"If I Could Bottle That Energy..."

I don't know if any of you had grandparents that would say "If I had could bottle your energy, I'd sell it and make a million dollars," as you were tearing around their house with your cousins when you were little, but it was a common refrain in my family. I noticed that they would say it less and less as I got older, and a study in The Journal of Pediatrics may point to why.
Eiholzer et al published a paper to be released in the November issue examining the metabolism and energy expenditure of young boys who play ice hockey. The boys were compared to their teenage hockey playing counterparts in areas like daily energy expenditure, sleep, spontaneous physical activity, and amount of energy they spent training. It turns out that the activity level (specifically the spontaneous physical activity level, like taking off running in the parking lot or beating up your brother, I suppose) of young boys doesn't seem to suffer one bit if they get less sleep. This is completely different than what the researchers found with the teenagers and from what previous studies on overtraining and sleep deficiency have found with adults. It actually seems to defy the principles of physics and common sense. How can you keep up that level of maddening 8 year-old craziness if you don't get enough sleep?
In their conclusion Eiholzer and colleagues offer a possible theory why. The write that the findings suggest an important point- "child-specific control of physical activity" may be the answer. Now I have to admit I don't exactly know what "child-specific control" means, so I Googled for it. No luck, except the article's abstract was returned to me in three search results. So, I've gone to the source, Dr. Eiholzer himself, and asked the following:
(by "child-specific control")... Does this mean that the level of control is related to the age group somehow, or that the prepubescent boys have more choice in their physical activities and therefore perform more of them? Does this suggest that parents who control their children's activity levels rather than allowing the children to choose them hamper the effect somehow? Furthermore, are the controls of sporting activity by the coaches any more or less regimented in this club? How should a coach of young athletes use this information to increase or decrease the amount of practice time or activity level (or spontaneous activites) within practice to the best effect?
The one question I probably should have asked... "How do you bottle that stuff?"
Reference:
Eiholzer U, Meinhardt U, Rousson V, Petròa R, Schlumpfa M, Fusch G, Fusch C, Gasser T, Gutzwiller F (2008). "Association between Short Sleeping Hours and Physical Activity in Boys Playing Ice Hockey." The Journal of Pediatrics 153 (5) pp 640-645.

The Study Every Chiropractor Should Have in Their Malpractice Defense File

JMPT released a study this fall that every chiropractor, osteopath, and defense attorney should have in their malpractice defense file. The often-too-common scenerio feared by many a manipulator is a patient who comes in with neck pain, gets adjusted, and calls the next day complaining of shooting pain in the arm that 'wasn't there' before. Especially in litigious America, these cases find their way into courtrooms and generally end with ill feelings on one side or the other (not to mention the occasional dirty look at the grocery store... these people generally do have to live in the same town, afterall).

This case report by Murphy and Beres describes a patient who was referred by a neurosurgeon for nonsurgical treatment for a disc herniation in his neck with no myelopathy (nerve damage). Ten days later and before his appointment with the practitioner, the symptoms of myelopathy (such as numbness, burning, or tingling in the arms) began. The article suggests that the rush to blame the chiropractor for instigating nerve damage after adjusting a herniated area may not be such an open-and-shut scenario. In this case the myelopathy began between the initial neurological consult and the first adjustment as a natural course of the disease process. While it may not happen with every herniation, Murphy and Beres do present a very real case of how a non-emergency neck problem can turn south without anything being done to provoke it. One study alone will not exonerate a practitioner, but a combination of clear communication, solid documentation, and pieces of evidence like this may prevent feelings of resentment between doctors and patients if it were ever to happen again.

Reference:

Murphy DR, Beres JL (2008). "Cervical Myelopathy: A Case Report of a “Near-Miss” Complication to Cervical Manipulation." Journal of Manipulative and Physiological Therapeutics 31 (7), pp 553-557.

