Manipulation Under Anesthesia in San Francisco Bay Area

March 18, 2011 by drburt

There are thousands of people in the United States and Abroad who suffer from a chronic pain daily. They are tired of taking pain medications and yet they are not surgical candidates, or still have pain after the surgery that have already had. The good news for all those patients who suffer from pain and lack of mobility is that there is a non surgical solution to this problem. It is a simple and painless procedure that is offering a pain relief and restores range of motion. Manipulation Under Anesthesia also known as MUA is the solution to the problems to many neck, low back and shoulder chronic pain sufferers.

MUA is the procedure where manipulation of the spine or shoulder is performed in a surgical center under sedation. This procedure is one of the most effective methods of altering chronic pain conditions where chiropractors work together with medical doctors in order to achieve the best results possible. The techniques used in manipulation under anesthesia (MUA) have been described as low-velocity/high-amplitude in contrast to the usual chiropractic adjustment which is most commonly described as a high-velocity/low-amplitude thrust or “impulse.” The purpose of high-velocity technique is to overcome the conscious patient’s protective reflex mechanism which would prevent the separation and movement of the joints. In a joint manipulation, the articulation is moved through its entire passive range of motion and past the elastic barrier and into the paraphysiological space where joint cavitation occurs. Cavitation of the joint is an audible “report” signifying that the articulation has been distracted sufficiently to affect the physiology and function of that synovial joint.

Manipulation Under Anesthesia has been recognized and used in the manual therapy arena for over sixty years. It is a great procedure for those who do not respond to a traditional care or invasive surgical procedure.The MUA procedure continues to gain widespread support and recognition in the medical community and is helping to bring much-needed relief to a grater patient base than ever before.

A Doctor of Chiropractic with post graduate degree – Manipulation Under Anesthesia Certified with Hospital privileges would be a chiropractor who would perform this procedure. It is a rule that two chiropractors perform MUA procedure. First one is a primary doctor and the second one is an assistant. The reason why you need an assistant is because patient is unconscious and the assistant is supporting the body on one side while the other chiropractor is performing a manipulation and stretches. Then they switch sides. Manipulation Under Anesthesia is not only safe, but also highly successful in treating acute and chronic musculoskeletal conditions.

Who Is The Best Candidate for MUA?

Patients who have received conservative care for 6-8 weeks for their neck, mid-back, lower back and shoulder with very limited improvement in symptoms or findings. Also patients who still have pain after the surgery would also be the candidates for this procedure. Common indications for Manipulation Under Anesthesia include neck, middle and lower back pain, chronic muscle pain and inflammation, acute and chronic muscle pain and inflammation, acute and chronic muscle spasm, chronic fibrositis, nerve entrapment, disk pathology including herniated disks, torticollis and failed back surgery.

What is Manipulation Under Anesthesia Procedure Like?

MUA procedure is an ongoing process for three consecutive days. During these three days the patient is being treated in a surgery center under supervision on Board Certified Anesthesiologist and two Board Certified Chiropractors where spinal manipulative therapy and stretches are performed. After the procedure, treatment continues as strengthening and stabilization programs are initiated over the next few weeks in a chiropractic office. Post-Procedure care is a vital part of the MUA procedure. Follow-up visits with a Chiropractic Physicians are important at this time as the stretches accomplished during the MUA procedure are built upon, helping the patient to regain strength and prevent future pain and discomfort.

What Are The Effects of Manipulation Under Anesthesia Procedure?

The proposed effects of therapy include the following:

Breaking up scar tissue (adhesions) both in and around the spinal joints, commonly caused by multiple injuries or failed back surgery.
A decreasing chronic muscle spasm
Overcoming super-sensitivity of injured areas, making the patient unable to cooperate for effective treatment
Stretching persistent shortened muscles, ligaments and tendons
Relief from pain and radiating symptoms caused by damaged invertebral discs.
Most importantly however, Manipulation Under Anesthesia affords patients immediate relief and noticeable difference in their daily lives post-procedure. These positive results only continue to improve with time and post-MUA therapy.

