Life is too short to eat a bland diet.  There are a select few things that I absolutely adore, and great food is one of them.  A few years back before I began to monitor my general eating habits, I suffered from gastric reflux.  My doctor at the time prescribed Tagamet (so this was before it was available over the counter) and a bland diet.  I ate chicken broth, rice, potatoes, dry white toast, and plenty of other white empty carbohydrates that were supposed to keep acid reflux away.  It didn’t work.  I swallowed the Tagamet after every meal in order to be able to tolerate food of any kind.  That was before I understood my body and how it metabolizes foods.  I soon learned that taking the medication to control the acid in my stomach all the time killed all of the acid, even the amount that was necessary to break down food properly.  I suffered many troubles before I finally figured out that a good dose of apple cider vinegar would neutralize the excess hydrochloric acid that gave me the horrible heartburn I felt after eating certain foods.  It works for me even today. If I feel the burning sensation in my chest after a rich meal or one heavy in the white carbohydrates a so-called bland diet is filled with, I swallow a tablespoon or two of apple cider vinegar and the fire is put out.  It is cheap.  Even the top of the line organic variety of apple cider vinegar costs only a couple of dollars for a whole quart.  A quart lasts me a whole year.  No harm is done to my body from taking it, and it works like a charm.  There are some cases, however, in which apple cider vinegar is too simple a band-aid to put on the problem.  One such case is that of the hiatal hernia.  I promised a practice member with a new diagnosis of hiatal hernia that I would do some research and let him know what I came up with.  Maybe some of you have the same problem and can benefit from what I have learned.

Hernias occur when something protrudes through a hole.  Sometimes that something is troublesome and sometimes it is not.  Holes in tissue occur when tissue is too thin or too weak, and sometimes people are born with weak spots in their tissues causing hernias to be present at birth.  The diaphragm is a smooth dome-shaped muscle that separates the chest cavity from the abdominal cavity.  There is a hole in the diaphragm called the hiatus and the esophagus passes through this opening to the stomach.  When a portion of the stomach protrudes through this hole, this is called a hiatal hernia.  Normally the hiatus allows only the esophagus to pass through it, but sometimes the muscles around the esophagus become weak and a portion of the stomach will slide through the opening.  This in itself is not a major problem.  In fact, the vast majority of hiatal hernias are completely without symptoms and people discover that they have them only incidentally.  When hiatal hernias do cause a problem is in the event of gastric reflux, or the leakage of the strong hydrochloric acid from the stomach into the esophagus.  This results in inflammation of the lower part of the esophagus and what is commonly referred to as heartburn.  If you have ever suffered from it, you know that it is more than just uncomfortable and is often what leads people to the doctor to locate the hernia in the first place.  Doctors recognize eight different varieties of hiatal hernias, but 90% of them are sliding hiatal hernias, or the ones where the junction of the esophagus and the stomach and a portion of the stomach itself slide up into the chest cavity when abdominal pressure is increased.  Researchers believe that the Western diet, which is not fiber-rich, leads to chronic constipation and an inevitable chronic increase in abdominal pressure.  This makes the incidence of hiatal hernias greater in our country according to some research teams.

Hiatal hernias tend to become more common in people as they age.  Generally fewer than 10% of people under the age of 40 have them while an average of 70% of people over the age of 70 do.  Muscle weakness and decreased elasticity tend to follow aging which explains the increase in hernias in people as they get older.

There is no treatment that is required to treat a hiatal hernia per se.  If gastric reflux is a problem as the result of a hiatal hernia, then treatment of the reflux might be necessary.   Surgical intervention is called for in a minute percentage of hiatal hernia sufferers, but generally not for the sliding type. Most often people are more comfortable if they reduce the acid production in their stomachs by avoiding the foods which irritate them. Cigarette smoking weakens the valve that opens the stomach, so smoking will make reflux worse if you tend to have it.  If you do have a hiatal hernia, avoid heavy lifting or anything that makes you strain because straining increases abdominal pressure and will cause the hernia to move upward into the chest more than usual.

