodiverticulum or pulsion diverticulum resulting from herniation of the submucosa through the Killian dehiscence, forming a sac where food and other contents may accumulate.
Mallory-Weiss syndrome refers to mucosal and submucosal tears of the distal oesophageal venous plexus associated with violent retching/vomiting and projection of gastric contents against the lower esophagus. Alcoholics are at particular risk. Cases present with painless hematemesis. Treatment is typically supportive.
Dx: imaging plays little role, but contrast esophagram may demonstrate some mucosal tears filled by contrast (bottom right image). CT scanning may help to exclude other causes of upper GI bleeding
Boerhaave syndrome: esophageal rupture secondary to forceful vomiting
Mechanisms involve forceful expulsion of gastric contents especially with large undigested foods when esophagus forcefully contracts against closed glottis with 90% occurring along left posterolateral wall
Hiatus hernias (HH): herniation of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity.
Many patients with HH are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric/chest pain, postprandial fullness, nausea and vomiting
Sometimes HH is considered synonymous with gastro-oesophageal reflux disease (GORD), but there is a poor correlation between the two conditions!
2-types: sliding hiatus hernia 90% & rolling (paraoesophageal) hernia 10%. The latter may strangulate leading to ischemia and complications.
Esophageal Leiomyoma is the M/C benign esophageal neoplasm. It is often large but yet non-obstructive. Gastrointestinal stromal tumors (GIST) are the least common in the esophagus. Should be differentiated from Esophageal carcinomas.
Imaging: contrast esophagram, upper GI barium swallow, CT scanning. Gastroesophagoscopy is the Dx method of choice.
Esophageal carcinoma: presented with increasing dysphagia, initially to solids and progressing to liquids with obstruction in more advanced cases
<1% of all cancers and 4-10% of all GI malignancies. There is recognized male preponderance with the squamous cell subtype due to smoking and alcohol. Barrett esophagus and adenocarcinoma
M: F 4:1. Black individuals are more susceptible than White individuals 2:1. Poor prognosis!
A barium swallow can be sensitive in identifying esophageal mass. Gastroesophagoscopy (endoscopy) confirms the diagnosis with tissue biopsy
Overall the most common malignancy is 2ndary gastric fundal carcinoma invading distal esophagus
Squamous cell is typically found in the mid esophagus, Adenocarcinoma in the distal region
Gastric carcinoma: primary malignancy of gastric epithelium. Rare before the age of 40. The median age at diagnosis in the United States is 70 years for males and 74 years for females. Japan, South Korea, Chile, and Eastern European countries have one of the highest rates of stomach cancer in the world. Stomach cancer rates are declining worldwide. Gastric cancer is the 5th causes of cancer-related death. Association with Helicobacter pylori infection 60- 80%, but only 2% population with H. Pyloris develop Stomach cancer. 8-10% have an inherited familial component.
Gastric Lymphoma is also linked to H. Pyloris infection. Gastrointestinal Stromal Cell Tumour or GIST is another neoplasm affecting the stomach
Clinically: No symptoms when it is superficial and potentially curable. Up to 50% of patients may have non-specific GI complaints. Patients may present with anorexia and weight loss (95%) as well as vague abdominal pain. Nausea, vomiting, and early satiety d/t obstruction may occur with bulky tumors or infiltrative lesions that impair stomach distension.
Prognosis: Most gastric cancers diagnosed late and may reveal local invasion with regional adenopathy, liver, and mesenteric spread. A 5-year survival rate of 20% or less. In Japan and S. Korea, early screening programmes increased survival to 60%
Imaging: Barium upper GI study, CT scanning. Endoscopic examination is the method of choice for the diagnosis. On imaging, Gastric cancer may appear as an exophytic (polypoid) mass or Fungative type, Ulcerative or Infiltrative/diffuse type (Linitis Plastica). CT scanning is important to evaluate local invasion (nodes, mesentery, liver, etc.)
Celiac disease aka non-tropical sprue aka Gluten-sensitive enteropathy: A T-cell mediated autoimmune chronic gluten-induced mucosal damage resulting in loss of villi in the proximal small bowel and gastrointestinal malabsorption (i.e., sprue). Considered in some cases of iron deficiency anemia of undetermined cause. Common in Caucasians (1 in 200) but rare in Asian and black individuals. Two peaks: a small cluster in early childhood. Typically in 3rd and 4th decades of life.
