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Posted by >David G. Wedemeyer, DC</b> on 6/13/07 at 13:44
Dr. Kiper I have a question and a possible study subject for you. I have a 98 yo grandmother who has such a dimunition of the plantar soft-tissues that her tarsals appear to be ready to poke through her skin. She went to a podiatrist who suggested a gel insert.
Do you think your SDO is appropriate for her and if so I would be willing to fit her and report on her progress.
Result number: 1
Posted by >David G. Wedemeyer, DC</b> on 6/13/07 at 13:39
Thank you Linda. I agree as a profession we are underutilized, in fact statistics vary but in the US routine chiropractic care is only utilized by less than 10% of the population.
My profession can only blame themselves for that because they refuse to integrate into mainstream medicine and schools. For now we are physician specialists in conservative spinal care with most insurers. I believe we are much more than that, at least I practice with that paradigm.
Good luck to you Linda,
Result number: 2
Posted by >David G. Wedemeyer, DC</b> on 6/13/07 at 13:31
Scott I understand your disbelief over Gabapentin, seems like it's one of the biggest 'blockbuster' medications out there in terms of being prescribed (and income for Pfizer). My point is that pharmaceutical companies have the advertising dollars to promote a drug like this to the physicians, hence the incredible off-label use of the drug and it's popularity.
It doesn't surprise me one bit, they were after all fined and reprmanded for their aggressive marketing of off-label use of Neurontin.
Result number: 3
Posted by >David G. Wedemeyer, DC</b> on 6/12/07 at 18:59
Excellent area Dr. Steve. I had family in Arroyo Grande many years ago (they have been local for a log time now) and we would go to Pismo to see them. I wouldn't mind retiring up there, even pondered moving there out of college. Stuck in the 'OC' for now. Be well..
Result number: 4
Posted by >David G. Wedemeyer, DC</b> on 6/12/07 at 18:52
You know how I know this post doesn't pass the smell test?
'i haven been to some of the best doctors in the country, these two are not the greatest. They might be for insets thats all.'
I prefaced my suggestion with:
'I actually am more familiar with orthopedists than DPM's though I know of a couple I trust. I am not willing to say they are TTS specialists but rather specialists in the lower extremity with years of treating experience.'
1. If I were a surgeon and found out you either had seen or had previous procedures done 'all over the country' and were exhibiting signs of physician shopping, I wouldn't help you either. The spectre of litigation from the many other failures wouldn't appeal to anyone.
2. YOUR opinion is that said Dr. doesn't have the greatest reputation 'with his patients'. I can in fact name many who would say otherwise. Further proof that you wouldn't be happy unless you call the shots I bet.
3. Neither of these surgeons makes inserts (insets..?). I would bet you have never been to see them because neither is a huge fan of 'inserts'.
4. You also failed to spell one of their names correctly, leading me to believe you have never seen either of them professionally nor their name prior.
5. I see one post under your name prior to this. If your goal is to contradict a suggestion based on much greater experience than your own, reveal your true name and identity or else kindly retract yourself from my leg and cease the banal, incredulous mistruths.
End of discussion.
Result number: 5
Posted by >David G. Wedemeyer, DC</b> on 6/12/07 at 13:43
Scott it could be that sales for Neurontin have been over 80% for 'off label' use. We forget Neurontin was approved as an anticonvulsant medication. It has a litigious and storied history concerning the marketing practices that made it such a hit and which Pfizer inhereited when they bought out the rights to it. They also manufacture Lyrica which is aimed at the diabetic neuropathy/post-herpetic neuralgia patient and is another antiseizure/epileptic. See a pattern here?
Result number: 6
Posted by >David G. Wedemeyer, DC</b> on 6/12/07 at 13:32
Linda I am pleased to hear you have found a good team to help you. I am not a podiatrist Linda nor a medical doctor of any kind, but thank you for you kind words. I am actually a chiropractor who has completed the pedorthic program and will take the board exam soon.
I emphasize foot care in my practice because I feel that often there is an enormous link between what I see in my office as a DC and the lower extremity. I also feel there is an even greater gap between what the medically trained physicians provide and pedorthic education.
Someone posted here that patients want to know how much we care before they want to know how much we know. One thing I have learned from you posters is that you want to be heard as well as diagnosed.
Result number: 7
Posted by >David G. Wedemeyer, DC</b> on 6/11/07 at 15:16
Often when providers make orthotics for a PF patient they overpost the medial arch to prevent pronation. This leads to an overcompensation of supination during propulsion which strains the medial-central band of the plantar aponeurosis. There is also the spectre of a large population out there with what we term an uncompensated forefoot varus, which providers often post the insert to avoid pronation, furthering the damage.
Dr. Ed please chime in here anytime...
In layman's terms they post it incorrectly for the condition, leading to more stress on the PF. This is also why I believe many people get better results from an OTC insert than a custom device; the OTC insert is more neutral causing less iatrogenic symptomatology than an improperly posted custom device.
If these factors are kept in mind by the provider when making the prescription, I do believe that a custom orthosis from a neutral non weight-bearing cast is always more beneficial in treating pathology.
Linda if your physiotherapist is correct then what follows is that whoever made your orthotics was incorrect in their design. The majority of inserts are either prefabricated or posted to correct overpronation of the midtarsal joints. The problem is that this is a very simplistic view of a very complex problem.
In my office each patient undergoes a full exam including gait analysis both visual and digital. Many of the orthotics patients bring with them on their first visit are atrocious and incorrect for their feet. Podiatrists (and C.Peds)have long been the leaders in understanding the myriad of factors which need to be addressed when making an orthotic .
Result number: 8
Posted by >David G. Wedemeyer, DC</b> on 6/11/07 at 13:30
Esther unfortunately there is no magic bullet for treating CRPS.
RSD (CRPS Chronic Regional Pain Syndrome) is a tricky entity to treat. Typically physical therapy helps very early, beyond that a nerve block is diagnostic as well as the treatment. If a nerve block made the pain worse, there is good cause for your to physician to reconsider your diagnosis. You should discuss this with her/him and possibly seek another opinion.
I am wondering why you would receive an epidural for PF or lower extremity nerve entrapment. Maybe one of the podiatrists here could tell us if this is standard practice for those complaints?
Result number: 9
Posted by >David G. Wedemeyer, DC</b> on 6/09/07 at 01:22
Juleen diagnostic tests should confirm the primary diagnosis and weed out the differentials. Your doctors are just being conservative which is a good thing Juleen. Unfortunately TTS is a son-of-a-gun occult entity for physicians to be certain about lacking the a confirmatory electro study.
I know of several foot & ankle specialists I have sent both patients and family to in Orange County, I actually am more familiar with orthopedists than DPM's though I know of a couple I trust. I am not willing to say they are TTS specialists but rather specialists in the lower extremity with years of treating experience.
Drs. Gerken and Tischler at Newport Orthopedic Institute are top notch. Let me know if you'd like more names.
I still maintain that if you have a somewhat flexible heel a lateral wedge in a properly constructed orthotic works miracles if the impingement is caused by a functional defect.
Result number: 10
Posted by >David G. Wedemeyer, DC</b> on 6/08/07 at 17:54
Velma many of the myriad of nerve entrapment disorders are verifiable by taking a good history of your complaint, orthopedic, sensory and muscle strength (intrinsic)testing and of the foot and ankle gait analysis.
EMG/NCV, MRI PSSD etc. should never be the only criteria to arrive at a diagnosis regardless of the type of physician. If your EMG/NCV is coming back negative it may well be that the large myelinated nerves further up the chain are not affected yet. Most provocative orthopedic tests are somewhat specific in reproducing your complaint and if not, your doc should try and reproduce it in the office. Tinel's sign at the ankle is somewhat specific, where the doc taps the retinaculum and it reproduces your pain.
I assume you have tried conservative treatments such as a laterally wedged custom orthotic, physical therapy? Carpal tunnel syndrome at the wrist is a similar mechanism of injury and both respond to conservative care in a great many cases early on.
Result number: 11
Posted by >David G. Wedemeyer, DC</b> on 6/07/07 at 22:44
Indeed we did discuss this very thing Ed. I believe once gas hits $4/gallon people will start to change their habits and I predict we will reach that price point this summer.
I've long said hydrogen is the fuel of the future for cars. I just hope the fuel cell tank is near impossible to puncture or these cars may become the new Pinto!
Result number: 12
Posted by >David G. Wedemeyer, DC</b> on 6/07/07 at 14:27
Sadly here in Cali SUV's are the rave and sales of large gas guzzling trucks are higher than in most states. Hopefully people will begin to think about this as we did back during the big gas crisis and purchase more fuel efficient vehicles, utilize public transportation and lower their speed. One can dream...
Result number: 13
Posted by >David G. Wedemeyer, DC</b> on 6/07/07 at 14:22
Kathy M are you a runner or engaged in physical activity which requires pressure on the toes beyond normal walking?
Result number: 14
Posted by >David G. Wedemeyer, DC</b> on 6/07/07 at 14:20
I agree more information would provide a more accurate answer here. I assume he is referring to an equinus position of the ankle due to foot drop, flaccid paralysis as opposed to a primary equinovarus from a UMN lesion. It is important to now if this is a result of an upper motor neuron vs lower motor neuron insult.
In either case a solid ankle AFO can be used especially if the deformity meets certain criteria for a custom versus an OTC brace.
Result number: 15
Posted by >David G. Wedemeyer, DC</b> on 6/06/07 at 23:38
Certainly not me John I have no cogent portend for the future of Iraq whether we withdraw or not. I feel either way the cost was too great compared to the benefit. To use simile while we meant to remove a gangrenous toe the patient now has full blown RSD!
I always felt the real impetus behind this war had more to do with bravado and sabre rattling (and oil, N Korea, Iran etc) than an illusory cache of weapons or what a human rights violator Saddam Hussein was. To buy the latter one would have to first perceive our administration as altruists, which they are not.
Result number: 16
Posted by >David G. Wedemeyer, DC</b> on 6/06/07 at 23:25
Dr. Steve B what part of Calif do you practice in?
Result number: 17
Posted by >David G. Wedemeyer, DC</b> on 6/06/07 at 22:25
Marie sardonic is one word that has been used to describe my wit. Coming from the woman who single handedly at times staves off the onslaught of right leaning posters here, I take that as a compliment! Politically I'm Switzerland unless the subject is GW, the champion of mediocrity (and less) and his merry band of absolute screw ups.
Result number: 18
Posted by >David G. Wedemeyer, DC</b> on 6/06/07 at 19:44
Success in Iraq to me would mirror western civilization here in the good ol' USA.
Truly democratic processes such as more Starbucks than formal schools, a McDonald's or other chain of high fat artery clogging faux food on every corner, chad controversies and vote tampering, congressional crime, presidential sex scandals (thanks Monica!), ludicrous fuel prices without restraint, whole seasons of Dateline tv devoted to perverts and deviants who prey on children via the internet ad nauseum, ad tedeum.....:P
Result number: 19
Posted by >David G. Wedemeyer, DC</b> on 6/06/07 at 19:30
PAB yes there are a variety of braces made to accommodate foot drop. Any good pedorthist can also add a rocker bottom to the sole of your shoe to aid in propulsion since braces for foot drop maintain the ankle in a dorsiflexed (toes back towards the shin)position.
A Richie or AFO gauntlet with the proper shoes will hopefully be very helpful to you, I suggest you discuss it with your physician.
Do you have bilateral foot drop (both feet)?
Result number: 20
Posted by >David G. Wedemeyer, DC</b> on 6/05/07 at 19:42
Result number: 21
Posted by >David G. Wedemeyer, DC</b> on 6/05/07 at 17:36
I concur! I would add improper shoe wear and under supportive shoes, inserts and like Dr. Kiper stated, overuse injuries from sports.
Most people buy shoes and supports based on appearance and price rather than quality. Midfoot twist during gait is a challenge to the supportive structures of the foot.
Result number: 22
Posted by >David G. Wedemeyer, DC</b> on 6/04/07 at 18:18
This is an outcome report based not on a study or studies but performance based on their own proprietary data: '..outcomes shown below have been collected using our state-of-the-art outcomes system, the ASTYM Analystô..).
Let me guess, you work for Performance Dynamics or are a practitioner? How about one peer reviewed journal study demonstrating ASTYM's superiority to existing instrument based techniques?
Result number: 23
Posted by >David G. Wedemeyer, DC</b> on 6/04/07 at 13:58
John I have experienced Graston and ART first hand (I perform ART in my office). The truth is whether it is massage, myofascial release, ART, ASTYM, Graston or any other soft-tissue technique they all are efficacious. The one thing that differs is subjective and that is the skill and experience of the practitioner and the appropriateness of the technique for the condition.
That said Graston and ASTYM are instrument based techniques. I prefer to use my fat German digits to the feel of a metallic instrument, others prefer to save their fingers from the daily trauma from deep tissue work. I also much prefer to have the control over the depth and intensity of the treatment in the acute phase as many people cannot tolerate an instrument right out of the gate and it could be more harmful to healing tissue during this time.
I describe soft-tissue injury and healing in this way to my patients. Muscles heal in days to weeks based on the rich blood supply available to them. Tendons and ligaments have no direct blood supply and therefore heal in weeks, to months, to years by forces imparted on them which stimulate cellular reorganization of the ground substance that makes these tissues.
Think of it this way. have you ever cut your finger very deeply and years later after the wound heals it is tingly and less flexible? When your soft-tissues are sprained or you encounter micro-tears your body sets up an inflammatory cascade of cellular 'glue' similar to a blood clot to protect the wound site. This material is arranged in a very haphazard pattern, much less elastic and much more highly innervated. All of this is for protection and to alert you prior to re-injury or further damage. It is also much more prone to re-injury,
The techniques we are discussing here all seek to cause a new injury to the affected tissues and utilizing the normal active and/or passive (depending on the phase of care) motion of the tissue realign the new material according to proper tendon, ligamentous and fascial planes. The adjustments or manipulation we as chiropractors provide work in much the same way and in the spine it is much more effective than just PT alone.
