Satori’s outstanding Osteopath, Katherine Liberatore, said to me the other day, “I like working with you because you are so open”. This was said while I was applying Laser Therapy to her strained quad muscle. Having seen the dramatic results of Laser Therapy on a torn biceps muscle (see last week’s blog), Katherine elected for some Laser to her sore hip. What she meant by ‘open’ is that it is encouraging that a chiropractor and an osteopath can work side-by-side (figuratively and literally: our treatment rooms are beside each other). Despite some obvious overlap between our therapies, Katherine and I co-exist at Satori Urban Wellness for the betterment of our patients.

Her comment was in reflection of a patient encounter we shared earlier that day. A new patient had come to see me with a six-month-old wrist injury. She hurt the wrist pushing a heavy piece of furniture. No obvious indication how the wrist was injured, but it became very painful immediately following the furniture move. No broken bones, just pain. She sought out a chiropractor who attempted to help but his treatment made no difference to her pain and limited mobility. Six months passed, with varying degrees of pain and limited wrist range of motion, until she was referred to me by her family doctor.

I carefully examined her wrist using the standard wrist tests and compared it to her healthy wrist. It was obvious that the wrist had some instability and a noticeable bump in certain positions. Following her first visit, I consulted with Katherine about possible diagnoses for this wrist complaint. Various mechanical considerations crossed my mind: Distal radio-ulnar instability due to wrist ligament damage and a subluxated lunate (a small carpal bone of the wrist) were at the top of my list. Katherine agreed, having not examined the patient herself. A second treatment, incorporating Laser Therapy, Kinesio-Tape, and manual therapy proved only mildly successful. Time for more consultation, I thought. This time, Valerie (RMT) and Katrine (RMT & osteo-in-training) were around the office to consult. Having had previous clinical experience with a ganglion cyst, Katrine suggested this as an alternative diagnosis. Katrine then asked a few questions and then concluded that it must be a ganglion cyst. Having personal experience with a ganglion cyst on her wrist, Val also suggested this as an alternative diagnosis. Enough consultation. Time to research ganglion cysts of the wrist. Lesson learned. It might definitely be a ganglion cyst. Time for a second opinion. I referred my patient to Katherine so a second set of hands and eyes can evaluate this wrist. Katherine agreed that a cyst is likely, although there is carpal and metacarpal bone instability as well. Perhaps years of flute-playing had led to a latent wrist problem that became aggravated during the furniture move. Next step: We referred the patient back to her family physician for a diagnostic ultrasound to confirm the presence of the ganglion cyst. When confirmed, she will have a couple options: drain the cyst with a needle, or ignore the cyst but continue to improve wrist function and pain via manual therapy.

This is how healthcare and wellness care should operate. In just a short period of time (1 – 2 weeks), the chiropractor (myself), osteopath, and two massage therapists collaborated on diagnosing a wrist injury that had been present for six months and missed by a different chiropractor and family physician.

Many points can be made about this story. The one I choose to highlight is the collaborative nature of the Satori therapy team. Not one ego in the bunch - just a team of complementary medicine therapists striving to improve each and every patient’s life. Had I been working in an office by myself, I may never have reached the diagnosis. Being part of the Satori team ensures excellent care, no matter which therapist you start with. Many patients start with massage therapy – for various reasons – and end up benefitting from chiropractic care or naturopathy. And, in turn, many chiropractic patients see synergistic results with massage therapy. And, as this story highlights, even if you start with chiropractic, I may feel that the osteopath is a better fit for you clinically, and vice-versa.

The bottom line is your health is our priority.

About Michael Berenstein

Muscle injuries are common:  Over-exertion strains happen everyday.  Tight hamstrings develop strains when we run for the bus; Tight hip-flexors (psoas) strain when we start walking after a long day of sitting on the job.  Tears to the muscles are a different story.  They are one step beyond a strain.  The muscle fibers don't just get stretched beyond their normal limits, they actually begin to tear away from one another.  This results in a lot of bruising and swelling, not to mention the damage to the appearance and function of the muscle.

One commonly occurring muscle tear is the biceps muscle.  The biceps is a two-headed (see: BI-ceps) muscle that runs from the upper arm (near the shoulder) across the elbow.  It functions to bend the elbow.  Simple.  Until it develops some weakness and/or tightness.  Then, an overexertion causes a tear.  Bruising, swelling, and often a lumpiness to the muscle develops.  Next step: Recovery.

A 76-year-old patient of mine tore his biceps muscle lifting a heavy box down from a shelf in a store.  Ouch!  When the bruising became apparent, he visited his family physician.  He was told to rest and expect at least 6 weeks for the bruising and injury to recover.  Thankfully, this gentleman came to see me as well.  I said, "We can do better than 6 weeks, can't we!".  I had confidence I could help him beat the 6-week projection due to previous histories helping others with hamstring tears using my Laser Therapy device.  Laser stimulates tissue repair by dilating blood vessels to bring nutrient-rich blood to the injury and carry waste products away; Laser stimulates energy production within the injured tissue cells to accelerate tissue repair.  Below is the result in photos:

3 visits so far:

1st Visit: February 15, 2012 Maximum brusing Moderate pain Decreased strength & function	2nd Visit: February 22, 2012 Significant reduction in brusing Limited pain Increased strength & fucntion	3rd Visit: March 2, 2012 Brusing gone No pain Function & strength nearing pre-injury levels

About Michael Berenstein

Blogging during the work-week at times is tough due to an erratic schedule (read: my schedule depends on YOUR schedule). So, on this family-day long weekend Monday, I thought I’d blog about a topic I’ve touched on time and time again: Setting Goals. You can most certainly stumble into accomplishments. But, for proper motivation, set your goals ahead of time. Be realistic, yet challenging. Without setting your goals, you have nothing to aim for. You might, instead, just hope for the best.

