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Are Insurers Aware of Their Legal Obligations to DCs?
My articles fall under the "ethics" column, but in reality, I attempt to offer information regarding ethical and legal business procedures.
Coffee: The Good, Bad & Ugly ... And Its Relevance to Your Treatments
Coffee is an integral part of American life. You see commercials with smiling people chatting over cups of coffee.
Acupuncture for Carpal Tunnel Syndrome
Statistical data indicates that "Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide." About three percent of the adult population suffers from it.
Concussions, Chiropractic and the Pituitary Dimmer Switch
You may remember one of my past columns, "Concussion: A Pituitary Dimmer Switch" (Aug. 1, 2016). In that article, I discussed evidence suggesting a history of concussion increases the risk of depressed pituitary function.
Did Big Pharma Shut Down Leading Integrative Pain Management Organization?
The Academy of Integrative Pain Management (AIPM) – known until a few years ago as the American Academy of Pain Management (AAPM) – has announced it is ceasing operations despite 30 years as a leading voice for integrative pain management and partner in the Integrative Pain Care Policy Congress (2017 and 2018), "the only collective of its kind to unite representatives from 75+ organizations and agencies – including licensed and certified health care professionals, public and private payers, people living with pain, federal agencies, purchasers of health care, researchers, policymakers, and policy experts – to improve access to comprehensive integrative pain management (CIPM) for all."
Dry Needling & Acupuncture Are the Same Procedure
A letter in response to the article "Dry Needling is not Acupuncture" by Steven Collins. This article, published in the March 2019 issue of Acupuncture Today takes the stance that due to the difference in philosophy behind applying Acupuncture and Dry Needling, they are therefore not the same procedure.
A Moment of Slience for Dr. Glenn Hultgren (1932-2019)
Dr. Glenn Hultgren, a longtime Colorado chiropractor and founder of the Christian Chiropractors Association (CCA), went home to be with the Lord on Feb. 5, 2019.
Getting Past the Landmines of a Disability Claim (Pt. 2)
When a new claims reviewer is assigned to your disability claim, do you know if the person has read your entire file?
ASA Launches New National Meeting for the Profession: Dr. Len Wisneski—A Key Speaker at the Event
The American Society of Acupuncturists' first national meeting, "The State of our Union," will be held June 1-3, 2019 in Washington, D.C.
Cervical Spine Degeneration: Treatment - Exam to ELDOA
Let's take a difficult chronic cervical degenerative case and discuss the rehab treatment options. Often these patients have hypolordosis, reversed curves, cervical degeneration and spondylolisthesis.
WebMD Makes Historic Invite to Chiropractors
WebMD enjoys monthly traffic of approximately 150 million visits (5 million a day), which is why it is widely considered the most popular health site on the Web.
New Discoveries in Old Concepts: Re-examining the Chinese Medicine Theory (Part 1)
This article, divided into three parts, aims at disclosing the flaws in TCM theories, elucidating modifications made to correct conceptual drawbacks, and providing a firm basis for balanced theoretical structures and highly reproducible clinical applications.
Top Social Media Do's & Don'ts
For years, health care practitioners have avoided embarking on the social media highway, primarily due to patient HIPAA privacy issues and the time needed to give the process due diligence.
CBD & Chinese Medicine (Part 2)
Clinically I have observed improvement in a wide range of presentations and their associated symptoms. The typical dose of sublingual oil is .5 - 1ml of organic whole plant hemp CBD oil at a concentration of 50 mg/ml, one to two times per day.
Beyond the Herb & the Needle
In my last column, I discussed a variation on the popular "Four Gates" acupuncture combination most commonly used for the common clinical expression Liver Depression Qi Stagnation.
A New Approach to Correcting SI Dysfunction (Pt. 2)
When an SI joint is fixed, the patient will typically have tenderness in the joint, but the degree of tenderness will vary over the course of the joint.
We Get Letters & Email
Seminar Adjusting Isn't the Problem; This Is. Give me a break. Dr. Lehman's entire article ["Quickie Seminar Adjustments Have No Place in Chiropractic," February 2019 issue] is a straw man written for the lawyers.
The Profession's "True" Opinion of Dry Needling
The opinions expressed by the author do not reflect the position of the acupuncture profession. Both the CCAOM, who develops academic and clinical guidelines and core curriculum requirements for master's level programs in acupuncture, and the NCCAOM who maintain evidence-based standards of competence and credentialing for acupuncturists agree that "dry needling is an acupuncture technique."