Bottom line is abnormally restricted range of motion in any joint, space or plane = pain and dysfunction. In order to restore normal joint or soft-tissue mechanics light force whether by high velocity manipulation, ART, ASTYM, Graston etc. all have a great benefit on restoring motion, decreasing pain and causing the micro-trauma sufficient to begin remodeling and thus healing.
Now if practitioners would just relate this to people without the sales pitch and competitive marketing we could all get on with healing. I for one wont spend several thousand dollars for molded metal that cannot sense what my hands over the years have become extremely sensitive to until the PROVE that it is more effective.
Result number: 24
Posted by >David G. Wedemeyer, DC</b> on 6/04/07 at 13:30
Lori has your doctor suggested a weight-bearing ankle/foot orthosis (AFO) and shoe mods for the lateral column pain? A reverse Thomas heel in the shoe and/or cuboid pad in the AFO could be of help. Typically an orthotic with these modifications built in does the trick but given the chronic nature of your complaint, immobilization of the foot and ankle is indicated here.
I agree with Dr. Ed's recomendation post-surgery and that avoiding it altogether will avoid the same problem with the left foot.
Knowing that you have rheumatoid arthritis is a huge factor. Depending on the amount of joint change you have endured immobilization may be your only resource short of more permanent changes, ie; surgical correction.
Result number: 25
Posted by >David G. Wedemeyer, DC</b> on 6/03/07 at 20:31
It doesn't Ed. This is probably an effective system but like Graston, ART and the ilk it's marketing before duty. If everyone with a new and improved soft-tissue mobilization technique would focus on patient outcomes they wouldn't have to market as aggressively for new recruits.
They also have a very distinct bias towards my profession, while Graston and ART have no such exclusivity compunctions.
Result number: 26
Posted by >David G. Wedemeyer, DC</b> on 6/03/07 at 20:24
I would add ....a steel shanked shoe and a reverse Thomas heel built in would augment the othotic.
Result number: 27
Posted by >David G. Wedemeyer, DC</b> on 6/01/07 at 18:43
Kathy just curious, has your doctor ever stated whether these sinus infections were bacterial or viral? I would assume your oral care doctor would have indicated if you were having issues with your gums that could allow entry of bacteria.
Certain viruses favor the facial nerve and it's branches. Certainly either could cause your symptoms. Sounds like a variant of trigeminal neuralgia. Interesting clinical tidbit here....pulsed ultrasound has an excellent effect on the facial nerve and postherpetic neuralgia.
Result number: 28
Posted by >David G. Wedemeyer, DC</b> on 6/01/07 at 14:57
A wall across the US wouldn't solve every contingency but it sure is a start. We need to protect the ports and airports as well. the bottom line is our borders are a gaping invitation for terrorism both economic and politically motivated.
Again stopping Saddam doesn't halt terror from Islamic fundamentalists. We need to first stop funding it at the source by buying less oil. If we dropped our oil consumption say 30% I bet the Saudi's would tighten up the belt on money they send to expatriates training in Islamic terror camps elsewhere.
Terrorism doesn't stem from the US it enters it to strike at the heart of democracy. We need to stop it from entering our borders freely through our education and immigration system as well as open land.
Result number: 29
Posted by >David G. Wedemeyer, DC</b> on 6/01/07 at 14:45
The temperomandibular joint has a capsule being a synovial joint and is therefore manipulable. Malocclusion of the bite can cause chronic spastic contraction of the muscle trismus that aid in mastication and opening and closing of the jaw. Pain during mastication, clicking or popping during opening and closing of the jaw and latral or medial deviation on opening and closing the jaw would be indications that the TMJ is subluxed and that manipulation could be effective.
What I have found more effective is treating the supporting musculature and a bite or night guard. great care had to be taken to 'adjust' a TMJ as it is fairly easily dislocated (even from yawning).
Frank pain, swelling, auditory disturbances and sinus pain are indicators you should see your primary physician.
Result number: 30
Posted by >David G. Wedemeyer, DC</b> on 5/31/07 at 15:03
John you're right we had no idea what form or strategy the insurgents would take but has no nation including ours learned anything from Vietnam, Afghanistan etc? When you walk into a village brandishing a stick you can and will expect fierce oppostion the majority of the time.
The theme that we are liberators is laughable, sure Saddam was an incredibly monstrous dictator and no one wanted him to gain nuclear capability (or another WMD pogram). The fact is that his military and weapons programs were crippled in the Gulf war and the administration is just using the buzz phrase 'The war on terror' when in fact he is a puny player on the world scale and much less responsible for radical Islamic funding and training than Syria and Afghanistan.
The truth is our own avarice for cheap oil is what funds radical Islam, not Saddam and the Bathists. One reason that Bin Laden will never be killed or caught is because of our ties to the Faud royal family, oil and the immense money the elite in our government make
off of their association and business dealings with the Saudi's.
The entire point I am making is that we were bald faced lied to about why we were going into Iraq and now that we are there, there is no accountability for the egregious cluster **** we are in. Our military has been castrated by this administration, particularly Rumsfeld. Can we win in Iraq? Who knows but now we cannot afford to up and leave you are so very right. Now the whole middle east and in particular Isreal is at stake. This much we have learned from the previous excursions to promote 'democracy' that we have set out on.
As for protecting our way of life, we should have spent this money protecting our borders, increasing military spending, recruiting and deporting flight students on the ten year college plan.
Result number: 31
Posted by >David G. Wedemeyer, DC</b> on 5/31/07 at 11:59
Dr. Michaud's book is my bible Jeremy. Isn't his family involved in one of the more prominent orthotics labs?
Any good OTC product is marketed to a specific group or pathology. The fact is in my area the only Cpeds listed in the phone book are owners of the Starbucks type entity of that same mass marketing paradigm.
Result number: 32
Posted by >David G. Wedemeyer, DC</b> on 5/31/07 at 09:11
We should also remember that all of the pundits who paint a bleak picture of the outcome of our withdrawal from Iraq have completely missed the mark in every other aspect of the war. The main fact is that the middle east will not be more stable as a result of our invasion and that like it or not, Saddam did have control of his people and we never will.
I am not saying the only answer is a swift and immediate withdrawal but we have to consider that we screwed the pooch big time going in there in the first place based on the lie that was WMD. Iraq had nothing to do with 911, nor did it's citizens. The truth is Al Kaeda and it's unconventional army of miscreants are our real enemy and to date we haven't accomplished a victory in stopping Bin Laden.
Just wait until the Kurds try to establish a autonomous state in the north, Turkey will never allow it and to date they have been our ally. The opposing factions in Iraq and neighboring countries have been warring longer than we have been a country and we think we can make them a democracy and play nice now just because we occupied their land and told them to do so?
Leaving Iraq does not mean failure in the war on terror, it means stemming the flow of blood, we have failed already and unfortunately we are far less safe here at home because of the blunder. The next administration needs to focus on our domestic problems and forgoe nation building and meddling in the middle east. We wouldn't have cared about Iraq at all if we weren't so dependent on crude oil.
Result number: 33
Posted by >David G. Wedemeyer, DC</b> on 5/30/07 at 18:09
Jason actually I first saw these at a local bike store. I like the q-angle laser used for knee alignment, makes good biomechanical sense to me. If you're not having any medical issues in the lower extremity I say go for it.
Result number: 34
Posted by >David G. Wedemeyer, DC</b> on 5/29/07 at 23:06
Unfortunately RSD (CRPS) is one diagnosis an insurer will fight tooth and nail. It is expensive and difficult to treat once it reaches the chronic stage and that means lengthy temporary disability and multiple doctors fees.
A sympathetic nerve block is not only an effective treatment it is diagnostic for RSD. Now it's up to your lawyer to link the onset of injury to your employment, which i am sure that you already know.
Good luck Hope and don't give up. I got out of denied work comp claims because although I love a good fight I couldn't bear to watch some pencil pusher or hired gun physician decide the futures of good people who deserved timely medical care and got the shaft instead. I hope you find relief and win your claim.
Result number: 35
Posted by >David G. Wedemeyer, DC</b> on 5/29/07 at 20:45
Jen may I ask how old you are? If you are observing a dimunition in the arch or arches I would recommend discussing it with your podiatrist. Can you climb stairs or raise onto the balls of your feet without a significant increase in pain? The recent increase in weight you discuss could be a cause of muscle or tendon damage, particularly the posterior tibial tendon (diabetes, obesity and hypertension are significant factors. It's antagonist is the tibialis Dr. Sanfilippo discussed and injury to the posterior tibialis induces a decrease in arch height and is very painful.
Result number: 36
Posted by >David G. Wedemeyer, DC</b> on 5/29/07 at 10:41
I couldn't agree more Julie regarding the pronounced extension of the lumbar curve that ball places on the user. One problem with most acute low back sufferers is dimunition of the lumbar lordotic curve due to muscular involvement.
That in mind this would not be an exercise I would suggest for rehab but rather core strengthening once a patient progresses to performing floor crunches and has attained a stronger core and abdominal wall. I use foam rolls and a swiss ball now for various floor exercises and have noticed the abs, like all muscles, adapt to the same routine and lose their effectiveness over time.
Matt Furey's programs are for the hardcore for certain Ed. He seems to be 100% about the marketing.
Result number: 37
Posted by >David G. Wedemeyer, DC</b> on 5/29/07 at 10:24
Ladies I just responded to another PF sufferer on the ask the doctors board regarding casting for PF. Occasionally I cast chronic PF with an ankle/foot orthosis (AFO)when all else fails, including various over-the-counter casts/boots.
The reasoning for indicating a custom AFO is that severe pronation and supination cause a twist in the midfoot during gait that affects the fascia causing repetitive micro trauma. This is usually amenable to control with a proper orthotic and shoe wear. When it is not an AFO can immobilize the midtarsals and allow them time to heal, it will completely limit medial to lateral and pronatory/supinatory movement of the foot.
Typically I see an open release performed at this time among other various procedures such as EWST, cortisone injections, cryotherapy etc. Possibly one of the foot doctors here can discuss those options with you.
Result number: 38
Posted by >David G. Wedemeyer, DC</b> on 5/28/07 at 22:45
There you go gang an example of success with weight-bearing exercise for chronic PF. Good to hear it Arlene!
Result number: 39
Posted by >David G. Wedemeyer, DC</b> on 5/28/07 at 22:42
Is this Ms. Lisa from Texas? If so I recall you had several medical issues including spinal degenerative changes and a possible rheumatoid condition (??).
Regardless after a period of time if what I am providing does not resolve a patient's issue they are referred out and I feel you should at least let the ortho evaluate you. I would also recommend you find a pod or cped who can fit you with a CUSTOM therapeutic orthotic (or possibly custom AFO while you heal). With any luck you may find relief finally and it is the conservative route (and most cost-effective).
Result number: 40
Posted by >David G. Wedemeyer, DC</b> on 5/28/07 at 12:55
I saw this ad on tv and actually this approach looks interesting. It's only $10 which is unusual in itself.
A lot of you expressed interest in ab and core exercises so I am offering myself up as the sacrificial ab lamb. Dr. Ed I didn't order the Matt Furey wheel, I tried a similar device at the gym and decided it wasn't very forgiving on the low back erectors unless you're already in top shape.
The ab's are very difficult to target and it seems everyone has a new mousetrap out there to perform them, so I am always looking for an ab/core workout low back patients can safely engage in at home following treatment. I'll post as I go along if anyone is interested.
Result number: 41
Posted by >David G. Wedemeyer, DC</b> on 5/28/07 at 11:04
Lisa a short leg cast can be effective in treating PF, although depending on the type of cast you could experience muscle atrophy over time. Judging by your other symptoms it appears you may have a biomechanic fault that needs to be addressed as well. Were you dispensed a custom orthotic and new shoe wear to treat the condition?
ART or any well performed soft-tissue technique can really help a painful PF and most PF resolves with conservative measures, so I am assuming your case is one that was chronic for a long period hence the open release. Did you discuss other options with your physician?
If not perhaps he/she would refer you to a podiatrist or cped who can cast you for a proper support and shoes. The fact that your gait is affected and your low back is symptomatic suggests the cause of your current symptoms could be a mechanical one.
Result number: 42
Posted by >David G. Wedemeyer, DC</b> on 5/26/07 at 23:58
Velma Drs. Andrew Gerken and Alexander Tischler are both excellent physicians who specialize in the foot and ankle. I know Dr. Gerken tends to treat chronic and difficult cases and every patient that I have referred to him has been very pleased. Lory is his front office person. No referral is necessary but you can tell him Dr. Wedemeyer directed you to him.
Result number: 43
Posted by >David G. Wedemeyer, DC</b> on 5/26/07 at 15:34
I know of several top notch orthopedic foot & ankle specialists and podiatrists in the orange county area. Where are you located?
Result number: 44
Posted by >David G. Wedemeyer, DC</b> on 5/25/07 at 15:10
In addition to the essential fatty acids there are mono and polyunsaturated fats (omega-6) that are necessary to maintain a variety of healthy functions in the body(John is right, they are heart healthy). Nuts are one food that are loaded with these 'good fats'. The trick is to achieve a 2:1 ratio of omega-3 over omega-6 which is not the standard theme in the American diet.
Also not all polyunsaturated fats are created equal. I try to only eat Olive and Canola oil and avoid the exotic ones so prevelant in our supermarkets. Likewise, it is very rare I will knowingly eat anything containing partially hydrogenated oil.
Result number: 45
Posted by >David G. Wedemeyer, DC</b> on 5/25/07 at 15:01
People make too much out of the wheat issue. If you have allergies to wheat gluten yes, otherwise you need a good varied source of complex carbs (and B vitamins) daily and wheat is one of them.