Am I a Candidate for MUA?

Medical screening is an absolute necessity for each patient who is planning to get an MUA. Medical history and physical examination and where indicated, CBC blood studies, chest X-Rays, EKG’s and other diagnostic tests such as MRI or CT’s. Feel free to CONTACT us at our primary San Leandro Chiropractic Clinic at (510) 481-BACK (2225) and we will be more than happy to answer any of your questions.

Sincerely, Dr. Eduard Burt, D.C., MUAC a.k.a Doctor of Chiropractic, Manipulation Under Anesthesia Certified.

Diabetes, Diet, Chiropractic and Your Health

March 16, 2011 by drburt

The current global prevalence of diagnosed with diabetes is 165 million and is estimated to increase to 250 million by 2010 and to 330 million by 2025. These alarming figures do not include undiagnosed diabetes or pre-diabetic states.

When a physician diagnosed a patient with diabetes that individual must adjust to a healthier lifestyle. One of the most important factors is making changes in a diet. There is no necessity to skip meals or your favorite foods that you have always loved. It is a scientific fact that skipping meals will increase glucose level in your blood stream, and that is not a good thing, especially for some who has diabetes. Moderation is the key.

It is important to stay away from deep fried foods or oily items, these foods always increase sugar blood level. A great healthy substitute to these foods would be low fat dairy, green vegetables and fruits. It is very difficult to cure diabetes, however, it is possible to bring it under control and live a normal life. Besides keeping a healthy diet it is important that individual with diabetes exercises on regular bases. The best form of exercise would be a cardiovascular training – swimming, jogging, cycling. This will keep your weight in control and will help to control your diabetes.

Foods that contain a lot of fiber is another great way to prevent an individual gaining extra pounds, thus keeping the sugar level low in your blood stream. A great example of foods with great fiber content would be: oat bran, beans, rice bran, cereals, fruits, and vegetables. Garlic can help you with your cold and it can also help you with your diabetes. It is rich in potassium, zinc and sulphur, those are essential elements that can keep your sugar blood level low.

If possible avoid foods that have high Sodium content (salt). You can simply get your sodium dose from many vegetable or other natural foods. This way you will shoot two rabbits at the same time – eating healthy and tasty foods.

It is essential that a person with diabetes keeps in touch with his/her doctor who can check the overall health condition of the person. A regular chiropractic adjustment will help to keep your system running at the higher potential. It is not a secret that nervous system controls everything in our bodies. Thus, if there is no interference from a subluxation the individual will feel even better. Chiropractic care along with massage therapy will also help to enhance joint mobility, decrease muscle soreness and keep your energy level up. Below is the list of symptoms that an individual might experience with diabetes. Chiropractic care can be of tremendous benefit for these conditions.

Musculoskeletal Disorders Associated With Diabetes Mellitus (DM)

Intrinsic Complications of DM

Limited joint mobility

Stiff hand syndrome

Diabetic muscular infarction

Increased Incidence With DM

Dupuytren’s disease

Shoulder capsulitis

Neuropathic arthroplasty

Osteopenia (in type I)

Flexor tenosynovitis

Acute proximal neuropathy

Proximal motor neuropathy

Pyomyositis

Diffuse idiopathic skeletal hyperostosis

Possible Association With DM

Osteoarthritis

Carpal Tunnel Syndrome

My personal advice, please treasure your health from the very young age. That is the most important asset that an individual can have. Many times we go to a doctor when things went wrong long time ago and it is way too late to do something about it.

If you have anything to add to this post, please feel free to Post a comment or share your thoughts through Facebook, Twitter or comment section below to join the conversation.