News in Brief
Doctor of chiropractic Named to NIH Advisory Council; Major Donation by Foot Levelers; In Remembrance: Nancy Singleton.
The Short Leg Dilemma Revisited
I was told I have a short leg, is one of the most common statements made during my new patient consults. It seems almost universal. Heel lifts are sold over the counter at every pharmacy.
Someone You Know Needs Chiropractic™
This is the slogan we have been using for almost two years in our latest effort to educate patients and get them to refer their families, friends and co-workers.
Pain in the Butt and Lateral Thigh: Pt. 2 - A Case Report
A recent case history offers the perfect model for this second installment. The patient is a 25-year-old male who works in a tire store and hurt his low back.
The "Other" White Crystal: There's More Than One Addiction in America
Traditional Chinese Medicine (TCM) is considered holistic medicine, this includes our knowledge base and ability to provide sound, and evidence based nutritional advice.
Is Dehydration the Cause? A Commonly Overlooked Etiology
Water covers 71 percent of the Earth's surface. It's found in every living organism and is considered the "universal solvent," yet we take it for granted as the foundation for optimal health.
NBCE: Successful Reboot of Computer-Based Testing
On Jan. 12-13, 2019, the National Board of Chiropractic Examiners (NBCE) administered Part I to 1,245 examinees at 18 chiropractic colleges.
Unifying State Associations
The year of the pig is underway—there are so many issues facing the profession that it's hard to know where to begin.
Surgeon General's Advisory on Conservative Care: What If?
U.S. Surgeon General Jefferson Carter, MD, MPH, is urging medical physicians to increase referrals to qualified doctors of chiropractic.
SLR Variations, Confirmation and Differential Diagnosis
Hip flexion and knee extension serve as the foundation for a number of radicular and sciatic tests, the most common being straight leg raising.
A Shocking Change at the NCCAOM
Although it's still early in the year, the NCCAOM is already changing things up ... again, with a "CEO transition."
Spirit of the Points: The Heart Meridian
The early Chinese considered their emperor to be God's representative on earth. As such, the emperor manifested those traits that we would all want in a leader, a president or a chief executive: goodness, wisdom, fairness, truthfulness, unselfishness, love for all.
Integrative Pain Management Takes a Huge Hit: AIPM Folds
The Academy of Integrative Pain Management (AIPM) – known until a few years ago as the American Academy of Pain Management (AAPM) – has announced it is ceasing operations despite 30 years as a leading voice for integrative pain management and partner in the Integrative Pain Care Policy Congress.
December, 2001, Vol. 01, Issue 12
Natural Anti-Inflammatory Supplements: Research Status and Clinical Applications
By James P. Meschino, DC, MS
Editor's note: Dr. James Meschino holds a masters degree in science with specialties in nutrition and biology. He is on the board of advisors of the Academy of Anti-Aging Research, and is the Clinical and Research Director for the RenaiSanté Institute of Integrative Medicine in Toronto.He is also an assistant professor in the division of Graduate Studies and Research at the Canadian Memorial Chiropractic College (CMCC,) and a postgraduate faculty member of the American Council on Exercise (ACE). In recent years, scientific studies have demonstrated that many forms of arthritis and joint inflammatory conditions can be managed effectively through specific dietary and supplementation practices, in addition to joint mobilization; manipulation; muscle therapy; acupuncture; and exercise.1
Beyond the use of glucosamine sulfate as an effective intervention to halt joint cartilage destruction and help regenerate new cartilage in osteoarthritis cases, substantial clinical and experimental evidence supports the use of other natural health products, which demonstrate proven abilities to block inflammation, and reduce the signs and symptoms of arthritis and other joint inflammatory conditions. Studies indicate that many of these natural agents provide similar efficacy as conventional anti-inflammatory drugs, and are safer to use with respect to reported adverse side-effects.
Most medical practitioners have failed to embrace these alternative anti-inflammatory agents, and tend to rely primarily on synthetic anti-inflammatory drugs as their principal approach to managing these problems.2 It is well documented that these nonsteroidal anti-inflammatory drugs (NSAIDs) produce intestinal tract ulcers (with potential internal bleeding) in 10-30 percent of long-term users, and erosions of the stomach lining and intestinal tract in 30-50 percent of cases.3 As a result of these side effects, NSAID use is associated with 10,000 - 20,000 deaths per year in the U.S.4 Even the new COX-2 inhibitor drugs have only been reported to reduce intestinal tract damage by 50 percent, and their toxicity to the liver and kidneys is still under review.5
Anti-inflammatory drugs have been shown to accelerate damage and erosion of joint cartilage, advancing the osteoarthritic process. Conventional NSAIDs are also known to cause liver and kidney damage with long-term use.6 These and other statistics have lead certain esteemed investigators to conclude: "The epidemiological data highlight the importance of implementing acetylsalicylic acid (ASA)/NSAID therapy only when strictly necessary."7
Reducing Inflammation Naturally
The discovery that certain natural agents produce marked anti-inflammatory effects presents an opportunity for chiropractors and other natural health practitioners to add an important and effective adjunct to the management of these cases.