The same goes for flax oil or ground seeds. Vegan sources of omega-3 are just not nearly as efficient or powerful as fish oils. The company I use (Metagenics)checks for contaminants and enterically coats the capsule; no fish taste at all. I take about 3 grams per day and sprinkle ground golden flax on cereal, oatmeal etc. It is better to vary your sources.
As far as those who feel everything must be in it's natural state for the body to use it, I just don;t agree. The multi-vitamin that I take is synthetic and proven with a plethora of studies to be just as effective as food sources of these nutrients. Many of the delivery systems for pharmacology are used in the production of vitamins and supplements and not surprisingly many of the people who patented and developed these delivery systems are on staff at neutraceutical companies.
Dr. Barry Sears of Zone Diet fame is just one such researcher. He has written several books on omega-3 fats and their use in chronic pain and inflammatory states. he is a huge proponent of essential fatty acid supplementation and wrote the book on the glycemic index based diet.
Result number: 46
Posted by >David G. Wedemeyer, DC</b> on 5/25/07 at 10:27
Oma's suggestion is rooted in good nutritional fact Susan. Most baked goods today contain partially hydrogenated oils which contribute to the inflammatory response. Your body was meant to ingest a ratio of 2:1 omega-3 over omega-6 according to the current literature. The processed American diet is said to typically contain a ratio that is omega-6 over omega-3 that can be as high as 18:1 in the reverse direction.
PHO's are being banned in a few US cities due to their deleterious effects in creating an inflammatory cascade that initiate the production of PGE2 which is the mother of pain and inflammation. Avoid PHO laden food, especially if you are healing from an injury or have a rheumatoid condition.
Interestingly fish oils have a similar effect on PGE2 that non-steroidal anti-inflammatory over-the-counter such as aspirin, ibuprofen and medications such as Celebrex and Vioxx target.
Result number: 47
Posted by >David G. Wedemeyer, DC</b> on 5/24/07 at 15:50
I have a fair concern for Dr. Ed and John's pancreas....and adrenals....
Result number: 48
Posted by >David G. Wedemeyer, DC</b> on 5/23/07 at 18:00
Dr. Goldstein do you know of any podiatrists in the Orange County area of California who provide cryotherapy?
Result number: 49
Posted by >David G. Wedemeyer, DC</b> on 5/23/07 at 17:58
John exactly dead on. You wouldn't fly without a plan and equipment check right? Julie and Ralph make great points in this discussion. Julie phrased what I was trying to say much better than I did, I tend to be prolix.
Although we approach treatment very differently and my care is below the level of a foot surgeon, the foot surgeons here appear to be more knowledgeable about conservative care than I was aware of. I respect that a great deal as well as the fact that all of the allied professionals have a unique clinical perspective to add.
The point is the diagnosis. let me say that again: The diagnosis! the timing pain level and length of illness to name a few all have a role in deciding appropriate treatment.
Result number: 50
Posted by >David G. Wedemeyer, DC</b> on 5/23/07 at 15:23
John as I stated before it needs to be determined is this acute, chronic or a sub-acute injury prior to implementing stretching of any kind as well as a diagnosis that it is in fact PF. Example:
'A patient walks into the office and states they have pain on the bottom of the foot following stepping off a curb and twisting their ankle. This was over one year ago and he/she has also had increasing pain on the outside of the ankle'.
On visual exam and palpation she is determined to have posterior tibial tendon syndrome stage 2 and concomitant PF. Would I advise this person to perform weight-bearing calf raises to strengthen the calf/soleus or begin passive PT and non weight-bearing stretches to evaluate her response prior to leaving her to her own devices and possibly rupturing the tendon thereby causing more pain and disability? More than likely he/she would be prescribed the passive non weight-bearing stretches and possibly new shoe wear and a brace until he/she heals enough to tolerate active exercise.
Early (acute)PF does not respond well to active weight-bearing exercise in my experience, the inflamed fascia needs time to heal and passive PT works wonders for these patients, ART, Graston (or just plain good old myofascial release like I perform), electrical muscle stim, ultrasound etc.
As the condition becomes more chronic (as it is in low back cases) weight-bearing exercise tends to achieve greater gains. The sooner you can get a patient to actively participate in their rehabilitation the better the outcome in my experience. Sticking solely to passive modalities increases the patients reliance on the provider and increases disability time.
The science and art in any practice is to know when each is appropriate. There is no magic bullet in treating these people John but providers with experience in treating PF know when to have the patient bear weight while stretching and when not to. Often passive stretches are not only inappropriate they are harmful and vice-versa.
Result number: 51
Posted by >David G. Wedemeyer, DC</b> on 5/23/07 at 10:18
Marti there are no stupid questions. Weight-bearing exercise would be standing and bending at the waist to stretch the back of the hamstrings. Non-weight bearing would be the same stretch sitting on the floor.
Result number: 52
Posted by >David G. Wedemeyer, DC</b> on 5/22/07 at 15:24
Oma is it too personal to ask why your husband no longer works for Axiom?
Result number: 53
Posted by >David G. Wedemeyer, DC</b> on 5/22/07 at 15:16
You're very welcome Moonie. I believe it would be prudent to have your physician check your thyroid, B12 levels, fasting blood glucose and add a rheumatoid panel to the work-up. In the absence of clinical findings there I would suggest EMG/NCV to find the etiology of your neuropathy.
Any of these findings could lead your doctor (s) to suggest SSD benefits if they feel they are warranted and preclude you from working in your usual and customary occupation.
Good luck and keep us posted.
Result number: 54
Posted by >David G. Wedemeyer, DC</b> on 5/22/07 at 15:08
* I meant to say concentric (muscle shortens) + eccentric (muscle lengthens).
Result number: 55
Posted by >David G. Wedemeyer, DC</b> on 5/22/07 at 14:59
There are different reasons, conditions, muscle groups and ligaments that respond differently to weight-bearing vs. non-weight bearing exercise. If you don't have a background in physiology it's just too much information to go into here on this board. Any of the doctors here will tell you that not all ligaments and muscles have the same tension, length, strength or fiber arrangement. Likewise the capsular pattern of any joint affected by the muscle must be considered when prescribing any exercise in rehabilitation.
Typically there is an acute phase of care in which passive treatment is provided and non-weight bearing exercise would yield the best benefit and be the safest method. As the patient's complaint resolves they can then begin an active phase of care in which weight bearing and eccentric (decreasing the angle of the joint as in a biceps curl) contractions are warranted. In chronic cases typically both types can be done.
Mike I think your device is great but I must disagree it is the panacea especially in chronic PF. Keep in mind that weight bearing exercise improves proprioception, twitch fiber response and that it activates muscle memory where non-weight bearing is not efficient with respect to these necessary constituent properties of healthy skeletal muscle.
To answer your question John these links are just two of many studies that advocate weight-bearing exercise for many common musculoskeltal conditions.
Result number: 56
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 19:55
Scott 'gets it'. we need to supplant all healthy natural foods with pills and carcinogens to thrive. If we don't thousands of CEO's and drug reps will have to find new work. If people become healthier and there is a sharp decline in the rabid rate of disease in this country there will also be less PAC money for the pharm co's to ply their trade.
Result number: 57
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 19:50
Entirely plausible Susan, I was being facetious.
I am a huge proponent of the idea that the majority of the lethal, recurrent and chronic illnesses in this country are preventable. MD's must be given credit though many are catching on and using complimentary and alternative therapies as an adjunct to their medical training.
Food is a drug albeit the one by which all other life processes are possible. The state of our food supply and what I encounter in practice in terms of diet and lifestyle often incompatible with life.
Result number: 58
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 19:42
Sorry to hear about your troubles Moonie. When were you diagnosed with psoriasis? You mention neuropathy was this originally a low back complaint aside from the issues with the foot or in the lower extremity? You also mention attorney was this a work comp case hence a work comp attorney?
The reason I ask is that your presentation is fairly complex and I feel I must have wandered in late in the discussion. What was the original mechanism of injury? I assume you have also seen a rheumatologist (psoriasis) and if so was this diagnosis somehow linked to this claim?
You're right you're a young woman and contrary to what you might hear obtaining SSD benefits is not a simple task unless this is short term to compensate you because your WC benefits have run out. What state are you in?
Result number: 59
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 16:15
Marie you tickle me!
Well....she's not my cup of tea per se but I would have to peruse his wife to make an informed opinion on the veracity of paying this women for her services.
Result number: 60
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 09:38
There could have possibly been sarcasm contained in my last post.
Result number: 61
Posted by >David G. Wedemeyer, DC</b> on 5/21/07 at 09:34
Anytime Richard. There is so much confusing and conflicting data out there regarding nutrition that it's intelligent to ask.
It sounds as though you need the extra iron and slow fe+ is the way to go. Ferrous iron is well tolerated by the body where ferric is not. The male dose is 8mg/day where premenopausal females require 18mg. I would add that vitamins C and B2 aid in iron absorption while ingesting caffeine within within an hour reduces it's efficiency. Iron can be extremely toxic in high doses so give yourself a day off at least weekly.
If you want to gain lean body mass you need quality protein at the right time. The body requires a minimum of .6 grams of protein per kg (2.2) of body weight just to maintain lean body mass. A 154 lb. (70 kg)person then needs 56 grams of protein daily just to maintain their ideal weight. Since your goal is to gain a little I would boost this to 1 gram per kg from food and an additional protein shake or bars. When I was training hard I would consume 1.5 and took a full spectrum AA supplement. There are a lot of quality weigh protein supplements that contain the full spectrum of AA's available and they're worth the effort searching them out. They might even be more cost-effective.
Result number: 62
Posted by >David G. Wedemeyer, DC</b> on 5/20/07 at 13:20
Richard what are your goals? Maintaining your body weight, losing weight, gaining lean body mass or two of the above? One really important factor is dietary protein intake (which also correlates with parathyroid function and calcium loss, which Iíll get to), your height, weight, age etc. If you train hard your body's demand for protein is obviously higher and you can learn to calculate your needs based on these factors and keep to your goals.
Basically if you get the 9 essential amino acids your body can synthesize the non-essentials from them in the gut. I see some on your list in which you're absolutely correct that they are not essential and expensive. The BCAA tabs you take are probably good but IMO not a complete amino acid supplement. In all unless youíre a competitive body-builder you're getting way more than enough of the non-essential AA's and too much of three of the essential AA's.
The 9 ESSENTIAL amino acids:
Histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. (it has long been argued that arginine should be included as an essential AA).
I have used creatine and it is effective short term, but you gain a lot of water weight on it. It does contribute to fast twitch fiber strength and force of contraction, great for explosive power in athletes and mortals alike.
I would also add that Centrum is not a very good multi and when you take fish oils (EPA/DHA) it's smart to research and find out the source of their product. Many companies don't batch test for mercury levels. I can give you some suggestions of companies that offer great products that won't break the bank if youíre specific about your needs.
Lisa makes a good point about iron supplementation. I donít dispense a mutli with iron to men unless they are vegans and if you eat red meat and greens you probably get an adequate amount already. I highly doubt a Centrum contains enough of any of the fat soluble vitamins to lead to toxicity to begin with. Amino acids are food and unless you take an extremely large amount are harmless. I tend to supplement and not rely on these items but instead on a solid diet where a lot of people go overboard. The company I buy from sells only to doctors and their quality and purity is the best in the industry and I know where they get their ingredients from, none of it is from China.
Result number: 63
Posted by >David G. Wedemeyer, DC</b> on 5/18/07 at 18:28
I'm seriously doubting this person is a physician and if he is Scott has to be correct about his dubious nature. Why would anyone go to this extreme to annoy a web board? As mama always said:
Result number: 64
Posted by >David G. Wedemeyer, DC</b> on 5/18/07 at 18:26
I think you're all missing the key point here (I know I should not type this misogynist statement...):
IS SHE HOT?!?!?!?
Result number: 65
Posted by >David G. Wedemeyer, DC</b> on 5/18/07 at 18:21
Come on now we all know only analogues of natural substances created in a lab are safe and efficacious! WTH would the pharm lobby do if such reasonable legislation was enacted? Would it provide the impetus for intense further study by NHIC of complimentary and alternative (CAM) medicines at the behest of big pharm?
What galls me is how simple vitamins (which are a food or cofactors of our food) and supplementation were hailed as expensive urine and are still decried as quackery by many in the AMA. I can see the cogency in their argument when I think of iron deficiency anemia, B12 neuropathy polyneuropathy, neural tube defects due to folate insufficiency, scurvy due to vitamin C depletion......to name a few. It is amusing that almost every pharmaceutical company in business today has a supplement line for sale despite this bias.
I applaud Dr. Paul. The onus of proving an advertisement is false or misleading should be the task of the FDA and not assumed to be correct without all of the evidence. Likewise the company making the claim should be accountable for doing their due diligence through studies and clinical trials just like the drugs that are let into the market.
Result number: 66
Posted by >David G. Wedemeyer, DC</b> on 5/18/07 at 17:56
Richard although I am not a dietitian, we do receive one years training in nutrition in college. If that's acceptable to you shoot the question.
Result number: 67
Posted by >David G. Wedemeyer, DC</b> on 5/17/07 at 20:49
I tried that back bend/wheel exercise and I must tell you men should probably stick to fishing and basic couch activities :P
Result number: 68
Posted by >David G. Wedemeyer, DC</b> on 5/17/07 at 20:44
Chris I would add that if your orthotics are uncomfortable you should discuss this with your doctor or cped. You may need rearfoot posting or other modifications. A properly dispensed orthotic should after the initial break in period be comfortable.
Additionally when you say exercise are we talking about running on concrete or at the gym on soft mats? There is a huge difference.
Result number: 69
Posted by >David G. Wedemeyer, DC</b> on 5/15/07 at 01:49
I check this thread every so often and sadly the theme appears to be the same: snake oil. I urge any of you suffering from a disc protrusion and considering a conservative approach to find a Cox technique practitioner.