College Kids Get Mumps Two Years Ago, CDC Freaks Out

An article published in the New England Journal of Medicine this spring detailed what the authors called a "resurgence" of mumps in the United States. The US Department of Health and Human Services in their Healthy People 2010 Initiative had set a goal of eliminating mumps, but an outbreak two years ago in Iowa colleges (of the 6500 + cases, none were fatal) made some medical researchers doubt if the goal was achievable.
The collection of symptoms known as mumps is on a resurgence (because as any good pathologist will tell you, a disease doesn't cause symptoms, per se, but rather the specific reaction of the immune system to being overcome by a certain pathogen is how a "disease" is classified), primarily amongst college-aged adults, despite a doubling over the last twenty years of the number of times those people were vaccinated as children. The most telling line in the journal's abstract: “A more effective mumps vaccine or changes in vaccine policy may be needed to avert future outbreaks and achieve the elimination of mumps.” How should we read that conclusion?
Either: 1) One of the most controversial vaccines on the market, the MMR vaccine, may not work, and if that’s not the case, 2) There may be recommendations to increase the vaccination schedule from two to three shots. Isn’t the colloquial definition of insanity repeating the same thing over and over but expecting different results?
Reference:
Dayan GH, Quinlisk MP, Parker AA, Barskey AE, Harris ML, Hill Schwartz JM, Hunt, K, Finley CG, Leschinsky DP, O'Keefe AL, Clayton J, Kightlinger LK, Dietle EG, Berg J, Kenyon CL, Goldstein ST, Stokley SK, Redd SB, Rota PA, Rota J, Bi D, Roush SW, Bridges CB, Santibanez TA, Parashar U, Bellini WJ, Seward, JF (2008). "Recent Resurgence of Mumps in the United States." New England Journal of Medicine 358 (15), pp 1580-1589.

Global Differences in Approach to the Same Ailment

The New England Journal of Medicine periodically asks their online readers to give their opinions on a common condition, citing three possible responses and inviting comments and voting for what could be the best response. The most recent case involved an otherwise healthy 21-year old college basketball player who had a what amounted to a boil on his bum. NEJM presented three viewpoints for treatment: 1) Incision (or lancing) and draining the boil, 2) Incision and draining the boil plus a course of anti-MRSA (which stands for methicillin-resistant Staphylococcus aureus ... MRSA) drugs, or 3) Incision and draining the boil plus a course of anti-MSSA (methicillin-susceptible Staphylococcus aureus... MSSA) drugs. Staphylococcus aureus is associated with the common staph infections patients get in hospitals. Recently an antibiotic resistant strain has appeared in the United States (MRSA) and is giving the anti-antibiotic movement some serious reason for concern. The fear is that the emergence of MRSA represents the preamble to an age of "superbugs," the drug-resistant strains that get created by natural selection when antibiotics are overused. Hence, there was some interesting discussion on the NEJM forum regarding that very topic.
Hammond and Baden followed up the case study with the results of their poll and some analysis. One of the most interesting points to the article was an interactive map showing how doctors, students, allied health care professionals and "others" voted based on country. Over 11,000 people representing 124 countries weighed in on the case and responses varied by geography. In the article the authors state "Participants in North America favored incision and drainage plus anti-MRSA therapy (53%); those in Asia and Russia and South America favored incision and drainage plus anti-MSSA therapy (49 to 54%); and those in Africa, Australia and Oceania, and Europe were largely split between incision and drainage alone (36 to 45%) and incision and drainage plus anti-MSSA therapy (34 to 42%)." It appears that, depending on where you live and who you believe, either your risk for catching an anti-biotic resistant strain of Staph is greater (i.e. North America) or your doctors are just more worried about it.

