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October 30, 2010

Rickrolling another generation.

Chaperoned a party at my son's school tonight.  As the next to last tune the DJ played "Never Let You Down" by Rick Astley. The kids were dancing and having a great time. I don't consider myself a part of the cultural or intellectual "lete", but a couple of us parents had a tough time keeping our smug grins under control - yet another generation was innocently being Rickrolled - made my evening! Give it another 20 years and this song might actually be "in" again!

October 25, 2010

Low vitamin D may raise cancer risk


U. ROCHESTER (US) — Two new vitamin D studies suggest intriguing ties between a deficiency of D and breast and colon cancer, particularly among African Americans.

The research adds to mounting evidence that some connection exists between vitamin D and cancer, although it is not yet known how vitamin D modifies or contributes to cancer risk. Evidence is also inconsistent as to whether vitamin D might be used for cancer prevention.

Many of the body's tissues and cells have vitamin D receptors, making it a potent regulator of cell activity and growth. Researchers report vitamin D might generally improve DNA repair, reduce inflammation, and promote the death of potentially malignant cells.

October 23, 2010

Sorry honey, no more pole dancing!

Today, I had the curious experience of being asked for an "intyg" (doctor's note) for a patient that needed to take a break from pole dancing class due to recurring low back pain.  A first for me!!
Thankfully, it was "recreational pole dancing" not for "professional purposes" - or so I was told. What has the world come to??!!

October 17, 2010

Study Suggests Yoga Can Help Counteract Symptoms of Fibromyalgia.

James W. Carson, et al. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain, 2010; 151 (2): 530  Cited from Sciencedaily.com (Oct. 14, 2010).

According to new research conducted at Oregon Health & Science University, yoga exercises may have the power to combat fibromyalgia -- a medical disorder characterized by chronic widespread pain.

"Previous research suggests that the most successful treatment for fibromyalgia involves a combination of medications, physical exercise and development of coping skills," said James Carson, Ph.D., a clinical health psychologist and an assistant professor of anesthesiology and perioperative medicine in the OHSU School of Medicine. "Here, we specifically focused on yoga to determine whether it should be considered as a prescribed treatment and the extent to which it can be successful."

The researchers divided a total of 53 participants in two groups: one test and one control group. After eight weeks both groups were reasessed both with questionnaries and physical exams with regard to pain, fatigue, stiffness, poor sleep, depression, poor memory, anxiety and poor balance.  The yoga group did better not only statistically but also to the extent that improvemnts were clinically visible.



October 08, 2010

Seven Steps to Avoid Burnout.


The author outlines real world steps to avoid burnout:
1. Plan ahead, avoid overcommitting
2. Separate work and leisure time
3. Set boundaries for expectations from others
4. Keep sharp boundaries between work and play
5. Eliminate "busy work"
6. Create connections to "other realities"
7. Maintain a healthy lifestyle - including exercise.

Comments: The timestamp on this one is going to reveal that I am in gross violation of at least two of these recommendations - but this how I relax and have fun.
Personally, I would probably add a few points:
8. Keep the faith (if you have one). If you believe in God: Know that there are no accidents, no random events and that most events in your life have a purpose - even if you may not be able to realize it for one or five or ten years later (been there!!).
9. In reference to #8: Keep a positive perspective and avoid the trap of continuing to feel like a victim.  Take control of your emotions and reclaim the mastery of your life: Do what you have to do; find Faith, find your source of passion, reinvent yourself in charity, find your destiny - but find something - most importantly something more important than yourself and your current circumstances! 

October 04, 2010

Benefits of Taking Naps At Work

Harvard Business Review, Blog.  Tony Schwartz.

The author reviews a series of physical and mental advantages to short duration naps.  This includes increased energy level, faster reaction times, vastly improved productivity and improved learning ability.
The internet search firm Google, recognizes the importance of having a rested and energetic crew and actually provides napping pods for its employees.