The Cox system is not manual manipulation but specific distraction of the vertebral units by means of a table that flexes towards the floor and is directed at one disc or motion segment. I have seen many very hot low backs respond very quickly to this gentle treatment.
Any insurance that covers chiropractic covers this treatment and I have never met a Cox practitioner who asked for 20 visits in advance. You will quickly know whether or not it is working in your case and you as the patient can always choose not to continue if the treatment goal is not being met. Even better find a DC who is well versed in McKenzie techniques as well, they work and save time, aggravation and money as they can be performed at home later in the course of treatment.
Unlike 'spinal decompression' the Cox technique is taught as a core class in most chiropractic colleges and there are numerous peer reviewed studies indicating it as an effective and safe treatment for neck and low back pain.
Good luck to all of you,
Result number: 70
Posted by >David G. Wedemeyer, DC</b> on 5/14/07 at 23:30
Big, warm congratulations for Ms. Lisa. Well done!
Result number: 71
Posted by >David G. Wedemeyer, DC</b> on 5/14/07 at 23:27
To coin a colloquial California phrase:
You're awesome Jillian!
Result number: 72
Posted by >David G. Wedemeyer, DC</b> on 5/14/07 at 23:09
Larry any healthy synovial joint can be manipulated within reason although it is far from a panacea, excepting the spine due to it's anatomy and the intervertebral disc. I don't advocate blindly manipulating say a plantar flexed first ray as the joints in the feet lack this feature (the disc) and you could make the joint highly unstable stretching the capsular ligaments.
I first assess the joint in question including the entire history, xray and range of motion etc. If it in fact a reduceable fixation the manipulation is typically only an adjunct to orthotic therapy to maintain the correction. A spine is drastically different as the disc (a healthy disc) can and does change shape due to forces acting upon it, whether that be manipulation, exercise, stretching, traction etc.
Many of the bones of the feet can sublux below the level of a drastic structural change and be effectively reduced in a gentle fashion. I think all of us who provide orthotics would agree with this statement.
If you can reduce the defect and maintain that position with a properly designed orthosis the effect is even more dramatic and efficacious.
If you;re truly interested Thomas Michaud, DC wrote a text on foot orthoses and has a section devoted to manipulation of the lower extremity. His understanding of the subject is not disputed and conservative.
To answer your question more fully can a rigid plantarflexed first ray, degenerative arthritic changes, a rear or forefoot varus/valgus malposition etc. be altered by manipulation? No, and I wouldn't advise trying. Can some of these structures be affected in terms of range of motion and pain relief? Certainly.
Knowing when to treat with manipulation is never as important as important as knowing when not to. James Cyriax was a huge proponent of learning to understand the difference and used orthopedic manipulation for a variety of extremity complaints. Will you ever visibly see a structural change on plain film post-manipulation? I guess that may depend on your visual acuity and we don;t xray people capriciously to observe the minute structural changes inherent in a subluxation.
Result number: 73
Posted by >David G. Wedemeyer, DC</b> on 5/14/07 at 15:01
Receptionist: 'Dr. Wynazonski is waiting for you.'
Patient: 'Which doctor?'
Receptionist: 'Oh, no, he's fully qualified.'
Q:Why did the guru refuse Novocaine when he went to his dentist?
A:He wanted to transcend dental medication.
Result number: 74
Posted by >David G. Wedemeyer, DC</b> on 5/14/07 at 14:43
I've been fortunate to train with a couple of DC's who can adjust any joint in the body. The cuboid is a troublesome one due to it's shape as you indicated and sometimes I find a cuboid pad/taping is just as effective, especially long term and severe varus forefeet.
The door is always open Ed, in fact you may have noticed my recent pleas to get you out here. I may visit your area this summer as well..
Result number: 75
Posted by >David G. Wedemeyer, DC</b> on 5/13/07 at 21:59
Regardless of how you may feel about this board, doctors in general or another person's shoes, you can simply choose to keep it to yourself. It is inane, banal and discourteous to the majority for the minority to supplant pertinent and helpful information given freely and replace it with daily odious minutiae which has no relevance to helping others.
I may not always agree with a poster, doctor or many people in daily life, but I try not to publicly denounce them and undermine their authority or opinions. There is an appropriate way to influence people and then there is manipulation and sadly that is what I feel is at work here in regard to the negative posts aimed at Dr. Wander.
Many of you have very interesting stories and much to share with each other and there is an appropriate heading under this board to do so. Instead of doing so it seems a few people would prefer to publicly excoriate him for what they perceive as some personal slant or offense. Keep in mind it is very difficult to inflect emotion into text and while his answers may seem curt to you, they seem professional to others which they are. We all get frustrated at times and the better part of valor is to know when you're pissing someone off and back off and discuss it when cooler heads prevail.
The doctors here freely give their time, experience, opinions and invite a much different and more open dialogue with the public than in an office setting. I personally feel on that alone they should be treated with a modicum of respect. I wouldn't enjoy being persecuted as he has here or in real life and I do hope everyone will think about this. He doesn't have to do this, none of them do and none are being paid for their time. Even the most benevolent altruist enjoys compensation and here the only currency is a simple thank you.
Result number: 76
Posted by >David G. Wedemeyer, DC</b> on 5/13/07 at 14:09
All those who agree that Dr. Ed is in need of a California vacation to visit Dr. Wedemeyer say 'aye'.
We only say this out of concern and owing nothing to Dr. Wedemeyer's self-serving need to extract every nuance of Dr. Ed's prodigious clinical acumen in treating the foot and ankle, gait analysis, orthotic manufacture and pending cped exam questions.
Result number: 77
Posted by >David G. Wedemeyer, DC</b> on 5/12/07 at 17:59
Ralph it's entirely possible it was a muscle stim unit to prevent atrophy or possibly they are implanting a form of electrical nerve block in CPS (RSD) now. You stated she was in a body cast so I assumed fracture. Either way some patients achieve wonderful clinical results with electrical modalities.
God knows CPS is a difficult entity to treat, especially once it's chronic.
Result number: 78
Posted by >David G. Wedemeyer, DC</b> on 5/12/07 at 11:41
Ralph if Hope has a surgically implanted stim unit it is a bone growth stimulator. TENS is a unit that targets pain only, it is mostly ineffective for muscular stimulation as they have better units/frequencies for stimulation of muscle and bone and they are quite different. The fact that she was in a body cast is what leads me to believe this.
Result number: 79
Posted by >David G. Wedemeyer, DC</b> on 5/12/07 at 01:59
John e-stim at the foot is extremely uncomfortable but I do have a remedy for you if you;re interested. It's a sock with a lead embedded in it and the other lead is placed distal (usually the opposite shoulder). TENS and galvanic current are very well tolerated in this way. If you;re insured they may cover the cost as well with a rx from your doc. Either that or send me the rx (since I haven't examined you myself) and we can figure out a way to send one to you. I use these all the time for PF patients. DW
Result number: 80
Posted by >David G. Wedemeyer, DC</b> on 5/11/07 at 16:02
As I recall John Biden's original plan included closing the borders and maintaining the current Iraqi army. The exception would be all soldiers of rank, they would have Bathist loyalties where the grunts typically do not. Makes sense when you recall the overwhelming surrender of their ground units during Desert Storm. We really screwed the pooch this time around due to Rumsfeld's 'Leaner, meaner force'. By not engaging them with an unequivocal and overwhelming force and not segregating the combatants we have created an ignominious cluster f.
We face a much larger problem if we simply withdraw and the current liberal theme to withdraw funds and set a date to withdraw worries me even more. We all need to think this through, while it was a blunder and a lie that conceived this war we cannot afford to lose in that region. Period. We simply cannot allow Iran, Iraq, Syria or any of those other Islamic states to achieve nuclear capability.
At stake here is our entire economy, losing Israel who is our only true ally in the region and more oil revenue will fund terrorism.
As for Israel they have been persecuted and chased all over the globe for an eternity and yet that small blip on the map is still the most fearsome force in the middle east. They are the toughest and smartest people on the globe (IMO) and very key to stability in the region. I respect them a great deal and hope our success in Iraq aids them along the way.
Result number: 81
Posted by >David G. Wedemeyer, DC</b> on 5/11/07 at 11:48
John you progressive. Don't you know that modern warfare has regressed back to two amigos staring each other down in a Baghdad alley until one flinches upon which they wrassle?
Result number: 82
Posted by >David G. Wedemeyer, DC</b> on 5/11/07 at 10:31
Marie Joe Biden is the sanest man in Washington today. I wish he was running for office. A lot of staunch conservatives despise him but I think on most issues he is dead on.
Iraq could have been won if they had implemented his plan. Cut the country into 3 regions with a central government in Baghdad and drive the rest out or eliminate them. It could have worked and they just didn't listen because Rumsfeld had to have his own micro-managed war plan.
Result number: 83
Posted by >David G. Wedemeyer, DC</b> on 5/11/07 at 10:24
Dr. W I have heard of that style I just don't recall the name at the moment. Very hardcore.
I was again imbuing levity into the conversation, Bruce actually said 'boards don't hit back'. It was from a movie of his. I admit to going through a period of intense martial arts movie geekdom.
It's pretty great your son and you have something you share a passion for. Not having a family of my own I envy you that. I hope you and your son enjoy soccer for a long, long time. My thing currently is cycling and I don't know what I would do if I had to quit, we see too many people who have to give up their outlet don't we?
Result number: 84
Posted by >David G. Wedemeyer, DC</b> on 5/11/07 at 10:16
Nancy do you have any swelling in the calf area? I mean a very obvious and visible swelling?
Result number: 85
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 21:00
Just great John and Larry. I now have a disturbing visual!
Result number: 86
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 20:59
Sorry I heard 'bad back' and just jumped the gun Marie.....marketeer that I am :P
Hmm...maybe a heel spurs bus to shuttle you people about to the different contributing docs on the board....
Has anyone else noticed I've been exceedingly playful lately? Well I can't discuss it anyway...
Result number: 87
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 20:40
Call me crazy Dr. W but full contact without protective gear just sounds plain nuts! I think you grew up in the wrong era, maybe you should have been one of these 'X' gens who seems to gravitate towards extreme sports.
I've practiced Hwa-rang do, Shito-Ryu & Shotokan karate, and JKD/kickboxing (where I got my grappling experience). I really miss the training and camaraderie so more than likely I will take up BJJ soon.
Didn't Bruce Lee say 'soccer balls don;t hit back'?!!??
Result number: 88
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 14:59
Jeremy their SWW202 appeared like a well constructed shoe. Why would you not recommend this with an AFO? One patient has concomitant DJD in the same leg knee and could only find relief with this shoe.
Please email me drdavwed at sonic dot net, I am curious.
Result number: 89
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 10:24
Great explanation and thanks again Dr. Wander, I was curious why Jeremy liked this shoe type so much. I admit I had limited experience with them and I'll give them a shot.
I've seen quite a few PF cases lately where they were dispensed PowerSteps and they asked about a casual or recreation shoe. I am slowly adding a few shoes to the office, New Balance, Aetrex, JS, Spiras etc for the patients convenience. I also give them a pair with their AFO or offer them a discount on modified shoe wear do they can walk out and I am reasonably assured that they will be compliant.
Do either you or Jeremy have much experience with Spiras? I've had a couple of patients swear by them so I called Spira and requested a catalog and samples.
On a side note I noticed you revealed you've been a martial arts enthusiast for many years. I've certainly done my time in this pursuit as well and intend to go back to training. I'm considering Brazilian Jiu-Jitsu since as I get older the idea of spending as much time on the ground as possible is appealing.
Result number: 90
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 10:08
Thanks for the response Dr. Wander, no harm no foul.
Result number: 91
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 01:27
Result number: 92
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 01:20
Try these links Joel:
I just finished the course in LA and am taking the exam in August Joel. It's well worth the effort. There are several knowledgeable C.Ped's on this site that are great about answering your questions.
Result number: 93
Posted by >David G. Wedemeyer, DC</b> on 5/10/07 at 01:16
ptjoel I posted a response over in insoles/orthotics where you can find cped classes.
Result number: 94
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 22:43
You seem to favor this shoe type Jeremy. I guess you have witnessed good results from this foam type clog. May I ask what pathologies in particular have you found respond to them and what foot types? I'll have to rethink an old conclusion here yet again.
Result number: 95
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 22:06
That has to be the most tragic stock investment in recent history John :P
of course it's no worse than the coffee company I bought into that was recently absorbed by the Jolly Green Giant of Bean. I was surprised no one showed up at my door to remove my arm as compensation for buying me out :)
Result number: 96
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 21:48
I like to live in that illusory haven in my mind where even a prostitute wouldn't have sex with Dick.
Result number: 97
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 21:43
I've been following the threads regarding posts being deleted and the resultant hurt feelings and misunderstandings. I noticed one of my posts in the 'Ask the Doctors' forum was deleted or possibly lost as a result of being in the thread. To me it's not a huge problem if you'd prefer that I also not post in that forum, just let me know.
I do try to restrict my comments to my scope and experience and add a perspective based on years of conservative care of musculoskeletal complaints. I hope my presence here is appreciated and if it is not I would prefer to know that as well.
On one hand I can certainly understand Dr. Wander, based on many years as a physician and surgeon being frustrated with non-medical people doling out advice. Internet forum or not it is just not appropriate to give an OPINION, although I agree that sharing your personal experience in another part of the board is helpful and should be welcomed and encouraged.
On the other hand I feel doctors can forget the dramatic effect that their words impose on the people who look to them for answers and compassion. Perhaps we all can learn something from this experience
Result number: 98
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 01:35
I can't seem to find the CPT code for clones either.....
Result number: 99
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 01:29
Must be a Diebold server :P
Result number: 100
Posted by >David G. Wedemeyer, DC</b> on 5/09/07 at 01:28
Good God Susan don't tell me that, I gorged on sushi just last night :)
Result number: 101
Posted by >David G. Wedemeyer, DC</b> on 5/07/07 at 19:24
That is so disturbing on so many levels. They're teaching the next generation of Al Queda'a martyrs their ABC's of venomous hatred for the U.S. and Israel.
