Maximizing the Patient-Doctor Encounter

Ancient Chinese, Greek and Egyptian literature document how physicians encouraged the use of touch for therapeutic and diagnostic purposes. Thousands of years later, touch still serves as the primary basis of healing. Touch is not a quaint ritual relegated to ancient beliefs or distant lands, but a vital part of everyday clinical skills.

From the first handshake to the last pat on your shoulder, your doctor touches you. You do not know your physician intimately, yet clinicians have privileged access to your intimate life. Such access is essential for good doctor-patient relationships. However, as a patient, it's important to maximize this relationship by establishing communication and trust with your doctor. Here are a few general guidelines to keep in mind when undergoing any type of clinical examination:

Ask for explanation as to the purpose of any specific examination. Ask for specific requirements of examination. Expect permission of touch to be obtained. Require a third party if it is a sensitive exam. Require privacy for dress and undress. The moral to this story is simple but important: Establish a relationship with your doctor, one based on a clear understanding by both parties of what is to be expected. The road to health is not always easy, but doctors are there to help us make the ride as smooth as possible.

Reference: Bowers LJ. Intimate strangers: issues of touch. Topics in Clinical Chiropractic 2000: Vol. 7, No. 3 pp 11-18.

Exercise for Back Pain: Just Do It

A variety of exercise guidelines are recommended for managing back pain. Exercise has long been regarded as an effective mechanism by which to cope with pain, mentally and physically.

It is generally agreed that the sooner you become active, the sooner your condition will improve. However, which specific exercises you perform may not be as important as the fact that you do exercise, according to a recent study in the Journal of the Neuromusculoskeletal System. The study noted that, although many specific forms of exercise have been suggested for dealing with lower back pain (especially in recent years, with the increasing popularity of "cure-all" exercise devices and regimens), the more pressing concern may be to focus on certain general objectives during your workout, such as:

decreasing pain; strengthening muscles; decreasing structural stress; increasing fitness levels; stabilizing "moveable segments"; improving posture; and improving mobility. If you're suffering from back pain, schedule an appointment today with your doctor. For more information on back pain, go to http://www.chiroweb.com/tyh/backpain.html.

Reference: Hooper PD. Does it matter what exercises patients do for back pain? Journal of the Neuromusculoskeletal System 2000: Vol. 8, No. 2, pp49-52.

Fish Reduces Women's Stroke Risk

If you still haven't incorporated fish into your diet, now may be the time to reconsider. Higher fish intake has been associated with reducing the risk of certain types of stroke in middle-aged women. Several mechanisms may be involved, especially the high doses of certain fatty acids commonly found in fish.

According to an extensive study conducted among nurses, women with the highest levels of fish intake had a 49% reduction in the risk of blood clot related stroke. This positive relationship was incremental, in that each higher level of fish intake (i.e., one or less times per month vs. two or more times per month, and so on) correlated with less risk for stroke. It's important to note that among women who used aspirin on a regular basis, there was only a minimal change in stroke risk. However, these results provide evidence that consumption of fish, particularly the fatty acid component of fish, are associated with a reduced risk of total stroke and blood clot related strokes.

Your doctor can tell you more about the benefits of fish and other foods, and outline a complete nutritional program suitable to your specific needs. Additional information on nutrients can also be found on line at http://www.chiroweb.com/tyh/nutrients.html.

Reference: Hiroyasu I, Rexrode KM, Stamfer MJ, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. The Journal of the American Medical Association 2001: Vol. 285, No. 3, pp304-311.

Dietary Supplements: Not Always Risk-Free

For more than 5,000 years, the Chinese have made extensive use of ma huang, primarily for respiratory conditions. In the United States, ma huang and a variety of dietary supplements that contain ephedra alkaloids are widely promoted and used as a means of losing weight and increasing energy.

Alkaloids are chemical substances that contain nitrogen. Some of the more familiar members of the alkaloid family include caffeine, cocaine, morphine, and nicotine. As you've probably already guessed, alkaloids may not be the safest of ingredients, a suggestion investigated in a recent study in The New England Journal of Medicine. The study revealed that cardiovascular and central nervous system side-effects were frequently attributable to use of dietary supplements containing ephedra alkaloids. Hypertension was the single most frequent side-effect, followed by heart palpitations; tachycardia (an abnormally fast heartbeat - more than 100 beats per minute); stroke; and seizures.

