Saturday, July 12, 2008

In between patients

I was just sitting down for a moment at my desk waiting for the next patient to arrive and it occurred to me that I am a lucky man. It is a Saturday and I am working just until noon today. A lot of folks ask me if I hate having to come in and work on the weekend. I don't because of the people I get to work with. I have found that over the years I have made a multitude of friends who just happen to be patients as well. They come in all shapes and sizes with differing afflictions and a commonality in that they all came too me seeking help. They have referred their families and friends and now as they are in the maintenance phases of their care make a visit every so often on a Saturday morning.

I actually look forward to Saturdays at the office when I get to treat and reconnect with old friends. I am not too sure that sort of thing exists in medicine as prominently as it might have in the past. Doctors are pushed to the extremes and don't have as much time to linger with their patients and develop a friendship. I often ask patients if they have a familiar relationship with their primary care or family physicians and answers in the affirmative are becoming slim. I ask occasionally because of our inability to write scrips for medicines that I feel may help a patient with a symptom of issue that is hindering our care. It would be nice if patients had relationships with their family physicians that allowed them to call and say something like,"My chiropractor asked me to call you and tell you that he thinks I have condition ABC because of these three things that he found when he checked me out today and he wondered if it would be possible to have you consider prescribing drug X to help combat that." As is now normal, the doctor almost always says that he or she would need to see the patient first and the first available time they could do that would be in about a month. That is provided, that they actually got to speak to the doctor personally which, as you all know, is a fleeting if not an altogether lost cause.

My sense is that this will only worsen as time passes and as we shift to a socialized for of health care delivery. Be careful what you vote for.

Tuesday, July 8, 2008

Back Pain, Sleeping, and Mattresses

I am often asked by patients whether or not their mattress makes a difference on the way their back feels and if so what type should they choose. That often draws a lengthy speech about sleeping and sleep surfaces which after I have repeated it for the 20th time in a day gets a bit tiring… for me. So, in the interest of keeping all of my patients informed and reducing the strain on my vocal cords I will give you my opinion right here for you to read at your leisure.

Mattresses are fairly recent inventions when compared to the history of modern man. We have been sleeping on our backs, sides and fronts since our adaptation of bipedalism and only in the last fifteen hundred years or so have we added a cushion for our comfort. The cushion began as leaves and sticks and slowly progressed through sacks filled with straw, corn cobs, horsehair, and animal pelts, to hammocks and hammocks with horsehair and more, to what we have today which, is some combination of springs, air, cotton padding, space foam, water and other materials.

Since their beginning mattresses have been designed with the same end goal which was to act as a pad or cushion of some sort between us and the hard ground. They are pretty successful at that now compared to early models but, you have to ask yourself if that is what your body really wants. It feels good to your skin to be suspended off the hard floor but the reality is that our bodies are made to sleep on hard surfaces when they are properly tuned. The tuning part is what we work on together and I have to be honest and say I have never found someone who was perfectly tuned. But, you are probably better at sleeping on hard surfaces than you think. You have become accustomed to sleeping on a soft fluffy bed and it feels welcoming and normal to you but you could probably do with a much firmer sleeping surface. The rationale behind a harder sleeping surface is related to the body’s ability to maintain postural control of your spine and other important structures. The spine is made to support itself as you lie down. Pressure from the surface you lie upon registers with touch receptors in your skin to tell you when they have been over stimulated and need to be relieved. This little dance between your skin getting sore and your postural muscles being able to hold your spine in a stable position during sleep is what is important. This is commonly subverted when the surface you sleep on is so soft that there is no, or relatively no skin feedback to make you move. If you don’t move a lot during a normal night’s sleep then your spine starts to sag on its ligamentous support and eventually, over the course of time, becomes weak and possibly distorted which can lead to pain and dysfunction.

In case you think your mattress isn’t too important just think about the amount of time you spend on it. Every night, for 6-9 hours you lie atop this modern bag of cornhusks and pray for a good night’s sleep. You should be turning every so often to relieve pressures that are building up on your skin and spine. But is f the top of your mattress is too soft then you likely are not moving enough. That leads to all sorts of problems as outlined already. If I asked you to maintain a posture for one hour you would begin to see the craziness of thinking that you could maintain your sleeping posture without change for 6-8 hours. If you want verification, try looking to the right as far as you can by turning your head and then hold that position for ten minutes. You will quickly see how malposition effects you in short order. Now imagine hours of that.

So, my bottom line… pick the firmest sleeping surface you can stand and add a tiny bit of padding to the top to provide the smallest extra skin padding you can get away with. The big, thick, pillow tops are not all they are cracked up to be and the new fangled NASA foams and their ilk are overrated. The only modern “better mousetrap” might be the Select Comfort beds which allow you to change the stiffness of the bed as you feel necessary They do allow you the option of deflating the mattress somewhat if your back is sore and needs a softer surface for a night or two. The key with them is to make sure you re-inflate them to the firmest setting your body is comfortable with once you back returns to normal.