The only way to fight fundamentalist Islam is to cut off their money supply by becoming independent from middle east crude. The war in Iraq is over, we lost and things will only get worse when we leave. On top of that now they're all angrier than a disturbed bee colony at us.
Result number: 102
Posted by >David G. Wedemeyer, DC</b> on 5/07/07 at 17:12
I guess the status quo is in effect here....they're using words like maybe...unlikely...could have.
It will take an outbreak of suspicious deaths before the FDA does their due diligence I'd bet. Meanwhile I only buy locally grown foods whenever possible and range-free meat and poultry.
Result number: 103
Posted by >David G. Wedemeyer, DC</b> on 5/07/07 at 17:04
Thanks for the additional perspective Richard. I think this company is really skirting the professional and ethical boundaries of pedorthics. Their entry window has a large sign that says: 'custom inserts'. They're DMO from a foam cast and Amfit accommodative. They do have a large variety of OTS although no one I know of is ever offered these until they gasp from the price of their 'custom' inserts.
Result number: 104
Posted by >David G. Wedemeyer, DC</b> on 5/07/07 at 11:35
Got it Jeremy.
I should have add the term 'therapeutic' to what I posted earlier.
Result number: 105
Posted by >David G. Wedemeyer, DC</b> on 5/07/07 at 10:35
I'm having a hell of a time finding facility codes for billing office visits in outer space ED,
Result number: 106
Posted by >David G. Wedemeyer, DC</b> on 5/06/07 at 14:02
More about the business practices of these decompression machines. It should be noted this is from a
Result number: 107
Posted by >David G. Wedemeyer, DC</b> on 5/06/07 at 13:40
I recently was in one of the 'commercialized' pedorthic (?) stores sizing up their business. I know you do not agree with their business model and now I understand why.
There was no pedorthist in the front of the store, instead they had three 'fit specialists' helping their clients. One offered to 'evaluate' my friends feet and proceeded to perform a sham exam on the spot while pitching him on 'custom orthotics' and various shoe ware.
He asked if he had any pain and my friend said yes in the middle of his foot. The 'fit specialist' then began a long well scripted dialogue about foot dysfunction related to gait etc and suggested a $395 'custom orthotic'. I asked him outright don't you need a physicians prescription to make a custom orthotic and he responded ' we don't need a prescription to make any orthotic but if you have one we will put it in his file'.
There was a lot more dialogue but my question is this: at what point does a pedorthist need to refer out to a physician? I was under the assumption that custom means a prescribed orthosis and prefab is fine without a prescription. Is it legit to call a foam box casted poly orthotic 'custom' and dispense it regardless of pathology of the foot and price?
On a side note I completed the cped course and am studying up for the exam in August. I also have been pestering a local podiatrist and his cped to allow me to be in the office one morning per week to learn and gain more experience with the clinical side, shoe mods etc.
Result number: 108
Posted by >David G. Wedemeyer, DC</b> on 5/06/07 at 13:06
Interesting Oma I had never looked that deeply into their various claims about FDA approval.
While I am sure some people are helped by 'spinal decompression' I feel more are harmed emotionally and financially by their overt and specious marketing, not to mention the unreported abject failures which are never disclosed.
My colleagues are catching on though (and this is the old school camp's newsletter which I do not subscribe to):
As I stated before there IS a CPT code for this type of treatment which the patient is NEVER informed of. The code maxes out in reimbursement in my state at $25 and is the only code which describes mechanical traction, which is precisely what this machine does. Period. Fabricating or coveting a 'better' code or codes is just wishful thinking, there already IS a code for this treatment. If the Dr. doesn't like the reimbursement and spent $100K on fancy traction what can I say, it sucks to be you.
The fact that $25 is paltry reimbursement does nothing to help sell machines so they have manufactured studies and marketing to appeal to both doctor and patient while completely ignoring standard billing practices by fabricating this as a 'new' and 'unique' treatment and knowingly omitting this information during the consultation process.
This type of omission is fraudulent and I am surprised that no one has initiated litigation (mainly the insurance carriers). You may not indiscriminately bill one patient's insurance and in another case choose to collect cash and not bill that patient's benefits because it is not financially convenient; especially in Medicare.
Of note I noticed that one of these companies is aligned with a certain California chiropractor who is well known for his audacious advertising and marketing. Samples of his ads were instrumental in providing the impetus for an overhaul of worker's comp in my state. If this guy supports anything it has to be viewed with skepticism.
Result number: 109
Posted by >David G. Wedemeyer, DC</b> on 5/03/07 at 11:42
A doctor and his wife were having a big argument at breakfast. 'You aren't so good in bed either!' he shouted and stormed off to work. By midmorning, he decided he'd better make amends and phoned home. After many rings, his wife picked up the phone.
'What took you so long to answer?'
'I was in bed.'
'What were you doing in bed this late?'
'Getting a second opinion.'
Result number: 110
Posted by >David G. Wedemeyer, DC</b> on 5/03/07 at 11:33
The rapid turn around and no needed correction disturbed me as well Jeremy. Of course as you are well aware many labs make no intrinsic mods period and make an excellent orthosis but that could also mean prefab with accomodation.
I couldn't find the company you mentioned obviously. I'll ask them who developed this device and scrutinize them, afterall as I recall they are marketing this sub 10K if I'm not mistaken.
Result number: 111
Posted by >David G. Wedemeyer, DC</b> on 5/02/07 at 23:46
I know lasers have been around for a while in the podiatric, orthotist/prosthetic market but this looks interesting. The rep claims it is not costly like the Bergman scanner.
I am getting a virtual tour tomorrow of their system. They hope to use this for braces as well, I'm sure you have to use their lab too, which seems to be the weak point in any of these new technologies.
Result number: 112
Posted by >David G. Wedemeyer, DC</b> on 5/02/07 at 00:56
If you truly want to understand Mormonism there is a really great book that compares it (and every other major religion to Christianity). It's not light reading but Dr. Martin was a brilliant Christian apologist and to date no one has refuted his work. The Mormon chapter is an eye opener.
Esther almost all of the Mormons I have encountered are very good people.
Dr. Walter Martin
'Kingdom of the Cults'
Result number: 113
Posted by >David G. Wedemeyer, DC</b> on 5/02/07 at 00:46
I'll add intemperance to the list Bill :)
Result number: 114
Posted by >David G. Wedemeyer, DC</b> on 5/01/07 at 00:19
James there is a product for hydration made by Alacer that's inexpensive and tasty. I think it's called electro-mix (?). You can find it at most health food stores. It never hurts to keep hydrated....water, minerals
Result number: 115
Posted by >David G. Wedemeyer, DC</b> on 5/01/07 at 00:10
Consider trying Mike W's rig it may be just what you need. Sometimes passive stretching without engaging the opposing agonist muscles is what gets people over the hump with chronic myofascitis. Other people here have reported good luck with ART, electrostimulation and the like. Active stretching cannot exceed your body's physiologic barrier but a person knowledgeable in physiology may be of help.
Also Calcium/Magnesium in a 2:1 ratio (1000mg/500mg)and make sure your other electrolytes are up (potassium, sodium) and adequate water intake. Electrolyte balance is important not only in athletes but in all of us, maybe this is a factor in your case? I have witnessed many people with chronic muscle spasm and/or tightness really make progress by just doing these simple things.
Result number: 116
Posted by >David G. Wedemeyer, DC</b> on 4/30/07 at 12:25
'Top 10 Signs You've Gone to a Bad Chiropractor'
10. When you walk, you make a wacky accordion sound.
9. Keeps saying, 'A spine is like a box of chocolates.'
8. Repeatedly asks, 'You a cop? You sure you aint' no cop?'
7. Over and over, you hear crunching sounds followed by, 'Uh-oh.'
6. There's a two-drink minimum.
5. At end of session, lies down on the table and says, 'My turn!'
4. He was nowhere near Woodstock and yet he's covered with mud.
3. Rushes in late to your appointment still wearing his Burger King uniform.
2. Hints that for an extra $50, he'll 'straighten' something else.
1. You're fully clothed and he's naked.
Result number: 117
Posted by >David G. Wedemeyer, DC</b> on 4/29/07 at 16:56
Interesting thread. I personally avoid anything with Splenda (sucralose) in it after the cyclamates ban and aspartame scrutiny. The fact is these substances are neuroexcitotoxins whose actions on the brain and body are not fully understood.
For 16 years the FDA was not going to approve Nutrasweet due to questions about it's safety raised by both FDA and Monsanto scientists(a division of Searle. Donald Rumsfeld later became their CEO). Rumsfeld's political influence was the single greatest factor in Nutrasweet eventually being approved as a food additive, not the safety of the product.
The FDA needs to get it's act together and investigate more of the additives in our foods (and supplements). Look at trans-fats, Crisco was the original product containing this horrible substance. We now are being told by responsible medical research that trans-fats should be avoided and hopefully they will next turn their attention to the artificial sweeteners.
For the most medically advanced nation and arguably the country with the best food controls, we have the highest rates of adult onset diabetes, rheumatism, irritable bowel, acute food-borne pathogen illness not to mention obesity (especially rising in children).
Does anyone remember Upton Sinclair's 'the Jungle' which exposed the horror of the meat packaging industry around the turn of the 2oth century? It has been nearly another century and the FDA has done nothing to control the safety of our food supply. About the only area we rank high as a developed country is in drinking water safety, of course it's loaded with chlorine.
Result number: 118
Posted by >David G. wedemeyer, DC</b> on 4/28/07 at 00:13
Dr. Wander have you seen this study?
Interesting article but it appears this study was based on chondroitin sulfate alone if I am not mistaken. The NIH trial reveals no findings of the chondroitin alone subset group. Every study that I have found thus far only achieved good results with a combination of the two.
Result number: 119
Posted by >David G. Wedemeyer, DC</b> on 4/27/07 at 13:56
Janice, It's really difficult to offer anything but suggestions on a board but I would suggest an orthopedic foot & ankle specialist or podiatrist evaluate you. If this is primarily an achilles, soleus muscle dysfunction PT may help a lot along with the proper orthosis.
Do you have any pain at the ball under at the 2nd-4th toes or inside of the ankle just below the malleolus (the bumps on either side of the ankle)or at the heel in the back?
Cross-friction can be done every other day, ice frequently afterwards and wear supportive footwear. When they made your 'custom hard orthotics' did they use plaster to cast you or a foam impression box and was this done by the pod? Some people have a more rigid foot and require an accommodative rather than a rigid orthosis.
Result number: 120
Posted by >David G. Wedemeyer, DC</b> on 4/27/07 at 11:01
cross-friction massage is very simple, even to perform yourself. For PF start at the inside edge of the heel and work about an inch towards the middle of the foot. The motion is side to side not the length of the foot and use pressure to your tolerance. It's going to be painful in some cases yes. The key is to work slowly and deep and in time you'll feel the attachment of the PF to the heel (if you use your thumb) but you can roll on the ball as well. I use an instrument sometimes since the goal is to cause a new minor trauma to the tissue to engage new healing, I am sure you'll be much kinder than I would about it to yourself :)
Waldies I just don't like at all but the Montrail is a good shoe. The Cped's here know a great deal more about individual shoes than I do so maybe they can answer this better. As for Goodfeet I am also not a fan of their 'inserts'. You should be evaluated by a doc for dysfunction of the foot (if you haven't already). What is the cause of your PF? I find a lot of patients develop their PF from arch related changes and improper footwear over time. I have yet to see a PF case that did not resolve when a prescription orthotic was necessary and provided along with the appropriate shoes (and therapy).
Result number: 121
Posted by >David G. Wedemeyer, DC</b> on 4/27/07 at 10:46
John If it's prescription it could be dexamethasone in gel. I have used this on chronic ligamentous injuries over the years with good results. I avoid iontophoresis and prefer ultrasound, I've just seen better results. The cost of ultrasound treatments is very inexpensive, I charge $35 per. Just remember with the foot or hand you want them to submerge the sound head and affected part in a tub of water. Direct application to the hand or feet is really uncomfortable for most people.
Result number: 122
Posted by >David G. Wedemeyer, DC</b> on 4/26/07 at 23:08
Two men are playing golf one sunny day. As one of the men lines up to tee off on the ball, a funeral procession begins to pass by. The golfer stops his swing, takes his cap off and bows his head in respect and prayer.
After the procession has passed his friend, impressed by this show of compassion says ' that was very nice how you paid your respects to that dead person'.....
He replies: 'It was the least I could do, we were married for 35 years'
Result number: 123
Posted by >David G. Wedemeyer, DC</b> on 4/26/07 at 22:54
John sounds interesting, could you possibly find out who makes it and let me know?
Result number: 124
Posted by >David G. Wedemeyer, DC</b> on 4/26/07 at 18:56
Good post Justin and good luck to you on the road to recovery.
What everyone needs to remember is that no one approach always works and that being flexible, whether you are a doctor or a patient is an important trait. The other is patience; it often takes time to create the changes that lead to dysfunction and pain and it takes time to heal. your journal idea is an excellent one and shows a proactive approach.
PF has quite a few possible causes and knowing what created the symptoms yields a a better treatment outcome. Sometimes just a change in shoes or an insert resolves a person's complaint and sometimes therapy or more invasive measures are necessary.
Result number: 125
Posted by >David G. Wedemeyer, DC</b> on 4/26/07 at 18:40
I don't agree Dorothy that 'The only responses have been those that have mocked the idea'. I posted this link to my response where I have provided you a resource that is well accepted as the definitive work on magnets and electricity and how they effect the human body.
The section on PEMF is very in depth.
Result number: 126
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 22:56
There is a retired plastic surgeon from LA who has a whole line of magnet infused devices for every contour of the human body Ed. He makes quite a killing off of it I hear.
