Welcome to November!

The trees have changed and the leaves have dropped.  That means winter can't be far behind.  I especially enjoy this time of year because of the sensory stimulation!  I feel that the sights, sounds, smells and tastes of November are unmatched by any other month.

November, however, is not without its trials.  Our gaits change to match the walking surface, our driving skills change to match the weather and sometimes, our stress level can rise with the onset of the Holiday Season.

Taking that into account, I have written some unique pieces for your reading enjoyment.

The first column describes the difficulty faced by those who sustain a real whiplash injury.  Remember, whiplash is not just sore muscles, it is damage to the supporting mechanisms of the neck.  This includes bones, ligaments, discs and muscles.

This study evaluated the duration of pain and if there was a relationship to claims of monetary compensation.  The results are surprising.

I followed this with a novel idea that I had regarding the possibility that depression may be metabolic, rather than chemical.  It might be thinking outside of the box, but that is what changes and improves health care.  I did find some support of this idea.

Eileen's Pear Salad is one of my favorites and I do hope that she makes it once a week.  I enjoy it that much!

With the onset of the Holidays, I felt that it was appropriate to warn everyone, again, of the fraud that exists at this time of year.  I cannot stress enough to be careful when purchasing Holiday gifts and products online or from anyone that you don't know and trust.

The last article is about the 2005 'Consumer Reports' recommendation for using Chiropractic care.  It wonderfully supports the benefits of Chiropractic, but it also makes one foolish statement....you will know what I mean when you read it.

In closing, I hope that you have a wonderful November and enjoy the Thanksgiving Holiday that best way that you know how!

I am already working on the December ENewsletter...so be prepared!

Dr. Frisch

PREDICTING INJURIES

There are so many different factors that must be considered when trying to determine what injuries have been sustained during an auto crash, even a small fender-bender.  Each individual must be considered exclusive while performing the appropriate examination.

The issues of gender, height, weight, and body proportion must be considered while evaluating the size of the vehicles involved, the speed of the impact, the angle of impact, and the positioning of each person in the car at the time of the crash.

If this sounds difficult, it is, but we are not done yet! 

In addition to the initial physical examination performed after a crash, the factors of prior trauma and existing degeneration must be evaluated.  Even if someone has existing trauma and injury before a crash, they can and usually do sustain much more trauma during an accident than someone who did not have prior trauma.  This is because their spine was unstable to start with!

A recent British study¹ attempted to determine who might sustain the greatest trauma from a crash and how long those symptoms might last.  Police records were gathered on 503 people who had sustained only 'slight' vehicle damage.  These people where given a comprehensive questionnaire at the start of the study and they were re-surveyed at 6 months, 1 year and again at 2 years (Only at 2 years if they were compensated).

Study Findings:

• 78% of the participants reported pain at the end of one week.

• 52% had neck pain at the 1-year follow-up.

• A history of neck pain and being older did increase the risk of immediate whiplash pain.

Significance:

The two most significant predictors of pain at the 1-year testing period were:

1. If the individual had initial post-crash pain.

2. If there was a compensation claim pending.  (Remember, however, that the more severe the injury, the more likely it is that someone is forced to file a compensation claim!)

To stifle the critics who believe that money drives the issue of a claimed whiplash, this study found two stunning gems:

1. First, 53% of those people seeking monetary compensation DID NOT have whiplash symptoms or complaints!

2. Second, at the 2-year follow-up mark, 70% of the people who had already settled all compensation claims reported continued whiplash pain when compared to those who had not yet settled.

This means that chronic whiplash pain may be predictable by the severity of immediate post-crash pain; and that those people seeking compensation for that pain were more likely to continue having pain long after the compensation coverage ended.

1. Pobereskin, LH. Whiplash following rear end collisions: a prospective cohort          Journal of Neurology, Neurosurgery and Psychiatry. 2005;76:1146-1151.

IS FALL REALLY DEPRESSING?

With the onset of Fall some people seem to express feelings of sadness and even depression.  They may attribute it to shorter days with less sunlight (SAD), recognition that nature’s growth cycle is ending and winter is inevitable, or the simple fact that the Holidays are approaching and that is often a stressful time for many families.

Seasonal depression, however, may actually have a purpose.  I know that this may sound a little odd at first, but please bear with me.  I think that you will soon see the direction of my thoughts.

It has been proposed by Randolph Ness of the University of Michigan, as well as others, that situational depression may serve an evolutionary purpose for survival (Ness, 2000. Lilienfild & Marino, 1999, and Goode, 2000). 

Several situations were proposed:

·        Suppose that you were in competition with a bigger, stronger rival for a mate and that attempting to confront the rival may result in injury or death.  To realize and acknowledge your inferiority may result in a situational depression that prevents you from doing something stupid.  It may actually keep you alive to find a different mate at a later date.

·        A second proposal involves useless effort.  Imagine that a young girl desires to be a professional musician and she practices endlessly to become proficient, but she never excels and she is mediocre, at best.  Her instructor and others, who care about her, finally get her to realize that she is wasting her time.  She becomes depressed, but then realizes that they were probably right and this allows her to focus her efforts in a direction in which she may have real talent.

·        A final theory suggested that useless effort may also apply to either limited resources or reassigned resources.  Imagine that a harsh government is stealing and reapportioning food and wealth to a select few or that maybe a whole country is suffering with famine.  By becoming depressed, even before starvation or illness occurs, the people may begin to withhold physical and mental effort in an attempt to save resources and live through the crisis.

In these situations, it is possible that depression may hold a temporary benefit for the people experiencing it.  Depression in this context may allow the person to stop a fruitless effort and redirect for positive effect, avoid injury or death from a rival, and even save mental and physical energy during a time of crisis.

In that same context, I would suggest that seasonal depression may have a similar mechanism.  Fall may be the personal realization that summer is dying away and that a stark, white, frozen landscape is unavoidable.  This may lead some to begin reserving both mental and physical energy to last out the long, cold winter.  Seasonal depression then, might actually be a self-preserving, coping mechanism, even if the individual doesn't realize it.  It may be metabolic in origin!

(You heard it here first folks!)

As I was sitting in my home office writing this column, I actually began to wonder if this was a real possibility or the simple meanderings of an overly tired doctor.  I pulled out text after text, but I could not find any supporting documentation for this idea.  I considered it an idea at this point because a true theory should have a refutable hypothesis, and how could this idea be tested?

I decided that certain parameters must be set if I were to prevail in my idea:

1.      Fall would have to be definitive time period.

2.      Comparisons would need to be made by regions of the United States, independent of snow and cold or with independent chemical body markers consistent with all .

3.      Age-related parameters would be 30-60 years of age. Subcategories of working adults versus non-working adults would attempt to be determined and compared.

4.      No gender relationship would be analyzed.

Investigations of peer-review, published research, with my list of criteria was quite interesting.  Most research was still stressing the issue of white and brown light therapy for seasonal depression, but not all research followed that theme.

A recent study, published in the Journal of Medical Hypothesis, investigated the possibility that depression may be a metabolic depression of activity and not a mitochondral dysfunction.  In other words, the body is preparing for a change to occur, like hibernation, rather than reacting to an internal cellular disease process.

The down-regulation of activity was initially studied using metabolic markers of bears during the hibernation process.  They reported.....Hibernation in bears and major depression with melancholic features are characterized by withdrawal from the environment, lack of energy, loss of weight from not eating and burning stored fat, changes in sleep pattern, and the following of similar neurobiological findings: reversible subclinical hypothyroidism; increased concentration of serum cortisol; acute phase protein response; low respiratory quotient; oxidative stress response; decreased neurotransmitter levels; and changes in cyclic-adenosine monophosphate-binding activity. Signaling systems associated with protein phosphorylation, transcription factors, and gene expression are responsible for the metabolic depression process during pre-hibernation and hibernation.

In closing their report of findings, they stated that the findings of the bears is closely associated and might be indicative of human findings of depression and mood disorders.

Although I could not find any studies that related exactly to my criteria for a research study, I did find a couple of theoretical studies that were close to my idea of a Preparatory Seasonal Depression (PSD).  I made up this term, but in this instance, it is appropriate.  Now that I have given this idea a name (PSD), a baseline of criteria and a degree of supporting evidence, we have a hypothesis.  This hypothesis is now ready to be refuted.  When this hypothesis is unable to be refuted, it is then supported and becomes fact!  This is how research works!  I will be excited to see how this train of thought (no pun intended) regarding seasonal depression develops over the coming years.

Ideas create change and change benefits the world!

Tsiouris, JA, Metabolic depression in hibernation and major depression: an explanatory theory and an animal model of depression. Med Hypotheses. 2005;65(5):829-40.

EILEEN'S CORNER

This is a very simple, but still 'elegant' salad that you can serve to even the most refined palates!

Eileen

HOLIDAY GIFTS THAT BITE!

The Holiday Season is nearly upon us.  If you count Halloween, it’s already here.  It has been estimated that fraud will cost consumers $260 million this year alone.  For every Good Samaritan, there is a con man or woman waiting to prey on you.  As you open your wallets, be aware that there are hucksters who will play on your emotions to take your money.  The recent and fraudulent Hurricane solicitors are just one example.  Online shopping is another.  This was post by the Minnesota Office of the Attorney General just last year.  It is worth a second glance!

...Over the past few years, consumers have increased their use of online shopping during the holiday season. For 2004, industry experts predict that consumers will spend between $16-17 billion in the holiday shopping months of November and December, up approximately 25% from last year’s on-line holiday spending. This year, experts have calculated that consumers have spent over $300 million shopping online on the Monday following Thanksgiving. As consumers become more web-savvy, and as an increasing amount of households purchase high-speed internet access, consumers are selecting online shopping at a higher rate than past seasons. One firm notes that there are currently over 350,000 websites dedicated solely to online shopping.

Although shopping online may be convenient, consumers should be aware of potentially fraudulent practices they may encounter on the web. For instance, consumers should be prepared to take actions to protect their personal information. Consumers who give out personal financial information online before researching the company and its privacy policy increase their chances of becoming victims of identity theft. In addition, the security of consumers’ personal information may also be jeopardized by using insecure browsers or websites, or failing to remove pesky “spyware” from their computer, which potentially fraudulent operators use to track online transactions and financial information on a given computer. Consumers should never give out their social security number, computer passwords, or ATM codes to unknown parties, as these disclosures could also lead to identity theft.

Consumers may also experience problems with billing or delivery, and should closely examine a company’s business policies before agreeing to do business with it. Under the Federal Mail/Telephone Order Merchandise Rule, merchandise must generally be delivered within 30 days.

The Minnesota Attorney General’s Office suggests that consumers review the following information before shopping online this holiday season:

• Check with the Attorney General’s Office, Better Business Bureau, and Federal Trade Commission to inquire if there has been a problem with a company. In addition, talk to friends and family or review other consumer reports on the company’s business policies.
• Don’t rely on how professional a website looks for proof of a company’s legitimacy.
• If a consumer has never heard of a company, he/she should request a brochure or catalogue in the mail before making an online purchase. Consumers should always be careful when purchasing items from unfamiliar companies.
• Consumers should pay for purchases with a credit card -- not a debit card or electronic check. By using a credit card, in the event that a consumer runs into problems with a purchase, the Fair Credit Billing Act affords him/her the right to dispute, and potentially reverse credit card charges for products or services that were not received or billed improperly.
• Consumers should never give out personal information such as their social security number, credit card number, or check routing information unless they know how it is being used, to avoid becoming a victim of identity theft.
• Examine a company’s return policy and privacy policy before purchasing goods or services.
• Print out records of purchase orders, confirmation numbers, and all webpages visited during the order. If a consumer runs into trouble with an order, such information may be helpful in resolving disputes with the company.
• Make sure a company has a phone number where consumers can call a live customer service representative to address any concerns.
• Use a secure browser that “encrypts” or otherwise protects personal information.
• Use secure websites when shopping online. A secure website is indicated by a “lock” icon and begin with “https,” rather than “http.”
• Consumers should remove “spyware” from their computers, to avoid potentially fraudulent parties from tracking online transactions and personal information.

If consumers have questions or complaints about online shopping, please contact:

Office of Minnesota Attorney General Mike Hatch

1400 Bremer Tower
445 Minnesota Street
St. Paul, MN 55101
(651) 296-3353
1-800-657-3787
TTY: (651) 297-7206
TTY: 1-800-366-4812

CONSUMER REPORT MAGAZINE LIKES CHIROPRACTIC!

A 2005 Consumer Reports article stated that Chiropractic care for back pain and arthritis is not only the most affordable method of care, but also the most effective.  This included all other forms of treatment, including prescription medication.

This is in direct contrast to the media delivery mechanism of just a few short years ago.  I still remember when Medical Doctors were not allowed to associate with Chiropractors.  They would not even take the direct referral of a patient who might have desperately needed medical care.  I did experience this as recent as the 1980’s.  To the doctor’s credit, however, most of this was politically driven by state and national organizations (AMA).

Even though the Consumer Report article noted that people recommended Chiropractic care as also being the most effective for neck pain, they were quick to note that ‘adjusting’ the cervical spine may lead to possible strokes.  They were wrong in that regard.

  …Recent studies show the risk of stroke following a cervical manipulation is 3 per 10 million manipulations. Most consumers don't realize that common over-the-counter drugs are actually hundreds of times more likely to cause serious reactions, such as gastrointestinal bleeding, liver damage, or even death, than drug-free chiropractic manipulation. In fact, a recent report compiled by AHRQ and the National Center for Health Statistics stated that an estimated 4.3 million Americans experienced adverse reactions to medications in 2001 (ACA)…

The topic of cervical manipulation leading to strokes was generated within the medical profession when a number of MD’s performed a study in which they attempted to deliver ‘chiropractic-type’ thrusts to the subject’s cervical spines.  Needless to say, they did not have the appropriate education or training to perform such manipulations (They thought it was easy!).  Several of the subjects did suffer a stroke as a direct result of their study. 

People with a personal bias against Chiropractic seem to always spew that study if they want to try and discredit Chiropractic, as if it should hold any merit.  They are rarely aware that it was a medical study and NOT a chiropractic study that created the strokes!

I am pleased to see that the media is becoming chiropractic-friendly.  It is about time that health care is delivered according to effectiveness, rather than an outdated, medical model that, at best, neglects musculoskeletal trauma, leading directly to arthritis and preventable degeneration.  You will note, however, that once again, it was patients who delivered the word to the public!!!

Have a great month and a wonderful Thanksgiving!

Dr. Frisch