A closer inspection of the numbers (see table) reveals that the NEJM is not telling the entire story. For instance, the range and "split" between European nations doesn't look right at all. Close inspection of the interactive map provided shows that some European nations such as The Netherlands, Sweden, and Norway voted as high as 79%, 69%, and 73% in favor of lancing and drainage alone. In fact the average preference for voters in the WHO's Top 25 health care systems was for incision & drain (47%), followed by incision & drain with anti-MSSA (34%) and incision & drain with anti-MRSA a distant third (19%). Three of the top 25 countries (San Marino, Andorra, and Monaco) were not represented by voters, but of the remaining 22, 18 are European nations. If those countries are assessed as a 'European' block, the number of responders who prefer incision and drain alone for the case jumps to 51%.
The bigger question is why the difference between worldwide and North American (55% of whom preferred incision & drainage with anti-MRSA medication) responses for a case involving an otherwise healthy college athlete. The skewing of the data based on a higher North American response rate would lead a reader to believe that anti-MRSA therapy was more popular worldwide by a thousand votes. However if you look at the breakdown of votes by continent, North America is the only place where anti-MRSA therapy was more popular than incison and drainage without anti-biotic. If MRSA has become such a threat in North America because of this strain of Staph's adaptation to the most commonly prescribed anti-microbial, wouldn't it make sense to stop this trend in its tracks, especially in a case involving someone with an apparently fully functional immune system?
References:
Chambers HF, Moellering RC Jr, Kamitsuka P (2008). Management of skin and soft-tissue infection. New England Journal of Medicine 359 (10) pp 1063-1067.
Hammond SP, Baden LR (2008). Management of Skin and Soft-Tissue Infection — Polling Results. New England Journal of Medicine 359 (15) p e20.

Evan's Road to Recovery

The power of celebrity can be an amazing force for good when it comes to directing the public's attention and the government's research dollars. The attention Christopher Reeves directed to spinal cord injury research very well may have saved Buffalo Bills player Kevin Everett's life last year. The Boomer Esiason Foundation, founded by the former NFL MVP and four time Pro-Bowl quarterback, has raised money for cystic fibrosis research since 1994. From Bono's campaign to end poverty to Angelina Jolie's work on behalf of refugee children as a UN Ambassador, the platform of celebrity helps causes get noticed.
This week US Magazine interviewed actor, comedian, author, and mother Jenny McCarthy about the road to recovery she and partner Jim Carey have been on with her 5 year old son, Evan. In the interview McCarthy recalls her emotions the first time she heard Evan laugh and the promise she made the first time he hugged her. Jenny McCarthy has been a staunch advocate for Green Our Vaccines and sought out John McCain recently to discuss their similar view on vaccination.
About that promise: In an earlier article written by McCarthy and Carey, the pair detailed the dietary changes and detoxification program they credit Evan's recovery to. An excerpt from CNN.com:
"We believe what helped Evan recover was starting a gluten-free, casein-free diet, vitamin supplementation, detox of metals, and anti-fungals for yeast overgrowth that plagued his intestines. Once Evan's neurological function was recovered through these medical treatments, speech therapy and applied behavior analysis helped him quickly learn the skills he could not learn while he was frozen in autism. After we implemented these therapies for one year, the state re-evaluated Evan for further services. They spent five minutes with Evan and said, 'What happened? We've never seen a recovery like this.'"
With five books under her belt detailing her experiences with pregancy through this recovery process, Jenny McCarthy has made a tremendous shift from a comedic actress whose charms were mainly noticed by men to a champion who has formed an iron-clad bond with an army of young mothers. I think there is little doubt she will proudly continue to carry that torch long after her days in the spotlight have gone.

Sodium Benzoate- One Mother's Story

This was sent to me through the Holistic Mom's Network email loop I belong to. Chris granted me permission to share her story, thank you.
"Posted by: mindfulmama2
Mon Oct 20, 2008 1:13 pm (PDT)
I just received my Pure Facts newsletter from the Feingold Association
and that always gets me so riled up about the topic of hidden food
ingredients.

