CDC Just Changed Its Opioid Prescribing Guidelines. Here’s What to Know

Guidance covers acute, subacute, and chronic pain and replaces 2016 guidelines

Hard thresholds for pain medication doses and duration are no longer promoted through the CDC’s new Clinical Practice Guideline for Prescribing Opioids for Pain.

The new guidance — which covers acute, subacute, and chronic pain for primary care and other clinicians — updates and replaces the controversial 2016 CDC opioid guideline for chronic pain. The 2016 guideline was interpreted as imposingstrict opioid dose and duration limits and was misapplied by some organizations, leading the guideline authors to clarify their recommendations in 2019.

The 2022 recommendations are voluntary and give clinicians and patients flexibility to support individual care, said Christopher Jones, PharmD, DrPH, MPH, acting director of CDC’s National Center for Injury Prevention and Control in a CDC press briefing. They should not be used as an inflexible, one-size-fits-all policy or law, or applied as a rigid standard of care, or replace clinical judgement about personalized treatment, he emphasized.

“Patients with pain should receive compassionate, safe, and effective pain care,” Jones stated. “We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life.”

The guidance, published in Morbidity and Mortality Weekly Report, addresses four key areas: initiating opioids for pain, selecting opioids and dosages, deciding prescription duration and conducting follow-up, and assessing risk and potential harms of opioids. It suggests that clinicians work with patients to incorporate plans to mitigate risks, including offering naloxone.

The 100-page document indicates opioids should not be considered as first-line or routine therapy for subacute or chronic pain, and points out that non-opioid therapies often are better for many types of acute pain.

“For patients receiving opioids for 1 to 3 months (the timeframe for subacute pain), the 2022 guideline recommends that clinicians avoid continuing opioid treatment without carefully reassessing treatment goals, benefits, and risks in order to prevent unintentional initiation of long-term opioid therapy,” wrote Debbie Dowell, MD, MPH, chief clinical research officer for CDC’s Division of Overdose Prevention, and guideline co-authors in a commentary published in the New England Journal of Medicine.

For chronic pain, clinicians should maximize use of non-opioid therapies and consider initiating opioid therapy only if the expected benefits for pain and function are anticipated to outweigh the risks, Dowell and colleagues noted. When opioids are needed for chronic pain, clinicians should start at the lowest effective dose, evaluate benefits and risks before increasing dosage, and avoid raising dosage above levels likely to yield diminishing returns, they added.

“These principles do not imply that nonpharmacologic and non-opioid pharmacologic therapies must all be tried unsuccessfully in every patient before opioid therapy is offered,” Dowell and colleagues wrote. “Rather, expected benefits specific to the clinical context should be weighed against risks before therapy is initiated.”

The new guideline offers tips for tapering opioids when warranted, but is not intended to lead to rapid opioid tapering or discontinuation, Jones noted. The recommendations do not apply to sickle cell disease-related pain, cancer pain, and palliative or end-of-life care.

The 2022 document incorporated feedback from approximately 5,500 public comments since the new version was first proposed in February, including reactions from people who discussed their experiences with pain or opioid addiction and barriers to pain care. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft version.

“The science on pain care has advanced over the past 6 years. During this time, CDC has also learned more from people living with pain, their caregivers, and their clinicians,” Dowell said in a statement. “We’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”

The clinical practice guideline supports the HHS Overdose Prevention Strategy, the CDC said. The agency also is providing additional information associated with the guideline to clinicians and patients.

Common Foods that will Trigger Anxiety

What is Anxiety?

Anxiety is a fear or worry about something happening in the future, such perceived to be stressful, dangerous, or unfamiliar situations. It is a natural response to stress.

Occasional anxiety is completely normal, though. We all experience jitters, nerves or fears from time to time before important events, job interviews, or public speaking. However, experiencing, intense, excessive or persistent anxiety can interfere with the quality of your life and health.

Persistent and intense feelings of anxiety can be hard to control and may hinder your daily activities, job, school work, relationships, and social life. Some people even experience panic attacks characterized by sudden feelings of anxiety or fear that may last for several minutes or longer.

If you have been experiencing anxiety for 6 months or longer that is interfering with your life, you may have an anxiety disorder, such as generalized anxiety, social anxiety disorder and/or phobias. However, even if you experience occasional or mild anxiety, it is beneficial to look into the root causes of the issue and reduce anxiety triggers.

Symptoms of Anxiety

The symptoms of anxiety may differ from person to person, depending on the situation or form of anxiety disorder. Common signs of anxiety may include:

– Increased heart rate

– Rapid breathing

– Feeling tense

– Feeling nervous

– Having a sense of danger

– Restlessness

– Trouble concentrating

– Sense of stress, distress, dread, or worry

– Intense general fear or worry

– Intense fear or worry about a specific situation, place, person, or activity

– Feeling out of control

– Trembling

– Sweating

– Feeling tired or weak

– Gastrointestinal (GI) distress

– Difficulty falling asleep

– Feeling a disconnect between your body and mind

– Painful or worrisome thoughts or memories you are unable to control

– Having difficulty controlling fear or worry

– Urge or behaviors to avoid things that may trigger anxiety

– Nightmares

– Panic attacks

– Overthinking

– Procrastination

– Lack of patience

Nutritional Factors That May Trigger Anxiety

We consider triggers of anxiety, factors such as conflicts in relationships, financial troubles, painful memories, social events, public performances and personal trauma, to list a few. However, you may be surprised to know that your nutrition and overall health may also trigger anxiety. In fact, when your nutrition and overall health is compromised, these commonly considered factors can trigger anxiety even more so.

Let´s take a close look at these nutritional factors:

Blood Sugar

Not eating regularly may lead to a blood sugar drop. Eating a diet high in refined sugar and sugary processed foods also lead to sugar crashes and potentially trigger anxiety. When you eat sugar, your body releases insulin to take care of excess sugar in your bloodstream. However, too much sugar makes it difficult for your body to balance your blood sugar levels and create balance. This leads to sugar crashes and ups and downs that may trigger anxiety, irritability, worry, nervousness, and sadness.