Clinically: Abdominal pain is the m/c symptom, malabsorption of nutrients/vitamins: IDA and guaiac-positive stools, diarrhea, constipation, steatorrhea, weight loss, osteoporosis/osteomalacia, dermatitis herpetiformis. Increased association with T-cell lymphoma, Increased association with esophageal squamous cell carcinoma, SBO
Dx: Upper GI endoscopy with multiple duodenal biopsies is considered a diagnostic standard for celiac disease. Histology reveals T-cell infiltration and lymphoplasmacytosis, Villi atrophy, Crypts hyperplasia, Submucosa, and Serosa are spared. Rx: elimination of gluten-containing products
Imaging: Not required for Dx but on Barium swallow fluoroscopy: mucosal atrophy and obliteration of mucosal folds (advanced cases only). SB dilation is the most typical finding. Nodularity of the duodenum (bubbly duodenum). Reversal of jejunal and ileal mucosal folds:
�The jejunum looks like ileum, the ileum looks like the jejunum, and the duodenum looks like hell.�
CD: chronic relapsing-remitting autoimmune inflammation that affects any part of the GI tract from the mouth to the anus but at onset most typically involves the terminal ileum. M/C presentation: abdominal pain/cramping and diarrhea. Path: granulomata formation that unlike UC is transmural, potentially leading to strictures. Areas affected by the inflammation are typically patchy
Complications are numerous: malabsorption of nutrients/vitamins (anemia, osteoporosis, developmental delay in children, susceptibility to GI malignancy, bowel obstruction, fistula formation, extra-abdominal manifestations: uveitis, arthritis, AS, erythema nodosum and others. 10- 20% may require abdominal surgery after 10-years of CD usually for strictures, fistiluzation, BO.
Dx: clinical, CBC, CMP, CRP, ESR, serological tests: DDx of IBD: anti-Saccharomyces cerevisiae antibodies (ASCA), perinuclear antineutrophil cytoplasmic antibody (p-ANCA) histologically or in serum. Fecal Calprotectin test helps to DDx IBS and evaluate response to treatment, disease activity/relapses.
Dx of choice: endoscopy, ileoscopy, and multiple biopsies may reveal endoscopic and histological changes. Video capsule endoscopy (VCE), Imaging may help with Dx of complications. Rx: immunomodulatory drugs, complementary medicine, diet, probiotics, operative. No cure but the aim is to induce remission, control symptoms and prevent/treat complications
Imaging Dx: KUB to DDx SBO, Barium enema (single and double contrast), small bowel follow through. Findings: skip lesions, aphthous/deep ulcerations, fistula/sinus tracts, String sign, creeping fat pushed loops of LB, cobblestone appearance d/t fissures/ulcers pushing mucosa, CT scanning with oral and IV contrast.
Imaging from a Crohn’s patient who had a small bowel resection for obstruction.
(B) MRE of the same area shows a fibrostenotic stricture
UC: characteristically involves only the colon but backwash ileitis may develop. Onset is typically at 15-40s and is more prevalent in males, but the onset after the age of 50 is also common. More common in North America and Europe (hygiene hypothesis). Etiology: A combination of environmental, genetic and gut microbiome changes are involved. Smoking and early appendectomy tend to show a negative association with UC, unlike in CD considered some of the risk factors.
Clinical Features: Rectal bleeding (common), diarrhea, rectal mucous discharge, tenesmus (occasionally), lower abdominal pain and severe dehydration from purulent rectal discharge (in severe cases, especially in the elderly), fulminant colitis and toxic megacolon can be fetal but are rare complications. Pathology: No granulomata. Ulcerations affect mucosa and submucosa. Pseudopolyps present as elevated spared mucosa.
