Back Pain - Surgery vs Chiropractic

Where Should Back Pain Sufferers Seek Care If They Want To Avoid Surgery?

A new study released in the prestigious Spine Journal (15 May 2013 - Volume 38 - Issue 11 - p 953–964) sheds some light on this question. Apparently, the type of physician that you see first, will significantly increase your chances of getting back surgery. From the journal article:

"Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor."

Moral of the story... "If you go to Midas, you're gonna get a muffler. If you go to a surgeon, you're gonna get surgery." (thank you Dr. Perman for that great quote) I recommend trying the most conservative approaches first, and surgery should always be the last option. For more information, go to our website at www.DrGordonOnline.net

Obamacare - The Pros and Cons

After yesterday's Supreme Court ruling on the Affordable Care Act (Obamacare), I have several patients and friends ask for my opinion on the pros and cons of the legislation.  Below of summarized what I feel to be the good and bad aspects of the Obamacare legislation.  Some portions of the law have already gone into effect, while the major portions of the legislation including the 'individual mandate tax' to purchase health insurance, will be begin in 2014.

 

Pros:

• Insurance companies will no longer be able to deny coverage based on pre-existing conditions.
• Younger adults will be able to stay on their parents' insurance plan until the age of 26.
• A larger portion of the general population will have insurance coverage.
• Starting in 2014, all lower income individuals will be able to enroll in Medicaid.
• Closing of the 'donut hole' in Medicare Part D coverage.
• No annual or lifetime benefit limits in insurance coverage.
• Anti-discrimination language is included to ensure equality amongst provider groups (MDs, DOs, and DCs)

Cons:

• Infringement upon individual liberties - for the first time in American history, individuals are being forced to buy a product against their will.
• Government being interjected between the doctor and the patient.
• By 2019, 4.8 million seniors will be forced out of Medicare Advantage.
• Obamacare cuts $528 billion dollars out of Medicare, resulting in decreased services and reimbursement to providers.
• A reduced number of providers will accept Medicare patients due to the reduced reimbursement and increased paperwork involved.
• The 'Doctor Fix' dilemma - there has been a steadily increasing reimbursement percentage cut for Medicare providers.  Neither political party is willing to implement the pay cut (currently over 27%) because they realize that it will result in a mass exodus of providers from Medicare.  This will cause a shortage in doctors for Medicare beneficiaries, increase wait times in offices continuing to take Medicare patients, and increase emergency room visits.  This 'Doctor Fix' composes over $500 billion of which the supporters of the Affordable Care Act propose to pay for it, and equate the implementation of this Act as a net 'cost savings'.  The problem is that if the 'Doctor Fix' is never implemented, the Affordable Care become 'unaffordable' costing the American taxpayers over $500 billion dollars. 
• Increased taxes associated with Obamacare / the Affordable Care Act:
  • Individual Mandate Excise Tax - beginning in 2014, those without 'qualifying' health insurance will be taxed 1% of their adjusted gross income (this rises to 2% in 2015, and remains at 2.5% for 2016 and beyond).
  • Employer Mandate Tax - applies to employers with over 50 employees that does not provide health insurance for employees.  The employer is fined $2,000 - $3,000 per full time employee (amount depends upon whether the employee acquires their insurance through an exchange).
  • Surtax on Investment Income - applies to individuals making over $200,000, and families and small business owners making over $250,000.  Applies an additional 3.8% tax on investment income (capital gains, dividends, etc...).  This would bring capital gains tax rates to 23.8%, and dividends tax rates to 43.4%.  This tax does not apply to non-resident aliens.
  • Excise Tax on Comprehensive Health Insurance Plans ('Cadillac Plans') - beginning in 2018, there will be a new 40% tax on high-end 'Cadillac Plans'.
  • Medicare Payroll Tax Increase - for those making over $200,000, their Medicare Payroll tax will increase from 2.9% to 3.8%.
  • Medicine Cabinet Tax - Americans will no longer be able to use their pre-tax dollars in Health Savings Accounts (HSAs) or Flex Spending Accounts (FSAs) to purchase non-prescription, over the counter medications (except insulin).
  • Flex Spending Account Cap - imposes a cap of $2,500 on FSAs (currently unlimited).  This tax has been dubbed the "Special Needs Kids Tax" because many families with special needs children use their FSA to pay for education costs, and will be hit especially hard.
  • Medical Device Manufacturer Tax - Obamacare imparts a new 2.3% tax on all medical devices costing over $100.  This will increase healthcare costs.