The fact that blood sugar may trigger anxiety is not new knowledge. One of the first research on the topic that blood sugar may trigger anxiety was published in 1966. This study looked at people with reactive or functional hypoglycemia characterized by a relative drop in their blood sugar without reaching the hypoglycemic range.

Subjects experienced anxiety, depression, insomnia, trembling, racing heart, dizziness, and forgetfulness. They were also consuming a diet high in refined carbohydrates and caffeinated beverages. Once they were put on a low-sugar, high-protein, and caffeine-free diet, their blood sugar levels evened out and their anxiety symptoms resolved.

Since this discovery, there have been a number of research studies that have shown how blood sugar levels may trigger anxiety. A 2015 cohort study has shown that a high glycemic load may lead to mood imbalances, hence it may trigger anxiety.

According to a 2016 case report, adding more protein, fat, and fiber to a diet may improve anxiety, mood, concentration, energy, and blood sugar issues of a subject with generalized anxiety and hypoglycemia. Once they returned to her former diet of refined carbohydrates, it triggered anxiety and symptoms returned.

GUT-Brain Axis Dysfunction

Your gut and your brain communicate through the gut-brain axis. One way they connect is through the vagus nerve which begins in the brainstem and travels down into the gut and stimulates bowel motility and the production of neurotransmitters like serotonin in the gut. 

The other way your gut and brain communicate is through the microbial species that make up your microbiome. When your microbiome and the gut-brain axis are disrupted it may lead to a number of cognitive dysfunctions and mood disorders including anxiety, depression, obsessive-compulsive disorder (OCD), attention-deficit disorder (ADD), sensory processing disorder, autism, Parkinson’s disease, dementia, and Alzheimer’s disease. 

The simplest way to understand the connection between your GUT and your brain is thinking about a time when you felt nervous before a presentation, exam, date, or another event. Chances are that you have felt butterflies in your stomach, nausea, stomach pain, or even diarrhea.

A 2017 scientific review agreed that GUT dysbiosis and inflammation may trigger anxiety, depression, and other prevalent mental illnesses and probiotics may help to prevent or help treat anxiety and depression by restoring normal microbial balance. A 2019 review has shown that probiotic supplements, probiotic-rich foods, and a gut-healthy diet may help to balance your gut microbiome and lower symptoms of anxiety. 

Neurotransmitters Imbalances

Neurotransmitters are natural chemical messengers that send information throughout your brain affecting brain health and mood. It is important that they remain balanced to keep a stable mood and mental health.

Neurotransmitters, such as gamma-aminobutyric acid (GABA), glutamate, dopamine, serotonin, and norepinephrine are responsible for regulating your emotions and various functions of your body. They have been shown to trigger anxiety and other mood disorders.

Only glutamate and GABA take up 90% of the neurotransmitters in the body. They are responsible for regulating emotional responses to potentially threatening stimuli that may trigger anxiety.

Glutamate is the main excitatory neurotransmitter in your body. It is involved in every neural pathway in your body, including the ones that affect, relieve, or trigger anxiety. N-methyl-D-aspartate receptor (NMDA) is an important glutamate receptor and ion channel protein located in the nerve cells that are relevant for anxiety.

NMDA may benefit learning and memory, hence it may allow you to unlearn anxiety-provoking behaviors and thoughts and may enhance the benefits of cognitive-behavioral therapy (CBT) to reduce reactions to thoughts and situations that trigger anxiety.

GABA is the main inhibitory neurotransmitter that may help with anxiety relief. This is why doctors may prescribe barbiturates or benzodiazepines that may increase GABA and relieve anxiety. However, these medications do not bind to GABA receptors and also may lead to increased tolerance levels, addictions, toxicity, and serious or even fatal side effects. Instead, there are natural solutions that I will discuss later in this article.

Foods that Can Trigger Anxiety

If you have anxiety, it is extremely important to look at your diet. Inflammatory foods may cause general pain, joint pain, stomachaches, headaches, mood swings, insomnia, and of course, anxiety.

Sugar and Processed Foods

Refined sugar is incredibly inflammatory. When you eat too much sugar, your body simply cannot process it quick enough. As a result, it releases pro-inflammatory messengers called cytokines that may lead to physical and mental health issues.

Processed foods are not only high in sugar, but are usually high in other anxiety-triggering substances such as processed vegetable oils, artificial flavorings, gluten, and additives. Consequently, sugar and processed foods may both trigger anxiety.

Gluten and Grains

Gluten is a protein found in a variety of grains. Gluten is particularly problematic for those with Celiac disease or gluten allergies. However, a large number of the population is sensitive to gluten and may experience inflammation, pain, and health issues from it. Gluten may also trigger anxiety. For some, even gluten-free grains are difficult to digest and trigger anxiety.

Gluten can cause ruptures in the intestines’ fibers causing leaky GUT. It can hinder digestion processes and accumulates toxins which will interfere with the microbiome.

Artificial Flavorings

Artificial ingredients are designed to enhance flavor, texture, color or to extend shelf life.

Aspartame and MSG (monosodium glutamate) are two particularly dangerous artificial flavorings that may trigger anxiety. However, you need to be careful with all artificial ingredients and other additives or preservatives, including MSG, artificial coloring, high fructose corn syrup, guar gum, sodium benzoate, trans fats, and any artificial flavoring. They all may lead to inflammation, increase the risk of chronic disease, and trigger anxiety.

Some of them have the cruel purpose of insatiability, so you will eat certain foods and never feel satisfied, always craving more. It will lead to a chain reaction of inflammation, leaky GUT and, of course, anxiety.

Processed Vegetable Oils

Processed vegetable oils, such as corn oil, canola oil, soybean oil, safflower oil, cottonseed oil, and peanut oil are high in omega-6 fatty acids. This means that they are also inflammatory and contribute to pain and health issues. Processed vegetable oils may trigger anxiety as well.

Conventional Meat Products 

The kind of meat you eat absolutely matters. Animals raised for conventional meat products are not treated by the highest of standards. They are treated with hormones and antibiotics and fed with grain instead of grass. As a result, conventional meat products are inflammatory and may trigger anxiety.

