Commercial Drive – East Vancouver Chiropractor; Dr. Dominic Chan DC – “Study Finds Even a Little Too Much Tylenol Can Lead to Overdose”

I came across this article and it immediately made me think of a few patients I have come across in the last few weeks. In that time I have seen a couple of patients who have reported taking 6-8 extra strength Tylenols everyday for a few days straight prior to seeing me. Understandably, these patients were in so much pain that they felt they needed all this Tylenol to ease their pain. To clarify, the recommended dosage for extra strength Tylenol is no more than 8 tablets every 24 hours for an adult. Now with the amount of pain these patients were in, I can easily imagine a scenario where they may have taken ‘just a little more’ than recommended.  

A new study suggests that all that extra Acetominophen can add up over several days and lead to a dangerous overdose. Researchers from University of Edinburgh in Scotland found that these smaller, “staggered overdoses” can even be more harmful than a single large overdose.This study only reinforces the idea that, “…maximum recommended daily doses should be strictly adhered to.” said  Dr. Joshua Lenchus, an associate professor of clinical medicine at the University of Miami Miller School of Medicine.

The researchers also found that these people who suffered “staggered overdoses” were also the ones most likely to have brain or liver problems, need kidney dialysis and die from complications. This problem surprisingly, is not a new one. The potential harm that can be a result of acetominophen, especially in large doses, has been known for quite a while now. In fact, even the manufacturers know about the risk! This is such a problem that the Food and Drug administration asked acetominophen manufacturers to lower the dosage of the drug in pills to a maximum of 325mg. Later, the makers of Extra-strength Tylenol announced that they were LOWERING the maximum daily dose of their product to help curb the incidences of accidental overdoses. 

Now if you think that just because you don’t take Tylenol, that you’re safe….well you’d be wrong. Acetominophen, the active ingredient in Tylenol,  is a very common pain killer. Along with drug-store brands, Acetominophen is also found in a myriad of other products. Here’s a list of just some of the other products; Triaminic Fever & Pain, Alka-Seltzer Cold and Sinus, Bayer Select, Benadryl Sinus Headache, Dayquil, Excedrin, Robitussin Cold Cough and Flu, and Theraflu Cold & Sore Throat. Remember, this is only a short list too!

If you are suffering from pain that is musculoskeletal related and requires you to take 4-8 painkillers a day, please consider a safer alternative! Chiropractic is more effective than any of these drugs because it addresses the root CAUSE  of the pain and not just the symptom of pain itself. Like I’ve told patients before, if your bedroom door is squeeking, the solution is not to go to the living room and pretend there’s no problem. Fix that darn door and be happier that you did!

If you’re in the Commercial Drive neighborhood of East Vancouver, come visit my clinic of visit my website; COMMERCIAL DRIVE – EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC!!!!  

 

Reference:   

Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity

1. Darren G N Craig¹,
2. Caroline M Bates¹,
3. Janice S Davidson¹,
4. Kirsty G Martin¹,
5. Peter C Hayes²,
6. Kenneth J Simpson^2,*

DOI: 10.1111/j.1365-2125.2011.04067.x

Commercial Drive – East Vancouver Chiropractor; Dr. Dominic Chan DC – “Many Acute Low Back Pain Patients Don’t Need X-Rays”

This is the message being promoted by a major physicians group from the US. The American College of Physicians is claiming that X-rays, CT scans and MRI’s are routinely ordered for patients with acute low back pain, but may be unnecessary. What’s more, the college is reminding people that these scans are not without risks. All of the above mentioned imaging techniques expose patients to radiation.

Another concern brought up this doctors group is the presence of ‘false positives’. What that means is that using these scans whether it be X-rays, CT scans or MRI’s, can expose findings that may be completely unrelated to a patient’s symptoms. For example, it is possible to see what appears to be abnormalities in scans, such as bulging discs, while the patient reports no symptoms at all. However, once such abnormalities are uncovered, they may be treated, potentially with an unneeded surgery, experts say.