I hope this information helps you to understand the pros and cons of the Affordable Care Act (Obamacare), as well as to help guide you in making an informed decision on Election Day in November 2012.

Hypertension - What You Need To Know.

The following are important factors regarding managing high blood pressure:

• Sleep apnea doubles the risk of having elevated blood pressure and is one of the number one risk factors for hypertension.
• Drugs such as contraceptives, anti-depressants, antibiotics, and anti-inflammatories can increase your blood pressure and interfere with blood pressure medications. 
• Studies show that purple potatoes, olive oil, raisins, and dark chocolate all lower blood pressure. 
• Herbal extracts including grape seed extract and pomegranate both lower blood pressure. 
• Daily magnesium supplementation can lower systolic and diastolic blood pressure. 
• Exercise and weight loss are essential to lowering your body mass index (BMI) and thus your blood pressure.

Omega 3 Helps To Prevent Alzheimer's Disease

The following article from Fox News describes the benefits of Omega 3 oils in the prevention of Alzheimer's Disease: Eating foods such as chicken, fish and nuts may help lower blood levels of a protein strongly associated with Alzheimer's disease and memory problems, according to new research. In the Columbia University study, people who consumed diets rich in omega-3 fatty acids had significantly lower levels of a protein called beta-amyloid in their blood than those who did not consume as much of the nutrient. According to the research, eating one more gram of omega-3s than average per week was associated with 20 to 30 percent lower levels of beta-amyloid. One gram is approximately equal to half a fillet of salmon. However, study author Dr. Nikolaos Scarmeas, a neurologist at Columbia University Medical Center in New York and a member of the American Academy of Neurology, recommended not focusing on eating particular quantities of omega-3s, but rather, simply incorporating as much of the nutrient into one’s diet as possible. "It was a continuous association. More and more intake of omega-3s was associated with lower and lower levels of beta-amyloid in the blood. There was no threshold effect," Scarmeas said. The association between omega-3 consumption and beta-amyloid was unaffected by whether or not a person took supplements - meaning if two people consumed the same amount of omega-3s, one through food and the other through supplements, the person who consumed more omega-3 rich foods typically had lower blood levels of beta-amyloid. It is believed that the build-up of beta-amyloid in the brain, not the blood, is a precursor for Alzheimer's. However, past studies have indicated there may be a relationship between blood levels and brain levels of the protein. “There is complex, conflicting literature; we do not understand very well biologically how levels of beta-amyloid in the blood, brain and spinal fluid are related exactly,” Scarmeas said. "In some studies, higher levels of beta-amyloid in the blood relate to higher levels of beta-amyloid in the brain. Other studies have suggested the opposite." Scarmeas added that his own lab had observed that people with higher blood levels of beta-amyloid were more likely to develop dementia, while people with lower levels tended not to. “Some of these [participants] have already been followed up on,” he said. “We know those with lower levels of beta-amyloid in the blood were less likely to develop dementia.” The beneficial impact of omega-3 on brain health would fall in line with past studies of the nutrient, according to Scarmeas. Omega-3s have long been associated with positive benefits for memory and cognition. Scarmeas speculated that omega-3s may be able to reduce oxidative stress on the brain and the resulting vascular damage, or even have some kind of impact on beta-amyloid in the brain. Though, there is not enough support yet to suggest the nutrient and protein are directly related, he added. "Previous studies have suggested that omega-3s and other aspects of diet may be related to brain function," he said. "Here we demonstrate one possible mechanism could be through amyloid, the main biological mechanism that relates to Alzheimer's disease. There have been animal studies suggesting omega-3s could relate to amyloid brain biology. We've demonstrated this association may also be present in humans." The study was published Wednesday in the journal Neurology.

How The New PIP / Auto Accident Legislation Will Affect Florida Consumers.