Too Much Caffeine

Caffeine may trigger anxiety. Coffee and other caffeinated drinks, such as sodas and energy drinks may cause jittery effects and stimulate a flight or fight response similar to anxiety. Sodas and energy drinks are also full of sugar and artificial ingredients that can further trigger anxiety.

How To Reduce Anxiety Naturally

Conventional treatments of anxiety often include pharmaceutical medications. However, these medications usually serve as a “band aid” without addressing the cause or fully solving the problem. You will be happy to learn that it is possible to reduce anxiety naturally through a nutritious diet, a healthy lifestyle, and appropriate supplementation.

Anti-Inflammatory Healing Diet

An anti-inflammatory healing diet is essential for your overall health, including your mental health. Remove any foods that may trigger anxiety, including refined sugars, processed vegetable oils, processed foods, junk foods, artificial ingredients and flavorings, gluten, grains, conventional meat products, caffeine, and toxins. 

Instead, turn to nutrient-dense, anti-inflammatory and healing foods, including leafy greens, such as kale, spinach, and Swiss chard, non-starchy vegetables, such as cucumber and celery, herbs and spices, such as turmeric, ginger, rosemary, and cinnamon, low-glycemic index fruits, such as berries and lemon, healthy fats, such as avocados, organic ghee and butter, and coconut oil, clean protein, such as organic grass-fed beef, pasture-raised poultry, wild-caught fish, wild game, and free-range eggs, nuts and seeds for fiber, and fermented foods, such as kimchi, sauerkraut, and kefir. 

Reduce Stress and Prioritize Good Sleep

Anxiety is your body’s natural response to stress. High and chronic stress and a lack of quality sleep may trigger anxiety. To reduce anxiety, it is crucial that you reduce stress and prioritize good sleep.

Try prayer, breathing exercises, daily gratitude, journaling, spiritual practices, nature walks, and quality time with loved ones to reduce your stress levels. Practice positive self-talk and learn to reframe your thoughts. 

To support your sleep cycle, aim to go to bed and wake up at the same time each day. Develop a nighttime routine that works for you. Turn off electronics close to bedtime. Engage in relaxational activities and perhaps sip on a calming herbal tea before bed. Invest in a comfortable bed, sheets, and pillows.

Improve Gut Health and Bowel Motility

Your gut affects your brain and mood and compromised gut health and gut flora imbalance may trigger anxiety. Improving your gut health and bowel motility is clearly crucial to prevent anxiety. Eating an anti-inflammatory is the first step, however, there are other ways to support your gut health.

It is really important to calm your body and eat your food in a relaxed state.  This will help your body produce enough digestive juices to adequately break down, sterilize and absorb the nutrients you are putting inside of it.  When you are stressed out, you will not be able to digest food effectively.  If you eat on the go often, it is best to do smoothies and things that are light and easy on your digestive system during these more stressful periods.

Move Your Body Properly

Physical exercise has enormous benefits for your mental health. A lack of movement may trigger anxiety and increase mood imbalances. Research has shown that regular exercise can reduce the frequency and intensity of anxiety and panic attacks.

Exercise regularly, 20 to 30 minutes 5 times a week, and move your body every day. Mix up your routine and find different forms of exercise that work for you. Swimming, hiking, running, and biking are great for cardiovascular health and anxiety relief. Weight lifting, resistance training, kettlebell workouts, and CrossFit are fantastic for your strength.

Yoga has been shown to have both physical and mental health benefits and may help to combat anxiety. Pilates and barre workout is low impact exercises that help to build strength while calming your mind as well. Moving your body doesn’t have to mean structured workouts. Move your body daily by stretching, going for a short walk during lunch, dancing for your favorite song, running around with your kids, and playing with your pets. Remember to have fun.

Consider Seeing a Functional Health Practitioner

Sometimes it’s hard to combat anxiety alone. If you have tried everything and nothing seems to be working, consider finding a functional health practitioner to help you identify the root cause that may trigger anxiety.

Finding the root cause that triggers anxiety is key to figuring out the best natural nutritional and lifestyle solutions to eliminate anxiety from your life. Please do not hesitate to contact Vick Physiotherapy International for professional advice and a free first assessment.

Any joint pain after COVID-19 infection? Why could that happen?

Hello everyone! It has been nearly a year since I last wrote a post! Time literally flies!

In the past year, I have basically focused 100% of my time on my PhD program. Now I have 3 more semesters left, which makes me thrilled to think that I am going to accomplish one of the biggest goals in my career, being a Doctor of Philosophy in Neurosciences with a large application in motor behavior and biomechanics.

However, I have been missing the interaction with my readers and patients, as I am not really using social media nor my blog for professional matters. So today, I officially resumed my school activities, got a brand new computer, and I feel recharged after a full month of holidays here in Europe! So let´s write a post!

Today I would like to talk about joint pain (arthralgia) after COVID-19 infection. I have been hearing from patients, friends and colleagues about this late side effect of this terrible viral infection, so I have done some research about the topic in order to bring the most up to date information for you.

The general answer for joint pain after COVID-19 is plain and simple: your immune system is hyperactive. And what that means?

After contracting the corona virus and/or taking the full vaccine scheme, the immune system is fighting a battle that seems endless. Doctors do not know why it is taking so long for our bodies to adapt and recover from the infection, so the cascade of events is as if we are still sick. The immune system is hyperactive because it understands that both the virus and the vaccine are strangers organisms inside the body, and it is literally putting an entire army of white cells into combat.

As a result, inflammation processes arise, and symptoms such as swelling joints, pain, and general discomfort can occur.

I, personally, did not get infected by the corona virus, however, I am fully vaccinated, and after taking my jabs, I absolutely felt drowsy and extremely tired. I did not add more activities into my routine, and still, I would feel exhausted after a regular day at work and school. I did experience some mild pain and discomfort on both knees, and I totally attributed that as a side effect of the vaccine. But the uncomfortable sensation vanished after 2 or 3 weeks after the jabs, and I carried on with my life and workout routines, although I see that many other people have not overcome those bad symptoms.