As such, a review of the physiological action and clinical studies, involving the use of proven natural anti-inflammatory herbal agents, enables practitioners to use these substances in a safe and responsible way, and thereby help patients eliminate or minimize their reliance upon more dangerous NSAIDs and other synthetic anti-inflammatory drugs. Experimental research reveals that the efficacy of many natural anti-inflammatory agents stems from their ability to modulate the activity of the enzymes, cyclooxygenase and/or 5-lipoxygenase.8 The pathophysiology of joint inflammatory conditions involves the conversion of arachidonic acid to prostaglandin series -2 (PG-2) by the cyclooxygenase enzyme. PG-2 synthesis is known to produce a pro-inflammatory effect, exacerbating joint inflammatory conditions. Accordingly, the conversion of arachidonic acid to leukotriene B4 (LTB-4), by the 5-lipoxygenase enzyme within white blood cells, is also known to contribute to inflammation. White blood cell count in normal synovial fluid is less than 100ml on average. However, cellular response rises to 800ml or more in osteoarthritis and much higher than this in rheumatoid diseases, implicating white blood cells in the T-cell-mediated inflammatory response in inflammatory joint conditions.9 As is the case with many synthetic anti-inflammatory drugs, the active constituents of anti-inflammatory herbs have been shown to block the activity of the cyclooxygenase and lipoxygenase enzymes, inhibiting the synthesis of pro-inflammatory eicosanaoids of the PG-2 and LTB-4 series. These natural substances have been shown to reduce inflammation and pain associated with various types of arthritis and traumatic joint injuries. Unlike their synthetic counterparts, they have not been shown to cause erosion injury to the intestinal tract, accelerate cartilage destruction or produce liver and kidney toxicity.8 For these reasons, the following herbal agents can be considered viable alternatives to conventional anti-inflammatory drugs in a large percentage of arthritic patients and those suffering from other joint inflammatory conditions.
Effective Anti-Inflammatory Herbs and Supplements
Curcumin is the active anti-inflammatory agent found in the spice turmeric. It has been shown to inhibit the activity of the 5-lipoxygenase and cyclooxygenase enzymes, blocking the synthesis of pro-inflammatory eicosanoids (PG-2, LTB-4). A large double-blind study demonstrated that curcumin was as effective as a powerful anti-inflammatory drug (phenylbutazone) in reducing pain, swelling and stiffness in rheumatoid arthritis patients. It has also been shown to be effective in the treatment of postsurgical inflammation. Other studies indicate that curcumin can lower histamine levels and is a potent antioxidant. These factors may also contribute to its anti-inflammatory capabilities.
For best results, practitioners should consider using a 95-percent standardized extract of curcumin derived from turmeric. As a singular agent, the daily dosage to consider is 400-600mg, taken one to three times per day. (Lower doses can be used as part of a combination formula containing other anti-inflammatory agents). Side effects are rare, but primarily include heartburn and esophageal reflux. As curcumin inhibits the cyclooxygenase enzyme system, it may reduce platelet aggregation and thus may potentiate the effects of anti-coagulant drugs. To date, no bleeding disorders have been reported with curcumin supplementation, but its concurrent use with warfarin or coumadin should be considered a contraindication.2,8,10,11,12,13,14
Boswellia -- In clinical studies, the gum resin of the boswellia tree (yielding 70 percent boswellic acids) has been shown to improve symptoms in patients with osteoarthritis, and rheumatoid arthritis.12,13 Research indicates that boswellic acids inhibit the 5-lipoxygenase enzyme in white blood cells. As a singular agent, the usual dosage is 150mg, one to three times per day. (Again, lower doses are effective when combined with other natural anti-inflammatory agents.) Boswellia appears to have no important side-effects or drug-nutrient interactions of concern.15,16
White Willow Bark Extract provides anti-inflammatory phenolic glycosides, such as salicin, which have been shown to be effective in the treatment of arthritis, back pain and other joint inflammatory conditions. These phenolic glycosides are known to inhibit cyclooxygenase, blocking the production of PG-2, and exert a mild analgesic effect.