I was reading an article and it reminded me of an experience I wanted to
share. Last year, my family attended a party where they served one of
those flavored waters and sodas for the kids. My son, Garrett, chose
the colored flavored water as a healthier alternative to the soda
although I didn't know he had anything before the chaos started. Within
ten minutes of drinking it he had the worst outburst I can ever
remember. He was 7 at the time and not prone to tantrums. Well he
screamed, and cried and you would have thought some one was trying to
kill him. We tried to quickly get him to the car and on the way there
he let loose of the entire contents of his bladder. He had been out of
diapers for 4 years with no problems. It took us about a half hour
before we could calm him down and I later found out what he had been
drinking. I researched it that evening and found out that the drink
contained yellow dye #5 and sodium benzoate. For my son it was an awful
combination and apparently from my research it is for others. Here is
one article many that I found.
http://money.cnn.com/2007/09/07/news/companies/sodium_benzoate/index.htm\
?section=money_topstories


I keep talking about this because I hope that in the future these
discussions can help some other families.

Warmly,

Chris"

Celiac Disease and the Autoimmune vs Nervous System Battle

The Journal of Neuroimmunology published a paper earlier this year discussing Celiac Disease (CD) and its possible link with the nervous system. Celiac disease is an increasingly common gastro-intestinal problem that has autoimmune properties. The symptoms of inflammation, bloating, pain, weight loss and irritable bowel make this a challenge to treat nutritionally. The above study investigated the neurological relationship between the immune system and nervous system in people diagnosed with CD, and found that in almost half the cases the immune system would attack the nervous system proteins. Interestingly this attack mode wasn’t correlated with the other neurological symptoms of headaches, depression, epilepsy, etc, and the reaction of the antibodies didn’t change with a change in diet, either. Why is this interesting? Most of the journal articles on neurology seem moderately obsessed with these symptoms and their absence points to an entirely different tack in neuroscience research.
The immune systems of people suffering from CD are in a state of hyper-vigilance for some reason and are easily provoked to attack self-antigens (little markers on each one of our cells that tell our immune system what is part of us and what is a foreign invader). Some theorize that the timing of the vaccination schedule in those predisposed to autoimmune diseases, combined with the introduction of solid foods in infants (CD is among the group of gluten-intolerant diseases) may not only contribute to the recognition of self-antigens as foreign invaders but also cause immune reactions to normal foodstuffs like wheat, dairy, etc.
Reference:
Briania, C., Zaraa, G., Alaedinib, A., Grassivaroa, F., Ruggeroa, S., Toffanina, E., Albergonic, M.P., Lucac, M., Giomettod, B., Ermania, M., De Lazzarie, F., D'Odoricoe, A., Battistinaf, L. (2008). "Neurological complications of celiac disease and autoimmune mechanisms: A prospective study." Journal of Neuroimmunology 195 (1) pp.171-75.

Cervical Disc Degeneration Decreases Balance and Posture

JMPT, one of the primary sources of peer reviewed information for chiropractors and osteopaths, recently published a paper on the effect of cervical disc degeneration on balance and posture. Chiropractors refer to areas of vertebral misalignment which predispose the body to degeneration as vertebral subluxations. Subluxation degeneration left untreated not only affects the region where the problem is found, it also has global effects on posture and balance. From the evidence presented in this study its reasonable to believe that as the cervical spine is rehabilitated and adjusted, balance and posture will naturally improve without any additional specific balance or posture training. This is also important information for an aging population in regards to fall prevention; getting regular adjustments can help reduce the risk of further catastrophic injury.
Reference:
Boucher, P, Descarreaux, M, Normand, MC (2008). "Postural Control in People with Osteoarthritis of the Cervical Spine." Journal of Manipulative and Physiological Therapeutics 31(3) pp 194-190.