Apparently, joint pain will occur all day long, and there is nothing one can do to diminish the sensation. Cold therapy, heat therapy, ultrasound, laser and even deep immersion wouldn´t result positively… What did help a few people I know was to change daily habits in order to help your immune system to take a little break, which means, eating less processed food, avoiding sugar and alcohol, stop using drugs and unnecessary medications, as well as prioritizing a good night of sleep and performing daily workouts for at least 30 minutes.

Those change of habits will not trigger the immune system, and the GUT will do all the work to release the proper neurotransmitters for brain optimization and decrease stress levels. The simple and obvious consequence will be that your blood circulation will improve, so your cells will be nourished. Cortisol levels will decrease, so you won´t be stressed out. Brain fog won´t happen, so you will be able to focus and concentrate more on your daily tasks. The circadian rhythm will regulate, so you will have a proper night of sleep and wake up fresh in the next morning.

So is that the solution for my joint pain after COVID-19? Yes and no. By changing your daily habits, you will simply decelerate the cascade of events that your immune system is working on, so it will be less hyperactive. It is not medical advice nor a protocol to be followed. It is a tip from experience that helped other patients and friends to sooth their pain. And it worked!

Let me know how it works for you by dropping a comment bellow. COVID-19 reactions are still a mystery to the medical field, so collecting evidence is important to build common sense and develop pros and cons for a healthy life.

If you have any enquires or if you want help to change your daily habits, feel free to reach out to me at +1(602)6393726 or send an email to vickphysiotherapy@gmx.com.

Daily thought: “you will always benefit from a healthy body”.

Military research finds no sex difference for Ankylosing Spondylitis

The incidence of ankylosing spondylitis (AS) did not differ between men and women in a large study of military personnel, which called into question the previous assumption of male predominance for this disease.

In a retrospective study that included more than 700,000 military service members, the incidence rate was actually slightly lower for men than for women, at 26.53 versus 31.36 per 100,000, according to Michael H. Weisman, MD, of the Cedars Sinai Medical Center in Los Angeles, and colleagues.

Accordingly, the incidence rate ratio for men was a nonsignificant 1.16 (95% CI 0.91-1.49, P=0.233), the researchers reported online in Arthritis Care & Research. The sole prior population-based study on the incidence of AS in the U.S. was from Olmsted County in Minnesota from 1980 to 2009. In that study’s largely white, homogeneous population, men were three times more likely to have AS than women, but a Canadian report suggested that the incidence amongst women was increasing.

To provide an up-to-date estimate on the incidence of AS — a heterogeneous disease characterized by pain and stiffness of the spine and considerable disability — Weisman’s group analyzed data from the longitudinal Stanford Military Data Repository from 2014 to 2017. Amongst 728,556 active duty personnel, they identified 438 incident cases of AS, for an overall incidence of 27.22 per 100,000 person-years. The greatest difference between sexes was seen amongst individuals ages 24 and younger, amongst whom the incidence rate for women was 21.43 per 100,000 person years compared with 11.11 per 100,000 for men, for an incidence rate ratio of 1.93 (95% CI 1.13-3.29, P=0.015).

A total of 92.69% of patients diagnosed with AS reported having low back pain, and 83.56% had received either x-ray or MRI evaluation of the sacroiliac region. Additional clinical features more frequently experienced by AS patients versus non-AS individuals included (all P<0.001):

• Uveitis, 11.42% versus 0.32%
• Psoriasis, 7.76% versus 0.70%
• Inflammatory bowel disease, 1.83% versus 0.30%

In a multivariate analysis, the adjusted odds of AS were slightly but nonsignificantly lower among men than among women (OR 0.79, 95% CI 0.61-1.02, P=0.072).

However, the adjusted odds ratios rose significantly with increasing age:

• Ages 25 to 34, OR 2.62 (95% CI 1.95-3.52)
• Ages 35 to 44, OR 5.13 (95% CI 3.79-6.93)
• Ages 45 and above, OR 7.30 (95% CI 5.17-10.32)

A further finding was that white patients were significantly more likely to have AS compared with Black patients (OR 1.39, 95% CI 1.01-1.66).

A secondary analysis that required two separate diagnostic codes for AS supported the findings of the primary analysis for the lack of association of AS with male sex, with an adjusted odds ratio of 0.99 (95% CI 0.70-1.40).

In discussing their findings, the researchers pointed out that there were several possible explanations for why their findings differed from those of the earlier Olmsted study. One was that the previous study relied on the modified NY classification criteria for AS, which required the presence of sacroiliac x-ray changes, whereas in this study, almost two-thirds of patients underwent advanced imaging, such as MRI, that could detect more subtle changes.

The use of a military population also might have contributed to the differences in study findings. The majority of the U.S. military is younger than age 30, which is the time frame when AS symptoms first appear. Military personnel have full access to free specialty healthcare, and spinal complaints are addressed by a specific Department of Defense clinical practice guideline.

“Our findings challenge the widely held belief that AS in the U.S. occurs substantially more frequently in males than in females,” the authors concluded.

A limitation of the study was its use of a military cohort, who may be more physically fit and healthier than the broader population. The researchers therefore called for further investigations involving other populations.

Source reference: https://onlinelibrary.wiley.com/doi/10.1002/acr.24774

Guillain-Barré Syndrome recur after mRNA COVID vaccine, but the risk is really low

Guillain-Barré Syndrome (GBS) is an acquired demyelinating polyneuropathy that often begins in the lower extremities and ascends over time with loss of reflexes, causing muscle weakness, or in the most severe cases, paralysis. Some cases may start a few days or weeks after respiratory or gastrointestinal viral infection. GBS is often reversible.

Researchers from the Maccabi Healthcare Services, the second largest HMO in Israel, searched cases that had been diagnosed by a hospital neurology department, linking them with COVID vaccine records, medical care encounters, and hospital visits after patients received at least one vaccine dose. They conducted a manual review of the electronic medical record of all cases to ensure patients with a GBS diagnosis were accurately identified.