My comments: Alternatives to naps include certain kinds of meditation ("providing a serious "power nap" effect), and music with frequencies scientifically proven to be able to drive the brain into deep restful states, such as products from www.pzizz.com.

October 01, 2010

Side effects of QTF

In 1995, Canadian insurers sponsored a study to assess the effects and severity of whiplash injuries in Canada.  The effort was called Quebec Taskforce on Whiplash Related Disorders (QTF), and was produced by a number of prominent researchers and authorities.  The study was later published by the prestigious journal, Spine.  These researchers were challenged to evaluate the relevant literature produced to date and produce a general assessment of the status and effects of whiplash.  The study, while initially generating a lot of buzz, has since been thoroughly discredited and is now regarded as deeply flawed and biased by many.  The reasons for this are many: When a study is sponsored by an insurer (an interested party= bias) the outcome is immediately suspect.  It was claimed that a large part of this bias manifested in the phase of the study where they excluded various studies, that in retrospect was counter the eventual final conclusions of QTF.  One of the conclusions was that most whiplash injuries heal within 6-12 weeks.  While that may be true for some, but certainly not all, it is also a handy argument ("I'm sorry Ma'am, research has proven that injuries such as yours heal within......, so we do not believe that you are actually hurt") for insurance companies both in court and when talking to injured insured parties, it is not true for a staggering number of real life whiplash victim. What's worse: For some people (and we seem them regularly in our offices, in Scandinavia I believe) are people who did not feel the effects of the injury immediately after, received no treatment and end up with headaches, numbness in the arms, memory and fatigue problems and dizziness years after.  X-rays may reveal loss of lordsis (normal neck curve) and extensive degenerative changes in the mid and/or lower neck, dating the injury back 5-15 years - right around the time of that accident where "nothing happened".
Thanks to extensive and relevant critique, QTF is no longer taken seriously by informed professionals, but could still be abused by unscrupulous parties elsewhere, say in Scandinavia, where the knowledge and experience about whiplash injuries is still in its infancy.

Effect of dark chocolate on blood pressure.

Authors: Karin Ried et al.  BMC Medicine 2010, 8:39 

In this meta-analysis, the authors looked at studies that investigated the possible effects of dark chocolate and other other flavanol-rich rich cocoa compunds on a couple of types of high blood pressure. Thirteen studies performed between1955 and 2009 met the inclusion criteria.

Meta analysis looked at the association between type of treatment, dosage, baseline bloodpressure.

It appears that dark chocolate indeed has a positive effect on blood pressure, or in scientific speak:"Our meta analysis suggests that dark chocolate is superior to placebo in reducing systolic hypertension or pre-diastolic prehypertension".  They were very excieted about their results, indeed. 

Just to be clear, this study did not include milk chocolate or white choclolate.

September 28, 2010

The Danger of NSAID painkillers - Diclofenac: Similar CV cardiovascular risk to Rofecoxib in health people

June 8, 2010 inCirculation: Cardiovascular Quality and Outcomes.
Background: The Cox-2 inhibiting anti-inflammatory (NSAID) drug Vioxx (Merck) was famously pulled from a host of markets following research that showed a marked rise in cardiovascular complications and deaths in patients who were on the drug.  Interestingly, other Cox-2 inhibitors, using very similar ingredients were allowed to remain on the market.  "NSAID" stands for "non-steroidal anti-inflamatory drug" which really means a non-cortizone related drug.

In their study, Emil Loldrup Folbøl et al investigated the dangers of similar drugs that remain on the market, including ibuprofen (in high doses), naproxen and Celebrex (Pfizer).  The study involved about 1 million Danes, who had filled at least one prescription of a relevant drug and fulfilled the other selection criteria.

They found a significant increase in death rates with odds ration 1.91 and 1.66 from use of Diclofenac and Rofecoxib, respectively. The sample size was insufficient to make any conclusions about the use of Celebrex. 
There was indications of increased risk of stroke (fatal and non-fatal) with high doses of ibuprofen (odds ration 1.29), Naproxen, however,  was not associated with an increased risk of cardiovascular failures.
 Their study also revealed that all NSAIDs, except Celebrex, dramatically increased the risk of serious increased internal bleeding. They also concluded that these various complications varied with the dose taken, meaning that patients who either took more or took it for a longer time were more likely to have complications.