Many people feel that they have a disease when they are diagnosed with a hiatal hernia.  It is not usually a great big deal, and as I mentioned before there is no required ongoing treatment for it.  Listen to your body, try everything you can to reduce acid production in your stomach, and don’t panic most of all.  It might not hurt to try a little apple cider vinegar if the notion strikes you.  It could make a huge difference like it did for me or it might not help at all. It shouldn’t hurt.  Either way, you win.  Treat your body well.

Last week one of the members of our practice expressed appreciation for my writing a column about anxiety, mentioned the fact that a friend of hers has been diagnosed with fibromyalgia, and asked if I would write on the subject.  In doing research for this week’s column, I decided to present the side of the subject as seen by some medical professionals as well as some personal experience with patients who have had the diagnosis.  Please realize that the issue of fibromyalgia is a controversial one in that it has been referred to by some as a “wastebasket diagnosis,” meaning that some believe that fibromyalgia is diagnosed only if doctors don’t know what is really wrong with you.  Those who have the diagnosis would beg to differ.  Either way, people are finding help with the problems associated with the disorder.

Fibromyalgia is a syndrome, or a condition which includes a pattern of symptoms which must be present in order for a diagnosis to be made.  It is characterized by the presence of certain symptoms for three months or longer.  These symptoms include widespread muscle tenderness and pain.  Widespread is described as being both above and below the waist and on both sides of the body.  There are eighteen specific trigger points that are tested, and pain must be present in at least eleven of these eighteen in order for there to be a diagnosis of fibromyalgia.  Sleep disturbance is also a symptom of the disorder.  This can include tossing and turning, waking frequently during the night, and awaking from a night’s sleep without feeling rested.  Another symptom in the syndrome is any unusual joint or muscle stiffness that will not go away once one gets up and begins to move around.

While it is not classified as a psychological disorder, fibromyalgia has as part of the syndrome a major psychological component. Anxiety and depression are present as part of the diagnosis, and the presence of any emotional upset and stress actually cause exacerbations, or flare-ups in the condition.  Many doctors prescribe antidepressants as treatment for the condition of fibromyalgia.  There is no cure for the disorder, no diagnostic tests other than trigger point tenderness to confirm diagnosis, no defined cause of the disorder, and no specific drugs to prescribe for treatment.  The only thing doctors can do is to treat the symptoms of the syndrome individually.  There is no blanket prescription available to treat fibromyalgia as a disease.

The best treatment for the disorder is exercise, but this creates somewhat of a catch-22 for sufferers.  To exercise hurts.  Not to exercise makes the problem worse.  The main thing to be aware of is that consistent home treatment must be fit into the daily routine.  Sometimes this calls for drastic lifestyle changes.  The degree to which one can get better depends upon the degree of commitment to take an active role in home treatment.  Medications are used by some doctors to aid sleep and to reduce the aches and pains of muscular tension.  Antidepressants might be used to improve sleep, relieve depression, and possibly relieve pain.  Strong narcotic drugs are not usually used in treatment of fibromyalgia because they are ineffective for this particular disorder and because they are addictive.

Taking medications can actually become part of the problem due to the fact that no medication comes without its side effects.  In addition to this, there is no proof that the use of drug therapy is effective in the long-term treatment of fibromyalgia.  The syndrome itself has not been blamed for any damage to the muscles, organs, or tissues of the body, so not medicating is not going to cause any harm.  There are support groups available for those who have been diagnosed with fibromyalgia.  If you are interested in such groups, ask your doctor for more information.

There is much talk about CAM, or complementary and alternative medicine, in the medical arena today.  This includes chiropractic among other things.  Chiropractic has been used very successfully in the treatment of fibromyalgia.  Case in point:  a 40 year old woman came to our office suffering with the symptoms of fibromyalgia for the past 7 years.  It was affecting her work and family life.  After a thorough case history, examination, and necessary x-rays, a course of treatment was started.  Within a month, the woman began to report that she didn’t feel as tired or as physically sore as she did prior to treatment.  After two months of care, she reported that she could perform more of her daily duties than before and not feel exhausted at the end of the day.  Today she is living a normal, healthy lifestyle without the array of antidepressants and muscle relaxers that she once felt she needed.