They identified 702 GBS cases between 2000 and 2020; 48% were women and the average age was 53. Of these patients, 579 received one Pfizer vaccine dose and 539 received two doses. The researchers followed these patients for a median of 108 days after the first dose and 90 days after the second. This study is the first to assess the safety of mRNA COVID-19 vaccines in previously diagnosed cases of GBS.

A total of five formerly diagnosed GBS patients were referred to the hospital for neurological concerns after they had the vaccine. Two patients had paresthesia, one had tremor for several months, and one was evaluated for a seizure. These four people were released from the emergency department within a few hours without medical observation. The fifth patient had progressive leg weakness and paresthesia that started soon after she received the first vaccine dose, which lasted for several weeks. She was admitted to the hospital several days after receiving her second dose.

The clinical picture and electrodiagnostic evidence were suggestive of sensorimotor demyelinating polyneuropathy, and the patient was treated with plasmapheresis in the hospital and, by the day of discharge, had a significant improvement in her lower limb weakness and only minor proximal weakness without any sensory disturbance. The analysis was limited because it relied on medical records and diagnosis, the researchers acknowledged. It included only hospital visits and may have underestimated other symptoms that presented only in the community. Nevertheless, any significant serious neurologic concern would probably have been evaluated in a hospital setting.

There were a small number of GBS cases following the swine flu vaccination campaign in 1976, and this question has unfortunately been a vaccination barrier ever since. In reality, patients often are more at risk of neurologic complications such as GBS from the infection than they are from the vaccination designed to prevent it.

Source reference: https://jamanetwork.com/journals/jamaneurology/fullarticle/2783708

What Exactly Is a “Mild” Stroke?

It’s important to know that every stroke is different and therefore every recovery will be different. No one can estimate minor stroke recovery time with absolute certainty. Still, there are some patterns worth noting for mild stroke patients. Hopefully these patterns can help you understand what lies ahead on the road to recovery.

To understand the severity of a stroke, it helps to know what the NIH Stroke Scale is.

The NIH Stroke Scale is an assessment tool used to assess the secondary effects of a stroke. This scale helps your medical team “score” you in a variety of areas that can be affected by a stroke, such as movement, vision, and speech.

A high score indicates a significant stroke while a low score implies a mild or moderate stroke. Specifically, a stroke is considered mild when a person scores less than or equal to 5 on the NIH Stroke Scale (out of a possible 42).

Scoring as low as 5 signifies that not many secondary effects are present. For instance, if mobility was affected, the individual is unlikely to be paralyzed. Perhaps the person can lift their affected arm but it may drift down after 10 seconds or so.

It is possible for a mild stroke patient to have significant impairments in one area, but a score as low as 5 would imply that most other areas are unaffected. For example, if speech was severely affected, then mobility and vision remain mostly unaffected for the mild stroke survivor.

Of course, these statements are all generalities. Because every stroke is different, every prognosis will be unique, even for minor strokes.

How Long Does Mild Stroke Recovery Take?

If you had a mild stroke, your stroke recovery timeline will probably be shorter than others with more severe strokes. Because mild strokes do not typically cause major impairments, recovery is usually fast. Sometimes recovery from a mild stroke can occur within 3-6 months. Other times it can take longer.

There are many variables that affect the time it takes to recover. Instead of focusing on recovery time, it can help to focus on the recovery process instead.

When you focus on the steps you can take to recover, you are empowered to take action. And action is how results are made.

Stroke Recovery Process for Mild Stroke

After a stroke, you will spend some initial time at the hospital. But instead of going to an inpatient rehab facility (where patients participate in 3+ hours of therapy per day), mild stroke patients are often discharged straight home.

Generally speaking, if you are able to accomplish the activities of daily living on your own, you are likely to go straight home after the hospital. Your rehabilitation team should instruct you on how to continue rehabilitation at home before discharge.

Once you arrive home, recovery is in your hands. It’s up to you to pursue rehabilitation through various home therapy programs that address your specific needs, especially if it’s not recommended that you go to outpatient therapy.

A Proactive Approach Is Necessary

There’s a myth that mild stroke survivors don’t need to do much to recover, but that’s not true. It’s best to avoid assuming that recovery will take care of itself.

One study noted that “patients with mild stroke are assumed to achieve full recovery with little or no intervention. However, recent studies suggest that such patients may experience persistent disability and difficulty with complex activities.”

This means that a full recovery from stroke is not guaranteed, even for minor stroke survivors. However, even though it’s not guaranteed doesn’t mean it’s not possible.

The ingredient that makes recovery possible is action. Regardless of the size of your stroke, it’s important to participate in rehabilitation in order to maximize your chances of recovery.

With a rigorous therapy regimen, most mild stroke survivors can achieve a full recovery, or get very close to one.

Taking Charge of Your Recovery Time

Instead of participating in therapy at an inpatient rehab facility, most mild stroke patients are discharged home and must keep up with rehab on their own, and/or with outpatient therapy.

Even if you do go to outpatient therapy, it is imperative to participate in a rigorous at-home therapy program as well. This will help patients get the consistent practice that’s necessary to maximize results.

Some mild stroke patients stop pursuing rehab and feel like they are stuck at the level of impairment that they left off with. This doesn’t have to be true.

The brain is capable of changing throughout our entire lives. Whenever we begin to put in the work, the brain will respond. This is why recovery is possible even decades after a stroke.

Again, the essential ingredient is action. You get better at the skills that you practice regularly, no matter how long it has been since your stroke.

Mild Stroke Recovery

Overall, recovery from a mild stroke takes less time than recovery from a massive stroke. The results you see will be dependent upon how consistent you are with rehabilitation. 

Because mild stroke survivors often do not go to inpatient rehab, recovery is in your hands. The good news is that, if you keep up with a rigorous home therapy program, you are likely to see a great recovery.

In-home physiotherapy may be better designed by a Physical Therapist, who can personalize treatment and select proper activities in order to increase quality of life. If you want to have a physiotherapy assessment, please give us a call. We are ready to work with you!

Foam Rolling, is it For Me?