This of course, brings up the problem of cost. “Health-care costs are increasing unsustainably, and a crucial concern for everyone is how do we maintain or improve the quality of care without increasing costs? One way is for physicians to stop ordering tests that may not be beneficial,” said Dr. Amir Qaseem, one of the authors of the back pain guidelines, and director of clinical policy in the medical education division of the American College of Physicians (ACP) in Philadelphia.

The new guidelines on diagnostic imaging for people with low back pain are published in the Feb. 1 issue of the Annals of Internal Medicine.

Here is some more sobering information about imaging and back pain. Low back pain is very common in society today. In fact just about everyone will suffer a severe bout of low back pain in their lives according to the U.S. National Institute for Neurological Disorders and Stroke. Data from the ACP states that about $90 billion a year is spent on treating low back pain in the US alone. In 1997, the average cost of treating a low back pain patient was reported at $4,795. By 2005, this cost had ballooned to $6,096!!

Unfortunately, for patients increasing cost does not seem to be resulting in better outcomes. The ACP cites findings from six different studies that conclude that patients with spine problems that got radiological studies did not significantly benefit. To be more precise, these patients reported similar or WORSE scores on quality of life and physical assessments scores compared to people who did not undergo scans. The ACP went on to add that abnormal findings often do not change treatment plans for patients. In addition, it is very difficult to say with certainty that an abnormal finding on a scan is indeed the cause of the patient’s pain. To shine a spotlight on this point, a study conducted on patients over the age of 60 who did NOT have back pain was surprising. The study found that about 90% of these subjects showed signs of spinal degeneration or bulging discs on scans, even though they did not complain of any symptoms.

Now as an aside, I am not one promoting the idea of forgoing scans altogether. I think in certain situations an X-ray, CT scan or MRI is absolutely crucial to the proper diagnosis and treatment of a patient’s complaint. However, in my practice I have encountered dozens of patients who’s doctors ordered an X-ray only to come back negative of any findings at all. As one can see, this can be very frustrating to patients because they truly are having pain and dysfunction but seem no closer to an answer.

In my practice, I use a series of physical exam procedures and orthopedic tests to reach a diagnosis. This method is like working backwards, so instead of trying to find out where a problem is coming from, I try to rule out possibilities so I know what it isn’t. Admittedly, this process is not 100%. In fact it’s nearly impossible to name a test/procedure/protocol that is 100%. But I can say, the results I have seen in my clinic have been very good for my patients and no radiation required!

If you’re in the Commercial Drive area of East Vancouver, stop by the office or visit the website;COMMERCIAL DRIVE – EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC

Amir Qaseem, M.D., Ph.D., director, clinical policy, medical education division, American College of Physicians, Philadelphia; Anders Cohen, M.D., chief, neurosurgery and spine surgery, The Brooklyn Hospital Center, New York City; Feb. 1, 2011, Annals of Internal Medicine

Commercial Drive – East Vancouver Chiropractor; Dr. Dominic Chan DC – “Ouch! Osteoporosis Drug Linked to Rare Leg Fractures!”

This news story definitely falls into the “Ouch!” category and is yet again a cautionary message to those who take prescription medication. Especially for conditions that can respond well to good old fashion sensible dieting, exercise and a healthy lifestyle.

This story revolves around a popular class of drugs called Bisphosphonates, often prescribed to fight the effects of Osteoporosis and fractures! The common names of these prescribed medications are Boniva and Fosamax.

Osteoporosis is a progressive ‘thinning’ of the bones and depletion of bone density due to loss of calcium and bone proteins. Osteoporosis is generally thought of as an elderly problem that more likely targets women. In both instances, this may not always be the case. Especially with society’s demographic leaning more towards an ‘older’ population, Osteoporosis will obviously become a bigger problem as time goes on.

The details of this report involve an unusual and rare form of fracture of the femur (the long leg bone in your thigh). The problem called, “Atypical Femur Fracture” seems to be unreasonably high in patients who are taking Bisphosphonate drugs, especially for longer than five years.

