Chiropractic + Naturopathic Doctor • May 2016 • Roundup

Ontario will set up a new clinic to help diagnose and treat people with Ehlers-Danlos Syndrome, or EDS, and it could expand to help patients with other rare diseases, Health Minister Eric Hoskins announced.

About 6,700 people in Ontario – an estimated one in 5,000 – live with EDS, a genetically- inherited disease that includes a group of connective tissue disorders, and causes acute and chronic pain, joint dislocation and lost vision.

An expert panel set up by the province found EDS is difficult to diagnose because it affects multiple systems, such as the nervous and/or orthopedic system, skin, joints, blood vessels, and internal organs, and symptoms can vary widely in each patient.

“A new centre of excellence at the University Health Network will be focused specifically on that disease, making sure we have the expertise and resources to support those individuals in Ontario living with EDS,” said Hoskins. “That centre of excellence has the potential to expand to look at other rare diseases.”

Just finding a doctor in Ontario with expertise in EDS has proved next to impossible for some patients, who complain the province won’t pay for treatment in the United States.

The new clinic will help people with rare diseases like EDS by giving doctors a single point of contact for information on related signs and symptoms, and to get advice from clinical experts on diagnosis and treatment options.

Progressive Conservative MPP Michael Harris, who has a private member’s bill to get more help for people with rare diseases, says too often they suffer in isolation and without the same resources available to people with more commonly diagnosed diseases.

“While there are one in 12 Canadians affected by a rare disease, many in the public, the media and government are unaware of the challenges patients face to get diagnosis and treatment,” he said.

Durhane Wong-Rieger, president of the Canadian Organization for Rare Disorders, said up to half of patients can’t get a proper diagnosis.

“There’s nothing more lonely, and nothing more alone, than to be a parent who is told your child has a rare disease, or in many cases, as with our family, having a child in which the disease is undiagnosed,” she said.

Harris introduced a motion to declare the last day of February as Rare Disease Day because there are about 7,000 different disorders affecting patients in Ontario.

“While we see today some acknowledgment from this government on the need to address the challenges faced by rare disease patients, it’s my hope through designation and recognition of Rare Disease Day in Ontario, we can help move that acknowledgment to action and the answers suffers deserve,” he said.

Legislation changes will allow B.C. seniors to live more independently: advocate

VICTORIA – Health Minister Terry Lake says he wants British Columbia’s seniors to have more flexibility to live independently before their only option is full-time residential care.

Lake said amendments introduced recently to the Community Care and Assisted Living Act aim to allow seniors opportunities to stay longer in their homes through part-time assisted living arrangements.

The Liberal government announced in its recent throne speech that it will modernize community care and assisted living.

A B.C. Seniors Advocate report last year concluded many seniors have been transferred to residential care facilities sooner than necessary because of existing rules.

“It’s important that people are competent and able to keep themselves out of danger,” Lake said. “But if someone just needs a little extra home support on a regular basis, let’s provide that as assisted living rather than bumping it up to residential care.”

Current legislation means seniors who required two or more of six prescribed services offered in assisted living were expected to move to a residential care home.The services included assistance with daily living activities such as eating, dressing, mobility and personal hygiene.

British Columbia’s seniors’ advocate Isobel Mackenzie said previous regulations had a negative impact on people who were still cognitively aware and able to carry on a conversation.

“If they suddenly needed help with what we call a therapeutic diet, if they need their food texturized, not allowed.Over you go to residential care,” she said.

As of last year, there were 4,430 units of publicly funded registered assisted living units in B.C., along with 3,247 units of private registered assisted living.

There were 27,421 publicly funded residential care beds in B.C., as of September 2015.

More than 9,000 seniors are currently admitted to residential care beds each year.

Mackenzie said removing current barriers to assisted living will increase assisted and independent living options for elderly people.

“It will be very positively received by seniors, particularly those who are in assisted living now,” she said.

Opposition New Democrat health critic Judy Darcy said she’ll be looking for the government to increase the number of subsidized care options for seniors wanting assisted living help.