An initial process always affects the rectum and remain a local disease (proctitis) in (25%). 30% Proximal disease extension may occur. UC may present as left-sided (55%) and pancolitis (10%). Majority of cases are mild to moderate
Imaging: not required for Dx but barium enema may reveal ulcerations, thumbprinting, in advanced cases loss of haustra and narrowing of the colon producing �lead-pipe colon.� CT scanning may help with Dx seen as mucosal thickening detected only in moderate and severe cases. CT may help with of Dx of complications. Plain film image reveals �lead-pipe colon� and sacroiliitis as Enteropathic arthritis (AS)
Colorectal carcinoma (CRC) m/c cancer of the GI tract and the 2nd most frequent malignancy in adults. Dx: endoscopy and biopsy. CT is the modalities most frequently used for staging. Surgical resection may be curative although the five-year survival rate is 40- 50% depending on staging. Risk factors: low fiber and high fat and animal protein diet, obesity (especially in men), chronic ulcerative colitis. Colonic adenomas (polyps). Familial adenomatous polyposis syndromes (Gardener syndrome) and Lynch syndrome as non-familial polyposis.
Clinically: insidious onset with altered bowel habits, fresh blood or melena, iron deficiency anemia from chronic occult blood loss especially in the right-sided tumors. Bowel obstruction, intussusception, heavy bleeding and metastatic disease especially to the Liver may be initial presentation. Path: 98% are adenocarcinomas, arise from pre-existing colonic adenomas (neoplastic polyps) with malignant transformation. The five-year survival rate is 40-50%, with stage at operation the single most important factor affecting prognosis. M/C rectosigmoid tumors (55%),
N.B. Some adenocarcinomas esp. mucinous types typically presented late and usually carry poor prognosis due to late presentation and mucin secretion and local/distant spread
Imaging: Barium enema is sensitivities for polyps >1 cm, single contrast: 77-94%, double contrast: 82-98%. Colonoscopy is a modality of choice for prevention, detection, and identification of colorectal carcinoma. Contrast-enhanced CT scanning is used for staging and prognosis evaluation of mets.
Screening: colonoscopy: men 50 y.o.-10-years if normal, 5-years if polypectomy, FOB, 1st degree relative with CA begin surveillance at 40 y.o
Pancreatic Cancer: ductal epithelial adenocarcinoma (90%), very poor prognosis with high mortality. 3rd M/C abdominal cancer. Colon is #1, stomach #2. Pancreatic cancer accounts for 22% of all deaths due to gastrointestinal malignancy, and 5% of all cancer deaths. 80% of cases in 60+. Cigarette smoking is the strongest environmental risk factor, a diet rich in animal fats and protein. Obesity. Family history. M/C detected in the head and uncinate process.
Dx: CT scanning is crucial. Invasion of Superior Mesenteric Artery (SMA) indicates unresectable disease. 90% of pancreatic adenocarcinomas are unresectable at Dx. Most patients die within 1-year of Dx. Clinically: painless jaundice, abd. Pain, Courvoisier�s gallbladder: painless jaundice and enlarged gallbladder, Trousseau�s syndrome: migratory thrombophlebitis, new onset diabetes mellitus, regional and distant metastasis.
CT Dx: pancreatic mass with strong desmoplastic reaction, poor enhancement, and slightly lower attenuation compared to the adjacent normal gland, SMA invasion.
Appendicitis: very common condition in general radiology practice and is a major cause of abdominal surgery in young patients
CT is the most sensitive modality to detect appendicitis
Ultrasound should be employed in younger patients and children
KUB Radiographs should play no role in the diagnosis of appendicitis
On imaging, appendicitis reveals inflamed appendix with wall thickening, enlargement, and periappendiceal fat stranding. Similar findings of wall thickening and enlargement are noted on US. Typical �target sign� is noted on short axis US probe position.
