Tag Archives: chiropractic neurology

Big News!

Happy New Year everyone! After a full month without any posts, I feel like I’m seeing an old friend for the first time in while!

It’s good to be back and I have exciting news! Our clinic now offers in-office blood work. It is a wonderful tool for us to be able to help further evaluate our patients and so far it has been a raging success.  We’ve been able to catch things on patients that may have otherwise gone overlooked. Our ultimate goal is to help our patients be as healthy as they can.

We offer a wide range of services including chiropractic, nutritional counseling, dietary management, neurologic rehabilitation and, now, blood work done right in the office!  We are very excited.  Below is a video that discusses exactly how it works. We hope to have more and more “vlogs” (video blogs) so look for those this year!

I’ve listed below a complete list of the blood work that we can perform here in the office with our new Piccolo Xpress.  You may click each link to read more about that particular profile.  If you have any questions please let us know!

Comprehensive Metabolic Panel (Waived) – ALB, ALP, ALT, AST, BUN, Ca, Cl, CRE, GLU, K+, Na+, TBIL, tCO2, TP
Basic Metabolic Panel (Waived) – BUN, Ca, Cl, CRE, GLU, K+, Na+, tCO2
Lipid Panel (Waived) – CHOL, CHOL/HDL*, HDL, LDL*,TRIG, VLDL*
Lipid Panel Plus (Waived) – ALT, AST, CHOL, CHOL/HDL*, GLU, HDL, LDL*, TRIG, VLDL*
Liver Panel Plus (Waived) – ALB, ALP, ALT, AMY, AST, GGT, TBIL, TP
General Chemistry 6 (Waived) – ALT, AST, BUN, CRE, GGT, GLU
General Chemistry 13 (Waived) – ALB, ALP, ALT, AMY, AST, BUN, Ca, CRE, GGT, GLU, TBIL, TP, UA
Electrolyte Panel (Waived) – Cl, K+, Na+, tCO2
Kidney Check (Waived) – BUN, CRE
Renal Panel (Waived) – ALB, BUN, Ca, Cl, CRE, GLU, K+, Na+, PHOS, tCO2
MetLyte 8 Panel (Waived) – BUN, CK, Cl, CRE, GLU, K+, Na+, tCO2
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Your 4 year old needs Ritalin Part II

Ritalin Methylphenidat

Yesterday I wrote about how the American Academy of Pediatrics has changed the guidelines about how young (and old) a child could be diagnosed with ADHD. The new guidelines say that a child as young as 4 and as old as 18 may now be diagnosed with ADHD.

They went on to say that Ritalin and other drugs are good choices for treatment even for the youngest patients. To me this sounds like a terrible idea.

So what are some effective alternatives?

First and foremost, we must look at a child’s diet.  A healthy diet is a big key to helping a child regulate his brain function.  The problem in ADHD is that circuits in the brain that are responsible for attention, focus and other executive functions are under active.  That is precisely why most of the medications that exist are stimulants.  These stimulants speed up the processing in these brain regions and allow the child to function more normally.  The problem is that they carry serious side effect profiles, some of them very dangerous.

So where, exactly, does diet fit into this? Good question. First, each and every child must begin the day with breakfast. Food provides the fuel that the brain uses to do its job!  If there isn’t enough of the right kind of fuel, the child’s brain cannot function as well as it should.

And what is the right kind of food? Each child should begin the day with a source of protein and a little healthy sugar in the form of fruit.  This will provide ample amounts of fuel so your child can make it until his next meal at lunch.  Do not allow a child to eat sugary cereals or pop tarts or to skip breakfast.  Those types of fuel (or lack thereof) only set the child up for a crash in blood sugar which deprives the brain of the vital energy it needs.

The rest of the day should be roughly the same.  Be sure that your child eats protein and a fruit or vegetable every time he eats. Steer them away from sugary snacks and drinks.  They have a negative impact on brain function.

Balancing Neurotransmitters

A natural program to balance neurotransmitters in the brain is important. Neurotransmitters are specialized proteins that each nerve in the brain uses to communicate with its neighbors. The balance of them is important.  In ADHD the focus has been on the neurotransmitters called dopamine and norepineprhine.  Others, however, may play a role and include GABA, glutamate, PEA and serotonin to name a few.