If you have been to a physiotherapy clinic in the last few years, then you have almost certainly witnessed, or felt first hand, the technique of foam rolling. Foam rolling is a popular technique that releases tight muscles and mobilizes the network of connective tissues.

When should I consider foam rolling as a treatment?

Scar tissue, adhesion and tightness develop in many ways, namely from trauma, or via less serious injuries, such as repetitive stress and postural dysfunctions.  This tightness needs to be dealt with in order to restore proper function and mechanics to the body.

Muscles need to have sufficient strength, but also sufficient flexibility.  Whether you are a rugby player, yoga instructor or office worker, it is important to not only have strength but to also have optimal function through a full range of motion.

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The Solution?

Foam rolling offers patients an inexpensive, effective and convenient method to reduce scar tissue, breakdown adhesions and improve tissue tone.  A patient will use their body weight between the roller and the soft tissue being treated.  The patient will roll along the length of the tissue.  When a tender spot is found,  focus on rolling on that area. The more time spent rolling on the specific area will serve to decrease the degree of pain and tenderness and improve elasticity in the muscle tissue. 

Interested in more information on the services we provide? Contact us today!

Exercising with Resistance Bands

What are Resistance Band Exercises?

Resistance bands are strips of stretchable rubber that come in a variety of resistance levels and colors.  They are used to perform strengthening exercises for your muscles by providing resistance during the entire movement, causing your muscles to work both concentrically (while shortening) and eccentrically (while lengthening).

When would I consider Resistance Band exercises?

Strength training is an integral part of rehabilitation after an injury.  It is important to do strengthening exercises to regain the muscle power you have lost, correct any muscle imbalances and to prevent re-injuring yourself.  Resistance bands are an inexpensive, effective and versatile method of strengthening muscles in a functional way.

Indications for using Resistance Bands include:

• Correcting muscle imbalance

• Posture correction

• After joint sprains e.g. twisting the ankle

• Post-surgery e.g. Joint Arthroscopy, Knee and Hip replacement and rotator cuff repair

• Shoulder impingement syndrome

• Improving balance and hip control

• Stabilizing hyper-mobile joints

• Correcting training techniques

• Core strengthening

Are Resistance Band exercises preferred to dumbbells, barbells or machine weight exercises?

In order to return to your daily activities or a specific sport, it is important to not just strengthen the individual muscles but to do functional strength training. Functional strength training focuses on doing exercises that involve rotation, pushing, pulling and diagonal movements, to mimic day to day movements we do. Exercises with weights only apply resistance in one plane using gravity, limiting you to bending and straightening movements, while with resistance band exercises can be applied in all planes of motion simultaneously. This prepares you to return to rotational sports such as hockey, golf or baseball, or household activities such as making a bed.

Every resistance-training exercise has a strength curve. The weight you can lift from the starting position may be less than the weight you can lift when the muscle is fully contracted. When using resistance bands, the resistance at the start of the movement is less and increases as you complete the movement.

Tips when training with Resistance Bands:

• While doing any resistance band exercise a neutral posture should be maintained.  Concentrate on aligning the neck, shoulder blade and shoulder joint, pelvis, lower back, hips while contracting the core abdominals and bending the knees slightly.

• Use the band strength prescribed by your physiotherapist/kinesiologist and stick with the prescribed sets and repetitions. Remember to rest between every set as directed.

• Perform all exercises in a slow and controlled manner.

• Avoid going into extreme joint positions when exercising e.g. locking the joint at the end of a movement.

• Breathe evenly while performing these exercises. Exhale while contracting the muscles and inhale while releasing.  Don’t hold your breath.

• Start off by performing the exercises without the resistance band until you are comfortable with the movement, then add the resistance.

For more information on all of the services we offer at Vick Physiotherapy International, please visit our services page.

Heel pain and what to do about it

Plantar fasciitis is the most common cause of heel pain. It is an irritation or inflammation of the plantar fascia — the ligament that runs from the heel to the ball of the foot. This is a strong, dense strip of tissue that supports the arch of the foot, almost like the string on an archer’s bow.

When the foot is on the ground, the plantar fascia is forced to stretch as the arch of the foot is flattened under weight of the body; like the string stretching as the bow is trying to straighten.

This leads to stress on the plantar fascia ligament, where it attaches to the heel bone. Some small tears of the fascia may result. These tears are usually repaired by the body, but repetitive stress may result in incomplete healing. A bone spur can form as the body tries to compensate for too much stress.

Pain in the heel can occur due to such bone spurs, inflammation of the plantar fascia (known as plantar fasciitis) or impingement of the small nerves in the foot. The condition is most common between the ages of 40 and 60.

Symptoms of plantar fasciitis include pain on or around the heel when weight is placed on the foot. This is usually worse in the morning, especially with the first few steps out of bed and can be described as sharp, burning or stabbing pain. Pain usually reduces during the course of the day as the tissue warms up. In most cases, there is no pain at night since the plantar fascia is not stressed. Prolonged standing, walking or getting up after long periods of sitting usually irritate the fascia.

Common causes

Overload of physical activity, excessive running or jumping

High arches, flat feet, abnormal gait

Wearing improper shoes while walking or running

Recent weight gain or pregnancy

Occupations that keep you on your feet

Diabetes contributes to heel pain in the elderly

Right steps to relief

In most cases, plantar fasciitis does not require surgery and can be treated conservatively. If you suffer from heel pain, make an appointment with your physiotherapist. Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Simply changing the way you walk to avoid pain could lead to other foot, knee, hip or back problems.

Therapy usually involves identifying the cause of your foot pain and a series of treatments. You may be prescribed specific footwear and exercises. Physical Therapists will design exercises to improve flexibility in the calf muscles and the plantar fascia. Treatment helps control pain and swelling. We may use ultrasound, mild electrical stimulation, ice packs and soft-tissue massage to help you recover as fast as possible. We may even recommend the use of orthotics depending on your condition. Keeping mobility and flexibility in the foot is key to improve quality of life.

Call our practice today, and we’ll help you take the right steps without pain!

