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The Sacred Cow of Surgery


Article Posted by Dr. Michael Raeburn, June 7th, 2011

 


I was doing some research on the effectiveness and cost of spinal surgeries and found a quote that made me laugh a little, and then it made me think a lot. Dr. David Spodick, MD, professor of medicine at the University of Massachusetts, has stated “surgery is the sacred cow of our health care system and surgeons are the sacred cowboys who milk it”.

 

Now I’m certainly not looking to tick off all the surgeons out there but I do want people to know that in today’s healthcare system surgery should not be the first option for back pain associated with disc degeneration, disc herniation and radiculopathy. Obviously pathologic conditions such as tumors, infections, cauda equine syndrome and the like require prompt surgical attention. Otherwise a trial of conservative care should be considered.

 

Often individuals with chronic back pain get wrapped up in a medical system that can create a cycle of pharmaceutical dependence and an inevitable trip to the surgeon. Dr. Sherman Cherkin DC and Dr. Richard Deyo, MD, a professor at Oregon Health Sciences University conducted a study in 1994 to compare international rates of back surgeries and found that in the U.S. surgery is unusually excessive and is directly attributed to the supply of spine surgeons: “The rate of back surgery in the United States was at least 40percent higher than any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per-capita supply of orthopedic and neurosurgeons.” In 2006, doctors performed at least 60 million surgical procedures of all types, that’s one for every five people in the U.S.

 

Many of these procedures are ineffective and very expensive, creating huge profits for hospitals and doctors. Back pain is considered 8th on the top ten lists of diseases in the U.S. and according to Forbes.com costs over $40 billion annually for treatment costs alone. Some estimates that factor in work loss, disability, imaging and other indirect costs range from $100 to $200 billion a year. Here is a list of pre-surgery costs for various back surgeries, not including any imaging rehabilitation or indirect expenses:

  • Anterior cervical fusion: $44,000

  • Cervical fusion: $19,850

  • Decompression surgery: $24,000

  • Lumbar laminectomy: $18,000

  • Lumbar spinal fusion: $34,000

Dr. Deyo’s research looked into the total final cost of these procedures and found that the average spine surgery case approaches $100,000 or more, and can be as high as $169,000 for a lumbar fusion. These costs could be justified if the outcomes were better, but they’re not.

Expense aside there is still the inherent risk of surgery itself to consider. According to Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public health, medical health care is now the third leading cause of death in the U.S., causing 225,000 preventable deaths every year.

Now I don’t want to come off as anti-surgery or anti-medicine because I’m certainly not. But if you’re about to make a decision that will shape the rest of your life, for better or worse, it should be an informed decision. Often conservative care is ignored by mainstream providers and is never brought forth as an option. However, the evidence is piling up and it’s showing that chiropractic and other non invasive therapies and procedures produce better patient satisfaction, better outcomes and are vastly more affordable.

 

Article by: Dr. Michael Raeburn
Certified Chiropractic Sports Physician
www.overlookchiropractic.com
Ph: 503-719-7742

This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

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What About The Children?


Posted by Dr. Michael Raeburn, on May 13th, 2011

 


If you asked one hundred parents what their willing to do to protect their child’s life I bet one hundred would say “Whatever it takes!” So why is it that one of the fastest growing health and economic concerns in the United States today are overweight and obese children? It’s estimated by the Centers for Disease Control (CDC), that currently one in three children are either obese or overweight. The CDC further states that childhood obesity has tripled between 1980 and the year 2000. There are several reasons for this sudden lack of health in our children including diet, lifestyle, genetics and medical illness such as Cushings syndrome or hypothyroidism to name a few.


A recent study published in the December, 2010 issue of the Wall Street Journal noted that the use of medications normally associated with adult disorders is on the rise in our children. The article was based on a study conducted by Medco Health Solutions Inc., which determined that roughly 25% of children ages 0-9 and 30% of adolescents between the ages of 10 and 19 are on meds for some kind of chronic condition and 7% of those are taking two or more prescriptions. Looking at the most commonly dispensed medications shows that these prescriptions are largely diet and lifestyle based and therefore preventable.