Barack Obama Letter About Chiropractic Care

March 4, 2011 by drburt

Dear Friends:

Doctors of chiropractic now make up over 60,000 licensed professionals in all fifty states, and care for millions of Americans every year. Almost a quarter of Iowans receivequality chiropractic care every year. As you know, chiropractic care is low-cost, drugfree, noninvasive, and has been shown to have a positive impact on patients’ health. I believe steps should be taken to acknowledge the important care chiropractors provide, and knock down unreasonable barriers of access and discriminatory insurance coverage that stand between so many patients and the care they need.

I have a plan to support doctors of chiropractic. First, I support expanding the range of chiropractic services covered by Medicare. Medicare currently provides reimbursement only for chiropractic adjustments, even though doctors of chiropractic are trained and licensed in all fifty states to provide a range of other Medicare-covered services. I support reimbursement reform that will reward and reimburse those who deliver high quality care and whose patients achieve good health outcomes, without restrictions against chiropractors or other health care professionals licensed to provide such care. Second, I recognize that neither the Department of Veterans Affairs nor the Department of Defense has achieved full integration of the services of doctors of chiropractic into their health systems despite direction from Congress. I support careful examination into the policy and practical barriers that restrict access to such services in order to remedy this problem. Third, I support commissioning doctors of chiropractic as officers in the Uniformed Corps of the U.S. Public Health Service. The U.S. Public Health Service Commissioned Corps is comprised of approximately 6,000 public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Given the critical role that doctors of chiropractic serve in each of these functions, I believe that we should commission chiropractors as officers in the Uniformed Corps. Finally, under the universal health care plan I have proposed, Americans will have access to a public insurance plan that will include comprehensive coverage, including all essential health care benefits. Benefits that are evidence-based or meet the current accepted standard of care would be eligible for coverage, and as such many, if not all, chiropractic services provided by doctors of chiropractic would be included in the public benefit package. My health plan also prioritizes preventive care, and chiropractors play a significant role in this effort. As we shift our health care delivery system towards a culture of wellness and disease prevention, I believe that chiropractors must play an integral role in expanding access to preventive care and strengthening our public health system. I look forward to discussing these important issues with you over the course of the next several months.

Sincerely,

Barack Obama

WWW.BARACKOBAMA.COM

TMJ And Neck Pain, Need Help With Chiropractic Care

March 2, 2011 by drburt

This blog post is based via interaction on the AskDrBurt a Question Blog. This is a real case, real patient who is searching for a solution to his never ending pain. It is a very long post and if you are a health care practitioner feel free to add your professional advice in a comment area. If you are a reader, and also have health related problems without a solution from your current medical practitioner please contact me via AskDrBurt a Question?

Thanks for the very concise and informative blogs Dr. Burt! I would like to ask for advice on presenting my symptoms to health care providers. I have been suffering TMJ symptoms for at least two decades if not more, but none of my health care providers wanted to consider TMJ disorder as a cause. Instead they seem to dismiss the idea and only treat symptoms when they’ve become severe and pretty blatantly obvious. Background/History:

1. Had a fall at age 10 (I’ll be 40 this year) that fractured/dislocated my jaw. No treatment at the time, as it appeared the injury would self heal and any manipulation might affect growth. Since that fall my jaw has always locked, popped,and grinded. It is also very small and my lower teeth have always been crowded.

2. Had ‘braces’ from age 12-14, doc seemed to push my lower jaw back when fitting a bite position for me, and it was always uncomfortable. My lower teeth are extremely crowded and within 2 months after removal of braces/retainer several of the teeth moved back again due to crowding, affecting any hope of a normal bite.

3. Have had significant tinnitus and frequent unexplained ear aches and jaw pains for years. Was told in early 2000’s that I grind my teeth very loudly at night.

4. In 2005 I cracked a 2nd to back/upper molar by night grinding. Began wearing a ‘boil and bite’ mouth guard’ (haven’t had dental insurance, didn’t prioritize or couldn’t afford a custom guard).

5. In 2006, I cracked a lower 2nd/back molar, and had to have it crowned. Still wearing a mouth guard, I cracked both the temp crown and the permanent crown through night grinding.