The levels of these neurotransmitters in the brain is important.  Levels that are too high or too low can cause the brain to function less than optimally.  In my office we measure these neurotransmitters in a urine test and have found them very helpful clinically.  If we find levels that are low, we can supplement to raise them.  For example, dopamine is raised by increasing dietary levels of tyrosine (or its derivatives) and serotonin is raised by increasing dietary levels of tryptophan (or its derivatives).  The process is relatively simple, but it is very effective. Through this process we are able to rebalance the neurotransmitter system and see improvements in behavior and attention.

Reprogram the brain

This sounds very much like something out of a science fiction movie, but it is all based in neurology.  In ADHD the brain is wired incorrectly.  The circuits that we want to work are not efficient enough to produce balanced brain function.  To change this we must provide a program of neurologic rehabilitation.  It can be done many ways, but in our office we use a combination of home exercises that include eye exercises, balance exercises, light and sound therapy and proprioceptive feedback with an in-offfice therapy called interactive metronome or IM.

IM was developed in the early 1990s and is used to help children with learning and developmental disorders as well as adult neuro rehabilitation patients. IM is a neuro-motor assessment & treatment tool used in therapy to improve the neurological processes of motor planning and sequencing.

The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions. A patented auditory-visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.

Over the course of the treatment, patients learn to:

  • Focus and attend for longer periods of time
  • Increase physical endurance and stamina
  • Filter out internal and external distractions
  • Improve ability to monitor mental and physical actions as they are occurring
  • Progressively improve coordinated performance.

I’ve used this program with many children and adults in my office and it works exceptionally well.  It is a great option for patients who have been diagnosed with ADHD and other learning disorders.

There are many options for parents with children with ADHD.  Medications are of course one of them, but there is no permanent benefit to taking them.  As a matter of fact, 50% of children who take medications will still need them as adults.  Rewiring the brain, dietary changes and rebalancing neurotransmitters has lasting and permanent effects.  In my opinion, it’s the best way to go.

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Your 4 year old needs Ritalin

Picture taken by myself of my Adderall prescri...

Unfortunately, your child’s pediatrician might agree.  The American Academy of Pediatrics recently changed the age at which children could be diagnosed with ADHD.  Now children as young as 4 and as old as 18 can be diagnosed with attention deficit hyperactivity disorder.  This diagnosis now also includes the old diagnosis of ADD, a term that is no longer used.

This change has led to fears that with more diagnoses there will be more drug therapies applied and perhaps some of these will be diagnosed incorrectly.  To me, these sound like legitimate fears.

The first problem I have is that the drugs approved for treating ADHD are dangerous and pose serious risks.  On top of that, they have only been approved to be used in children 6 and over.  No one has studied these medications on children younger.  This is a major problem. We cannot possibly know what these powerful stimulants can do to a developing brain.  These stimulants are, after all, a derivative of methamphetamine (basically speed!).

The guidelines are quick to point out that while Ritalin is an effective option, it should only be used once behavior modification has been tried unsuccessfully. The problem with that is I find many pediatricians are already too quick to write a prescription and move on to the next patient.  In a health care environment where most physicians are strapped for time as it is, they are unlikely to take the time to describe how to implement a program of behavioral modification and are much more likely to recommend something quick and easy like Ritalin.

A child that is just 4 years old is still developing.  Their brain is malleable and easily changed.  On one hand this is a good thing.  It means changes in their home life, behavioral modifications and therapeutic exercises have a great chance of working.  On the other hand it means the potential for negative change associated with medications is greater as well.

I see many children in my office for neurobehavioral disorders like ADHD.  I find I can recognize the hard signs in a 4 year of ADHD like breakdown in gait patterns, breakdown in eye movements or the persistence of primitive reflexes.  These are easily corrected with a program of brain rehabilitation and does not require dangerous stimulants.

These guidelines seem to be a way to open a new market for pharmaceutical sales.  As a matter of fact, the chairman of the committee who recommended the new guidelines, physician Mark Wolraich, is a periodic consultant to Eli Lilly,  Shire Plc, and other pharmaceutical companies. Eli Lilly and Shire hold exclusive U.S. patents for atomoxetine (brand name Strattera) and guanfacine (brand name INTUNIV), respectively, both of which the report recommends for treating ADHD in adolescents.

Parents should not be fooled by these recent recommendations.  Parents should seek drug-free alternatives for their children if they believe that they have ADHD. We just don’t know what these medications can do to a young brain.