 

According to the same study 30,000 prescriptions for non-insulin-dependent (type 2) diabetes were given to children between the ages of 0-9, and 394,000 prescriptions written for ages 10-19. Statens are a type of drug used to control high cholesterol, and 94,000 children ages 0-9 and 11,000 children ages 10-19 were dispensed staten drugs to control their cholesterol levels. These numbers are truly frightening. These medications are designed for adults and adult metabolism; there is not a lot of research to conclude secondary effects on young children. It seems exercise and diet may be a cheaper, safer and better solution.

 

The consequences of childhood obesity may include but are not limited to:

  • Breathing problems such as sleep apnea or asthma.

  • Fatty liver disease, gallstones and gastric reflux.

  • Joint and musculoskeletal problems.

  • Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.

  • Increased risk for cardiovascular disease due to high blood pressure or high cholesterol.

  • Obese children and adolescents have a greater risk of social and psychological problems such as discrimination and poor self-esteem, which can continue into adulthood.

  • Obese children are more likely to become obese adults.

So the bottom line is this, if you want to be a friend to your child the best thing you can do is make the right choices for them. Take the soda away, take the fast food away, and take the computer away. A child does not have the capacity or the experience to understand the long-term implications of an unhealthy diet and lifestyle.

Don’t let your child pick their own food, it will likely be high calorie low quality. Don’t let your child sit in front of a video game or the internet without at least 60 minutes of physical activity in their day. Even little changes in daily activities and diet now may dramatically improve your child’s emotional and physical wellbeing, and improve their chances at long term success and happiness in life.

 

Article by: Dr. Michael Raeburn
Certified Chiropractic Sports Physician
www.overlookchiropractic.com
Ph: 503-719-7742

This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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Back Health - Taming the Fire Breathing Dragon

 


Posted by Dr. Michael Raeburn, April 1st, 2011

 


As a Chiropractor I’m often asked the obvious question, why does my back hurt and what can I do about it.  This is a great question considering the National Institutes of Health estimates that 8 out of 10 people will experience back pain at some point in their life 1.  So congratulations if you’re one of the lucky 20%, but if you’re not there may be something you can be doing.


I know it’s corny, but it helps to think of back pain as an unpredictable fire breathing dragon.  You can be proactive and gear up, charge in and attack it, or you can wait for it to eventually come out of its cave and burn you.  Outside of genetics and pathologic process there is a lot that can be done to combat and even prevent back pain.

  • Maintain proper nutrition.  Diet and exercise to reduce excess weight, increase mobility and decreases mechanical stress on all structures.

  • Drink lots of water and less caffeine and alcohol.  Staying hydrated helps to prevent degenerative disc disease by maintaining disc and muscle pliability.

  • If you don’t exercise start.  Even mild exercise increases the amount of oxygen and nutrition the discs receive and provides support to spinal structures.

  • Quit smoking.  Smoking causes spinal discs to degenerate by reducing blood flow and oxygen to the lumbar spine.

  • Don’t forget to stretch before strenuous activity.  House chores and yard work can be as demanding as a trip to the gym.

  • Listen to your mother and “Don’t slouch” when standing or seated.

  • Wear shoes that fit well and are comfortable with low heals.

  • If you work at a desk maintain good ergonomic position, use a chair with lumbar support or place a rolled up towel or pillow behind you. Get up from your seat and move around at least once an hour and don’t forget to stretch.

  • Learn the proper way to lift things and get help when you need it.  It’s easier said than done but using your legs and core will save your back.   Bending at the waist, twisting then lifting is a great way to damage a disc…don’t do it!

  • Core, core, core.  Core strength is a major contributor to spinal stability and is the x-factor in the predisposition to injury and the ability to recover from it.

  • Learn how to perform plank exercises, quadruped exercises and abdominal strengthening in a safe and efficient manner.