6. Bought a tempurpedic matress topper and tempurpedic cervical pillow in hopes the highly recommended product/brand would alleviate some of the grinding. It has helped and improved sleep quality too!

6. After that experience, I gave up caffeine, stopped any gum chewing (never was much for it anyhow), began eating organics, regular yoga and massage, and between 06 and present consulted with a family therapist for work stresses as needed. I do regular cervical stretches (provided by physical therapist) get massages and do TMJ self-massages. Life is very low stress right now (got my masters in 2010 and it’s my only debt, woohoo!) but my symptoms continue to worsen, which is pretty stressful as now I’m in constant pain. I am very fit and active, but very gentle on my neck/head with any activities. Unfortunately I’ve had to eliminate all but gentle stretching over the last 6 months due to neck/jaw/upper trap muscle spasms.

7. In 2008, after suffering pain, burning and numbness in my face, neck, shoulder, arms and hands, with loss of fine motor skills in my hands/fingers, I was diagnosed with a completely dessicated C-6/7 and a nerve-compressing herniation at 5/6. Orthopod performed dual discectomy and fusion with plate and screws. He informed me my pain tolerance was very high and I should be cautious of anything ‘uncomfortable’ vs. letting things become painful before seeking medical care. He tried Flexeril (and then Amrix), Mobic, and Vicodin as needed for 3 months before surgery. I asked if I would participate in physical therapy after surgery, but he said no the surgery should fix everything. There was no trauma, no accident, no specific injury that lead to this situation. Doc even diagnosed ‘undetermined’ for the cause. Seems a bit unusual to do that much damage and not want to find or diagnose a cause?!?

8. About 6 months later I began noticing the return of the hypertonacity in my SCM, levators,UT, and rhomboids. Last summer I gave up working out all together (other than stretches), my doctor put me on flexeril, which did very little for 6 months. In December she sent me to physical therapy (severe loss of range of motion in side to side neck movements, and severe loss of motor functioning in my hands with new burning/numbness). PT performed chiropractic manipulations from the thoracic region up to my c-spine, a minimal (maybe 2-3 minutes max) amount of muscle manipulation (the area directly to either side of my spine, thoracic up to c-spine), and traction 3x a week for 6 weeks. He also gave me some shoulder stabilizing exercises which did provide great and quick relief to a quickly rounding posture. I continue those at home. The PT provided temporary relief of the symptoms in my hands/arms but the neck/jaw/upper back symptoms remained, and any week that I was not able to get

all 3 sessions (Christmas and New Years the office closed), my symptoms came back within 3-4 days. 2 weeks after the end of PT, I was back to my original limitations and pain.

Last week my primary sent me for X-ray (TMJ specific) and a new C-spine MRI. She also ordered a TMJ specific MRI but that has not yet been scheduled. Waiting for the doc to call for my follow up post radiologist report. A good friend of mine is a radiologist in CA, so I sent him a copy of my films, and anecdotally (as a friend and I realize it’s not considered the best practice) he noted what appears to be a significant herniation at C-3/4 on the MRI. The x-rays were not of very good quality and he suggested I may need new films, but he said it was clear that my disc is no longer recognizable in the TMJ joints, there is significant condyle (sp) degredation and evidence of adhesions.