If the appendix is retro-caecal than US may fail to provide accurate Dx and CT scanning may be required
Rx: operative to avoid complications
Small bowel obstruction (SBO)-80% of all mechanical intestinal obstruction; the remaining 20% result from large bowel obstruction. It has a mortality rate of 5.5%
M/C cause: any Hx of previous abdominal surgery and adhesions
Classical presentation is constipation, increasing abdominal distension with nausea and vomiting
Radiographs are only 50% sensitive for SBO
CT will demonstrate the cause of SBO in 80% of cases
There are variable criteria for maximal small bowel obstruction, but 3.5 cm is a conservative estimate of dilated bowel
On Abd x-ray: supine vs. upright. Dilated bowel, stretched valvulae conivente (mucosal folds), alternative air-fluid levels �step ladder.� Absent gas in the rectum/colon
Rx: operative as �acute abdomen.�
Volvulus-m/c in the Sigmoid colon esp. in elderly. The main reason: chronic constipation with redundant sigmoid twisting on sigmoid mesocolon. Leads to Large bowel obstruction (LBO). Other common causes: a colon tumor. Sigmoid vs. Caecum volvulus
Clinically: signs of LBO with constipation, abdominal bloating, pain, nausea, and vomiting. Onset may be acute or chronic
Radiographically: loss of haustra in the LB, LB distension (>6-cm), �coffee bean sign� next slide, the lower end of volvulus points to the pelvis
N.B: Rule of thumb for dilated bowel should be 3-6-9 where 3-cm SB, 6-cm LB & 9-cm Coecum
There has been an increasing number of professional athletes and athletic teams in recent years that have chosen to use chiropractors to treat their injuries, help manage their pain, and help keep them at the top of their game concerning performance and stamina. Top athletes like Jordan Spieth, Phil Mickelson, Vernon Davis, and Aaron Rodgers recognize that value in good chiropractic care and have incorporated it into their overall health and wellness programs.
One of the biggest draws is chiropractic�s whole-body approach to health care. A chiropractor will not just treat the symptoms of a problem (such as pain), he or she will work to uncover the cause of the problem and recommend lifestyle changes that will help the athlete not only eliminate their pain, but resolve the issue causing the pain, and take steps to help prevent the problem from recurring.
The NFL Chooses Chiropractic
The National Football League (NFL) has long kept chiropractic care as a standard treatment for its players. The Professional Football Chiropractic Association estimates that the average team chiropractor for the NFL will perform anywhere from 30 to 50 chiropractic adjustments or treatments a week during the football season.
When you consider that the NFL teams employ around 35 chiropractors, that adds up to about 27,000 adjustments in that short 16-week span, but it�s worth it to keep the players in tip-top shape, and many continue chiropractic care even after they retire.
The PGA Chooses Chiropractic
Many top golfers in the Professional Golfers� Association (PGA), such as Arnold Palmer, Jack Nicklaus, and Phil Mickelson see chiropractic care not only as a necessary element in their wellness routines but also as a playing a vital role in their success.
Many use it to enhance their athletic performance, help prevent injuries, help heal from injuries, manage pain, and improve their overall health. Some golfers, like Masters Tournament winner Jordan Spieth, have a chiropractor who travels with him on a full-time basis and provides treatments several times a day.
Olympic Teams and Chiropractic
At the Olympics, the best of the best compete � and put their bodies through a lot of stress and punishment in the process. Most Olympic teams have two chiropractors who travel with them in an official capacity.
After practice or competition, they will get treatments to keep their bodies at optimal performance level. If any of the athletes sustain injuries, the chiropractors can help to manage pain and help heal the injury. Studies show that most injuries that are treated with chiropractic care heal faster and more complete.
The MLB, NBA, and NHL Choose Chiropractic
Most of the teams in the NHL, NBA, and MLB either have a chiropractor they refer to that is outside, or their organization or they have one on staff. This means that not only are chiropractors treating athletes, but they are also treating some of the best athletes in the world.
These people make a living based on how well their bodies perform so it stands to reason they would not turn to just any type of treatment or trend. They choose to reap the benefits of the tried and true chiropractic care.
Chiropractic for Athletes
Athletes know the many benefits that they can get from regular chiropractic care. Some of the top include:
It is drug-free and non-invasive.
It is very effective in pain management.
It can reverse the punishment that the body undergoes while participating in sports.
If you play sports, even if you enjoy a game of touch football on the weekends, you might benefit from chiropractic care. If it�s good enough for the pros, it�s good enough for you!
Migraines affect an estimated 38 million people, including children, in the United States alone. Worldwide, that total jumps to 1 billion. Migraine ranks number three among common illnesses in the world and number six among disabling illnesses. More than 90% of people who suffer from migraines cannot function normally or work during an attack.