“FDA is warning again about the possible risk of an uncommon form of fracture in patients who take bisphosphonates to treat or prevent osteoporosis,” Rear Admiral Sandra Kweder, M.D., deputy director of CDC’s Office of New Drugs, Center for Drug Evaluation and Research, said during an afternoon press conference Wednesday.

“Patients taking bisphosphonates who have experienced an atypical fracture are younger than patients experiencing typical osteoporotic fractures,” she said. “In some cases people have fractures of both femurs.”

Such fractures occur in the bone just below the hip joint or in the long part of the thigh bone. Over half of the patients who have had these fractures said they had dull aching thigh or groin pain that started weeks or months before there was a complete fracture, Kweder said.

The optimal length of time to take bisphosphonates isn’t known, but FDA officials think these fractures may be related to using these drugs for more than five years, Kweder said.

So as I have stated many time in these blog posts, please, please, please! be informed and educated about the potential side effects of the medications that you are taking! Unfortunately, your prescribing doctor may not be informed about all the potential side effects, especially with new research/news coming out daily.

As mentioned earlier in this post, Osteoporosis is a weakening of the bones that can lead to serious health issues. However, as countless studies have proven now, proper exercise, diet and a healthy lifestyle can make a significant difference in maintaining bone density. If you are concerned about Osteoporosis because of what you see on TV or from friends, ask your doctor about lifestyle changes first before resorting to medications like Boniva or Fosamax.

Better yet, if you’d like more information and are in the Commercial Drive area of East Vancouver, come by to see me or visit my website here; COMMERCIAL DRIVE – EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC

Commercial Drive – East Vancouver Chiropractor; Dr. Dominic Chan DC – “Study Suggests Chiropractic Better for Chronic Back Pain”

A study that appears in the Journal of Manipulative Physiological Therapeutics wanted to measure the difference between Spinal manipulation (Chiropractic), Acupuncture and Non-Steroidal Anti-inflammatory (NSAID’s) drugs for Chronic back pain.

For those who may be confused, NSAID’s are a class of drugs that are readily taken for pain relief. However, they also have the added benefit of having anti-inflammatory properties. They are more recognized for their brand names; Ibuprofen, Advil or Motrin.

This study followed a group of patients who were reported to be suffering from ‘chronic back/spinal pain’. The participants were separated into three groups; one group received Acupuncture treatment, another group only took NSAID medication and the last group received Chiropractic spinal manipulation.

Follow up was done after 30 days to see how the participants in the different groups fared. What the researchers found was surprising. At 30 days of follow up, only the Chiropractic group showed statistically significant changes. That is to say individuals in the other groups may have felt better, but as a whole, not enough to be ‘significant’ upon analysis.

This study reinforces what I’ve heard in my office for years, “Chiropractic helps people suffering from back/spinal pain, even if it’s been there for a long time”

Now a disclaimer. I had a chance to review this study and I have to admit, I think the sample size was small. It appears about 77 people started out in this study. I generally like to see a study involve many more people to get a better idea of a general effect in a population. But on the other hand, I think this study warrants some further investigation in a larger study. Not only would it be interesting to see if the same effects can be replicated in a larger sample but maybe a larger sample group could allow for a control group as well. In other words, a group of people who receive no treatment intervention at all.

For more information about your Chiropractor in East Vancouver, contact YOUR COMMERCIAL DRIVE – EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN HERE!!!

Commercial Drive Chiropractor – Dr. Dominic Chan, DC voted #1 Chiropractor in Vancouver and #1 in Health & Wellness Services!!

Thank you to all of you who voted me as #1 Chiropractor in Vancouver and #1 in Health & Wellness Services! The results have been published in the Friday, April 17th edition of the Vancouver Courier’s “Stars of Vancouver” insert. Thanks again everyone, from your Commercial Drive Chiropractor; Dr. Dominic Chan, DC