The body will store stress in many ways.  It helps to get to the bottom of any unresolved emotional issues and, amazingly, physical conditions improve.  It is almost impossible to have a negative physical response to a positive mental outlook.  The mind/body connection is undeniable.  Explore the possibilities that there might be some emotional baggage to free yourself from and pay attention to how your body responds.  Get physical treatments to help your body process the emotional stuff.  Massage, chiropractic, exercise in as large a dose as you can handle, and generally treating your body with respect will make an enormous difference in your overall well-being.  Make some calls and explore your options.  Help is out here, and taking an active role in your own care is the very first step to freedom from fibromyalgia and a host of other disorders.  Treat your body and your spirit well.

A gentleman who has been under care for a lower back issue for a couple of weeks asked me one day last week if I would take a look at his elbow.  He has been having pain in his elbow and his wife told him she thought chiropractors worked on all joints and that he should ask me about it.  After I examined his elbow and performed some simple orthopedic tests I told him he had tennis elbow.  “But I have never held a tennis racket in my life,” he said.  Tennis elbow is what he has and it never dawned on him that you can have tennis elbow without playing tennis.  He is a weekend carpenter, though, and spends a lot of time using screwdrivers and hammers on the weekends and in his spare time helping his son-in-law build things.  His is a classic case of overuse syndrome and it happens to fall into the category of injuries called tennis elbow.

Tennis elbow and golfer’s elbow are both injuries to the muscles and tendons in the elbow that result from repetitive stress, or overuse, syndrome.  Anytime a particular motion is performed over and over again repetitive stress injuries can occur.  In the case of the elbow, the bony prominences, or epicondyles, are insertion points for tendons and become inflamed from repetitive stress or strain.  There are two epicondyles in the elbow that are the points of pain for sufferers of tennis and golfer’s elbow.  The one on the thumb side of your elbow is the lateral epicondyle and the one on the pinky side of your elbow is the medial epicondyle.  If the lateral one is inflamed you have tennis elbow, or lateral epicondylitis and if the medial one is inflamed you have golfer’s elbow, or medial epicondylitis.

Tennis elbow is the most common injury to the elbow.  It is a painful condition that can cause localized pain on and around the bony area where the extensor muscles merge into tendons and insert onto the bones of the forearm.  The pain can also radiate down the forearm into the hand.  Motions that involve gripping anything or extending the wrist can make the pain more intense.  Sometimes the muscle bellies can become so tight from overuse that they put pressure on the nerves that go into the hand and the pain can mimic that of carpal tunnel syndrome.  Many times people come into our office with the misdiagnosis of carpal tunnel syndrome when in reality their extensor muscles are too tight and pain in the hand results.  As soon as the muscles are treated and the bones of the forearm and wrist are properly aligned the pain goes away and no surgery is needed.  Tennis elbow is treated similarly.  It is an inflammatory condition and usually goes away when the inflammation is reduced and the muscles are re-educated.

Golfer’s elbow is much less common but no less painful.  This condition results from overuse of the flexor tendons in the forearm.  Improper golf techniques or any period of excessive golf swing practice are the most common causes of flare-ups of this type.  The pain is as intense as it is for tennis elbow, but begins on the medial or pinky side of the elbow.

Treatment for both of these conditions is similar.  At home you want to decrease inflammation first.  The R.I.C.E. formula works best to accomplish it.  Rest the body part that hurts.  Don’t continue doing the motion that caused the problem in the first place.  It has been said that insanity is doing the same thing you have always done but expecting different results.  Don’t continue to cause the injury you are trying to treat.  Ice is always the best local anti-inflammatory for an injury.  Ice shrinks tissue and in the case of elbow epicondylitis there is tissue swelling, so ice will help.  Compression of the muscle bellies and the area over the bony epicondyles will aid in pressing inflammation out of the injured spot.  Elevation helps to aid in removal of fluid in an inflamed area, and since excessive fluid is commonly present it is a good idea.  After the inflammation has decreased, it is important to increase flexibility and strength in the muscles of the forearm again.  There are many good exercises available online for this or your healthcare team can provide some for you.

