Many of my patients see me for ailments related to poor posture and poor walking habits including upper and low back pain, and knee and foot pain. In these cases, I believe it is more important to spend my patient face time in patient education than in patient treatment. Treatment will make the patient feel better, and I believe the effects of my treatments last longer than treatments given elsewhere. Nevertheless, the effects are incremental and further treatments are required. While this has a positive effect on my bottom line, it has the reverse effect on my patient’s bottom line.
Patients who respond to patient education and resulting self care can see dramatic improvements. These patients can be discharged from treatment in as little as one to three treatments. Other patients who do not respond to patient education and self care can have positive results as well. However, improvement is not quite so dramatic and they require more treatment for good results.
That said, patients with long term issues tend to require more treatment than patients whose issues are more recent. Even in these cases, patient education and self care reduces the number of treatments.
Lymph drains from the body very slowly; much slower than blood movement. Lymph movement is measured in pints while blood movement is measured in gallons. In addition, damaged lymph nodes can retard lymph movement to the point where it causes lymphedema or swelling in the arms or legs. Manual lymphatic drainage (MLD) is a technique to help move the lymph up to 40 times faster than normal.
Breast cancer patients often have lymph nodes removed. Remaining lymph nodes are susceptible to damage either in treatment or by heavy pressure. When this happens it can result in severe lymphedema. The best treatment for this is MLD by especially trained therapists.
However, swelling does not have to progress to the point of lymphedema to be uncomfortable and even painful. In this case, MLD is a most excellent treatment. I had very good success in this type of treatment in cases of swelling due to bone breaks and surgery.
A patient states that he has been diagnosed with right sided Arthritis of the Hip. This diagnosis is complete with X-Rays and report which states there is mild osteoarthritis in the hip. He is being medically treated for this and is also self treating himself with expensive supplements. Yet the patient’s pain is still there after four months, he walks with difficulty and has a hard time climbing stairs.
As I look at the patient, I notice that his standing posture is not exactly consistent with hip pain yet he favors his right side while walking. He also states that he was also recently diagnosed with a pinched nerve in his lower back. Upon examining the patient in the prone position, I observe that his lower back muscles are very contracted. As I palpate his back and hip area he states that most of his pain is in the front, not at the side or the back.
I then tested the patient in the supine position. These tests reveal that the right psoas muscle is severely contracted. I then recall that the patient’s standing posture is consistent with unilateral psoas contraction and the whole symptomology is consistent with unilateral psoas contraction. I start the process to release the psoas and ask the patient to walk. The patient reports that while there is still pain, it is much less severe. As Willie Nelson puts it, we are “On the Road Again”.
I guess that the patient originally went straight to X-Ray without meaningful observation or examination. While there certainly is arthritis in the hip (X-rays cannot lie), it is most likely not the cause of pain.
My doctor friend’s son was a medical student at the University of Chicago and interned at a large Manhattan hospital. I first heard this from him. “Physical Examination is dead.” I think this case proves that. It is up to the “Alternative” medicine crowd to keep it alive.
“Round up the Usual Suspects” is a line made famous by Claude Rains in the 1942 movie Casablanca. This is also true in medicine where we look for usual suspects in order to diagnose a disorder.
In my practice, however, the usual suspects should have been “rounded up” before the patient sees me. Most of my patients have already seen their doctors, specialists, physical therapists, and chiropractors. They have had X-Rays, MRI’s, CAT scans and other procedures and still no help. I am sure that most people find relief with this course of action. However, a small number don’t get help and are in pain for years. In these cases, I suspect, the problem continues because “usual suspects” have hid themselves either in misdiagnosis, or excess pain. In some cases the pain is something else altogether and the usual suspects are in the clear.
Misdiagnosis. The “usual” case of misdiagnosis comes from “chasing the pain”. Those following my blog know that the upper back is often treated in upper back pain. Unfortunately, this treatment does not address the source of the pain and is often unsuccessful. The usual suspect is left untreated. When the correct suspect is rounded up, treatment dramatically reduces the pain.
Excess Pain. Sometimes the usual suspect is so stressed that treating it does not elicit the desired relief. The practitioner then looks elsewhere. However, other signs do point to the usual suspect. When a patient who complained of pain for 10 years came to me in desperation I was greatly puzzled by her situation. After application of a general treatment the area of pain calmed down enough so that I could determine that the usual suspect was indeed involved. This usual suspect did not respond to initial treatment because the pain level was too high. Once the pain was somewhat reduced a treatment plan could be developed.
Unusual Suspect. A patient complained of sciatica and was diagnosed with piriformis syndrome. As the patient was not responding to treatment, her MD suggested removing the piriformis altogether. She was assured she could live without it. When I treated the patient, I too thought that the piriformis was involved since that was the usual suspect. Again the patient did not respond my treatment. That is, the relief experienced was temporary where I usually got a better response to this type of treatment. The patient’s other complaints were caused by damp heat aggravated at the time of ovulation. I then suspected that in addition to her main complaint, she also suffered from endometriosis and that this actually was involved in her sciatica. She was eventually told that she had severe endometriosis which has spread to the posterior pelvis and was pressing on her spine and causing the pain. A true unusual suspect.
Cholesterol lowering drugs side effects include muscular aches and pains and peripheral neuropathy. If you are experiencing these effects with no known cause, then look to the possibility of medically induced pain.
Massage can help reduce these symptoms.
Don’t forget to tell your doctor about them as well.
See the full story in this linked article.
If you remember only 5 things for good health…
In his last column, Dr. Tedd sums up his philosophy
Dr. Tedd Mitchell • 9/19/10
After 12 years, this will be my last column for USA WEEKEND Magazine. It has been tremendously rewarding to be able to provide helpful hints on health. I’d like to leave you with a few of my thoughts on maintaining good health. Given all the uncertainties the national health care debate has brought, it makes even more sense to make personal health maintenance a high priority. So here are some tips to remember:
Health is your responsibility. It is not the doctor’s job, the hospital’s job, your spouse’s job or the government’s job to keep you healthy — it’s up to you. We suffer from chronic diseases that are too often the result of poor habits. The choices you make today usually determine the health you have tomorrow.
Stay active. If you’re looking for the fountain of youth, look no further than that pair of sneakers in your closet. A daily “dose” of 30 minutes of moderately intense exercise will go a long way toward keeping you healthy as you age.
You are what you eat. Diets high in saturated fats and refined sugars provide lots of calories and little nutrition. Imagine your plate in four quadrants; three of them should be filled with colorful fruits and vegetables. This is a simple but very important image to maintain whether you’re at home or eating out.
Stop smoking. Smoking is the greatest modifiable health risk facing our nation. For people who want to try to kick the habit on their own, stop-smoking aids are available at the local pharmacy. For those who need an extra push, professional help can be found with the help of your local doctor. However you do it, live smoke-free.
Keep a healthy emotional outlook. Life has ups and downs for all of us, but how we react to adversity influences not only our own psychological health but also the quality of life of those who live and work with us. It’s like Grandma Moses said: “Life is what we make it — always has been, always will be.”