Result number: 127
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 22:54
Exactly Ralph! I bet there is a practitioner out there who could arrange 20 visits at 6k up front to reduce the intra ocular pressure in my eyes.
Result number: 128
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 22:51
Dorothy I have never had an issue with you so I am not sure why you would drag my name into this matter. Dr. Wander and/or Scott R can tell you that i always post from one ISP (except last week when I was in a hotel in LA).
I wonder if this is even the Dorothy that i am familiar with here.
Suggestion: get a pet!
Result number: 129
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 22:42
Influence peddling and pandering are a national way of life; look at our political system. No one would get elected if our leaders didn't accept 'donations'. I wonder how much of this pharmaceutical advertising budget goes to state and congressional lawmakers? Until they can set laws and limits, name specifics and indict the players it is a puny argument.
I was sent free samples of diabetic inserts, depth shoes, handed out a baseball cap and sweatshirt (with the logo of the facility I trained for my C.Ped in), taken to breakfast (by a neutraceutical rep) and sent 4 TENS units all in the last two weeks and I'm not a medical doctor.
I am going to start asking for cash and vacations, I feel cheated....
Result number: 130
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 14:33
I have affixed powerful magnets to the bridge of my glasses and hope to report complete correction of my astigmatism soon. :P
Result number: 131
Posted by >David G. Wedemeyer, DC</b> on 4/25/07 at 14:30
'So examine doctors with caution. Make sure they know something beyond medical school because medical school's a joke. It's what they learned outside of medical school that really matters'
'Again, I don't mean to paint every doctor into the same corner; just because they have the initials MD after their names, it doesn't mean they're complete idiots when it comes to health'
Again Susan this is an opinion not a factual expose. One has to wonder when a natural health writer (who has not shown any credentials as his training) with an interest in companies that produce and sell 'wellness' products slams the primary caretakers and drug manufacturers in this country with specious, biased assertions that are not based in any scientific fact.
This guy is selling something and weakens your argument. Medicines have helped a lot more people than they have harmed and that is fact. Do drug adverse reactions and iatrogenic illnesses occur, certainly. Your physician the best trained person to decide what drugs work best for your condition, of course. What do you think they learned in 4 years of formal education (minimum)? Mainly how to effectively administer these medications for you when nature's system has broken down and the organism is in danger.
'Over half the time, the doctor's just going to write out a prescription for the exact drug that the patient named, whether or not it is medically necessary'
Give me a freaking break! There are strict DEA controls and protocols a physician must follow to prescribe. They do not include influence from the patient. They call this 'drug seeking' and I am far more aware of doctors refusing medications to patients who ask for them, especially by name. Most especially in the case of habit forming Class IV pain medications. Where is this so-called experts evidence to back up such a ludicrous claim?
I understand the thrust of your thesis Susan as I am after all a natural health practitioner. At the same time if my child comes down with (God forbid) an astrocytoma or Guillaine Barre syndrome I truly do not think a naturopath or Ayurvedic practitoner and herbs are the course I would follow. Drugs have risks and so do untested, unregulated and unproven 'natural' therapies.
The threat of damage from articles like this one are far greater than any supposed pharmaceutical conspiracy theory.
Result number: 132
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 23:45
Dorothy there is an excellent book on alternative healing written by an orthopedic surgeon/researcher that explores this subject in great detail. His research led to the use of bone growth stimulators for spinal fractures and limb regeneration studies. It's a great read.
'The Body Electric' by Robert O. Becker, MD
Alternative medicine is making a huge surge and is certainly worthy of intense investigation. Just today I was discussing cold lasers with an MD friend. Although an orthopedist he wore magnets in his insoles to cure his PF (I told him it was the insoles..lol).
Result number: 133
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 22:19
That completely violates 'man rule # 5' which states:
Never, ever engage in conversation with a strange man in the john.
Pretty funny Marie :P
Result number: 134
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 22:16
Did you hear about the insomniac, dyslexic, agnostic?
He stayed awake all night wondering if there really was a Dog?????
Result number: 135
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 16:23
'The doctor said he would have me on my feet in two weeks' claimed the man to his friend.
'And did he'? responded the friend.
'Yes, I had to sell the car to pay the bill'!
Result number: 136
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 14:48
Dorothy I am on your side for the record.
You posted 'It feels as though it would be 'breaking up' scar tissue but I can't really say what it is doing.'
I was just trying to clarify what you were describing so please take this as an affirmation of what you were alluding to.
Result number: 137
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 11:40
Janice you are correct and this is an important point with regard to PF (or any fascial or ligamentous injury). Without getting too specific typical PF pain is caused by micro trauma to the fascia, especially at it's medial insertion at the inner heel.
These soft tissues undergo the same protective changes seen in tendinitis (osis). The reason the ball you have discussed is so beneficial is that it is very similar in it's action to cross-friction massage, which is very beneficial to aid in the healing process. You're basically causing a new minor insult to the tissues to engage proper healing.
Although there are many modalities that speed recovery in PF in my own opinion after treating a lot of these cases conservatively, nothing is as effective as the shotgun approach; ice, ultrasound baths, electrical stimulation, stretching and orthotics/inserts and of course soft-tissue cross-friction massage. Increasing your vitamin C intake (along with trace amounts of manganese, copper, selenium, zinc and MSM) is also beneficial. Together these co-factors cross-link new collagen formation.
On the issue of 'scar tissue', this process is termed fibrosis. The net result of this change in tissue is decreased elasticity and increased vascularity and innervation leading to increased sensitivity. Yes 'scar tissue' is a real concept Dorothy.
Result number: 138
Posted by >David G. Wedemeyer, DC</b> on 4/24/07 at 00:21
I had a visit by my favorite 5 y.o. today (she brings her mom along if you ask her btw). She tells me this story about the what would seem usual and ordinary to us that only the child's mind finds so amazing. At the end says 'It really freaked me out'! Imagine a 5 y.o. saying this.
Her mother and I laughed pretty hard.
Result number: 139
Posted by >David G. Wedemeyer, DC</b> on 4/23/07 at 17:31
Jersey? Michigan? Try driving the 60 or the 101 in L.A. without being in a large urban assault vehicle like a Suburban. It would make NASCAR drivers sweat!
Result number: 140
Posted by >David G. Wedemeyer, DC</b> on 4/23/07 at 14:59
Result number: 141
Posted by >David G. Wedemeyer, DC</b> on 4/23/07 at 14:39
Great one Jillian! I hope no one minds me posting the occasional medical joke here, I truly believe laughter is the best medicine.
Result number: 142
Posted by >David G. Wedemeyer, DC</b> on 4/23/07 at 13:41
The difference between a psychotic and a neurotic is that while the psychotic thinks that 2+2=5, a neurotic knows the answer is 4 but it worries him.
Result number: 143
Posted by >David G. Wedemeyer, DC</b> on 4/23/07 at 10:25
Larry actually I believe our instructor truly wants everyone to pass. I honestly think I was more daunted by shoe nomenclature than my classmates by all of the biomechanics and 5 syllable words. If I put myself in their shoes I;d bet that after years of sales and fabrication skills, learning to use clinical skills is the challenge for them. Hopefully your classmate hung in there.
For me I will probably never fabricate or make shoes. Who knows though huh?
Result number: 144
Posted by >David G. Wedemeyer, DC</b> on 4/22/07 at 21:17
Dr. Ed & Marie thank you! I take the exam in August so for now I have to bone-up on the material but it was a great experience. I think if patients knew how much science and skill is involved in making orthotics, custom shoes and inserts pedorthics would be a much larger field due to demand.
It had to be more daunting for my classmates who overall had no experience with medical terminology, anatomy etc. They were a great group. A few of them have worked for the larger orthtotic facilities and had amazing skills at manufacture already.
Worth every minute but now I have to get back to the office tomorrow, I'm way behind :P
Result number: 145
Posted by >David G. Wedemeyer, DC</b> on 4/22/07 at 20:59
Judy Dr. Ed took the words right out of my mouth. Unfortunately we only hear about the occasional physician prescribing outside of the law. The fact is that almost all illicit use is gained by second hand non-physician dispensing of drugs.
We have a drug problem in this country Judy yes, we do not have a physician problem per se.
Result number: 146
Posted by >David G. Wedemeyer, DC</b> on 4/22/07 at 16:57
You're all making valid points I have nothing to add. I especially agree with the bullying issue, it needs to be addressed and enforced. We live in a much more complex and violent society now. When I was a lad we just beat the snot out of each other and it was over. Now kids use lethal force and grow up far too quickly. There are no innocence or teen years anymore (especially when children raise themselves).
On a different note I completed my pedorthic pre-certification classes today!!!
Result number: 147
Posted by >David G. Wedemeyer, DC</b> on 4/22/07 at 16:49
I'm just trying to draw out the epiphany she is alluding to here. Of course the pharmaceutical manufacturers spend a large slice of the marketing dollar on physicians; physicians prescribe medication. They also donate to and help fund medical educations and institutions. That is after all their market since you cannot obtain their product without a medical need for them.
I'm a chiropractor and even i would be the last person to vilify either the pharmaceutical companies or the good doctors that rely on them to treat you. Medications certainly help people and although I would rather never have to take them, often without them physicians cannot effectively perform the duties they were trained for.
I'm wondering if Susan is alluding to some conspiracy here by the drug companies to financially influence doctors to try their product. (Pfizer - neurontin scandal?) That's happened before I am sure but do you really believe physicians with their level of education and intellect are that easily influenced by pens, trips and donuts? I don't agree. In fact doctors like everyone else (in a business) constantly seek the most efficacious and consist 'products' available for their patient.
I'd bet the great majority of physicians are not in practice for the dollar alone. This website and the doctors who give their time gratis are testimony to this.
There are much more effective and simple ways to earn a good income with the advent of managed care. Sorry Susan I don;t know you but your comments seem to me more like specious paranoia than fact.
Result number: 148
Posted by >David G. Wedemeyer, DC</b> on 4/20/07 at 00:40
Jeremy hit the nail on the head SA. What you describe regarding your foot and Jeremy's comments mirror my own foot to the tee. A high arch with a flexible foot really needs an orthotic with more control. In my case I was fitted with a softer, accommodative device twice and one so rigid it hurt; neither worked for me. I found carbon a great fit and relief and also thin enough to fit in my cycling shoes.
Switching to SPD-R platforms and having my cleats adjusted did the rest. Unfortunately my Nike's just aren't comfortable and after having tried the SIDI's they will be my next shoe. Sometimes the shoe just doesn;t fit!
Result number: 149
Posted by >David G. Wedemeyer, DC</b> on 4/20/07 at 00:29
Jill I think having a solid diagnosis is the only appropriate way to proceed. Could OTC inserts make it worse? If the cause is truly related to inversion and compression at the ankle it is very possible for an OTC to exacerbate your symptoms by creating improper changes in the relationship of the forefoot to rearfoot.
Assessment of TTS is never simple and when I have seen it and couldn't find an obvious mechanical cause I refer it out to a podiatrist or orthopedist. You should ask around and find a referral you're comfortable with and see a doctor who specializes in the foot and ankle. If you do need a custom (medical grade) orthotic I can ask the pedorthist who is teaching the course I am taking right now for a referral.
He taught pedorthics at Oklahoma State University in Okmulgee so I bet he would know someone closer to you. What city/county do you live in?
Feel free to email me if this is the case so or begin a new thread o.k.?
drwedemeyer at wedemeyerchiropractic dot com
Result number: 150
Posted by >David G. Wedemeyer, DC</b> on 4/19/07 at 22:01
I think the crux of the problem with most of these serial or spree killers rest with the parents and family. You never hear anyone blame the folks, not for creating the monster but for recognizing the traits in advance. There is also the factor that a disproportionate number of these disturbed people come from broken homes; we live in a matriarchal society where mom works too long and hard to observe enough and dad is off scott-free and uninvolved.
I would think odd behavior, drug use, withdrawal from family and friends would tip parents off. I'd hope that tattoo's of 666 on a teen's body and disocrdant behavior would send up red flags in most normal and involved parents. Instead they seem to push aside these warning signs when they should seek help for their child. You have to take a test to drive a car but not to have a child. Go figure. let's put blame where it belongs in most cases; with the parents!
Result number: 151
Posted by >David G. Wedemeyer, DC</b> on 4/18/07 at 17:31
Yanni I couldn't cycle on the SPD or Speedplay platforms at all. I use the SPD-R platform now, wider base like the Look. Cycling is all forefoot and since you are not walking and using the rearfoot many people can get away with a properly fit shoe alone (and bike fit). One point I'd like to make is that your specific foot type makes a huge difference in what I suggest for the people that I fit.
Example; a flexible foot may need more control and a rigid foot may only need accomodative padding in the ball to offset problems. Couldn't hurt to ask your podiatrist and/or cped what would work for you and save yourself the trouble of guessing and ultimately spending a lot of time, effort and money in finding a good shoe/pedal/insert combo.
Result number: 152
Posted by >David G. Wedemeyer, DC</b> on 4/18/07 at 17:16
Jeremy take a look at this from SIDI.
They tend to have a better grasp than most cyclng shoe companies of sizing and available widths although I am sure most shops just sell a brand not a proper fit. Nike seems to be the worst in of construction of the high-end road shoes. I quit buying their tennis shoes as well.
They use a curved last which for me with a very high arch and curved foot combined with some actual room in the toe box and available widths made them my best choice for a new shoe. I have yet to see a quality cycling shoe built on a straight last. Rocket 7 is the one company that is a Certified Pedorthic facility and they will build you a custom shoe off a plaster cast but they are pricey.
Result number: 153
Posted by >David G. Wedemeyer, DC</b> on 4/18/07 at 11:59
Laurie sorry to hear you're having such trouble. You're not alone I have seen this complaint quite a few times before when patients are fitted with crutches. I would call your physician's office and inform them of the problem. I am assuming they either provided you the prescription or the crutches themselves as well as instructions?
I located a link that may help you:
Result number: 154
Posted by >David G. Wedemeyer, DC</b> on 4/18/07 at 11:38
Yes Laurie the axilla is in the 'armpit' region. Since crutches are essentially a new weight-bearing activity the body often responds with pain/numbness from the pressure on the nerve plexus in that area.
Remember you're supporting your entire body weight on the crutches as you walk. You could be overcompensating and supporting your weight with the wrists instead and if you think about it doesn't it seem logical this may be the cause of your pain?
Result number: 155
Posted by >David G. Wedemeyer, DC</b> on 4/17/07 at 23:35
Yanni and SA hello,
I hope I'm not intruding but your thread caught my eye because I am a cyclist who has had some experience with foot pain post-cycling.
I found Shimano shoes too flexible and cramped in the toe box. The same with my Nike carbon soles, except the are so rigid I can't wear them anymore. Have either of you tried SIDI Genius shoes? I'm thinking of buying a pair soon, I hear they're top notch.
Result number: 156
Posted by >David G. Wedemeyer, DC</b> on 4/17/07 at 22:31
Laurie it is highly doubtful that TTS and carpal tunnel share anything in common except being a possible compression neuropathy of the flexor retinaculum; one in the wrist and one in the ankle.
What I would bet on is that your crutches are causing you a brachial neuritis due to compression in the axilla. You should let the orthotist or PA who fit you with the crutches know, it is possible they need to be lowered or the pads need to be refit.
This doesn't mean you do not have carpal tunnel but based on what you have revealed here I wouldn't worry a whole lot just yet.
Result number: 157
Posted by >David G. Wedemeyer, DC</b> on 4/16/07 at 01:20
I just realized I was getting off-topic since you have TTS (?) Jill. The condition is different but most of the protocols are the similar. A varus heel can cause entrapment neuropathy in the medial ankle. Do you wear orthotics currently?
Has anyone evaluated your heel in relation to the forefoot? If you have a varus heel a lateral valgus wedge could help. I'd try finding a DPM or C.Ped near you and have the eval done before spending anymore time (or money)anywhere else. ART and the other modalities probably won't solve your problem without correcting the mechanical defect.
Result number: 158
Posted by >David G. Wedemeyer, DC</b> on 4/16/07 at 00:59
Have you read 'State of Denial' Marie? It's quite compelling in regards to your question.
I've never been a Bush supporter, but initially I did support the war based on the information we were fed. I now think he's incompetent as is Cheney.
Result number: 159
Posted by >David G. Wedemeyer, DC</b> on 4/16/07 at 00:51
I wish I had the desire to explore Linux again Ed, consumers basically have two choices Bill or Steve. I think my next computer will be a Mac though.
Funny how those Linux distro's run on fumes and never crash. The new GUI's in Linux tend to draw a lot of resources too now, is Ubuntu more RAm friendly?
Result number: 160
Posted by >David G. Wedemeyer, DC</b> on 4/16/07 at 00:42
Hello Dorothy. Quite a few of the brands you mentioned are adequate actually. I only endorse one brand and it's because theirs is the only one that I provide in my office (and that I take myself) Metagenics.
You have to purchase Metagenics from your doctor, but if you contact them they will locate one in your area. Price wise I'd say they're in the medium range but their quality, service, research, testing and reliability lead the industry. I take this one Dorothy.
They do sell cod liver oil as well. I was never able to consume that myself but many people swear by it's health benefits. I prefer the enterically coated capsules because you never taste the fish. I'm not very knowledgeable about krill oil but it sounds very tasty (laughing).
Result number: 161
Posted by >David G. Wedemeyer, DC</b> on 4/15/07 at 21:09
You're quite welcome Jill and thank you for the kind words. What part of Texas? I now a colleague in Dallas I could share my protocols for PF with.
Although PF is a fairly minor complaint the presence of this site proves how consuming, chronic and recurring it can be. I don't think just one conservative treatment resolves PF but if caught early I have had excellent results with electrical stim (with an Analgesic healthcare sock), subaqeous ultrasound, orthotic/shoe modification and soft-tissue therapy. Patients are also given home therapies and nutritional adjuncts.
Any PT or DC worth their salt should be able to provide these services. The orthotic support must be appropriate for your foot type and pathology so if your provider is not well versed in orthotics referral to a DPM or C.Ped would be of huge value. The team approach works wonders for PF.
Good luck Jill,
Result number: 162
Posted by >David G. Wedemeyer, DC</b> on 4/15/07 at 20:49
Dorothy you could try an omega-3 supplement (2:1 ratio EPA/DHA), they don't contain significant amounts of vitamin A. I take 1-2 grams of marine lipids in a gel cap daily. Also check to make sure they test for mercury.
Result number: 163
Posted by >David G. Wedemeyer, DC</b> on 4/15/07 at 20:45
I'm a huge proponent of EPA/DHA supplementation Ed. Their cardiovascular, joint, anti-inflammatory and hear protective effects are being heavily researched my medicine now.
Result number: 164
Posted by >David G. Wedemeyer, DC</b> on 4/13/07 at 10:26
Oh I know I'm a Geek John (laughing). I spent a little time and far too much effort tinkering with Linux then realized Windows and Mac are just far less frustrating. I have considered buying a Mac next time around because although Windows works fine for me I know eventually old Bill will end support for XP and force us into using Vista or his next great mistake. Plus Mac's just look 'cool'.
Result number: 165
Posted by >David G. Wedemeyer, DC</b> on 4/12/07 at 18:33
I totally agree Jillian I love AVG. I also scan monthly with Panda Activescan, it's free and effective. Norton and McAfee are bloatware.
Result number: 166
Posted by >David G. Wedemeyer, DC</b> on 4/12/07 at 12:16
John you should see how many are for sale in the various chiropractic and medical classified ads. This is a classic example of the sizzle and the steak; it looks, smells and sounds great when it's cooking but the meat tastes funny.
Result number: 167
Posted by >David G. Wedemeyer, DC</b> on 4/12/07 at 12:10
Apples are apples and PC's are PC's. Two totally different architectures and operating systems. Mac changing to an Intel chip only means you can now run PC applications on a Mac, which should be a benefit since there are more programs written for PC. Mac is built on UNIX based operating systems which is a true computer but in the past was more difficult to operate, I don't think they have that problem now and there are more software titles for Mac. Bill Gates love him or hate him made computers simply for the masses but as we are all aware that was at a cost; safety. It is very difficult to find in the wild viruses for Mac's actually and being UNIX based they are very safe by nature.
The only reason I ever bought a PC in the first place was for billing and I could not find any decent billing software for a Mac at the time, so I bought a PC and stuck with it. It's more of a challenge to run a Mac in a business environment unless you are using it for graphics, where Mac absolutely has the upper hand.
As for Vista it is just plain bloated, slow and confusing. Like XP when it first came out it will take them a couple years at least to patch all of the gaping security holes and bugs. I have had XP just plain stop operating over time and crash, fortunately I back up my data frequently as everyone should.
I don't buy antivirus or spyware/malware programs like Norton and my computers run clean and fast, I use freeware readily available on the internet. I also haven't had a virus in 3 years, although there are so many for PC's it is astounding. I also use a cache and file cleaner to remove Bill Gates ridiculous implementation of swap, temp and paging files which corrupt your computers data over time. If you would like recommendations let me know, with a small amount of work even Windows can run smoothly.
I have an HP laptop with an AMD Turion processor that is amazing and personally have never had a problem with their brand. I think many times it is not the manufacturer but the software and their conflicts that drive people to tears. Having used Windows, Linux and a Mac over the years I can tell you they're all a pain in the (_(_) until you get control of them.
Result number: 168
Posted by >David G. Wedemeyer, DC</b> on 4/12/07 at 10:32
You have made my entire week Diane Simply by seeing through the haze of advertising and recognizing the decompression machines for what they are 'sophisticated traction'. As I stated in a previous post on this thread insurers often do in fact reimburse for this procedure, the fact that they refuse to use this CPT billing code is proof that they live in a state of denial about the use of the appropriate code for traction.
Since they can only net about $25.00 per session they have repeatedly advised the unsuspecting doctors to collect cash up front to offset the $90k price of the units. I called one of these distributors and received the same pitch. When I inquired about the CPT code for mechanical traction they quickly deflected my questions. IMO not billing a patients insurance for a covered procedure is fraud by omission and unprofessional.
Are you going to post your MRI results? I am curious as to exactly what the radiologist had to say. Also an ALIF sounds horrible but at the same time I have encountered many patients who have had very successful ones.
Result number: 169
Posted by >David G. Wedemeyer, DC</b> on 4/11/07 at 22:32
Here is an epiphany; soft tissues heal by remodeling over time. Often they heal inadequately with restricted motion due to the body's response to pain and dysfunction laying down new proteins, ground substance modulators of pain and inflammation such as eicosanoids (prostaglandins) which limit motion and protect the organism from further injury. One of the important factors in pain and inflammation is the production of cycloogygenase (cox enzymes), these are the target of many NSAID and prescriptives such as vioxx and celebrex. More on this later.
Why is this relevant to this thread? Because the duration of this inflammatory process I believe is directly related to histologic changes in muscles and tendons which over time manifest chronic illness from 'itis' to 'osis'.
Many of these conditions respond well to appropriate cross friction massage, passive range of motion and manipulation (ART, Graston 'Superactive Techniques'). You're all so on track about producing a minor insult to the tissues to engage the body's healing mechanism. The problem is when range of motion is restricted tissues tend to heal inadequately, fascial restriction sets in and the new tissue is much less elastic, much more highly innervated and with less organization.
Has anyone ever sustained a deep cut and years later it feels 'tingly and weird'? This is an example of the pathologic changes any tissue undergoes with either inadequate treatment or chronic injury. The case for the utilization of this myriad of therapies probably no one disagrees with.
I'm awed by Dr. Ed's grasp of histopathology, none of the surgeons I have met ever discuss soft tissue injuries in this manner.
Result number: 170
Posted by >David G. Wedemeyer, DC</b> on 4/11/07 at 11:02
This is so true John but now there is hope; Superactive Techniques by Dr. Ed!
On a serious note I have investigated the Graston technique a bit and experienced it first hand. It is based on sound principles and it does provide the deepest soft-tissue work I have ever experienced. For me though paying over $3,000.00 for $100 worth of alloy instruments just doesn't jibe. They would achieve much greater usage and acceptance if they didn't include the secret handshake and focused on outcomes rather than marketing.
Result number: 171
Posted by >David G. Wedemeyer, DC</b> on 4/11/07 at 00:59
PS Sandra after careful consideration I feel it's best not to endorse any brand beyond the one I am familiar with. Many supplement companies cannot verify where they obtain their ingredients and this should concern everyone.
I found this article interesting and informative:
Result number: 172
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 22:39
Your doc does sound caring and imagine spending time with patients!
I wish you well Lisa and don't give up.
Result number: 173
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 22:33
Are the Pina Colada's included in the course fee? If so...I'm in!!
Result number: 174
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 22:29
Sandra actually more are safe than not, which is encouraging. I suggest asking any company you are buying your chondroitin sulfate (or any bovine source animal material)what the source of their ingredients are. Let's face it if you go for the cheap brand how confident can you be that they didn;t buy ground up cow parts from a safe source?
I provide Metagenics neutraceuticals in my office. They only sell to doc's but if you contact them they will find one in your area who sells it. Their bone and joint products are farmed from New Zealand cattle,which is considered the only country to be BSE free. No one knows for certain how expansive the Mad Cow threat is bu for me (and my patients) I do not take any chances.
I can attest to the quality of their calcium/magnesium and glucosamine/chondroitin products. I have also visited their facility and I can tell you they are the leader in research and testing for safety and purity.
Result number: 175
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 21:25
John I thin you are referring to McKenzie extension exercises. McKenzie was a PT who was way ahead of his time but his techniques now enjoy wide usage in PT and DC's offices. For a contained disc they are often very effective as an adjunct to manipulation. The Cox protocol is much more effective than McKenzie exercises for hot low backs. Cox is also the only person to have ever conclusively shown his technique to draw the herniated disc material back into the disc by vacuum effect in studies.
I've witnessed a few discograms first-hand. The ortho's I refer to rarely use them to find pathology but instead as a work-up prior to surgery. Often they cause iatrogenic disc pain in and of themselves.
Result number: 176
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 21:11
Jill I have several years practical experience with ART, not specifically in treating TTS (Hmmm..). I think when prescribing any treatment first your doctor's job is to define the etiology (origin) of the lesion. A history of ANY complaint is vital to arrive at a cogent diganosis and treatment plan.
TTS as I understand is a multifacted entrapment or compression neuropathy. The etiology can be intrinsic (space-occupying masses, localized tumors, bony prominences, and a venous plexus within the tarsal canal), extrinsic (external trauma due to crush injury, stretch injury, fracture, dislocations of the ankle and hindfoot, and severe ankle sprains) or tensioning (rearfoot valgus deformity causing eversion and dorsiflexion).
I'm sure the DPM's here have a greater knowledge of this syndrome than I do but here is what I understand and what I would recommend. If the cause of your problem is tensioning then any practitioner who makes a truly functional orthotic could help along with ART. Intrinsic and extrinsic factors are medical issues which are obviously best evaluated and treated by a physician, at least initially.
I use ART techniques for many overuse and entrapment neuropathies with very good results, it is a beneficial treatment. One observation that I have made over the years is the over diagnosis of Carpal Tunnel Syndrome (which is an entrapment neuropathy of another flexor retinaculum, in the wrist) we're all probably familiar with this complaint. I have seen a great number of diganosed CTS cases and successfully treated them using ART, interferrential current and ultrasound. Often the entrapment is not in the wrist but in the forearm or elbow (Dr. Ed and I discussed this just the other day).
It is always gratifying to see a patient leave with a 50% reduction in symptoms within one week when they were told they would need surgery.