In addition, I have been treated at the same dentist office by 2 dentists since 2008 and have always asked about my jaw issues, and noted that the only way the dentist could even work on my back teeth was for me to manually dislocate my jaw to open it wide enough. My dentist has been replacing amalgam fillings with composite to ensure better strength of those teeth that formed cavities in my childhood (havent’ had a cavity since 1982). At one point, my original dentist stated she wanted me to see a maxillo facial surgeon before completing my work, the last of which was to replace the crown I destroyed in 06 (yes, I dealt with the searing sensitivity of a ‘nub’ for 5 years..I can tolerate a significant amount of pain, and I have always been VERY particular with my dental care). She left the practice before finishing the work, and my new dentist avoided the subject on several occasions when I mentioned the referral. He said ‘we don’t refer unless things are bad’…to which I let him know my history of symptoms, self treatment, and injury from ‘unknown cause’. His reaction ‘yeah, wow that IS kind of bad”. End of discussion. He encouraged me to have the last crown placed, despite my voicing concerns that it would increase TMJ grinding, but he said it wouldn’t be a problem if he gave the crown a low profile. He was absolutely wrong. I have had to go back for 2 sessions of dental work where the crown surface was lowered, and the two teeth surrounding the crown, and one on the top jaw have also needed reduced as they are not under greater pressure with the new crown placement.

The only consistency in 30 years has been the night bruxism. The rest of my spine is happy and healthy, and symptoms have progressively radiated from the TMJ area down my head, neck and arms.

I apologize for the mini-novel, and if you can give any guidance I will be extremely grateful. I’m at the end of my wits as to why practitioners continually ignored that something was at the root of my symptoms as the symptoms have been significant. I now am wondering what can possibly be done if 3/4 is severely herniated as I already have 3 vertabra fused in my C spine?!? I don’t want to become disabled or severely limited, and if that’s the case I’m beyond frustrated that none of my practitioners ‘stepped up’ to give this proper attention. Any suggestion made by a practitioner has been followed to a T, but those have been rare. As of late, I started seeing a new primary and she is very interested in helping me come to the root of my symptoms, thank goodness.

I feel I am articulate (sorry, I know verbose fits this note as well) intelligent, patient, motivated, very healthy, active, self-aware, avoid any and all medications unless necessary, and find preventative care (such as healthful living, stress reduction, massage, chiropractic, etc) to be the best way to lead a healthy life.

So, how can I share this succinctly with practitioners as we go forward in the process of discovering a cause and hopefully finding solutions for the cause vs. remedying damaging and continual symptoms? I don’t want to sound whiny or self-involved, but after 30 years of this, and at least 10 years of being handed off to someone else or some other practitioner….only to utilize their every resource and still have issues (hello, TMJ disorder anyone?) I’ve lived through more pain, limitation and frustration than a person should expect in this day and age with our advanced medical system.

Thank you so very much for your time. I appreciate any advice. Confidentiality and discretion is also appreciated 🙂

Dr. Burt’s Answer:

Got your message via AskDrBurt a question. Long history of problems that have been avoided, ignored or misdiagnosed in the past. My main concern is the surgery that was performed on your cervical spine. Post surgical scar tissue formation is the main cause of excessive pain in your cervical spine. No Post Surgical rehabilitation was performed, such s physical therapy. I do not understand how come your surgeon said:”The surgery will fix the problem.” WOW. Limited ROM is making things even worse in your neck. Intervertebral discs stop getting their nutrition the moment the two adjacent vertebraes stop moving – process called imbibition. Solution – life long manual cervical distraction and maintaining whatever is left of a cervical lordosis. I have couple of products on my blog that would be of a great benefit to you. If you are interested I could send you direct links and you can evaluate them.

TMJ – TMJ is very closely related to a cervical spine. There is a close neurological relationship between TMJ and Cervical Vertebral Joints. The question is – did your jaw healed properly after it was fractured? If yes, then there is still some hope in correcting by special cranial work (S.O.T. technique – Sacro Occipital Technique) It is very hard for me to provide more recommendations as I would actually need to see, examine, evaluate and make my own diagnosis with areas of concern. Doctors of Chiropractic look at the health related problems from the causation point of view and not symptoms point of view. Find the cause and the problem will be fixed. Feel free to ask any additional questions. Perhaps by helping to find the proper solution to your problem is going to be the first step, second would be to find the proper health care practitioners.

PS: Would you like me to post your health history and the problems that you had with previous doctors on my blog? can keep your name confidential if you like, so no one will know who you are. This will open a door to many other health care providers reading your story and possibly commenting and adding valuable advice to your health related problem.