The authors concluded that the use of substances that contain ephedra alkaloids may pose a health risk to individuals, and that a better understanding of the adverse effects of such dietary supplements is needed. These recommendations echo other recent advisements from the health care community on the safety of dietary supplements. Talk to your health care professional about the pros and cons of dietary supplements before you begin taking any specific product. For general information on herbal supplements, visit http://www.chiroweb.com/tyh/herbs.html.

Reference: Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. The New England Journal of Medicine 2000: Vol. 343, No. 25, pp 1833-1839.

Tai Chi Improves Strength and Endurance

Originally practiced as a form of martial arts, tai chi consists of breathing exercises performed in conjunction with a series of body postures. People who practice tai chi often report attaining feelings of inner peace and a heightened self-awareness.

In a recent issue of the Archives of Physical Medicine and Rehabilitation, researchers found that tai chi "may be beneficial to elderly individuals for muscular strength and endurance enhancement," and that it is safer, more cost-effective and easier to perform than other forms of exercise. Subjects participated in a voluntary six-month tai chi program, which took place every morning in a park near the university. Each session consisted of a 20-minute warmup period, 24 minutes of Yang tai chi training, and 10 minutes of cooldown exercises.

Both men and women appeared to show "significant" increases in muscle strength after participating in the tai chi program. The researchers note many advantages that tai chi may have over other conventional exercise routines. Unlike most physical activities, tai chi requires no specialized equipment and can be performed in a variety of locations, making it both practical and cost-effective.

Reference: Lan C, et al. Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study. Arch Phys Med Rehabil May 2000;81:604-607.

For more information on acupuncture and Oriental medicine, visit http://www.acupuncturetoday.com

What We Want from Our Doctors

Previous studies have shown that what your doctor tells you can have a major impact on the your belief system. This has led some doctors to adopt a more patient-centered approach - one in which your doctor works to understand you as a whole, finds common ground, and uses this approach in managing your problem.

Is that the type of doctor you want? If it is, you're certainly not the only one. A recent study in the British Medical Journal investigated 865 patients' preferences for a patient-centered approach to care in the general practice setting. Patients were asked to complete a questionnaire before and after a consultation with a primary care practitioner; questions were asked about patient-centered approaches to care and about examination and prescription preferences.

Results showed that 88-99% of the respondents wanted communication with their doctor; 77-87% desired a sense of partnership; and 85-89% emphasized health promotion. Only 63% of the patients prioritized the actual examination, and even fewer had interest in their doctor giving a prescription.

What do we as patients want from our doctor? Perhaps more than anything else, we want a meaningful relationship. We want to feel as if our doctor cares about our health problems, is listening to us, and is working with us to maximize health. Remember these standards whenever you make an appointment with any health care professional.

Reference: Little P, Everitt H, Williamson I, et al. Preferences for patient-centered approach to consultation in primary care: observational study. British Medical Journal 2001: Vol. 322, pp 1-7.

The Continuing Saga: Work-Related Back Pain

Is your work repetitive? Do you exert your hands for a prolonged period of time? Are you frequently lifting, pushing, pulling or carrying heavy objects? If so, your working conditions may be exposing you to an increased risk for musculoskeletal problems. In 1994 alone, there were 705,800 musculoskeletal cases involving days away from work.

You're probably well-aware of the relationship between workload and low back pain (LBP). In recent months, we've reported on several studies documenting risk factors for LBP -- and there's more. In a recent study published in Spine, a working population was observed to identify high-risk factors for injury to the musculoskeletal system. The objective of the analysis was to determine to what extent body rotation and lifting are factors for work-related injuries. A high risk of LBP was observed for workers whose work involved rotation of the trunk (literally, twisting or turning the upper body) at a minimum of 60 degrees of flexion for more than 5% of working time, and for workers who worked with the trunk in a minimum of 30 degrees of rotation for more than 10% of the working time. The same was true for workers who lifted a load of at least 25 kilograms (about 55 lbs.) more than 15 times per working day.

If your work environment and/or job responsibilities put you at risk for back pain or other repetitive-motion musculoskeletal injuries, talk to your doctor about ways to limit your risk. For more information on back pain, visit http://www.chiroweb.com/tyh/backpain.html.