If your elbow hurts following any repetitive stress or overuse, don’t just ignore it.  Hammering, screwdriver use, key turning, computer work or, believe it or not, excessive hand-shaking can cause tennis or golfer’s elbow.  The longer you let the pain stay around without treating it, the longer it will take for the injury to heal.  Do not hesitate to ask your chiropractor about helping your elbows or other non-spinal joints in your body.  We sometimes get into a “zone” when we are treating the spine and don’t always talk about the other areas of the body that we can help.  It never hurts to ask.  Treat your body well.

In our Monday lunch staff meetings I usually make my best attempts to be inspirational or motivational but when we return from a seminar I always bring some tidbits home and share them with our staff so they can learn as we do about various topics.  This past weekend we attended the Spring Conference of the Georgia Chiropractic Association in Savannah and were reminded of some valuable facts that were part of the subject matter in our Monday staff meeting this week.  We were talking at the conference with many other chiropractors from all over Georgia and vendors from around the country.  We all agree that the body heals much better and more quickly if the spine is adjusted and nerve interference is removed and maintained but there are some conditions that people do not heal from no matter how many times they get adjusted.  Other intervention is necessary and we heard from a former professor of ours about the role the digestive system plays in the body’s overall ability to heal.  I know this does not sound as much fun to learn about as perhaps the secret to enlightenment or the latest techniques to get the best beach body but the health of your digestive system is paramount.

People suffer from many obscure conditions that can be traced to the malfunction of the gastro-intestinal system, or the gut.  The GI system plays vital roles in the operation of our bodies.  It digests food, absorbs nutrients that are converted to energy, transports small particles which are attached to carrier proteins across the lining of the gut into the bloodstream, acts as a major player in the chemical detoxification of the body, and acts as a defender against various infections because it contains many antibodies and other disease-fighting chemicals.  As long as the gut is performing its duties properly our bodies hardly know it is there.  Sometimes, however, the intestinal lining becomes hyper- permeable and allows particles that do not belong there to cross into the bloodstream.  Large particles of bacteria, partially digested food and toxins leak into the body. 

This is a major cause of improper healing.  It also is responsible for many cases of fibromyalgia and food allergies.    The gut is what allows the body to absorb nutrients and convert food to fuel.  If these functions are not working well the entire body is unhealthy.  Sometimes doctors might diagnose irritable bowel syndrome if symptoms of excessive gas, bloating, diarrhea, constipation, abdominal pain and indigestion are present.  While IBS might certainly be going on, the leaky gut problem is likely occurring as well.  When food particles leak from a hyper-permeable intestinal lining, the body assumes that these are foreign particles since they are not normally found in the bloodstream.  The body then develops antibodies that leak across the membranes and are similar to antigens on our own tissues.  The antibodies which are made to attack them actually begin to attack our own tissues and autoimmune disorders often develop.  Many diseases, according to Dr. Paul Goldberg, a leading authority on leaky gut and how to heal it, are direct descendants of leaky gut syndrome.  He traces rheumatoid arthritis, lupus, thyroiditis, fibromyalgia, multiple sclerosis and other diseases to serious complications within the digestive system. 

Often overuse of different medications, especially antibiotics, can be attributed to an unhealthy gastrointestinal system.  Excessive antibiotic usage results in high presence of yeast in the body and yeast secretes a number of enzymes which ultimately break down proteins.  The intestinal membranes are partially proteins and these enzymes can actually break down the membranes and their linings.  This results in leaky gut syndrome and there we are again with all of the unhealthy particles being released into our bloodstreams. 

People are obsessed with their outward appearance and making sure the body appears to be healthy on the surface.  We should be granting equal time to assuring the health of our organs and tissues for longevity.  It is no secret that our food supply is mineral-depleted due to over-planting and over-processing of the end products.  If we are not supplementing our diets with vitamins and minerals that are readily absorbable into our systems, we are missing the proverbial boat.  If we are not supplying our digestive systems with proper support to add back healthy intestinal flora and plenty of the right kinds of fiber to assure adequate transit time of our food through our systems, we are costing ourselves the health we could ultimately have.  Ask your health professionals to provide you with information on the proper nutritional path for you to follow to internal as well as external physical health.  While tests for leaky gut are not often performed they are available.  Sometimes just by process of elimination and testing probiotic supplements you can find relatively simple solutions to some extremely complicated physical issues.  Don’t wait until your health fails before you look for solutions to protect it.  Treat your body well.