My comments:  This story brings forth a whole host of possible comments, ranging from issues with governmental oversight, to positioning of inter-professional relationships, to public health and information issues - but I'll restrain myself.
I will choose just to concur with the authors' comments that most painkillers have some kind of side effect, ranging from negative to deadly and that most of them should be avoided as much as possible and for as long as possible. Wonder what the results would have looked like if they had focused in only on people who had taking these drugs for a year or longer ?   Having said that, in my daily work I do mention the possibility of managing pain temporarily with NSAIDs while we take care of the underlying causes. But that is as a temporary measure to help the patient cope in their daily life while we get them better - not as an actual treatment for the problem - and that is a major difference.

September 17, 2010

Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.

A Japanase study shows an 8% reduction in incidence of Influenza A in school children who were given 1200 IU Vitamin D per day preventatively during the fall periode. This was compared to a control group given a placebo treatment (designed to have absolutely no effect).  Considering the importance of Vitamin D in a host of other processes, making sure kids get adequate Vitamin D seems like a smart move.  Not sure how many studies there are on the efficacy of flu-vaccines, will have to look for that.

June 29, 2010

Free Chiropractic Lowers Illness Related Absensces

http://avisen.dk/gratis-kiropraktor-giver-lavt-sygefravaer_126376.aspx By Irene Stelling.
"Gratis kiropraktor giver lavt sygefravær"
By providing a package of free wellness services, which includes chiropractic, Hedensted Municipality in Denmark has reduced the already low sick leave duration of its workers to an even lower level, saving the municipality an estimated 10 mill Danish Crowns per year.

Kids & the Importance of sufficient Vitamin D.


Dr. Bo Nielsen of Doctors Natural reviews current research on Vitamin D. This important substance is actually horribly mislabeled: It is actually much less of a vitamin but rather acts as a hormone in a host of important processes, ranging from proper bone formation to immune system function.

June 28, 2010

Tur Att Ni Finns

"Tur att ni finns" ("I am happy that you are here") she had said casually as she exited the treatment room. On occasion a patient will say something along those lines to me, and I always smile and say "thanks", and under my breath thank God for my education and its ability to affect people's lives in such a positive way. Today, for reasons unknown, the comment hit me extra hard. The patient is a 70 year old woman who with her husband holds a small weekend extra job, that she dearly loves because it adds meaning and substance to her life.
We had just reminded each other of her status and state of mind when I first saw her about one year ago: She had been in tremendous pain, taking a daily cocktail of prescription painkillers,
which included Tramadol (morfine derivate) and anti-inflamatories (NSAIDs) - all with little or no effect. She was facing the necessity of giving up her beloved job which keeps her active and in contact with hundreds of people every week. She couldn't stand the pain from standing 8-10 hours a day, handling hundreds of 1 or 3 kilo bags. The medicine had virtually no effect and she did not know what to do.
Today, she is once again fully active, works like a maniac with no or few symptoms. She just had one of her busiest days prior to the Swedish Midsommer (equinox) celebration and she felt fine.
Through chiropractic care and a tailored stabilization program this patient had regained her health, her activity level and her quality of life. Yes, I guess so; "Tur att vi finns" - Gave me goosebumps all-over!

Eating Dark Chocolate Can Lower Your Blood Pressure

Good news: Dark chocolate has health benefits!
A group of Australian researchers have looked at studies from Medline, Cochrane and international trial registries from 1955 to 2009 for randomized clinical studies comparing to placebo, involving flavanol-rich products such as cocoa and thereby chocolate and the effect of systolic (the highest pressure) and diastolic (the lowest pressure) for a minimum of two weeks. While persons with normal blood pressure were not significantly affected, persons with high blood pressure (hypertension) and borderline (pre-hypertension) showed a statistically significant reduction in blood pressure. If only I like dark chocolate more!!