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Sidney Crosby’s got a new weapon

Dr. Carrick and Sidney Crosby seated at a press conference.

If you follow the NHL at all, you know who Sidney Crosby is.  He is arguably the best hockey player in the world.  He is the face of the National Hockey league. He is not playing hockey at the moment.

At the beginning of this year, Crosby was leading the NHL in scoring.  His team was playing well and was expected to make a deep run into the playoffs. Then two hits sidelined his season and possibly his career.  These hits, which came just days apart from one another caused Crosby to have two concussions which he had a very difficult time recovering from.

His symptoms were so debilitating that he couldn’t watch TV, drive a car or even shop at the grocery store. He had post-concussive syndrome with a unique component.  His vestibular system was affected.

The vestibular system is basically our balance center.  It allows us to stay balanced in earth’s gravitational field.  It tells the muscles of our neck, back and eyes how to respond to changes in position without conscious intervention.  This is important because if we needed to think about staying balanced every time we changed position, we wouldn’t think about much else!  Without our vestibular system, you and I could not walk, run or play. And we definitely could not skate at the level Sidney Crosby is accustomed to!

Sidney Crosby’s progress was moving exceptionally slow.  It was so slow that people in the media began to question whether he would ever play hockey again. He had been seeing some of the most prominent neurologists and concussion experts in the world with little to show for it. Then, a chiropractor who works with many professional sports teams recommended that he go see Dr. Ted Carrick.

Dr. Carrick is a chiropractic neurologist and head of the Carrick Institute.  In addition to being a chiropractic neurologist, he has a Ph.D in neurology.  His focus is to help people functionally rehabilitate their brains when there has been injury.  The results he has achieved with Crosby are quite amazing.

What do I mean, functionally rehabilitate? The brain has many, many functions.  It is very powerful.  Even small changes in the way the brain processes, interprets and executes function can cause symptoms.  Despite this fact, when people have concussions they are told time is the only thing that can heal the brain.  They are given no advice on how to rehabilitate their brain.  We understand rehabilitation when someone sprains an ankle or tears and ACL.  Those patients are given aggressive rehab programs to strengthen and heal their ankle or knee.  Why wouldn’t we do this for someone with a brain injury?

This is what Dr. Carrick has done for Sidney Crosby and it is also what we do here in our clinic.  We use the same techniques that Dr. Carrick is using on Crosby to help patients in our office every day.  As a matter of fact, I have studied under Dr. Carrick and seen him lecture on these brilliant techniques many times.  It is quite amazing.

So what exactly do we do? We use many different therapies designed to re-educate the brain and help it to more efficiently process the information it receives.  If the information is processed correctly it can respond appropriately and that is when we begin to see symptoms of many brain disorders improve.  The types of therapies vary depending on what and where the problem lies in the brian.  But they range from eye exercises to sound and light therapy to balance exercises to general brain games.  The list really is endless.

Dr. Carrick is hopeful the Crosby will begin playing shortly.  The progress that Crosby has made with Dr. Carrick is astonishing, but it’s not a miracle, it’s neurology.  I’m glad this type of rehabilitation is getting a little mainstream media coverage.  In my opinion, it’s just the tip of the iceberg!

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What’s that sound?

This is a transaxial slice of the brain of a 5...

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Tinnitus, or ringing in the ears, is an exceptionally common problem.  As many as 2 million Americans experience this on a daily basis.  It can range from very minor to annoying to debilitating.

Tinnitus is often associated with hearing loss.  Prolonged exposure to loud noises is the most common cause of hearing loss.  It is this loss of hearing that is actually causing the tinnitus.  Say what? Hearing loss actually causes people to hear sounds that don’t really exist? Yes!

People often describe tinnitus as ringing in the ears.  However, the list of sounds that are considered tinnitus is very long.  Other sounds that people might perceive include ticking, clicking, whooshing and buzzing to name a few.

Recent research, published online in the journal Proceedings of the National Academy of Sciences, suggest several new approaches to treatment, including retraining the brain, and new avenues for developing drugs to suppress the ringing.

As a chiropractic neurologist the above statement about retraining the brain got my attention.  This is something that is near and dear to the heart of all chiropractic neurologists.  We use techniques that retrain the brain every day.  We use these techniques to help people with a wide variety of conditions ranging from anxiety to muscular imbalances and pain.