Unlike ASA, naturally occurring salicin (salicylic acid) does not irreversibly inhibit platelet aggregation, reducing the potential for a bleeding disorder. White willow extract has been shown to be slower acting than ASA, but of longer duration in effectiveness. The usual dosage is 20-40mg of salicin, one to three times per day. (Note that 100mg of white willow extract at a 15 percent standardized extract of salicin content yields 15mg of salicin per dosage. A lower dosage can be used as part of a combination formula containing other anti-inflammatory agents.)
Side-effects are rare, but primarily include nausea, headache and digestive upset. Contraindications may include conditions where ASA is contraindicated, including gout; diabetes; hemophilia; kidney disease; active peptic ulcer; glucose-6-phosphate dehydrogenase deficiency; and possibly asthma. However, the salicin content in a single dosage of white willow extract is very low compared to the content of ASA (e.g., 15mg vs. 320mg ); thus, these conditions may not be absolute contraindications for the use of white willow bark extract. It is important to realize that besides salicin, white willow extract contains other phenolic glycosides, which are also known to possess anti-inflammatory properties.8,17,18,19
Ginger Root Extract contains oleo-resins that have shown clinical benefit in the management of various arthritic and muscle inflammation problems, including rheumatoid arthritis, osteoarthritis, and myalgias. The active constituents in this regard are gingerols (oleo-resins), which inhibit the cyclooxygenase and lipoxygenase enzymes. The usual dosage is 500mg, one to three times daily, standardized to a five-percent gingerol content. (A lower dosage can be used as part of a combination formula containing other anti-inflammatory agents). Side-effects are rare, but include heartburn and digestive upset. It should not be given to patients with gallstones. It may also induce a mild anticoagulant effect (by inhibiting cyclooxygenase enzyme in platelets), therefore it should not be taken concurrently with warfarin of coumadin. However, there are no reports of bleeding disorders with ginger supplementation and no adverse drug - nutrient interactions have been reported in the scientific literature to date.2,8,14,20,21
Bromelain contains anti-inflammatory enzymes that have the proven ability to suppress the inflammation and pain of rheumatoid arthritis and osteoarthritis, sports injuries, and other joint inflammatory conditions. Bromelain has been shown to inhibit the cyclooxygenase enzyme, inhibiting the synthesis of PG-2. Bromelain also helps to break down fibrin (fibrinolytic), thereby minimizing local swelling. The usual dosage is 400mg, one to three times per day (a lower dosage can be used as part of a combination anti-inflammatory formulation). Bromelain may inhibit platelet clotting and is a known for its fibrinolytic properties. Therefore, it may potentiate the effects of anticoagulant drugs such as warfarin and coumadin, and should not be recommended in these cases.2,8,14,22,23,24
Quercetin is a bioflavonoid compound that blocks the release of histamine and other anti-inflammatory enzymes at supplemented doses (minimum 100-1500mg per day). Although human studies with arthritic patients are lacking at this time, anecdotal evidence is strong for this application, as is experimental research investigation. There are no well-known side effects or drug-nutrient interactions for quercetin. 14,25,26,27
Devil's Claw contains the anti-inflammatory agent harpogoside. Devil's claw has demonstrated efficacy in the management of low back pain and is used traditionally as an anti-inflammatory by numerous southern African tribes. The usual dosage is 100-400mg, one to three times per day (a lower dosage can be used if part of a combination anti-inflammatory formula). The only consistently reported side-effect is mild digestive upset on rare occasions. It is contraindicated in patients with active gastric ulcers (may increase gastric acid secretion) and in patients taking warfarin or coumadin (due to its anticoagulant effects).8,14,28,29
The body of evidence supports the use of natural anti-inflammatory agents as viable alternatives to synthetic drugs or as a means to help patients lower their requirements for conventional anti-inflammatory pharmaceutical agents. A number of quality-oriented companies manufacture single and combination natural anti-inflammatory supplement products that meet the above dosage and standardized grade criteria, along with dietary changes to lower arachidonic concentrations, support joint cartilage synthesis and promote the formation of anti-inflammatory eicosanoids (e.g., PG-1 and PG-3). Massage therapists may consider discussing the use of these herbal and accessory nutrients with clients suffering from arthritis and other inflammatory joint conditions.
Click here for previous articles by James P. Meschino, DC, MS.
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