On the last day of the Florida legislative session, the Florida House & Senate agreed upon and passed a PIP Reform Bill which will change auto accident insurance coverage for Florida consumers. Some of the new legislation will go into effect on July 1, 2012 (other portions go into effect on January 1, 2013). This new legislation will have dire consequences for consumers in the State of Florida. To help inform the public, I have summarized the important changes to the PIP system so that consumers will have the information available in the event that they are in an auto accident. Please feel free to share this information with your friends, family, and neighbors.
• Time Limit To Report To Your Doctor’s Office Or ER:
o How It Affects You – The new legislation dictates that a person injured in an auto accident must present to a physician’s office or emergency room within 14 days of the auto accident. If the patient doesn’t seek care within 14 days, they will be ineligible for any PIP benefits for their injuries.
• Reduction Of Coverage to $2,500 from $10,000:
o How It Affects You – The new legislation differentiates between an ‘emergency medical condition’ (EMC) and a ‘non-emergency medical condition’ (non-EMC). An EMC can only be diagnosed by an MD, DO, nurse practitioner, or physician assistant, not a chiropractor (discriminatory against DC’s). If the patient is diagnosed with a non-EMC, they will only be able to use $2,500 of the $10,000 that the patient is paying for as part of his/her PIP insurance. The full $10,000 will only be accessible if the patient is diagnosed with an EMC. Unfortunately, the Florida legislature did not delineate what constitutes an EMC.
• Examinations Under Oath (EUO):
o How It Affects You – The new law permits the insurer to subject the injured person to an ‘examination under oath’ to determine if there are verifiable injuries that are not fraudulent. The law also allows the auto insurer to suspend payments to doctors until the patient goes through the examination under oath. You must attend the EUO or your insurer can ‘cut off’ your coverage.
• Rate Roll Backs For Insurance Premiums:
o How It Affects You – This new legislation was passed in the name of ‘anti-fraud’ and to reduce costs to Florida consumers. Unfortunately, the law makers did not include concrete rules to require insurance companies to roll back or reduce insurance premiums for consumers.
In conclusion, insurance companies will continue to charge Florida drivers higher rates for PIP coverage, but consumers will receive reduced benefits ($2,500 vs $10,000) and more ‘hoops to jump through’ to get care for their injuries. This law restricts consumer choice for healthcare and is a payoff to the insurance industry.
So, what should you do in the event that you are in an auto accident? Be sure to contact our office within 14 days of your accident (the sooner the better in the event that a referral is needed to an MD or DO). If a referral is necessary, we will be sure to get you examined by an MD or DO within 14 days to ensure that you receive the benefits for an EMC if it is deemed medically necessary.
For more information, contact our office at:
Dr. Jeremy Gordon – Chiropractic Physician – 905 N. Stone Street – DeLand. (386)734-9995

Obesity Linked To Autism?

The article below is from Reuters and it details new findings from the journal Pediatrics linking autism to a mother's obesity during pregnancy. Pass this information along to your friends and family.

(Reuters) - Children born to obese women are more likely to be diagnosed with autism or related developmental delays than the children of slimmer mothers, according to a U.S. survey.

The research, which appeared in Pediatrics, was looking for the impact on childrens' cognitive development from a variety of "metabolic conditions" in the mother, including high blood pressure or diabetes. The strongest links were found between obesity and autism-related disorders.

Although the study cannot prove that one condition causes the other, its authors caution that even the possibility is worrisome in the light of rising U.S. obesity rates.

"If there is anything you can do to make yourself healthier, this is yet another reason for moms to consider," said Paula Krakowiak, a researcher at the University of California, Davis, who led the study.

The study comes on the heels of a report from the U.S. Centers for Disease Control and Prevention that estimated one in every 88 children in the U.S. has an autism spectrum disorder. That number represents about a 25 percent increase from the agency's last report in 2006.

Krakowiak and her colleagues looked at 1,004 children who were between two and five years old, born in California and already participating in a study underway at UC Davis.

Of those children, 517 had an autism spectrum disorder and 172 had developmental delays. For Krakowiak's study, the children's diagnoses were confirmed by a re-evaluation at the UC Davis MIND Institute.

Milder versions of autism, such as Asperger's syndrome, form a "spectrum" of autism-related disorders. In addition, impairments in any one of the autism-related cognitive skill areas are considered developmental delays.

Among the children in the study with an autism spectrum disorder, 48 were born to mothers with Type 2 or gestational diabetes, 111 to mothers who were obese and 148 to mothers with any sort of metabolic condition, like high blood pressure.