This list is far from complete but it’s a good place to start.  According to an epidemiologic study published in the prestigious medical journal, The Lancet, “In the USA, back pain is the most common cause of activity limitation in people younger than 45 years, the second most frequent reason for visits to the physician, the fifth-ranking cause of admission to hospital, and the third most common cause of surgical procedures “2.  That’s some heavy information to take in but the good news for most of us is that we do have a choice.  Lack of information and motivation may be the two biggest hurdles to cross when it comes to battling or preventing back pain.  But if you don’t want the tempo of your life to be controlled by pain you do have help.  There’s an army of chiropractors, physical therapists, personal trainers and MD’s ready to cover your back while you go slay that fire breathing dragon.

 

Article by: Dr. Michael Raeburn
Certified Chiropractic Sports Physician
www.overlookchiropractic.com
Ph: 503-719-7742

This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

 

References:

1.)    http://www.nlm.nih.gov/medlineplus/backpain.html 

2.)    Epidemiological Features of Chronic Low-back Pain;
Although the literature is filled with information about the prevalence and incidence of back pain in general, there is less information about chronic back pain, partly because of a lack of agreement about definition. Chronic back pain is sometimes defined as back pain that lasts for longer than 7–12 weeks. Others define it as pain that lasts beyond the expected period of healing, and acknowledge that chronic pain may not have well-defined underlying pathological causes. Others classify frequently recurring back pain as chronic pain since it intermittently affects an individual over a long period.
Gunnar BJ Andersson MD,
Aug 14, 1999. The Lancet, Vol. 354 No. 9178 pp 581-585.

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Are you ready to Exercise?

 


Article by Dr. Michael Raeburn, March 8th, 2011



If you’re like me you know you need to get out and exercise more, but are you ready?  It’s not always as simple as lacing up the shoes and hopping on a tread mill.  For many of us exercise and physical activity is something dusty we left on the shelf years ago.  What we remember of strenuous exercise is just that, a memory.  The reality is that for many of us, if we try to recapture that bittersweet feeling of exertion, sweat and accomplishment we could be risking our long term health or worse. 


The rigors of exercise place increased demands on our entire body including cardiovascular, musculoskeletal and biomechanical systems.  Because of the risks associated with these increased demands the British Columbia Ministry of Health and the Multidisciplinary Board on Exercise created a self screening tool called the PAR-Q.  PAR-Q stands for “Physical Activity Readiness Questionnaire” and is for individuals between the ages of 15 and 69 who want to start exercising.  The use of the PAR-Q is also endorsed by The American College of Sports Medicine and the American Chiropractic Board of Sports Physicians.   There are seven questions total and if you answer yes to any one question you may be placing yourself at risk by increasing your current levels of physical activity. 

 

  1. Has your doctor ever said that you have a heart condition and that you should
    only do physical activity recommended by a doctor?

  2. Do you feel pain in your chest when you do physical activity?

  3. In the past month, have you had chest pain when you were not doing physical activity?

  4. Do you lose your balance because of dizziness or do you ever lose consciousness?

  5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

  6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

  7. Do you know of any other reason why you should not do physical activity?


If you answered yes to any one of these questions please consult with your physician or sports care professional prior to engaging in increased activity levels.  If you answered no to all of the questions above then you can be relatively confident that increasing your activity levels in a responsible way is safe.  To see an example of the PAR-Q form in its entirety along with some great exercise guidelines please visit the Canadian Society for Exercise Physiology web site at, http://www.csep.ca/cmfiles/publications/parq/par-q.pdf.


As a Chiropractor and sports physician I frequently recommend various stretches and exercises to my patients.  In my practice I’ve found that exercise and participation is often the best medicine.  In the future I hope to write more about activities that may be beneficial to various aspects of the musculoskeletal system and I highly recommend that each individual take the time to complete a PAR-Q prior to attempting any new stretching or exercise program.

 

Article by: Dr. Michael Raeburn
Certified Chiropractic Sports Physician
www.overlookchiropractic.com
Ph: 503-719-7742 

This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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