As always, my motivation for this blog topic is health and exercise. In years past, you’ve read about my various goals: (i) Run 5km; (ii) Cycle 60km with my father; (iii) Finish a Try-a-Tri length Triathlon; (iv) Finish a Sprint-length Triathlon. Goals set and met. My next goal is to run 10km, and compete and finish the Sporting Life 10km race on May 13.

The last four and a half months have been the busiest of my life, juggling work and new fatherhood. But, I reached a point recently when I realized I had yet to set my exercise goals for 2012. As a result, no exercise was being performed. I set my goal (10km), and started finding the time to work towards the accomplishment. Running at lunch-time or work breaks has become my new ‘thing’, due to my new time restraints of being a daddy (read: love spending time with Nathan).

Point being: Without having set my goal, I would never have gotten off the couch to start achieving it. Need helping planning a realistic goal for your current level of health and fitness? Talk to me. I’m no expert, but I play one in the office ;)

I’m just saying!

P.S. Just wrote this blog after returning from an 8.03km run in 42 minutes. Pace and distance both personal bests. This 10km race will be a piece of cake! Ha!!

For the majority of us who work five, six, or even seven days a week to earn a living and support ourselves and family, finding time to work on our health gets lost in the shuffle.  Conceptually, most of us prioritize our health.  But, practically, getting back, maintaining, or improving our health falls to the end of the priority list.  Necessarily, it falls behind work, nourishment, and sleep.  Sadly, it also tends to fall behind television and other lazy, yet enjoyable, past times.

Today's blog is just a reminder to move your health promotion up the list.

Factors that dictate our health:

1. Genetics
2. Luck (see Genetics!)
3. Sleep
   
4. Healthy Diet
5. Exercise
   
6. Intervention

We have no control over #1 & #2.  Diet requires some planning, but is very doable.  Exercise requires the most commitment.  Finding time to exercise may be the most difficult health promotion we need to find time for.  Perhaps we need to drop a few t.v shows from our weekly repertoire.  Or, maybe we turn our lazy lunch into an exercise session.

Intervention - refers to my role in your life: Chiropractic, Massage, Dentist, Medical Doc, etc.  It boggles my mind when people tell me they don't go to the dentist twice a year, or see their family doc every year for a physical.  Less mainstream, but equally important, I find it odd that more people are not making chiropractic and massage part of their routine.  Just like the maintenance of healthy gums and teeth, the value of a healthy spine, loose muscles is enormous.  The quality of your daily living improves, your functional capacity increases, and it will begin to influence the improvement of the other factors: Sleep, Exercise, & Diet.

I'm just saying!

Dr. B

We consciously or subconsciously calculate risk or cost to reward ratios in a lot of our decision making.  What are the risks?  What are the rewards?  Is it worth the risk?  A common example is when we choose to risk j-walking on the street to get to work on time.  Is it worth the risk?  Depends on the consequences of being late and the value to getting there on time.  Maybe you'll miss a call worth a lot of money?  Maybe I'll be late for a patient who will, in turn, never return due to the doctor's tardiness.  How about the risk/cost to reward ratio of choosing to be an amateur Luger, or Snow Board Aerialist?  High reward: Huge achievements of athletic proficiency, maybe fame, an olympic medal, perhaps.  High risk: Very sad story involving Canadian Sarah Burke who died in a training run when she fell and hit her head on the ground.  My deepest condolences to her family and friends. 

Risk/cost to reward is calculated in a more direct manner as it pertains to our health all of the time.  Is the reward of ordering bacon worth the risk of heart disease today, any day, everyday?  Should I do a certain back strengthening exercise in order to prevent low back pain?  Maybe the exercise will be performed wrong causing back pain?!

The motivation for this blog began the other day when I was discussing long term chiropractic care with a patient.  I was explaining the value of ongoing care: maintaining healthy spinal joint motion, a healthy nervous system, loose muscles and decreased stress.  The risk or cost to reward ratio here seems to focus more on the perceived value of reward compared with the cost to gain such reward. The cost includes a financial and scheduling commitment. The scheduling commitment can be overcome: We are creatures of habit. If we build one early morning, or one lunch-time, or one after-work treatment into our schedule, the reward will be enormous. Regarding the financial cost, I will say this: The cost of maintaining a healthy spine now will be far outweighed by the cost of pain control and arthritis treatment later in life, not to mention the improved quality of life now.

From my perspective, the reward far outweighs the risk or cost.