Recent Posts

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that starts with stiffness and pain in your shoulder joint. This condition usually starts gradually, worsens over several weeks or months and can be self-limiting and resolving within 1-3 years.

People at risk for frozen shoulder are those who have an episode of decreased range of motion to begin with. An example would be post-surgical where you are told to limit your shoulder movement to speed recovery. An example of this would be following neck surgery.

Treatment for frozen shoulder involves range-of-motion exercises, manipulation, physical therapy modalities including electrical muscle stimulation and ultrasound. Sometimes corticosteroids are injected into the joint capsule to help reduce inflammation. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

It is rare to have frozen shoulder reoccur on the same side, but many people will have frozen shoulder return several years later affecting the opposite side.

Frozen shoulder is usually broken down into several stages:

Freezing stage: This is at the onset where pain starts in your shoulder with no history of recent trauma. You start to notice a decrease in your range of motion.

Frozen stage: The pain starts to decrease but so does your range of motion.

Thawing stage: You start to notice an improvement in your overall range of motion.

If you or someone you know suffers from frozen shoulder and is looking for treatment or answers to questions please give our office a call to make an appointment. If you have specific questions ask to speak with Dr. Kevin E. Crowley. Our office is located in Alexandria, Ky. and we offer same-day appointments.

 

High Blood Pressure and Commercial Drivers



A lot of my patients who come in for their initial certification or recertification CDL physical exam have several questions regarding high blood pressure and CDL requirements. The basic regulations according to the FMCSA are as follows:

Stage 1 Hypertension: Medically certified to drive for a one-year period. Annual exams are needed.

 

Corresponds to a BP of 140-159/90-99


A driver with a blood pressure in this range is at low risk for hypertension-related acute incapacitation and may get their DOT medical card to drive for a one-year period. A DOT physical exam should be done annually thereafter and blood pressure should be at or less than 140/90. If at time of recertification it is 141-159/91-99 a one time certificate for three months will be issued. This will give the driver time to see their family doctor to get their blood pressure under control.

 

 

Stage 2 Hypertension: One-time medical certification of three months


Corresponds to a BP of 160-179/100-109.

The driver is given a one-time certificate for three months. At their recertification they will be issued a one year certificate from the date of the initial exam as long as their blood pressure is ≤ 140/90. The initial three months allow the driver to see their family doctor to help control their blood pressure.

A driver with a blood pressure in this range is a candidate for antihypertensive drug therapy. Provided treatment is well tolerated and the driver demonstrates a blood pressure is 140/90 or less, they may get their medical card for one year from the date of the initial exam. The driver should do a DOT physical exam annually thereafter.

 

 

Stage 3 Hypertension: Disqualified


Corresponds to a BP of ≥ 180/110. No medical certificate will be issued.

A driver with a blood pressure in this range is considered a high risk for an acute BP-related event, and is disqualified.

The driver may not be qualified for a DOT medical card, even temporarily, until blood pressure is reduced to equal to or less than 140/90 and treatment is well tolerated. The driver may be certified for 6 months and a recertification will be needed every six months thereafter if at recheck their blood pressure is ≤ 140/90.

If you have any questions regarding the CDL physical requirements or if you would like to schedule an appointment for the exam call Alexandria Chiropractic Center at 859-635-6666.

 

 

Treatment for Peripheral Neuropathy

If you or someone you know has been diagnosed with peripheral neuropathy  you are aware of the chronic pain associated with this disease. Some of the symptoms of peripheral neuropathy include:


  • Gradual onset of numbness and tingling in your feet or hands, which may spread upward into your legs and arms

  • Sharp, jabbing or burning pain

  • Extreme sensitivity to touch

  • Lack of coordination and falling

  • Muscle weakness or paralysis if motor nerves are affected


  •  




 

Peripheral neuropathy may affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Some of the causes of PN include diabetes, vitamin deficiency in alcoholics, auto-immune diseases, infections, trauma, heavy metal exposure and tumors.