For children with a developmental delay, 20 were born to mothers with Type 2 or gestational diabetes, 41 to mothers who were obese and 60 to a mother with any metabolic condition.

Overall, the connection between diabetes in a mother and her child being diagnosed with autism was not significant, but the researchers did find links between a mother being obese or having other metabolic conditions and her child having autism.

Developmental delays were associated with both obesity and diabetes, along with having any other metabolic condition.

"There is definitely an association present and it adds to the reasons for finding ways to lower obesity rates or diabetes rates and make greater efforts to change lifestyle factors," Krakowiak said.

She and her colleagues also noted that nearly 60 percent of U.S. women of childbearing age are overweight, one third are obese and 16 percent have so-called metabolic syndrome - a constellation of symptoms, including high blood pressure and insulin resistance, that raise heart risk.

Although nobody can say the nation's rising obesity rate is to blame for the prevalence of autism, Krakowiak said the parallel increases did catch her attention.

Hannah Gardener, an epidemiologist in the Department of Neurology at the University of Miami, told Reuters Health that she thinks it's natural for people to connect the two rates.

"There is a lot that is unknown and studies like these really help us figure out the questions that need to be answered," Gardener said.

But she warned that researchers are far from understanding what might create a link between obesity and autism.

Estrogen Increases Cancer Risk...New Study Findings

Below is important information regarding the safety of estrogen replacement in menopausal woman. This article was taken off of the Yahoo Health website:

"Several weeks after a study suggested that women who take estrogen-only hormone replacement to treat menopause symptoms may be at lower risk for developing breast cancer, another, much-larger study finds that when used for longer than 10 years, estrogen-only regimens actually raise a woman's long-term risk for breast cancer.

The new study was funded by the National Cancer Institute, part of the U.S. National Institutes of Health, whereas the previous one was partially funded by drug manufacturer Wyeth.

Researchers evaluated follow-up data from the Nurse's Health Study collected from 1980 through 2008. The women in the study were 30 to 55 years old in 1976. Overall, the risk for breast cancer was 88 percent higher among women who had taken estrogen plus progesterone for 10 to 14.9 years, compared to women who did not. This risk more than doubled for women who used estrogen-plus-progesterone therapy for 15 to 19.9 years.

Women who used estrogen-only therapy after menopause had 22 percent increased risk for breast cancer if they used it for 10 to 14.9 years, and 43 percent greater risk if they used it longer than 15 years.

There was no increased risk seen among women who took estrogen for fewer than 10 years. Women did not have an increased risk of dying from breast cancer, the study showed.

Hormone replacement therapy (HRT) fell from grace after the U.S. Women's Health Initiative study was stopped early in 2002 because HRT was shown to increase the risk of strokes and breast and ovarian cancer. Some subtleties have emerged since that time. For example, short-term use of HRT is now deemed fairly safe for some women who have severe menopausal symptoms. Estrogen-only therapy is reserved for women who have had a hysterectomy; women with an intact uterus who use HRT must take the hormone progestin (synthetic progesterone) with estrogen to prevent uterine cancer.

"For combination therapy there is so much data about the dangers that we really tell people that if they must take it to treat symptoms, they should only do so for a year or two at most," said study author Dr. Wendy Chen, an associate physician at Brigham and Women's Hospital and an assistant professor in medicine at the Breast Cancer Treatment Center at the Dana-Farber Cancer Institute in Boston. "For estrogen alone, there is more safety data for someone who wants to take it for five or six years."

Chen is scheduled to present her findings at this week's annual meeting of the American Association for Cancer Research in Chicago.

Her advice is for women to think about why they are taking supplemental hormones. "If it is for hot flashes, they don't last forever," she said. If vaginal dryness is the issue, there are vaginal hormone preparations. "You are not going to have the systemic effects that you will from talking a pill," she said.

Dr. Larry Norton, deputy physician-in-chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center and medical director of the Evelyn H. Lauder Breast Center, in New York City, does not recommend that women take estrogen after menopause.

"The jury is still out on how safe estrogen alone is, but I am not recommending it, and the major reason why is because every drug I know that reduces the risk of breast cancer reduces estrogen," he said. "Saying an estrogen is going to be safe raises an important question mark in my mind," Norton said. "Alternative treatments may help treat the symptoms and risks associated with menopause, so why take the chance?"

Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal."