Chronic pain is one of the most prevalent conditions in the United States, affecting an estimated 100 million Americans each year. To put that into perspective, that�s more than the number of people suffering from cancer, heart disease, and diabetes, combined.
Many of these chronic pain sufferers are looking for relief beyond pharmaceuticals which can have unpleasant and even harmful side effects. This has brought them to natural pain management methods like chiropractic care as well as natural substances like curcumin. For many people, these treatment options have brought them relief from the pain and help them return to a more normal lifestyle.
How does it work though? And, more importantly, can it work for you?
What is Curcumin?
Natural herbal turmeric capsules with fresh herb leaves and dry curcumin in paper
Curcumin is a spice that is a relative of ginger and is a component of turmeric. Often in the U.S., the terms curcumin and turmeric are used interchangeably. However, curcumin is what gives turmeric its bright yellow color.
While it is often found in curries and other traditional Indian food, it has also long been used to treat a variety of health issues including inflammation that causes pain in the body. These claims have been backed up by several studies that show the tasty spice has tremendous health benefits to offer.
These studies have shown that curcumin has strong anti-inflammatory properties although why it works is not yet completely understood. This information has prompted further studies to determine the efficacy of curcumin in treating a wide range of conditions including chronic pain.
One study examined the spice�s effects on people suffering from arthritis or joint pain. The results determined that turmeric extract (curcumin) supplements were just as effective as ibuprofen in relieving the pain in patients with knee osteoarthritis. It helped to reduce the inflammation that was causing the pain, bringing the patients much-needed relief.
Taking Curcumin for Better Health
You can get curcumin or turmeric supplements, but there is no standard dosage information available. Your chiropractor can advise you on how much to take and which supplement brands are the best.
You can also use the spice in the foods you eat and gain a good bit of the health properties that way. However, it may be more efficient and more comfortable to take curcumin or turmeric supplements, especially when you are treating inflammation and pain.
Curcumin is generally safe with very few side effects. As with any medication or supplement, some people are sensitive to the spice and may experience diarrhea and nausea.
However, that usually occurs at higher doses or after the patient has been using it for a long time. High doses could also pose a risk if the person has ulcers. It can also irritate the skin is applied topically.
If you are considering incorporating curcumin into your daily diet as a health supplement, you should first talk to your doctor or chiropractor to make sure it is safe for you. Women who are pregnant or nursing should not take the supplements.
People with conditions like diabetes, gallbladder issues, bleeding disorders, kidney disease, or immunity problems should take special care when using the supplement. Also, it can interact with medications like NSAIDs, aspirin, diabetes drugs, statins, blood thinners, and blood pressure medications so talk to your health professional, such as your chiropractor, before taking. They may adjust your dosage or recommend certain nutritional therapies to better support the supplement.
Your chiropractor can help you live a more natural, pain-free life and supplements like curcumin may be a part of that plan. They can help put you on the path to a life well lived.
Why is it that the ketogenic diet and intermittent fasting always seem to fall within the same topic of conversation? This is simply because intermittent fasting may be utilized as an instrument to achieve ketosis, the metabolic state associated with the keto diet. During intermittent fasting, the human body is depleted of glycogen stores. Once these glycogen stores are eliminated, fat stores are then released into the bloodstream in order to be converted into energy molecules, known as ketones, from the liver.
What is Ketosis?
Ketosis is a metabolic state which uses ketone bodies, or ketones, as fuel for energy. On a normal carbohydrate-based diet, the human body burns glucose as its main fuel source, where excess glucose is subsequently stored as glycogen. If the human body cannot utilize sugar as fuel for energy, it will utilize glycogen as fuel for energy. Once glycogen is depleted, you begin to burn fat. The ketogenic diet generates a metabolic state which enables you to break down fat into ketones, or ketone bodies, in the liver for energy.
There are 3 major types ketone bodies found in the blood, urine, and breath, including:
Acetoacetate: The type of ketone which is created first. It may be converted to beta-hydroxybutyrate or flipped into acetone.
Acetone: Made spontaneously in the breakdown of acetoacetate. It is a very volatile ketone and it is frequently detectable on the breath once an individual first enters ketosis.
Beta-hydroxybutyrate (BHB): The type of ketone which is utilized for energy and is most abundant on the bloodstream as soon as you’re completely into ketosis. It is the kind that is located in exogenous ketones and what blood tests quantify.
Intermittent Fasting in the Keto Diet
Intermittent fasting is composed of eating within a specific feeding window rather than eating throughout the day. Each individual, whether they are conscious of it or not, fasts intermittently from dinner to breakfast. There are lots of methods to intermittent fasting. A few individuals fast for 16-20 hours intervals on alternate days while others follow a 24-hour day fast. The most common intermittent fasting variety is the 16/8 method, in which you eat in an 8-hour window followed by a 16-hour fasting window.
Other fasting programs incorporate the 20/4 or even 14/10 methods. Other people follow 24-hour fasts one or two times each week. Intermittent fasting can get you in ketosis quicker because your cells will immediately absorb your glycogen stores and begin burning fat. However, what about once you get into ketosis? Is intermittent fasting worth following consistently? Following the ketogenic diet and intermittent fasting can be a great addition towards an individual’s overall health and wellness, providing various health benefits.
The keto diet and intermittent fasting can provide the following health benefits, including:
Healthy weight-loss
Fat reduction, not muscle reduction
Balancing cholesterol levels
Enhancing insulin sensitivity
Maintaining blood glucose levels steady
Health Benefits of the Ketogenic Diet
The ketogenic diet dramatically reduces your caloric intake, forcing your body to burn fat instead of sugar, which makes it a powerful tool for weight reduction. While individual results vary, the keto diet has always resulted in a decrease in body fat in a selection of situations. Within a 2017 study, subjects who followed a very low carbohydrate keto meal program significantly decreased body fat percentage and body fat mass, losing an average of 7.6 lbs and 2.6 percent body fat while preserving lean muscle mass.
Likewise, a 2004 research detecting the long-term consequences of a ketogenic diet in overweight patients discovered that the weight and body mass of those patients diminished dramatically over the span of two decades. Individuals who radically reduced their carb intake saw a substantial decline in LDL (bad) cholesterol, triglycerides, and enhanced insulin sensitivity. In 2012, researchers compared a ketogenic diet to eating fewer calories for overweight kids and adults. The results showed kids after the keto diet lost significantly more body fat. They also revealed a dramatic decline in insulin levels, a biomarker of Type 2 diabetes.
Health Benefits of Intermittent Fasting
Studies have shown that intermittent fasting may be an effective weight loss tool, more powerful than just cutting calories. In one analysis, intermittent fasting has been proven to be as successful as constant calorie restriction in combating obesity. In studies done by the NIH, there was reported weight reduction with over 84 percent of participants, regardless of which fasting program they picked.
Much like ketosis, intermittent fasting increases fat loss while preserving lean muscle mass. In one study, researchers reasoned that fasting led to greater weight loss compared to a low-carb diet, though the overall caloric consumption was exactly the same. If you are attempting to lose weight, then a keto diet or intermittent fasting can be a massive help. But that is not where the rewards stop.
Intermittent Fasting and the Keto Diet for Mental Health
Both intermittent fasting and the ketogenic diet can provide various mental health advantages. Both have been clinically shown to boost memory, improve mental clarity and focus, as well as prevent the development of neurological disorders like Alzheimer’s and epilepsy. On a carb-based diet, changes in glucose can cause changes in energy levels. During ketosis, your brain employs a more consistent supply of fuel: ketones from the fat stores, leading to better productivity and psychological performance.
Whenever you’ve got a consistent and clean energy source from ketones, the brain works better. In addition to this, ketones are better at protecting your brain. Studies reveal that ketone bodies might have antioxidant properties which protect your brain cells from free radicals and oxidative stress. In one study conducted on adults with diminished memory, the growth of BHB ketones in their own blood helped enhance cognition. Also, when you’ve got difficulty staying focused, your hormones can be to blame.
Your brain has two chief neurotransmitters: glutamate and GABA. Glutamate will help you form new memories, and get your brain cells to communicate with one another. GABA is what helps restrain glutamate. If there is too much glutamate, it can cause brain cells to quit working and finally perish. GABA is there to control and slow down glutamate. If GABA levels are reduced, glutamate reigns free and you experience mental fog. Ketones stop damage to cells by processing surplus glutamate into GABA. Considering that ketones raise GABA and lessen glutamate, they assist in preventing cell damage, preventing cell death and enhancing mental focus.
Researchers believe that intermittent fasting enhances memory, decreases oxidative stress, and conserves learning abilities. Since your cells are under moderate strain whilst fasting, the top cells adapt to the stress by improving their particular ability to deal with these circumstances while the weakest tissues die. This is much like the strain that your body gets when you reach the gym.
Exercise is a kind of stress that your body adjusts to improve and get more powerful. This also applies for intermittent fasting: so long as you are still alternate between routine eating habits and fasting, it is going to continue to benefit you. Implying equally that ketosis and intermittent fasting will help improve your cognitive functioning because of the synergistic and protective effects of ketones.
The ketogenic diet and intermittent fasting are two different nutritional strategies which provide many common health benefits. According to various research studies, both the keto diet and intermittent fasting can help boost ketones, helping the body burn fat more efficiently than any other nutritional strategy. And when these are utilized together, they definitely form a powerful dietary program. The article above discusses the differences between the ketogenic diet and intermittent fasting as well as demonstrates the health benefits of both of these dietary programs and how they can help improve overall health and wellness. Dr. Alex Jimenez D.C., C.C.S.T. Insight
The Perks of Intermittent Fasting and the Keto Diet
The ketogenic diet and intermittent fasting possess similar health benefits because both approaches involve ketosis. Ketosis has lots of physical and mental advantages, from weight loss to enhanced brain function. People following a ketogenic diet may use intermittent fasting as a tool to achieve ketosis and enhance their general well-being. 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. �
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.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