A young man came to our office two weeks ago bent over in pain and unable to straighten his posture.  At first glance, we thought it was another classic case of an aggravated bulging disc.  We would have treated it as such until we took x-rays of his spine and discovered a very different situation and an often missed diagnosis.  I know this information might be a great candidate for the bank of useless knowledge for many, but no knowledge is useless and I feel compelled to share some information with you about a condition known as Ankylosing Spondylitis. 

Ankylosing Spondylitis, or AS, is one of several conditions which have a tendency to cause inflammation of the spine and are collectively called spondyloarthropathies.  These include psoriatic arthritis, reactive arthritis, and arthritis associated with Chrohn’s disease and ulcerative colitis.  AS is a form of spinal and sacroiliac joint inflammation.  The sacroiliac joints are two small joints at the base of the spine which are key in weight-bearing and become very painful when they are inflamed.  The condition causes substantial pain at times, stiffness in and around the spine, and left unchecked will result in permanent fusion or “cementing” together of the joints involved.  “Ankylosing” refers to the process of the fusing together of the spinal bones and “spondylitis” refers to chronic spinal inflammation.  The process of ankylosing eventually results in the complete loss of spinal mobility.

The symptoms most often experienced by those with AS include back pain or sacroiliac joint pain which is worse at night or after long periods of activity.  Often people with AS adopt a forward-leaning posture which naturally relieves the pain associated with the condition.  AS makes standing erect very painful, so curving forward eases this discomfort.  Curving forward, however, tends to compress the lungs and makes breathing sometimes difficult.

Ankylosing Spondylitis is thought to be inherited.  Nearly 90% of those with AS are born with the HLA-B27 gene.  Sophisticated blood tests have been developed to detect the marker for this gene, but it does not definitely predict that a person will develop AS.  The gene is not specific for the disorder.  For example, in the United States, 7% of the population has the HLA-B27 gene but only 1% of the population actually has AS.  Research is active in this area, and it is said that a negative HLA-B27 test is more useful in ruling out AS than a positive one is in predicting it.  X-ray is the gold standard for the diagnosis of AS since the spinal abnormalities it causes are very distinct and can be very easily seen on plain films.  This is one of the very reasons that x-ray is necessary in the treatment of people in a chiropractic practice.  If the aforementioned patient had been treated without x-ray, he would have been treated for a condition he doesn’t have and this diagnosis would have been missed.

Many people with AS are under the care of a medical doctor as well as under treatment with a chiropractor.  Medicines are used to control inflammation but, of course, come with their side effects.  A chiropractor can keep spinal mobility and flexibility for as long as possible and help to create better posture.  Gentle flexion/distraction techniques are available and are very helpful in treating this disorder.  Physical therapy and exercise are also helpful since AS tends to cause a forward posture.  Curving forward results in lung compression, so it is essential that extension exercises and those that expand the lung capacity are prescribed and practiced daily.  Stretching exercises help to improve overall flexibility.  Swimming might be described as the perfect exercise for those with AS and many other conditions because it avoids the jarring impact to the spine that many other forms of exercise create.  Of course, nutrition is also of utmost importance when trying to manage this and any other condition.  One specific area of focus nutritionally has been on leaky gut syndrome, or the inability to digest and absorb foods properly.  Information is available on the proper supplements to use in order to increase absorption of nutrients.  Some very beneficial ones are those that promote healthy bacterial flora and those that aid in digestion, specifically acidophilus and bromelain.  Any time the body is not using the food it is supplied with properly, any of a host of conditions might occur, and AS is one of these.

AS is not necessarily crippling or debilitating.  The main piece of advice for those who suffer from it is to become actively involved in your treatment.  Do all that you can to keep your body active, limber, and in good condition.  Work with a team of healthcare providers, and don’t limit yourself to just taking medications that might or might not be beneficial.  Keep a positive attitude, and treat your body well.