Reference: Hoogendoorn WE, Bongers P, de Vet HCW, et al. Flexion and rotation of the trunk and lifting at work factors are risk factors for low back pain. Spine 2000: Vol. 25, No. 23, pp 3087-3092.

Children Burn More Calories After Low-Fat Meal

You may not realize it, but your children, and other people's children, are getting fatter. Obesity is the most common nutritional problem facing children in the United States. While countless theories abound as to the causes of (and solutions to) this dilemma, it is widely assumed that limiting the consumption of high-fat, high-calorie foods may be the most important factor.

While some believe that taking in excess calories leads to weight gain, others believe that not all calories are created equal. In a study designed to evaluate this latter premise, a group of obese and non-obese girls was given food with an equal amount of calories, but with different fat contents. Results indicated that fat storage was eight times higher after consuming a high-fat meal vs. a low-fat meal. Overall, children consuming low-fat foods used less than 50% of the fat they had consumed.

When the percentage of fat in the diet increases, the body can respond in two ways to maintain energy and fat balance: by using a larger amount of fat to maintain fat balance, or by breaking down the fat and getting rid of it as waste. Either way, diet composition is considered specific to the individual, and must be taken into account among the various risk factors that induce obesity in children.

Talk to your doctor about the specifics of a sensible diet for you and your children. It's never to early to start your kids on the path toward health and wellness.

Reference: Maffeis C, Schutz Y, Grezzani A, et al. Meal-induced thermogenesis and obesity: Is a fat meal a risk factor for fat gain in children? The Journal of Clinical Endocrinology and Metabolism 2001: Vol. 86, No. 1, pp 214-218.

For more information on nutrition, go to http://www.chiroweb.com/tyh/nutrients.html.

Tea Time

Atopic dermatitis (AD) is an allergic skin disorder caused by allergens in certain foods or in the environment. Mild cases of this condition generally improve with standard treatment. However, standard treatments fail many patients with more stubborn skin legions. Prior studies in animal models have demonstrated that tea (green, black or oolong) can suppress certain allergens and help in the treatment of allergic skin reactions.

Several studies have tested the effectiveness of oolong tea in the treatment of such stubborn legions. In one of the most recent investigations, published in the Archives of Dermatology, 118 patients suffering from various forms of AD were asked to maintain their standard dermatological treatment, but were also instructed to drink oolong tea daily after each of three regular meals.

After one month of treatment, 63% of the patients showed moderate improvement of their condition. The most beneficial effect was noticed after the initial week of treatment. However, a good response to treatment was still observed in more than 50% of the patients after a six-month period. These findings led the study authors to conclude that treatment of allergic skin conditions may be aided by the anti-allergic properties of the compounds in teas.

Reference: Uehara M, Sugiura H, Sakurai K. A trial of oolong tea in the management of recalcitrant atopic dermatitis. Archives of Dermatology 2001: Vol.137, pp 42-43.

Additional information on herbal/botanical products can be found at http://www.chiroweb.com/tyh/herbs.html.

Acupuncture Relieves Knee Pain

According to the National Institutes of Health, more than four million people seek medical care for a knee problem each year. A leading cause of chronic knee pain, particularly in young adults, is patellofemoral pain syndrome (PFPS). The condition occurs most frequently in adolescents who participate in sports, and is one of the most common diagnoses given at orthopedic centers and sports medicine clinics worldwide.

To date, no single therapy has been shown to be completely effective in treating PFPS. However, acupuncture has shown promise in treating similar conditions such as gonarthrosis and osteoarthritis of the knee. In an effort to evaluate its effectiveness on PFPS, a team of researchers from Jensen Fysikalske Institutt in Bergen, Norway performed acupuncture on a group of 70 patients aged 18-45.

Their results, which appear in a recent issue of the Journal of Alternative and Complementary Medicine, show that acupuncture "may be an alternative treatment" for patients suffering from patellofemoral pain syndrome. Improvement in the acupuncture group continued far beyond the initial six weeks, the scientists noted. "The score continued to increase more in this group than in the control group for all scales during the 12-month observation time," they said, "and is significantly different from the results in the control group at 12 months after inclusion."

Reference: Jensen R, Gothesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med Dec 1999: Vol. 5, No. 6, pp521-7.

For more information on acupuncture and Oriental medicine, visit http://www.acupuncturetoday.com