June 27, 2010

Insights of a Medical Heretic

http://www.dagensmedicin.se/asikter/blogg/gastbloggar/ingrid_eckerman/index.xml (in Swedish)
It's a blog, so read it from the bottom - up to get the time line right.
A retired medical doctor takes a critical look at her own profession and that of the governmental oversight body. Nice to see someone thinking independently for a change.

Work Disability after Whiplash.

Buitenhuis J, de Jong PJ, Jaspers JP, Groothoff JW. Work disability after whiplash: a prospective cohort study. Spine 2009 34(3):262-7.

A Dutch study done on the basis of 879 sent to people who had filed insurance claims following a car accident. Oftentimes, this scenario could spell trouble, as that there is amble opportunity for (deliberate or accidental) sampeling and statistical errors and other biases. This study appears to be without these flaws, however.
The purpose was to look at how neck pain after car accidents related to ability to work / disability over a period up to one year.
After 6 months, 51% remained symptomatic, and after 12 months 43.7% remained symptomatic. Of those 43.7%, about half (21.7%) still had persistent work disability (which in Holland most likely means total disability or off-work status).
The subjects were contacted at the 3, 6 and 12 months marks. Based on that information a statistically significant correlation was made between work disability and physical factors (including neck pain, stiffness, loss of motion, radiating pain in the arms, dizziness, headache intensity, and concentration problems.
Looking at the status at the 1 year mark, age and concentration problems proved to be good predictors for long term disabilty. No correlation was found between factors such as degree of manual labor (“blue/white collar” work), education level (as some insurance companies in some parts of the world sometimes like to imply).

10 Drinks Your Kids Should Not Be Drinking

From Dove, Laurie L. "10 Drinks Your Kids Should Not Be Drinking." 11 May 2010. HowStuffWorks.com. http://tlc.howstuffworks.com/family/10-drinks-kids-should-not-drink.htm

Good list to keep in mind along with some research and reasons as to why not.

1. Smoothies
2. Flavored water
3. Athletic power drinks (e.g. Gatorade)
4. Raw milk, juices and ciders
5. Fruit drinks posing as juices
6. Soft drinks (Coke, Fanta, etc.)
Over-sweetened tea drinks
8. Coffee
9. Energy drinks
10. Alcohol

Natural Treatment for Ulcerative Colitis (Ulcerös Colit)


Dr. Bo Nielsen of DoctorsNatural.com reviews new research regarding treating ulcerative colitis (ulcerös colit) with grapewine seed extract (in Swedish)

Good mood can run a long time after workout

From USA Today, June 2, 2009.By Nanci Hellmich, USA TODAY.
Exercise experts have known for years that moderate physical activity improves mood. Now a study shows that people are in a better mood for up to 12 hours after they work out.

Researchers at the University of Vermont had 24 college students ride an exercise bike for 20 minutes at a moderate intensity. Another 24 people did no exercise during the same time period.

Afterward, everyone in both groups filled out questionnaires that evaluated their overall mood at several intervals: one hour, two, four, eight, 12 and 24 hours. The questions addressed tension, anger, vigor, fatigue, confusion and depression.

The researchers found that people in the exercise group experienced a significant improvement in mood immediately after the exercise. They also had improved moods after two, four, eight and 12 hours compared with the people who didn't exercise, says Jeremy Sibold, an assistant professor in the university's Department of Rehabilitation and Movement Science.

At 24 hours, there was no difference in mood between the two groups. The study was presented last week at the annual meeting of the American College of Sports Medicine.

"There are other studies that show there is acute improvement in mood after exercise, but we found those improvements are more durable than we thought," Sibold says.

That's an especially important finding for people who have depression or stress, he says.

"Daily exercise can improve your mood and mitigate some of the stressors of your day," Sibold says. "It's clear that exercise is critical for both physical health and mental health."