My advice; get a proper diagnosis as to the cause of your TTS then make an informed opinion on who to have treat it. A diagnosis should not only be the what but the why, then you can treat it effectively.
I hope this helps Jill, keep us posted.
Result number: 177
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 18:27
Ralph I have seen quite a few people make incredible progress with glucosamine and chondroitin (and MSM).
Two words of caution though, glucosamine should not be taken by people with glucose tolerance issues and diabetics. Second, pick a good manufacturer because some like to grind up bovine trachea to make their product. The problem with this is cautionary since some of the material may be made from overseas animal products and not all of the data is in on prions from bovine spongiform encephalopathy (mad cow... Krutzfeld Jacob's).
I have resources to quality, safe manufacturers if you are interested.
Result number: 178
Posted by >David G. Wedemeyer, DC</b> on 4/10/07 at 11:30
Diane you sound well educated about your options and on the cautionary side which is intelligent. You're correct in stating that any surgical procedure is a permanent change of the architecture and with risks. I have seen patients who have tremendous success right off the bat and many other failed back syndromes after surgery, the truth is there exists a very low predictive value associated with spinal fusion surgery.
The same is true for whether it is chiropractic manipulation, 'decompression' therapy or the Cox distraction technique; all have benefits and all have risks. You have to weigh the risks against the benefits with your physician and make an informed choice. My only hesitance with these 'decompression' machines is the lack of true evidence based, peer reviewed studies and their ludicrous upfront costs. Perhaps if you could find someone with a great deal of experience with this mode of therapy and who would allow you to pay as you go while not misleading you about outcomes and breaking the bank.
As I stated in a previous post herniation is a term that is tossed around too freely. Frank herniation (sequestration)means extrusion of the nuclear material outside of the border of the disc. If you think about it this is invariably more often a surgical solution only. A disc protrusion on the other hand means the disc is contained and is often treatable conservatively. Add loss of disc integrity and height to the equation and your options begin to lean toward the surgical although early on in the process many patients respond to conservative measures.
In response to John's post actually very often a herniated nucleus will present with no associated leg pain (sciatica). Early on in disc pathology it is the opposite but once the pressure in the disc is released they tend to have less leg pain and greater back pain, especially on sitting as in Diane's case.
Without knowing the precise terminology used by the radiologist who read the MRI it is a guessing game Diane but it does sound like herniation.
Result number: 179
Posted by >David G. Wedemeyer, DC</b> on 4/09/07 at 23:28
Diane I am actually surprised an ortho would suggest that 'self-fusion' is a valid mode of treatment. Typically due to herniation, degenerative processes and/or trauma the spinal discs degenerate, lose height and the spine undergoes dramatic structural changes. The end result of this process is called spondylosis and it is usually fraught with a whole new plethora of symptoms.
One of the changes that occurs is that because of the approximation of one vertebra to another (in the absence of the disc as a shock absorber and the integrity of the distance between adjacent vertebra) is the probability of compression of the spinal nerves as the exit the foramen (small holes to the side between adjacent vertebra). Another would be bone spurring from excess joint motion which leads to encroachment of the foramen itself, even the cord if you have a congenitally small spinal canal (stenosis).
If you in fact have a contained disc (no herniation but instead a 'bulge') Cox distraction technique might be of great help. A sequestered, herniated disc is surgical.
What did your MRI say? I am assuming you have had one because without one the diagnosis of frank herniation is a difficult one to make.
I would consider a second opinion and from an orthopedic spinal specialist if yours is not one or a neurosurgeon.
Good luck and keep us posted.
Result number: 180
Posted by >David G. Wedemeyer, DC</b> on 4/09/07 at 13:46
Thanks Jeremy I am somewhat confused at this point over their conflicting criteria.
There are only two cped's in my immediate area and one owns a Foot Solutions, so I doubt they want to make nice with me. I have spent a lot of time and consult with an orthotist who owns a lab as well as a cped that I buy my TSB inserts from.
I understand your points and at the same time I do have far more experience in direct patient care than you might imagine. Whatever the outcome of the DWE issue I will continue to take workshops and online learning as I have prior to the the program, of course eventually I will receive credit for it.
Result number: 181
Posted by >David G. Wedemeyer, DC</b> on 4/09/07 at 10:46
I don't know the answer to that question Dr. Kiper, are we talking about the 3D0 scanner?. I will ask the company and let you know.
I'll email you my contact info.
Result number: 182
Posted by >David G. Wedemeyer, DC</b> on 4/09/07 at 00:06
Jim & Larry you have reminded me to reread Stephen Hunter. We need 'Bob the Nailer'
Result number: 183
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 23:58
Jeremy thanks for the advice. I began my review of foot and ankle anatomy last week in preparation, they do waive part 1 of the course requirements for allied health professionals. That leaves me the 84 hours you mention.
1. The cpeds.org site seems to have changed their information regarding licensure if I'm not mistaken. I recall seeing a change beginning this year which required 1,000 hours DWE as you suggest to sit for boards. The ABCOP.org website which as you know your field has elected to join seems to differ on this point (DWE). Do you know if it is required? I will fulfill it regardless, it can only benefit me.
I have no issue working with a cped or a physician but I wonder if they give credit for already having done most of this both in direct patient care and with a podiatrist. I'm a bit unusual as I have quite a lot of experiential hours already accrued.
Result number: 184
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 18:12
Yes Dr. Kiper the 3DO pad is a weight-bearing system and yes every device they sent me was IMO 'customized' semi-rigid. I wouldn't be surprised if they were all cast from the same software or of the same origin technologically. There has been very little new in the imaging market in recent years.
You're in San Diego if I'm not mistaken, I'd love to show you the ScanAny system. I live up the road in Orange County. I think for STJ neutral it has distinct advantages over plaster. There are no bells and whistles just a quality digital cast. I have found nothing like it price vs. performance wise. I'd like to see them open their data up to more labs though.
Result number: 185
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 18:03
Los Angeles through Bill Meanwell (International School of Pedorthics)
Result number: 186
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 15:45
Marie his goal I believe is to control the end game in Iraq. He wants influence and a piece of the financial pie at the conclusion of the war. He won;t achieve this if Iraq becomes a true democracy and like all extremist demagogues chaos is his prescription to achieve this goal.
He should be removed stat. The only chance we have to win anything resembling a victory in Iraq is to covertly remove any and all extremist leaders and close Iran and Syria's borders with Iraq. De fang the snake and it cannot harm you. Many of these fundamentalist extremists hate us for simply being Christian and pervert Islam to further this and control the minds of the populace. How can you reason with anyone who extolls this belief system and straps bombs on children to further and unconventional cowardly form of warfare?
The usual rules of engagement do not apply here. 9-11 should have taught us that much.
Result number: 187
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 15:31
I believe she is a pathologist Dr. Z. I only know this because our pathologist at Cleveland had these bona fides as well as being an MD.
Result number: 188
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 15:25
You're absolutely correct, Foot Levelers markets to us while we are in our clinical rounds by sending out their 1' foam impression box to the clinics with the offer of making us a gratis pair. They provide financial support to almost every facet of chiropractic education, continuing eduction, seminars and monthly publications so they have a very intelligent marketing program. Unfortunately their 'inserts' are what they are; customized (?) prefab accommodative EVA.
We should talk Dr. Ed after using ScanAny and becoming ever more interested in practical gait analysis (and being decidedly techno-geeky) I have some ideas for both orthotic and shoe manufacture I think you might find interesting. Your experience could be invaluable to the process. I've seen about everything out there and feel with the right programmers and medical input we would have a worthwhile project. Your idea of blending our individual training is very appealing.
I'm doing couch time all day watching basketball until dinner. If you're available let me know, we could discuss it extemporaneously. I start the cped course next weekend so this work week is going to be tough.
Result number: 189
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 14:37
Jim you should definitely see an orthopedic spinal specialist, pain in the testicle is a warning sign there is sacral involvement. You could very well have a concomitant TTS but regardless your symptoms suggest spinal involvement and are of greater concern.
keep us posted and good luck.
Result number: 190
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 01:10
Jim a 5th lumbar disc herniation typically refers pain in a very distinct pattern into the foot. You state you have a tear in your L5 and a bulge in S1 and this is where diagnosis of neuropathy gets tricky.
There are five lumbar intervertebral discs but there are no sacral discs. Depending on where the the nerve roots are being compressed or contacted by either nuclear material that has leaked into the interspace, by a free fragment, directly abutting the cord itself or a lateral disc contacting a nerve root your symptoms can be different and involve different nerves.
Dr. Ed of course is right on; the MRI is a confirmatory tool used to affirm your history and exam findings. Certainly a herniation with free fragment can present with atypical pain and be confusing. Along with positive orthopedic findings (deep tendon reflexes at the knee and ankle and various muscle tests, sensory deficits and patterns) the MRI is confirmatory. As Dr. Ed said needle EMG (motor) and NCV (sensory) would be indicated. Has your physician ordered these tests?
All together these whittle down the differential diagnosis. If the sacral nerves are involved it is because they form a plexus or bundle with the lower 2 lumbar disc's nerves (and route down the back of the leg ending in the foot) and not because of a sacral disc derangement as there are none. If you have any pain or numbness in your genitals or anus there is definitely sacral involvement.
Lacking the above I would bet your L4-5 and L5-S1 vertebrae (L4 and L5 discs respectively) are the locations of your complaint. Have they suggested surgery at this time?
Result number: 191
Posted by >David G. Wedemeyer, DC</b> on 4/08/07 at 00:17
Dr. Kiper you use Tekscan if I am not mistaken. I have a Quasar 3DO pad which is great for plantar pressure and a basic gait scan. Are you familiar with this device? The patient walks across the pad left foot then right, two passes.
Their orthotics though no matter what they claim are prefab 'customized' and as expensive as the lab I use now using ScanAny.
Result number: 192
Posted by >David G. wedemeyer, DC</b> on 4/07/07 at 22:42
We could challenge Lance Armstrong to a tag team ad hoc bike race wearing custom designed inserts. I bet with the proper device we could improve pedaling efficiency enough to finish the race by the time he wakes up the next day.
Result number: 193
Posted by >David G. wedemeyer, DC</b> on 4/07/07 at 22:35
I have fiddled with the APAS system (Gideon Ariel who is a major rocket scientist developed this), Dartfish and Comtemplas. The Dartfish seems to contain the specific controls and programs I am looking for and it is somewhat reasonable.
I do not have the room in my office for a full gait ramp so I am entertaining the idea of working something out with a PT that would be mutually beneficial; basically you can use my software and bill for your own patients so long as you perform scans for my patients as well.
Orthotics and prosthetics have always interested me, especially because of the amazing results people like our soldiers who lose limbs can now achieve despite their injuries. I am really glad to hear that these services are available to them, I don't think that anyone questions that these men and women deserve our very best and our gratitude.
On a side note I had to attend my continuing ed today and chose one that included lower extremity assessment and management. Sadly I don't think any of the doctors or cpeds here would have been impressed one bit. My profession is so far behind in teaching anything about basic orthotic management,let alone to quit passing off Foot Levelers as anything more than a very unscientific 'insert'. I can't wait to start the cped program. It seriously disheartened me, their belief system is that you can adjust anything and should offer this as a first line of treatment without any real depth of knowledge as to how the foot and ankle function and how to control it.
I have a business card for the orthotic side of my business which has a picture of two TL2100 orthotics without a topcover on them. I offered a couple up to people I had met today and was talking to and two asked what the things in the picture were!
Result number: 194
Posted by >David G. Wedemeyer, DC</b> on 4/07/07 at 01:05
Thanks for responding this question has been lingering in my mind for a while now. Hopefully once I complete the cped course I will gain even more answers. It's great to have DPM's to bounce ideas off of and I appreciate the help since I've worn out my welcome with a couple locally I am sure.
I've been working with mostly runners, cyclists and triathletes and a local bike shop and their staff. This led me to eye some 3D motion analysis equipment to provide bike fittings and gait/performance analysis since I love both sports and technology. I sense a need for such a rig here since the California lifestyle is very active.
I have a good friend I graduated with who lives in Dallas. If that's anywhere near you I may just take you up on your offer, I've been threatening to visit him for some time now.
Result number: 195
Posted by >David G. Wedemeyer, DC</b> on 4/06/07 at 22:36
Just a quick happy Easter greeting to all of you, be safe and be well.
Result number: 196
Posted by >David G. Wedemeyer, DC</b> on 4/06/07 at 15:07
John, Rick & Larry; AMEN!
Result number: 197
Posted by >David G. Wedemeyer, DC</b> on 4/06/07 at 01:14
Oddly that was one thing I had considered Dr. Kiper and a small met pad. I got the idea from an insert Specialized makes after market for their shoes.
Do you have a cycling SDO in the works? Heh
Result number: 198
Posted by >David G. Wedemeyer, DC</b> on 4/05/07 at 23:41
Marie I am non0partisan really, I tend to vote the issues. In this case foreign affairs are so complicated and sticky I just don;t see the good in this, she is not our ambassador to the middle east. You're right though about the current administrations abysmal handling of everything having to do with the war and our influence in the middle east.
Ok I'll sit back and watch this one and give ehr the benefit of the doubt. If she screws this up further can I then rattle my sabre? :P
Result number: 199
Posted by >David G. Wedemeyer, DC</b> on 4/05/07 at 18:20
Nancy worry about the home front please, the middle east is enough of a mess right now.
Result number: 200
Posted by >David G. Wedemeyer, DC</b> on 4/05/07 at 01:41
Ryan a little history of your complaint would help ie; mechanism of injury, diagnosis(es), type of doctors seen, location of the injections and contents etc. It hurts most when I bend backward/lean forward and pain is greatest in the am vs pm are also good starting points.
Degenerative disk disease in a man your age is rare unless you have had a great deal of trauma or congenital malformation such as idiopathic scoliosis or spondylolisthesis.
If you're receiving facet injections for disk disease you're right; they won;t work for long if at all.
Result number: 201
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