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How to get the most from your physiotherapy appointments

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An appointment with a physiotherapist is an excellent step towards improved function and injury prevention. To make the best use of your time, please use the following guidelines:

Wear comfortable clothes. Jeans or long sleeves are not advisable during your initial evaluation since the therapist may need to evaluate your joint stability. You may be asked to take off some clothes and put on a gown to give your therapist access to the body areas needing evaluating.

Make sure to arrive a few minutes prior to your appointment in case you need to fill out some forms.

Elaborate on the things you are unable to do, or the level of function you would like to achieve with your physiotherapist. This will help the therapist to serve you as effectively as possible.

Provide information about when the pain started, the nature of pain (sharp or dull), what caused it, and what aggravates it.

Remember that you and your physiotherapist are part of a team with a common goal – to get you better as quickly as possible. Do your home exercise program exactly as instructed and try not to miss any appointments in an effort to reach that goal.

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Quick tip

Using your hands, gently pull the toes back and forth or apart. This stretches the muscles underneath.

Inspiration

Enter every activity without giving mental recognition to the possibility of defeat. Concentrate on your strengths instead of your weaknesses, on your powers instead of your problems.

~ Paul J. Meyer

Avoid Dental Dangers: 10 questions to ask your Dentist

#1 Are you using universal infection control protocols?

Every dental office should be using standard of care infection control protocols. This includes using predominantly 1-time use materials such as suction tips, cotton products, cleaning cups, and neck aprons to name a few, as well as heat-based sterilization for all reusable items like drills and burs.

Ask to see your dentist’s process. This should include a special area in the laboratory for cleaning of the instrument, soaking in a glutaraldehyde or similar disinfectant solution, a way station to rinse after soaking, and a heat sterilizer. The sterilizer should be in excellent condition and the dentist must show that she/he has it tested often using special sterilization testing strips.

It is important to understand that in any dental office that is adhering to strict infection control procedures, and all of them should be, any and all infections become a non-issue. Whether it is COVID-19 or Hepatitis B, every patient is treated the same – as if they are infected. In other words, you have nothing to fear when visiting your office for treatment if that office follows the standard of care.

#2 Do you place amalgam fillings?

As strange it sounds to have to ask this in 2021, many offices around the world still allow placement of these mercury-based fillings. There are hundreds, if not thousands, of scientific, peer-reviewed, research articles showing the deleterious effects of mercury-amalgams to human health that the use of them should have been banned years ago.

There is no dispute that mercury vapors are emitted from these fillings 24h a day, with increased exposure during brushing, chewing and grinding. You can find many studies showing how you, the patient, the dentist and the assistant are all exposed when working with these fillings. In fact, biologic dentists have to wear and provide a lot of protection for all of you when removing these feelings (see 3#).

Biologic dentists strongly recommend that if your dentist is still placing mercury-amalgam fillings, you should choose another office. And do not be confused by the “amalgam” name or any comments by a dentist who says they are really silver fillings. Amalgams contain 50% or more mercury as the main ingredient. Silver, copper, and tin make up the rest, and are not exactly completely inert in their own regard. “Let the buyer beware” when it comes to amalgams.

#3 Are you a mercury-safe office?

Do you empty the SMART protective protocols when removing and replacing these feelings? You need to choose a biologic dentist when having your amalgams removed who is SMART certified and experienced in safe removal.

It is important to know that as recently as 2019, studies have come out showing not only vapor exposure during removals, but particulate matter exposure as well (small pieces flying as far down as your feet). This is important to know because most dental offices do not even use rubber dams, a basic protective barrier for your mouth, let alone all the other protective armamentarium.

Having your amalgam fillings removed can be very dangerous if not performed properly. Skipping any steps involved in the SMART process will expose you to high amounts of mercury exposure. Many years of observation, clinical experience, and scientific studies all contributed to the safe removal process. You need to treat the most potent neurotoxin on Earth with respect and prudent care.

#4 Do you ask me about my diet and other health related information?

Your dentist needs to do a comprehensive exam. If the first time you meet your dentist for an examination is at your cleaning visit, this is NOT comprehensive.

Your dentist needs to spend time with you discussing your health history (including dite and family history), getting records including x-rays, photographs, oral cancer screening, and periodontal probe evaluation, as well as discussing findings and recommended treatments. Simply walking out with a proposal the day of your cleaning is not comprehensive, not it is likely accurate. It takes time to carefully assess everything, study and devise a plan, and go over it in detail with you. The best dentistry in the world will fail in a patient with a poor diet.

Some offices offer complimentary 30-minute consultations, where you and your dentist can get to know each other and discuss all your concerns and desires BEFORE you actually do the exam. The comprehensive exam is the cornerstone of the practice, and it should be seen as a standard. It his imperative, especially in today’s “microwave” society, that you have enough time to truly build a trusting relationship with your dentist.

#5 Do you use fluoride in your treatments? Do you recommend its use for good oral health?

You should definitely refuse fluoride treatments used during cleaning appointments. Exposing your or your child to fluoride-tray treatments (when the dentist or hygienist places trays in your mouth filled with fluoride gel) is not only unnecessary but dangerous as well.

There are documented cases of children dying after swallowing the harmful chemical. You just look on the back of your toothpaste tube to see how toxic this material is… “do not use more than a pea-sized amount of paste and if swallowed, contact a poison control center immediately”.

Keep in mind that in-office fluoride treatments contain far higher amounts and concentrations of fluoride. A huge argument against community fluoridation is that there is NO dosage control.

The amount in those trays is enough to easily kill a child if swallowed. In addition to tray treatments, some dentists like to place fluoride varnishes on the gumminess to help sensitivity. This is unnecessary and again a fairly high concentration of the chemical. There are other ways to reduce sensitivity including ozone therapy (safe with no negative side effects) and other gels like MI paste.

Although fluoride does indeed help with sensitivity, it alters the enamel by weakening the collagen Maria, making it more brittle. This conversion from hydroxyapatite, the normal makeup of enamel, to fluoroapatite is what makes the enamel somewhat resistant to sensitivity and carious breakdown, but the disruption of the enamel matrix is forever changed and this permanent disruption is not necessary since there are other alternative treatments that do not alter the tooth.