In the late 1980’s I worked as a real estate sales director for a firm in Helen, Georgia, and I was the understudy of one Mr. Richard “Dick” Etherton.  He was in his late 70’s, very chauvinistic, and a member of the “Old School.”  I never really figured out just what the Old School was, but I was certain that a young, ambitious, and energetic female was not ever invited to be a part of it.  Dick was angry at the world that he was on his way out professionally and that he, by the order of the owner of the firm for which we both worked, had to train me to take his place.  He was hard on me.  He had a particular penchant for pointing out every little thing I did wrong.  I now understand some of his predicament, but then I thought he was just a grumpy fellow who needed to retire.  Every morning my cheerful greetings were met with his moans and groans about all of his physical ailments as he walked across the floor with an exaggerated limp.  I thought he was making half of it up, but now I know that was far from the truth.  Dick always complained that his gout was getting the best of him.  This was the perfect reason for me to do all of the grunt work around the office and, I thought, a huge excuse for him to have a legal slave.  I did not understand the absolute torture that people with gout actually experience until I started to deal with it clinically.

Gout is a name for a form of joint inflammation (arthritis) that affects primarily the big toe.  The type of pain it causes is inexplicable.  Some compare it to the feeling that the toe is on fire.  Most often the attacks of gout come in the middle of the night with no warning whatsoever and even the weight of a bed sheet on the toe is unbearable.  The affected joint becomes excruciatingly painful, hot, and the skin around it might even turn red and shiny to show the outward signs of the inflammation that is occurring inside.  Gout has been referred to as the rich man’s disease since it is exacerbated by eating rich foods and drinking excessive alcohol, but in recent years it has been recognized to be a complicated and widespread disorder that can affect anyone.  While gout affects mostly men, women are more susceptible to it after menopause.

Gouty arthritis is caused by the deposits in the joints of tiny sharp crystals formed by excessive uric acid in the bloodstream.  Uric acid is formed naturally by the metabolism of purines.  Purines are substances found in certain foods and in alcohol, especially beer and wine.  As the purines are broken down by the body, uric acid develops and in most cases is excreted naturally.  In some cases, though, an excessive amount of the uric acid builds up in the bloodstream and is deposited in joints in the form of tiny needle-like crystals which get into the joints themselves or the tissue surrounding the joints and cause pain, inflammation, and swelling.  The intense pain from gout usually lasts from 5 to 10 days per episode, and there really is no way to prevent attacks once they begin.  Sometimes it can be weeks, months, or even years between attacks at first, but as the condition progresses the attacks get closer and closer together.  Gout can ultimately bring about more intense pain and even joint destruction.  Treatment consists of non-steroidal anti-inflammatory drugs and in some cases steroids to control the acute nature of the attacks.  Most doctors suggest a preventative strategy to reduce the amount of uric acid in the bloodstream and, hopefully, squelch the intensity of future attacks. 

Foods which are high in purines and should be restricted or avoided altogether include organ meats, shellfish, red meats, peas, lentils, and beans.  Excessive alcohol intake should also be avoided, especially beer and wine.  No more than two drinks per day for men and one drink per day for women is a safe bet for those who suffer from gout.  Certain blood pressure medications can cause an increase in uric acid levels in the blood.  If gout becomes an issue and you are taking blood pressure medication, check with your doctor to make sure that the medications you are on are not increasing the likelihood of an attack of gout.  It is also a good idea to increase your water intake if you suffer from gout.  Increased intake of water can dilute the uric acid in your body and ultimately decrease the amount that is in your bloodstream.

For the time that I worked with Dick Etherton, I felt that he was a huge cross for me to bear.  His attacks of gout were intensified by his absolute defiance to do anything other than eat three or more portions of red meat every day, smoke multitudes of Winston cigarettes and drink copious amounts of Miller High Life.  I did not realize at that time, though, how much pain he was in more often than not.  I look back and am grateful that he was hard on me, as that helped build my work ethic and character, but I often regret that I was so hard on him, as that just added one more pain to an area of his anatomy that was pain-free before I came into his life.  Treat your body well.