A migraine attack is often debilitating and extremely painful. It is also challenging to stop once it starts. The best treatment for migraines is to prevent them from ever occurring. Several methods work for some people, but chiropractic is a popular preventative measure that many people have found to help them be migraine-free.
Migraine Symptoms
A severe headache is the first thing people think of regarding migraines, but there are other symptoms which include:
Pain located on one or both sides of the head
Photophobia (sensitivity to light)
Blurred vision or other visual disturbances
Pain that is pulsing or throbbing
Lightheaded and possibly fainting
Hypersensitivity to smell, taste, or touch
Loss of motor function or, in more severe cases, partial paralysis (such as with hemiplegic migraine)
Some migraineurs experience auras before an attack, usually around 20 to 60 minutes. This can give the patient time to take specific measures to stop the attack or minimize it. However, it is still the right course of action to incorporate certain activities into your lifestyle to prevent migraines.
Causes of Migraines
Doctors don’t know the exact causes of migraines, but research does indicate that certain triggers can initiate an attack. Some of the more common migraine triggers include:
Foods Processed foods, salty foods, aged cheeses, and chocolate.
Beverages Coffee and other caffeinated drinks as well as alcohol (particularly wine)
Hormonal changes occur mainly in women, usually during menopause, menstruation, and pregnancy.
Food additives Monosodium glutamate (MSG) and aspartame, as well as certain dyes.
Stress Environmental, stress at home or work, or illness that puts strain on the body.
Sleep problems Getting too much sleep or not getting enough sleep.
Sensory stimuli Sun glare and bright lights, strong smells like secondhand smoke and perfume, and specific tactile stimulation.
Medication Vasodilators (nitroglycerin) and oral contraceptives.
Physical exertion Intense exercise or other physical exertion.
Jet lag
Weather changes
Skipping meals
Change in barometric pressure
Some research also shows a possible serotonin component. Serotonin is integral to regulating pain in the nervous system.
During a migraine attack, serotonin levels drop. Migraine Treatments
Migraine treatments are classified as either abortive or preventative. Abortive medications primarily treat symptoms, usually pain relief. They are taken once a migraine attack has already begun and are designed to stop it. Preventative medications are typically taken daily to reduce the frequency of migraines and the severity of attacks. Most of these medications can only be obtained by prescription, and many have unpleasant side effects.
A migraine specialist can recommend medications and other treatments, including acupuncture, massage therapy, chiropractic, acupressure, herbal remedies, and lifestyle changes. Adequate sleep, relaxation exercises, and dietary changes may also help.
Chiropractic for Migraines
A chiropractor will use a variety of techniques when treating migraines. Spinal manipulation of one of the most common, usually focusing on the cervical spine. By bringing the body into balance, it can relieve the pain and prevent future migraines. They may also recommend vitamin, mineral, and herbal supplements and lifestyle changes, which usually eliminate triggers.
One migraine study found that 72% of sufferers benefitted from chiropractic treatment with noticeable or substantial improvement. This is proof that chiropractic is an effective treatment for relieving pain and preventing migraines.
If you have low back pain�or have had it, you are not alone. Experts estimate that around 80% of people will experience some type of back problem at some point in their lives. The Global Burden of Disease 2010 lists low back pain as the number one cause of disability worldwide. The good news is the majority of back pain is mechanical in origin or is not organic. This means that infection, cancer, fracture, inflammatory arthritis, and other serious conditions are not the cause. In fact, you may benefit by looking to your feet, knees,�and hips as the culprits.
The spine is the foundation for the body, supporting the spinal cord and the limbs. When there is a problem with any of the limbs it can affect the spine and vice versa. The intricate network of tendons, ligaments, and nerves work together within the incredible machine that is the human body.
How the Feet Affect the Low Back
When there are problems with the feet, it can cause problems through the legs and all the way to the spine. This can cause the ankle to pronate, meaning it rolls inward. This alters the way the bones of the foot line up which extends through the tibia, or shin bone.
This can cause a condition called knock knees and it can change the way the entire body is aligned. This puts the body out of balance, destabilizing the spine, and can even cause the pelvis to tilt to one side or the other. When you are walking or standing, the stress caused by the misalignment it can create a domino effect, causing or contributing to low back pain.
How the Knees Affect the Low Back
One thing to remember when assessing pain in the body is that where it hurts may not be the source of the problem. It could be a symptom. Because of this, knee pain could be caused by a problem with your back and back pain could be caused by a problem with your knees.
It is important to take this type of pain at more than face value and do a little investigating to find the cause. That is why chiropractic is so beneficial in these situations.
If you see a chiropractor for your knee or back pain, he or she will assess your issues, talk to you about the pain you are experiencing and help you get to the root of your problem so that you can treat it and, in turn, help correct other associated issues. Knees connect the foot and spine so problems that affect the feet and ankles,�as well as the spine, will very likely affect the knees and hips as well.
How the Hips Affect the Low Back
Muscle imbalances in the hip, such as tight hip flexors, can cause low back pain � or at least contribute to it. When the hip flexor muscles are too tight, it causes what is known as an anterior pelvic tilt.
In other words, the muscles cause an anterior pull on the pelvis. This affect posture and throws the entire lower body out of alignment. It can also affect the knees and feet if left untreated.
Hip flexors can become too tight if the person sits for extended periods of time or engages in activities like cycling and jogging. A chiropractor can guide you through exercises that will help release the tight muscles and stop the micro spams that occur as a result.
He or she will also assess your knees, feet, and ankles to ensure that the issue has not through them out of alignment as well. Correcting the cause of the problem will often correct the associated issues and resolve the pain allowing you to return to your normal activities.
Multiple sclerosis, or MS, is a chronic disease of the central nervous system, or CNS. While the etiology of the disease remains unknown, research studies have found that environmental factors, such as nutrition, may have an impact on the occurrence and development of MS. Other research studies specifically analyzed the association between certain dietary factors in multiple sclerosis, such as fat, dairy and meat consumption. Multiple sclerosis, or MS, epidemiology suggests that dairy is primarily involved in the clinical expression of the disease. The purpose of the following article is to show the effects of cow’s milk allergy in multiple sclerosis patients.
Abstract
Background: Exposure to some environmental agent such as different nutrition and contact with allergens may have a role in developing multiple sclerosis (MS). The present study was aimed to evaluate the cow’s milk allergy (CMA) in MS patients compared to healthy controls.
Materials and Methods: Between March 2012 and July 2012, 48 MS patients were selected and compared with 48 healthy subjectsto assess the frequency of CMA in MS patients compared to healthy control. Cow’s milk specific immunoglobin E (IgE) was determined by Immuno CAP. Sex and the frequency of CMA were compared between study groups by Chi-square test.
Results: Total of 96 subjects were assessed (22% male and 78% female). The mean age of the study subjects was 30.8 � 6.6 years. Mean age of case and control groups was 30.7 (�6.9) versus 30.9 � 6.3, respectively (P value = 0.83). There were no detection of cow’s milk specific IgE in serum of MS patients and healthy subjects.
Conclusion: There was no difference between MS and healthy subjects regarding CMA.
Keywords:Allergy, cow’s milk, multiple sclerosis
Introduction
Multiple sclerosis (MS) is achronic inflammatory demyelinating disease of the central nervous system (CNS)[1] and it is one among the common causes of neurological disability in young adults especially, women.[2] Autoimmune processes due to defects in regulatory T cells and failing of suppression auto-reactive CD4+ and CD8+ cells is suggested have a role in pathogenesis of disease.[3]
Although, the etiology of MS is unknown, there are some evidences for convolution with both genetic and environmental influences on susceptibility. Relative vitamin D deficiency,[4,5] Epstein-Barr virus,[6] and smoking[7] are among environmental factors that all have been associated with increased susceptibility to MS. Nutrition is another environmental factor thatpossibly involved in pathogenesis of MS.[8] Furthermore, dietary factors are frequently mentioned as a possible cause, there are very few clinical trials based on specific diets or dietary supplements in MS and there is no evidence in this respect.[9] Higher intake of different food compounds were considered to be associated with increased risk of MS[9] such as sweets,[10] alcohol,[11,12,13] smoked meat products,[10] coffee, tea,[11] and yet, none of these data were approved by subsequent studies. In 1991, in a study, it has been reported that dietary factors or food allergies may be among major causes of MS beginning and progression.[14] In the other hand, vitamin D has been implicated as being a risk-factor in MS,[15,16,17] and it is reported that decreased levels of 25-hydroxyvitamin D are associated with an increased risk to develop MS.[18] Furthermore, the totality of evidence for a protective role of vitamin D in MS has been supposed strong enough by some to warrant recommending vitamin D supplementation to people with MS.[19] Cow’s milk allergy (CMA) has an indirect potential to cause 25-hydroxyvitamin D deficiency from affected individuals tend to avoid dairy of cow’s milk products.[20]
In infancy, cow’s milkis the most frequently encountered dietary allergen, and the incidence of CMA varies with age.[21] In infants and adult the reported prevalence of CMA varies between studies; however, it is clear that CMA is common allergy in early childhood, with a prevalence of 2-6%,[22] and decreases with age.[23]
It is believed that exposure to some environmental agent that occurs before puberty may begin autoimmune process and pre-dispose a genetically susceptible person to develop MS later on. Based on this fact, the hypothesis of a link between milk consumption and MS has been considered since many years ago and epidemiological studies were carried out to support this correlation.[24]
It is considered that improvement of immunological defenses effect on treatment of MS patients, therefore, detection of allergens and elimination of them from the diet could decrease disability of patients,
The present study was aimed to evaluate the CMA in MS patients compared to healthy controls.
Materials and Methods
Between March 2012 and July 2012, 48 MS patients (referring to MS clinic of the referral universityhospital in Isfahan) were selected and compared with 48 healthy subjects (among patients� companions and acquaintances as control group) to assess the association between CMA and MS. MS patients were diagnosed to definitely develop MS according to the McDonald Criteria.[25] Patients were eligible if they had not received corticosteroids during last month and immunosuppressants over the last 3 months. This study was investigated and approved by the ethics committee at the Isfahan University of Medical Sciences and all subjects were explained about the aim and the purposes of the study and written informed consent was obtained from all of them.
Controls were matched with the patients in regard to age and gender. To determine the allergen-specific immunoglobin E (IgE) of cow’s milk, blood samples were taken from both groups of subjects and serum samples were transferred to the laboratory of Immunology.
ImmunoCAP (Phadia, Uppsala, Sweden) was used for allergen-specific IgE antibody in the serum of the subjects to be obtained. This technique is approved by Food and Drug Administration in US and has high-sensitivity and many good features[26,27,28] also in Iran are applicable only in the Asthma and Allergy Research Institute, Tehran University of Medical Sciences. Moreover, specific IgE antibody against cow’s milk was determined and applying statistical techniques, calculations were performed and results were extracted.
Data are presented as means � standard deviation or number (%) as appropriate. Independent sample t-test was used to compare age between groups. Furthermore, sex and the frequency of CMA were compared between study groups by Chi-square test. All analysis was carried out by the Statistical Package for the Social Sciences (SPSS)-20 and statistical significance was accepted at P < 0.05.
Multiple sclerosis, or MS, is a multifactorial, inflammatory, and neurodegenerative disease of the central nervous system which has been demonstrated to be closely associated with environmental factors like nutrition. Recent research studies on the role of diet in MS provided evidence that certain dietary factors, such as the consumption of dairy products like cow’s milk, influence multiple sclerosis incidence, disease course and symptomatology. According to these research studies, particular types of proteins found in cow’s milk have been demonstrated to stimulate the immune system of people with MS.
Dr. Alex Jimenez D.C., C.C.S.T.
Results
A total of 96 subjects were assessed and results of all blood samples were analyzed. On the total subjects, 22% were male and 78% were female and the mean age of the study subjects was 30.8 � 6.6 years. Table 1 shows the comparison of age, gender, and the frequency of CMA between study groups. As shown mean age of in case and control groups was similar and there was no statistical significant difference between groups (30.7 � 6.9 vs. 30.9 � 6.3 respectively, P value = 0.83). Of 22 male subjects, 50% were MS patients and 50% were controls. There was no significant difference between study groups in regard to gender composition. Results of CAP technique to determined allergen-specific IgE antibody against cow’s milk in MS patients and healthy subjects showed that, there was no any positive CMA in these subjects and there was no difference between MS patients and healthy subjects.