Pediatric Neurology recently published a study on children who grind their teeth while they sleep. Teeth grinding, or bruxism, is linked to a variety of disorders but is commonly thought of as an outlet for stress. Research written by Vendrame et al conclude that children diagnosed with migraine headaches also suffer from sleep disturbances. In my opinion, though, this wasn't the most important finding in their paper. In the course of discussing this phenomena, the authors highlight an important issue: Children suffer from tension headaches.
Often this is an ignored arena for parents. A lot of adults in this "shake it off" society seem to think that just because kids are small, (or don't have jobs, financial concerns, etc.) they don't have stress. Hey, between school shootings, instantaneous gossip via IM/text, the public humiliation readily available on Youtube (the #1 search result for "embarrasing" probably hadn't gone to her first prom yet), and parental pressure to perform academically/athletically/socially, I think there's plenty out there for a kid to get stressed out about. In addition to stress, tension headaches have been associated with risk factors such as high caffeine intake and anxiety, all of which can be found running rampant through the halls of most middle schools and high schools (Ohayon 2001). It shouldn’t be surprising then that the bodies of half of those children experiencing tension headaches are finding the only outlet for overactivity they can manage- their engines are still revving when they're supposed to be sleeping, and hence they're grinding their teeth at night.
References:
Ohayon, MM., Li, KK., Guilleminault, C. (2001). Risk Factors for Sleep Bruxism in the General Population. Chest. (119) pp 53-61.

Vendrame, M., Kaleyias, J., Valencia, I., Legido, A., Kothare, S.V. (2008). "Polysomnographic Findings in Children With Headaches." Pediatric Neurology. 39 (1) pp. 6-11.

Adverse Effects of SMT in Children

A recent issue of The Journal of Manipulative and Physiological Therapeutics contained an article from a chiropractic teaching clinic which looked back at its records for problems associated with adjusting children. Adjusting kids is a big issue within the profession of chiropractic; probably next to the stroke issue, there is none more controversial. That statement needs to be put into context though. The controversy isn't within the profession, but rather outside of it; hence, there is a growing body of research examining both topics to hopefully inject some hard science into what chiropractors as a profession have been saying for 100 years: Chiropractic is safe and effective, even for children.
The study by Miller and Banfield examined 781 files of children under 3 years of age who were treated at a British chiropractic college. The authors found a rate of adverse reaction to be one per 100 pediatric patients, or 1 every 749 treatments (keeping in mind that most patients are treated multiple times), none of which lasted longer than 24 hours or required hospital care. It should be mentioned here that the side effect rate for headaches alone is 18 of 100 for Singular and 14 of 100 for Concerta, two of the most commonly prescribed drugs for children in the US.
This article supports the evidence that chiropractic care is both safe and effective (85% of parents reporting improvement) for children under 3 years of age. An interesting note: A 3 year-old would be considered “old” for the majority of the patients adjusted in this review; almost ¾ of the patients were 3 months old or younger.
Reference:
Miller, JE, Benfield, K. (2008) "Adverse Effects of Spinal Manipulative Therapy in Children Younger Than 3 Years: A Retrospective Study in a Chiropractic Teaching Clinic." Journal of Manipulative and Physiological Therapeutics, 31 (6) pp. 419-23.

You are what you eat

This month Pediatric Neurology published a study investigating the effect of nutritional therapy on quadriplegic children (spastic quadriplegia was specifically studied, as in the children with cerebral palsy). Soylu et. al's main findings were an increase in body size and, more importantly, a decrease in the number of lower respiratory tract infections in the study group over a 6 month period.
I remember the wrapper on my hot ham & cheese sandwich at Holling Heights Elementary School in Omaha telling me: "Eat to Live, Live to Eat." While I still doubt their premise (not the eat to live part, but the concept that I cannot go on if I do not eat a hot ham & cheese) I don't discount the "You are what you eat" mantra pushed by every elementary school health teacher. This study supports the adage terrifically. If the body doesn't get the right nutrients, especially in a neuro/immuno compromised situation, how can it function properly? The simple answer is that it can't. Unfortunately there are plenty of non-compromised individuals totally ignoring this, fueling their own propensity for infections. The instructions are simple- put good things in your body, and it makes good you. Put bad things in, it still makes you...
Reference:
Soylu, OB, Unalp, A, Uran, N, Dizdarer, G, Ozgonul, FO, Conku, A, Ataman, H, Oxturk, AA. (2008) "Effect of Nutritional Support in Children With Spastic Quadriplegia." Pediatric Neurology 39 (5) pp 330-334.