Talk to you later

Reader’s Response:

Wow, thank you so much for your prompt response! I couldn’t agree more with your statement that fixing the cause usually resolves the symptoms, and that is my main mission now.

Unfortunately, the jaw was never re-evaluated after the initial fracture/dislocation at age 10. If I had to estimate, I would say ‘no’ as that’s precisely when the popping, locking, grinding sounds upon movement began.

Considering I only have the axis, atlas, 3 and 4 discs left in my c-spine (not sure I got the anatomy properly identified with those terms) I have always done as much to keep range of motion functional post surgery. 2×3 times a day I use a heat pack (dry rice wrapped in flannel) stretching under warm shower, and PT generated cervical stretches (I also use a stretching strap, theracane, pro-stretch for calves and mini-tough tennis ball to roll the balls of my feet, and a foam roller for myofascia release), and now spend most of my time at a standing desk, as only standing and flat supine laying down do not cause significant pain/numbness….if it can help, and it’s not surgical or drugs, I’m willing to try it. Please do send me links to the products you mentioned and I will determine if they are within my budget. Unfortunately I’ve not been able to work much due to the pain and the limited amount of time I can spend seated during travel, ugh!

Another concern….should I be wary of the x-rays recently taken…as the tech had me lie in a prone position and placed my head on what was like a slightly inclined podium on the x-ray table? How could joint position possibly be properly evaluated since I have a hard time with ROM on rotation, and the pressure point ended up right ON the TMJ area? Tech had to take 5 attempts on the left side, 8 on the right. In addition the MRI tech decided against the deliberately ordered contrast for the MRI, and there appears to be a black blurred area around my fusion and above due to the titanium. I would certainly have traveled to a larger metropolitan area if I had the funds available, but as an entrepreneur I’m without health insurance at present. I KNOW things will get better, I KNOW this will pass.

I suppose it can’t be too terribly invasive to post my information after removing identity…please feel free to edit anything as you see fit if it will make it more relevant to other practitioners.

I understand you cannot evaluate beyond the anecdotal information but I cannot tell you how absolutely grateful I am for your consideration and suggestions.

Again, thank you from the bottom of my heart for your reply, suggestions and care. If there is anything I can do to promote your business, your blog (through my blog) or your products please do not hesitate to share that process with me. I will oblige and remain extremely grateful.

Attached the x-ray taken a few weeks after the fusion 09 June 2008. What lordosis, ha!?! Sorry that IS humor albeit sarcasm…if we can’t laugh at ourselves…… ;0)

Very Gratefully,

Reader wished to keep his identity anonymous.

Dr. Burt’s Answer:

Hello again,

I agree with you 100% that your X-Ray tech just radiated you for nothing. Spine is a weight bearing structure and responds to weight bearing stresses. You could see better what is going with the spine when you shoot X-Rays in a standing position. Full spine X-Ray is an optimal if possible. Lower back problems are related to your neck problems. Every single subluxation and curve in a cervical, thoracic and lumbar spine must be taken into consideration in order to achieve the best results possible. I would not expose myself a second time to an additional dose of radiation at this point and time. The is still a small presence of cervical lordosis which is a positive sign. There is nothing that can be done at this point and time with your lower cervical spine. Sorry to say, but too much damage has been done by your orthopedic surgeon. The goal at this point is to keep the vertebraes and IVD (Intervertebral discs) from degenerating farther. If I would be you I would get these two products: #1. Bodyline BDL127 The Neck Decompressor and #2 Posture Pro Corp. POS107 Deluxe Full Spine Posture Pump Model 4100

Neck Decompressor will keep your IVD healthy and Posture Pump will help to keep cervical and lumbar lordosis in order. I use these products on myself and the members of family.

When the blog post will go live you can continue the conversation via DISQUS, thus many other doctors can add value to your condition.