Traditionally, patients with tinnitus are told the problem stems from damaged hair cells inside of the ear.  They are told it is these hair cells that are sending the wrong signals into the brain which interprets them as noise. Turns out, this is not true.

Because each hair cell is tuned to a different frequency, damaged or lost cells leave a gap in hearing, typically a specific frequency and anything higher in pitch.  It is this gap which causes problems for the brain.

Chiropractic neurologists have been saying for a very long time that ringing in the ears is actually brain based.  This new research supports this assertion. Below is information from coauthor of the recent study Shaowen Bao, adjunct assistant professor in the Helen Wills Neuroscience Institute at UC Berkeley

Experiments in the past few years have shown that the ringing doesn’t originate in the inner ear, though, but rather in regions of the brain — including the auditory cortex — that receives input from the ear.

Bao’s experiments in rats with induced hearing loss explain why the neurons in the auditory cortex generate these phantom perceptions. They showed that neurons that have lost sensory input from the ear become more excitable and fire spontaneously, primarily because these nerves have “homeostatic” mechanisms to keep their overall firing rate constant no matter what.

“With the loss of hearing, you have phantom sounds,” said Bao, who himself has tinnitus. In this respect, tinnitus resembles phantom limb pain experienced by many amputees. (From sciencedaily.com)

The neurons that have lost sensory input in the brain are the neurons that are responsible for the perceived noise that people hear.  These neurons have undergone a process called transneural degeneration.  To stabilize these neurons they need more input.  But because they cannot receive it from the hair cells in the ear that are damaged, other areas of the auditory cortex must take over.  This retraining of the brain takes time, but if performed diligently, the results can be phenomenal.

We know this is a possibility because the brain is plastic.  That is, it changes in response to the stress and environmental input it receives. When a finger is amputated, for example, the region of the brain receiving input from that finger may start handling input from neighboring fingers.

Drug therapy is aimed at increasing the levels of the neurotransmitter GABA in the brain.  GABA is the primary inhibitory neurotransmitter.  In order to slow down the firing rate of these over excited cells, we must increase the levels of this inhibitory neurotransmitter.  The good news is there are lots of natural therapies that work to raise GABA levels or drive GABA receptors in the brain.

One way is to use the amino acid taurine.  I use it frequently.  Another is a product called phenibut (Phen-i-bute).  It is a natural GABA derivative that crosses the blood brain barrier and binds to GABA receptors.  I also use this frequently in my practice. These supplements, however, I believe are temporary solutions.  The permanent solution is to retrain the brain.

Tinnitus is a complicated and elusive condition, but we appear to be headed in the right direction in terms of research.  Always remember, the brain holds the key!

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Anxiety or Depression? Test the levels of your neurotransmitters to guide therapy.

Depression

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Happy New Year!  A new era began at the Vreeland Clinic on January 1st this year.  Dr. Carrie and I would like to thank all of our friends and family for their well wishes.  We looked forward to continuing to serve the community for years to come!

Today I’d like to touch on something that has revolutionized the way I practice.

People come to me for many reasons.  Some people come to my clinic for weight loss or to get more energy.  Others for help with a chronic condition that hasn’t responded to traditional care.  Still others come to see me for a wide range of neurologic conditions.  These include things like Parkinson’s disease, multiple sclerosis, depression or anxiety.  It is the last two that I’d like to focus on today.

Anxiety and depression are extremely common in America.  Millions of Americans suffer from anxiety, depression or both.  These conditions may have many etiologies but one theory is a chemical imbalance in the brain.

Just what is this chemical imbalance?  When someone states that they have a chemical imbalance they are referring to an imbalance in the neurotransmitter system of the brain.  These neurotransmitters are really just proteins that each nerve in the brain uses to communicate with its neighbors.  Sometimes people can have too little of a certain neurotransmitter or too much of another.  This is problematic because it alters the way the brain functions.  It may cause anxiety and/or depression.

The pharmaceutical industry has figured that out and makes a large class of drugs that alters neurotransmitter function in the brain.  These are drugs like Prozac, Zoloft, Wellbutrin and Lorazepam to name a few.

Neurotransmitters are broken down into two categories – they are either excitatory or inhibitory.  That means they either tell the brain to go or tell the brain to stop.  The complexities of the neurotransmitter system are extensive and there is much more to it than “go” and “stop” but that basic principle holds true in most cases.