Current medications on the market that are prescribed for the treatment of peripheral neuropathy include Gabapentin (Neurontin), Pregabalin (Lyrica), Duloxetine (Cymbalta), pain medicines such as hydrocodone or oxycodone, Elavil and many others. All of these can offer mild relief of pain and all have potential side effects.



 

For my patients that have been diagnosed with peripheral neuropathy one of the recommendations that I make for pain control is TENS unit therapy with specialized garments that can deliver the pain relief effect directly to the area that needs it and with no side effects. For more information visit Tens Unit Therapy

This can be used in conjunction with the traditional medications listed above or in some cases in place of the medications. There have been several studies on the efficacy of the TENS unit therapy for peripheral neuropathy and researches agree that it is an effective form of pain relief.

TENS units are covered by many insurance companies and our office can call to check for coverage for you. If you have any questions regarding  TENS unit therapy or want to schedule an appointment to see if you are a possible candidate call Alexandria Chiropractic Center (859-635-6666) and ask to speak with Dr. Kevin E. Crowley.

 

Salt intake and Margaritas.

How much sodium is in your diet? Do you know? Do you care? Should you care? If you are like most people in this country you are averaging about 3000-3500 mg of salt intake per day. The Dietary Guidelines for Americans recommend limiting sodium to less than 2,300 mg a day — or 1,500 mg if you're age 51 or older, or if you have high blood pressure, diabetes or chronic kidney disease.  Sodium is essential in small amounts for your body to function properly. It can help maintain the right balance of fluids in your body, it helps transmit nerve impulses and it influences the contraction and relaxation of muscles. Your kidneys usually maintain the proper balance of sodium in you body by either holding onto it if you are low in sodium or excreting the excess. But if for some reason your kidneys can't eliminate enough sodium, the sodium starts to build up in your blood. Because sodium attracts and holds water, your blood volume increases, which makes your heart work harder and increases pressure in your arteries. Such diseases as congestive heart failure, cirrhosis and chronic kidney disease can make it hard for your kidneys to keep sodium levels balanced. Some people are sodium sensitive and this can cause an even bigger and more chronic problem.



So, where do we get most of our dietary sodium? The biggest culprit is processed foods followed by the evil salt shaker. Some healthy foods have low levels of sodium such as dairy products, meat and shellfish. For some people, and you know who you are, the majority of their sodium comes on a Friday evening on the rim of a large glass at Mexican Frisch's. ;-)



 

Some easy tips on reducing your overall sodium consumption would be to eat more fresh foods and less processed foods, use herbs and spices instead of salt when cooking and to limit salt heavy condiments such as soy sauce, ketchup, sauces and dips. One of the easiest things to do would be to banish the salt shaker to the back of your "Baking" cabinet next to the two cans of expired baking powder, the box of semisweet bakers chocolate that has turned a pretty shade of grey and the bag of  brown sugar that could be used to hammer nails. (Trust me you will never find it there.)

Your taste for salt is acquired, so you can learn to enjoy less. Decrease your use of salt gradually and your taste buds will adjust.After a few weeks of cutting back on salt, you probably won't miss it, and some foods may even taste too salty. Start by using no more than 1/4 teaspoon of salt daily — at the table and in cooking. As you use less salt, your preference for it diminishes, allowing you to enjoy the taste of the food itself, with heart-healthy benefits.

So the next time you're nibblin' on sponge cake or watchin' the sun bake and you order your margarita with the glass/small pitcher rimmed in salt, from the bartender (who not only knows you by your first name, but also what your usual is) ask yourself. How can I reduce my dietary sodium...starting tomorrow :-)

 

 

Insomnia and Obesity



I was going to title this article  "Awake for the Cake" or "Alert for Desert" or maybe even "Restlessness for...." I got nothin'. But in all seriousness how much a person sleeps at night can impact their weight. This is because the amount of sleep a person gets can affect certain hormones, specifically the hormones leptin and ghrelin (sounds like good names for storybook trolls), that affect appetite. Leptin and Ghrelin work in a kind of check and balance system to control feelings of hunger and fullness.

Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full. When you  don't get enough sleep it causes leptin levels to drop, which means you don't feel as satisfied after you eat and increases ghrelin levels, stimulating your appetite so you want more food. The two combined can set the stage for overeating which in turn may lead to weight gain.

Besides obesity, insomnia also goes hand in hand with chronic pain and fibromyalgia. Actually the clinical consequences of untreated sleep disorders can also include:

-High blood pressure

-Heart attack

-Heart failure

-Stroke

-Depression and mood disorders

-Attention Deficit Disorder (ADD)

So if you suffer from insomnia, chronic pain or fibromyalgia mention it to your chiropractor for advice, recommendations and potential treatment. If you have any questions about your health and whether or not chiropractic can help call Alexandria Chiropractic Center at 859-635-6666 today and ask to speak with Dr. Kevin E. Crowley.

How about "Restlessness for diet fecklessness" ...oh never mind.

 

 

Sugar Studies and ADHD



 

Just wanted to share a interesting study regarding sugar consumption and adrenaline. The study states that high consumption of sugar leads to an insulin spike which takes too much glucose from the blood causing hypoglycemia. Due to this state adrenaline is released which causes the fight or flight  energy surge. This agitation, irritability and shakiness from the adrenaline could easily be falsely labeled as ADHD. This could also be caused from not eating often enough and not enough protein.

A Yale study where adults and children were fed a comparable amount of sugar based on percentage of body weight. Blood glucose and blood adrenaline levels were measured every half hour for five hours. Adrenaline levels in children were 10 times higher than normal up to 5 hours later.

Another study involved changing school lunches. Lunches were changed from processed foods and sugars as well as eliminating BHT and BHA to fruits, vegetables, whole grains and proteins in 803 public schools and 9 juvenile correctional facilities.

After 4 years the academic performance in the schools rose 16 percent and the learning disabilities fell 40 percent in the public schools. In the juvenile correction facilities violent and non-violent anti-social behavior fell48 percent.

This reinforces what we should already be doing and that is trying to eliminate as much processed foods in our diet that we can, and to eat an appropriate amount of sugar. Basically more emphasis on whole foods, fruits and vegetables and a little less on pizza, pop and chips ;-)

- J PEDIATR 1995;126:171-7

 

What is whiplash? Part Two

In the previous post I talked about several injuries that can occur during a rear end collision. It is important to remember that the majority of these injuries occur before your head even moves. The S shaped curve is only present for a fraction of a second, but long enough for possible severe neck injuries. Check out the videos below to see what the s shaped curve would look like during a collision.  http://alexandriachirocenter.com/injury46.html

http://alexandriachirocenter.com/injury53.html

Several  factors can effect the severity of the injuries which is why at Alexandria Chiropractic Center we have our patients answer questions such as were you looking straight ahead or to the side? Did you have your foot on the brake when you were hit? Did you brace for the impact? This information helps us determine the potential severity of the injuries and helps us document cause and effect to the insurance companies.

And it doesn't take high speed collisions for severe neck pain. In fact most of the research looked at low speed (< 10mph) impact. To see what a rear auto collision looks like on a real person follow the link below. (Side note: I have no idea how much they paid the participants...but it wasn't enough.)

http://alexandriachirocenter.com/injury38.html

If you have any questions regarding neck pain as a result of an auto collision or if you're not sure if chiropractic can help you give us a call at 859-635-6666 today and ask to speak with Dr. Kevin E. Crowley.
 

What is whiplash? Part One

The term whiplash has been used to describe the injuries of the neck as a result of a rear end auto collision. It was eventually replaced with a flexion/extension injury and then in the early 90's it was replaced with cervical acceleration deceleration or CAD injury. Later doctors and research personnel used the term ramping to indicate how exactly the neck was injured. But with all of the new breakthroughs in diagnostic studies and overall technology used in research, whiplash was replaced once again in the late 90's. Today a lot more is known of the biomechanics of the neck during a rear end auto collision and the phrase that is presently used is a S shaped curve motion injury of the cervical spine. Kind of rolls off your tongue doesn't it? Regardless of what we call it I will briefly try and describe, in several parts, what happens to the cervical spine during a rear end auto collision.

The neck goes through several phases of injury during the collision and I will try and break it down as best I can. The first phase happens around 75 milliseconds or less than one 1/10 of a second. During this time the cervical vertebrae between C4-C7 begin to individually shear on one another.



 

When this happens several injuries can occur including a disc injury, facet joint injury and tearing of the capsular ligament. All of this can occur before your head even moves.                                                                                                                                                      - 110-150 milliseconds:the S shaped curve is over.

- 175-200 milliseconds:the drivers head is deflecting/bouncing off of the headrest.

- >200 milliseconds:you have seatback rebound of your body.

- 300-400 milliseconds: you can injure your discs, capsular ligament, interspinous ligament and supraspinous ligament.



 

 

DOT Guidelines: Sleep Studies

I have had a lot of commercial drivers come into my office complaining that another certified medical examiner has told them that they have to have a sleep study to rule out obstructive sleep apnea (OSA) because of one or more of the following reasons:

-Their neck size was greater than 17 inches (for men) or greater than 16 inches (for women).

-They were older than 55 and a sleep study was needed.

-They were overweight with a body mass index (BMI) greater than 35.

-They smoked or used alcohol.

The fact of the matter is that none of these reasons in and of themselves requires a mandatory sleep study. In fact the FMCSA mentions nothing about sleep studies in their regulation. In order to get the full scoop  on what FMCSA expects from the regulations, you must look at the “guidance” the  agency issues on various regulations. The agency has established guidance for  chronic sleep disorders, including sleep apnea.

In that guidance, the agency lays out the minimum waiting period for certification or  recertification of an individual with a chronic sleep condition after starting  treatment. There is a minimum one-month waiting period after starting a  continuous positive airway pressure device (called a CPAP). Individuals with  surgical treatment are to wait a minimum of three months before certification  or recertification. Medical examiners are directed by the agency to certify the  driver for only one year."

If you look at the FMCSA regulation itself it states:

393.41(b) A person is  physically qualified to drive a commercial motor vehicle if that person (5) has  no established medical history or clinical diagnosis of a respiratory  dysfunction likely to interfere with his/her ability to control and drive a  commercial motor vehicle safely.

Some of the confusion started when the FMCSA posted some possible future guidance on their website in April of 2012.  It was taken down about a week later but it clearly showed that the FMCSA is looking at trying to implement regulation on OSA. There was actually a bill introduced in the House and passed in the Senate and signed into law by President Obama in 2013 that will force the FMCSA to go through the formal rule making process before implementing any new regulations. This would include several long term studies, cost of studies (billions) vs. benefits, and an open comment period for all involved to discuss the consequences of any new regulations.

The bottom line is that OSA is a serious and real problem in the trucking industry and should not be ignored or downplayed, but it is up to the medical examiner to determine if a sleep study is warranted based on his/her exam results and the drivers history, not on FMCSA regulation. Although some employers can require them. There are even simple questionnaire's that I can perform in our office that can help determine the risks for sleep apnea syndrome. So if a medical examiner tells you that the FMCSA requires a sleep study based on neck size or age or any other reasons you need to ask them to show you where in the FMCSA regulations it states that. They won't be able to.

If you have any questions regarding FMCSA regulations or if you need to schedule a CDL exam call Alexandria Chiropractic Center at 859-635-6666.
 

Bad Decisions Can Haunt You

Halloween is just around the corner so I wanted to talk about bad decisions that could cost you your life. Just like the characters in horror movies we all are faced with decisions that help decide if we are still around when the credits start to roll. I'm going to try and list some poor choices both in the movies and in life that upon reflection maybe weren't the smartest. These are by no means in any order. First the movie choices.

1) Upstairs or the basement: As a child I always wondered why Shaggy, Scooby and Thelma always got the basement, because sure enough that's where the monster/caretaker in a mask was hiding. It never made since until years later I realized that Fred and Daphne were always alone upstairs...but I digress. Most basements are dark, cold, windowless, cobwebby places that make you feel as if someone is watching you from the dark corners and really should not be a first choice to investigate or hide when being chased by a villain. When given the choice always choose upstairs or better yet out the front door.