Discussion
Since many years ago the effect of diet such as fat intake in MS has been postulated.[29] There is a higher extent consumption of saturated fat, dairy products, and cornflakes (cereals) and a decrease in the consumption of unsaturated fat in area with high prevalence of MS.[29]
Though, the findings of these studieswere not confirmed by a large number of case-control studies, epidemiological studies have proposed the association between MS prevalence and animal fat consumption.[11,12,13] Because MS is believed to have an autoimmune basis, many factors such as dietary can induce autoimmunity and myelin breakdown by molecular mimicry.[30]
It seems that molecular mimicry may disrupt immunological self-tolerance to CNS myelin antigens in genetically susceptible individuals. CMA is one of the most common food allergen in infancy. It seems that immune system identifies some of proteins of milk as harmful and makes IgE antibodies to neutralize it. IgE antibodies recognize these proteins in next contact and signal the immune system to release some chemicals.[31]
Therefore, cow’s milk as a dietary protein has potential molecular mimicry with myelin autoantigens and may induce autoimmune process, so consumption of milk in MS patients may have a possible role in progression or relapse of disease. Furthermore, as mentioned earlier, vitamin D has been implicated as being a risk-factor in MS patients[18] and CMA transmits nutritional implications as affected individuals have a tendency to evade dairy products and have been shown to be lacking in 25-hydroxyvitamin D.[20]
Measurement of specific IgE confirmed an IgE-mediated sensitivity to cow’s milk and is a prognostic marker for persistence of CMA.[31]
In present study, we evaluated the cow’s milk IgE to find allergy to milk in MS patients compare to control as a marker of persistence CMA. The result of study did not show positive CMA in MS group and no difference between MS patients and control subjects.
Our findings was similar to result of Ramagopalan et al. study.[32] Ramagopalan, in a population-based cohort in 2010, investigated whether or not childhood CMA influences the subsequent risk to develop MS. They collected data by telephone interview from mothers of 6638 MS index cases and 2509 spouse controls in Canada and compared the frequency of CMA between index cases and controls and could not find any significant differences. Therefore, author concluded that childhood CMA does not appear to be a risk-factor for MS.
Another study suggested that factors of liquid cow milk influence on the clinical appearance of MS.[25]
Although, medical interest in the influence of diet on the rate and severity of MS disease were carried out,[33] as our best knowledge, there are few studies in food allergens and MS, so further studies are suggested to be carried out to investigate food allergens, in a large number of MS patients and healthy individuals based on individuals recall, then positive responses assess using advanced technique and results compared between MS patients and healthy subjects.
In summary, findings of our study investigated that there is no difference between subjects developing MS and healthy subjects regarding CMA and we could not find any association between CMA and MS.
Conclusion
This study evaluated the frequency distribution of cow milk allergy in MS patients compared to healthy controls. Although, there was no significant difference between two groups, the small sample size of MS patients may effect on the association of this hypothesis.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
Multiple sclerosis, or MS, is a chronic disease of the central nervous system, or CNS which is believed to be associated with environmental factors, such as nutrition. Research studies analyzing the association between certain dietary factors in multiple sclerosis demonstrated that dairy is primarily involved in the clinical expression of multiple sclerosis. The purpose of the article above was to show the effects of cow’s milk allergy in multiple sclerosis patients. According to the research study, dairy may have some effect on the prevalence of MS, although further research studies are still required to further conclude these findings. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topic Discussion:�Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Vincent Garcia trains in martial arts as a part of his activities. However, after he developed turf toe and he started to undergo knee pain, Vincent’s performance was affected. Dr. Alex Jimenez, a doctor of chiropractic, helped treat Vincent Garcia’s knee pain along with turf toe, gradually restoring his overall health and well-being. Dr. Alex Jimenez has also helped treat a variety of other sport-related injuries. Chiropractic care utilized corrections and manipulations that were manual to carefully restore the original integrity of the backbone, allowing the human body to heal itself. Vincent Garcia highly recommends Dr. Alex Jimenez as the non-invasive pick for many different accidents and/or conditions, including several sports accidents, among other problems.
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