Fluoride is the most reactive element on the entire periodic table and causes a myriad of systematic disturbances involving the thyroid, the pineal gland, and your bones, to name just a few. There are 65 published studies showing a definite correlation between fluoride and reduced IQ in children.

It is important to note that only 3% of the world uses fluoride as a “medicament” in our water supplies and as a prescription supplement. The majority of that 3% is the United States.

It is very difficult to completely avoid fluoride in dentistry as most of the resin materials (composite, sealant, glass ionomers) contain small amounts of it. Fortunately, there are some materials that do not contain it al all, and these are the options that most biologic dentists employ.

#6 When doing my periodontal treatment, is your goal to kill all my “bad” bacteria?

This may seem like a silly question, but killing your “bad” bacteria is the common goal of most dental offices. Most dentists will subscribe to the theory that bacteria in your mouth cause all your problems like tartar accumulation and decay. So they prescribe scraping, antibiotics, and antibacterial rinses like chlorhexidine (Peridex) to destroy all the germs.

While certain bacteria do indeed become opportunistic when pH is off and/or your immune system is compromised, it is only because your microbiome is not happy. This is why a comprehensive evaluation is so important. Taking a more functional approach is how your dentist can plan proper treatment aimed at getting your oral microbiome in a state where ALL your bacteria is happy and commensurate.

Some individuals will still require manual scraping (scaling and root planing) to remove hardened calcules, but keep in mind that work on prevention is also important, so you do not reach that hard level of treatment.

Seeing less patients and spending more time on comprehensive care, is the only way to provide truly focused, precise care. The model of getting in as many patients as possible and working as quickly as you can is not only counterproductive, but also poses more opportunities for mistakes.

You have likely heard of the stories of patients who have the wrong leg or organ removed because the hospital made a mistake when preparing the patient for surgery. Well, the same thing happens in dentistry in a busy, “chair-to-chair” office. The wrong tooth is pulled, a root canal is done on the wrong tooth, and a patient ends up having a crown placed on a perfectly healthy tooth.

Working on one patient at a time, and doing careful, focused care is the only way to practice in a health-conscious practice.

#8 Are you placing any metals in my mouth?

This used to be one of the controversial topics that separated conventionally-trained dentists from “holistic” dentists. Doing “metal-free” dentistry became the niche dentists employed when trying to become more natural.

It is important to understand that even porcelains (tooth colored veneers, onlays and crowns) contain metal salts, so it is impossible to provide completely metal-free dentistry. That being said, you can certainly avoid all obvious metals like amalgam, nickel, silver and titanium, to name a few.

We now have the technology and materials to provide tooth-colored, strong, stable restorations. Composite fillings easily last as long, or longer than amalgams. Zirconia-based crowns and implants are incredibly strong and biocompatible, finally offering a healthy alternative to titanium implants and metal-based crowns.

Gold restorations (ie – very high content gold – around 80-88% pure gold) for use in inlays and onlays is a strong, predictable restoration option. This is one metal that has stood the test of time both restoratively and compatibility-wise.

#9 Do you do root canals?

This is the most controversial topic in dentistry today. Most biologic dentists will tell you that you should never get a root canal because it can never be completely cleaned properly and becomes a focus of systemic problems.

Weston Price, a very famous dentist who practiced in the early 1900s, did many animal studies where he showed that root canals caused illness to rabbits when just a sliver of the tooth was placed under the skin.

His premise, which holds true today for the most point, is that a dentist can never get all the bacteria and other bugs removed from the nearly three miles of dentinal tubules inside the tooth. Therefore, onde the nerve (pulp) of the tooth becomes infected, you HAVE to remove the tooth. There is no other choice.

However, there are quite a few studies completed or in the process that show when the dentist uses the Fotona Lightwalker PIPS or SWEEPS laser protocol, along with oxygen-ozone therapy (or the ultrasonic GentleWave technology), you can indeed get the entire tooth clean, thereby creating a more biologically sound result. This is exciting information because now patients do not have to end up orally crippled by having all their root candled teeth removed.

Mastication process with artificial teeth or dentures is not properly, causing digestive problems due to chewing food incorrectly. Please, do your own research (look very carefully for reputable peer-reviewed studies and not just simple Google searches) before deciding whether to pull your teeth or do these special root canals.

There are certainly a fair number of dentists and consumers who completely eschew all root canals and ultimately having a non-vital tooth in your mouth is probably not an ideal situation to live with… but neither is pulling your teeth. It is always important to have a thorough discussion with your dentist and ultimately make your decision.

Get informed. Information is powerful and will help you decide if your gut instinct is correct.

#10 Do you offer a biocompatibility test?

Having any materials in your mouth 24/7 can possibly lead to systemic problems. Dentistry is the one profession where there are literally NO rules as to what they can place in your mouth. Metallurgists cringe when they know how some dentists place nickel crowns next to mercury-amalgams next to gold.

All of you with dissimilar metals in your mouth are walking around with a battery in your head. Your saliva is the electrolytic solution that allows all the metals to react with one another.

If you have ever tasted metal, felt a shock on a tooth when metal touches it, or possibly heard some radio sounds coming from your mouth, you are experiencing a galvanic response.

Most dentists pay no mind to this topic, but a biologic dentist will take it very seriously. They will offer the Clifford Biocompatibility Assay Test to their patients to see which material are suitable for their individualized system.

Some people can handle a lot of different materials, while others are very limited. You won’t know until you do the test. It is an inexpensive way to get peace of mind and security before you have your dentist place materials permanently in your mouth. This test also opens up the opportunity for some dialogue about your health and personal desires in this relationship.

Most biologic dentists offer this kind of test, but any dentist can do it. If your dentist does not offer it, simply ask to do one. Take charge of your health. True healthcare is not dictatorial anymore. It is a team effort, but one where you are in control. Choose your healthcare providers carefully and you will enjoy a mutually beneficial relationship and one that provides you with the best care possible.