2) Ignoring warning signs: In the movie Signs there were a series of, you guessed it, signs. But not all warnings are so obvious. For instance in The Sixth Sense it is not until the last few minutes of the movie that we realize the importance of the color red. Or in some movies there is a child who for the first time in their life have an imaginary friend, after moving into a new home where the previous tenants had died under mysterious circumstances. In The Orphanage the child in question also happens to draw a picture of his new friend wearing a creepy burlap mask worthy of a refrigerator magnet  For most parents this would be considered a warning sign.

3) Stopping in a remote area and asking for directions: If you're ever lost and are surrounded by cornfields, woods, or slaughter houses do yourself a favor and don't stop at the abandoned farmhouse to ask for directions. Keep driving until you see a waffle house or similar fine establishment where there are a group of people before you stop, and practice a little situational awareness. In the movie Simon Says the teen characters get lost (no gps in horror movies), stop at a cemetery and then ask for directions (against the advice of locals) for the nearest town. This is wrong on so many levels. Needless to say dismemberment soon follows. Another fine example is Children Of The Corn. Can you say Malachi?

4) Filming ongoing attacks: In todays world everybody loves to film things and post them on facebook for all their "friends" to see. Do yourself a favor, if you are witnessing a monster attack, zombie attack, levitating furniture or anything else of that nature...put down the camera and practice a little common sense. In the movie Cloverfield the character stubbornly films the entire horrific episode as it unfolds in front of him always positioning himself for a better view, only to be eaten at the end. Or in the Paranormal movies the people actually goad the spirits to "bring it on" just to film it and maybe later talk about their experience in 140 characters or less with their "followers". One guess as to what happened to them.  On occasion in the movies, like in life, you will see people who throw caution into the wind and make bad decisions galore. In the Blair Witch Project you have a group of college kids, lost in the woods (because they threw away their only map), ignoring warning signs, filming the entire time as they are being harassed by a evil presence and at the end they even go into the basement of a dilapidated house in the middle of nowhere. Tell me...what do you think happens?

Now that we know some of the poor decisions made in horror movies, let's move on to the real world bad choices.

1) Ordering lunch from a clown: I'm talking about McDonalds but obviously all fast foods are pretty much equal. (Quality not taste so no offense to the White Castle crowd.) Occasionally eating this type of food is ok but please don't make a habit of it. I know, I know you're screaming "But they have salads!", but be honest with yourself about what you usually end up ordering. Do yourself a favor and take a few extra minutes in the morning to pack a healthy lunch.

2) Not finding time to exercise: Life is hectic, life is busy, there are not enough hours in the day or days in the week for that matter but you have to start sometime. Setting aside 20-30 minutes three times a week to take care of yourself should be a priority. The benefits of exercise are nothing new so I won't bore you with studies or statistics (although studies have shown that people who have more birthdays live the longest :-). Bottom line is you know you should be exercising.

3) Smoking: Much like yelling "Is there anyone there?" when you hear a strange noise coming from downstairs or playing with an Ouija board by the light of a full moon, smoking is simply a bad decision. For information on quitting visit http://smokefree.gov/

4) Not getting regular blood work: Knowing your baseline numbers for fasting glucose, cholesterol, Vitamin D levels, thyroid function are just some of the reasons you should have annual labs drawn. Just like in the movies there are subtle signs that you could be missing, and by having blood work done regularly you are able to stay on top of your health. And if you suddenly start seeing small children running around in burlap masks you might want to think about a drug test as well. Unless of course you happen to have small children who like to do that sort of thing in which case... I can relate.

You could be one of those people who throw caution into the wind and frequently eat fast food, don't exercise, smoke and never get blood work but if you decide to do that please...DON'T GO IN THE BASEMENT! But in all seriousness by being proactive, making small changes in your diet/habits you are guaranteed to become healthier and happier overtime. And who knows you just might still be around when the credits roll. Have a safe and happy Halloween.

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