Examples of neurotransmitters include serotonin, GABA, epinephrine, norepinephrine, glutamate and dopamine.  Serotonin and GABA are inhibitory while epinephrine, norepinephrine, glutamate and dopamine are excitatory.

If you have anxiety and depression often times an imbalance exists in the levels of these neurotransmitters.

For example, high levels of glutamate may cause anxiety or seizures.  Low levels of GABA may cause anxiety.  Low levels of serotonin may cause depression.  Same goes for norepinephrine.

So how do you tell which neurotransmitters are low or which are too high?

Measuring Neurotransmitters

Measuring your neurotransmitters with a urine test is the best way to estimate your levels of neurotransmitters.  We do this routinely in our office for many patients.  It is incredibly insightful and directs our care for patients with anxiety, depression and many other conditions.

The measurement of neurotransmitters in the urine has been around for many years.  I’ve read studies dating to the 1960’s of scientists using similar methods to evaluate neurotransmitter levels.

Until relatively recently, perhaps the last 10-15 years, it has not been used frequently in clinical practice.  Now, through specialized laboratories, it is available to the general public and it is very affordable.

The knock on urinary neurotransmitter testing is that it does not correlate with brain levels of these hormones because the urine test is in fact testing whole body levels of neurotransmitters.

The very neurotransmitters that exist in our brain to make us happy exist outside the brain to serve the body in other ways.  So, yes, it is true that checking urinary neurotransmitter levels is technically a check of the entire body’s store of neurotransmitters.  But, through hundreds of thousands of tests these specialized labs have shown with high correlation that when neurotransmitter levels are abnormal certain psychiatric and neurological conditions are much more common.

Clinically, I have seen an almost one to one correlation in my patients with certain conditions an alteration in their neurotransmitter system.

The lab that I use will test all of the basic neurotransmitters plus a slew of metabolites of these neurotransmitters.  It provides a wonderful window into the neurological system.

If I find that serotonin is low, I supplement with something called 5-HTP.  If dopamine is low, I like to use L-tyrosine or an herb called mucuna pruriens.  The list can go on and on.

Once someone has been on a program for 6-8 weeks we recheck their neurotransmitter profile to gauge our therapy and adjust it if necessary.  We find that once a person’s profile returns to normal, their symptoms resolve.

If you have anxiety or depression, consider seeking out someone who does this kind of testing to improve your outcomes.  The brain is incredibly complex.  It never hurts to have a little extra information to guide your therapy.

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Chiropractic saves 40% on care for low back pain.

Chiropractic Caduceus

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My blogs generally focus on nutrition and other topics that relate to health.  That is the main focus of my practice.  But as a chiropractor by training I still see some patients that want just that – chiropractic.  I enjoy those patients because I feel as if it gets me back to my roots, so to speak.

Recently I came across a study that was just too good not to share with all of you.  It was about low back pain, its costs to patients and insurance carriers, and how starting your care with a chiropractor can save an astonishing 40%!  This is big news in this day and age with health care costs skyrocketing.  The medical profession and insurance companies should take notice and stop putting so many road blocks in the way of getting quality chiropractic care for people.

The new study showed that people who initiated care for low back pain with chiropractors saved an average of 40% over people who initiated care with a medical doctor.

The study collected data from 85,000 Blue Cross Blue Shield beneficiaries.  It concluded that insurance companies that restrict access the chiropractic will likely end up paying more for care.  This is precisely what insurance companies should be trying not to do.

The study was published in the December 2010 issue of the Journal of Manipulative and Physiological Therapeutics. It looked at Blue Cross Blue Shield of Tennessee over a two year span.  The people in the study had open access to medical doctors and doctors of chiropractic through self-referral.  There were no limits applied to the number of MD or DC visits and no differences in co-pays.

The study showed that people who started their care with a chiropractor instead of a medical doctor saved their insurance company almost 40%.  They calculated that would save BCBS of Tennessee $2.3 million annually.

I’m not one to listen to the insurance companies crying poor.  This story isn’t about saving insurance companies more money.  The point is that chiropractic has been shown to be more effective than conservative medical care and this study shows that it is also more cost effective.  Considering 85% of people will experience back pain in their life time and in a time when health care costs are on the national stage, this story should be front and center.

So next time you have back pain, make sure you see a chiropractor first.  Not only is it more effective, it will save you money!

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