When actor Will Smith plays a forensic pathologist who discovers neurological deterioration similar to Alzheimer’s disease in the brain of a former NFL football player, the world pays attention.

“Concussion,” the movie he starred in, which hit theaters over the winter holidays, brought further media attention to chronic traumatic encephalopathy (CTE), which has been linked to repeated head trauma.

Although the awareness is great, Dr. Robert Harbaugh, director of the Penn State Institute of the Neurosciences, said scientists and medical professionals have more questions about the condition than they do answers.

“It’s an easily understood and seemingly compelling story to say that someone plays football and because of this they develop a degenerative brain disease years later. However, this simple story doesn’t hold up very well when you look into the details,” he said.

Right now, CTE can only be diagnosed by autopsy findings demonstrating a particular distribution of tau proteins in the brain.The problem is that tau proteins are found in the brains of most people older than 30, and they become more prevalent with age. Furthermore, it is impossible to tell if this is the result of head trauma alone or other factors.

“Many things other than head trauma can cause deteriorating brain function and we don’t pay enough attention to them,” Harbaugh said. “Head trauma may be a necessary piece in this condition, but there may be other necessary pieces as well.”

Until researchers are able to tease apart the contributing factors and develop a plan for prevention, CTE will remain a controversial subject.

Dr. Matthew Silvis, director of primary care sports medicine at Penn State Health Milton S. Hershey Medical Center, said he understands the concern among parents wanting to know if they should steer their children away from playing football.

“As a parent, I’d be asking those questions too,” he said. “But the thing to remember is that this is not just a football problem. All contact sports carry a risk of repetitive concussion.”

Depressive symptoms are common in the first year after people have been injured at work, and the first six months appear to be particularly important to an injured worker’s future mental health, a new study by Toronto-based Institute for Work and Health (IWH) found.

This six-month period may be a window of opportunity to screen for symptoms of depression, and to provide the necessary support to those who need it, in order to prevent mental health problems in future, the study suggested.

The IWH study, published last September in the Journal of Occupational Rehabilitation, found that about half of injured workers feel many symptoms of depression at some point during the year after their injury.These are people who have not been diagnosed with depression prior to their work-related injury.

For most injured workers, depressive symptoms do improve over the course of the year. However, the course of depressive symptoms in the first six months is an important indicator of how well injured workers will likely feel by the year’s end. Of those with high levels of depressive symptoms early on, half will again report high levels at six months; of that half, seven in 10 will continue to experience depressive symptoms 12 months after the injury. In comparison, most people who start out with low levels of depressive symptoms will continue to have low levels by the six-month and 12-month marks.

In other words, said study author Nancy Carnide, levels of depressive symptoms appear to stabilize at six months.

“Our findings suggest that the first six months after a workplace injury are particularly important to an injured worker’s future mental health,” said Carnide, a PhD student in epidemiology at the University of Toronto and a research associate at IWH.This six-month period may be a window of opportunity to screen for symptoms of depression, and to provide the necessary support to those who need it, in order to prevent mental health problems in the future.

While there has been other research showing high levels of depressive symptoms among those who have been injured at work, this research is the first to explore how symptoms of depression evolve over 12 months after a work-related injury.

In an earlier paper to come out of this work, the team had looked at the trajectory of depressive symptoms over a six-month period.This new paper builds on that to report on depressive symptoms and returnto- work outcomes one year after the injury.

To conduct the study, the research team recruited people who had made a losttime claim for a work-related musculoskeletal injury with Ontario’s Workplace Safety and Insurance Board from 2005 to 2007. Eligible participants had to be off work at least five days, though many were off for longer. The researchers included only those people who reported no physician- diagnosed depression during the year before their injury.

Through phone interviews conducted one month, six months and 12 months after the injury, the researchers asked participants about their pain levels, depressive symptoms (20 in all, including sadness, poor appetite, difficulty concentrating, restless sleep, crying spells, to name a few), as well as their work status and return-to-work experience. Of more than 600 workers who took part in the first one-month interview, 344 completed all three follow-up interviews.Of those, 12 were excluded because they had been diagnosed with depression prior to the injury, leaving 332 people in the final sample.

Older people are increasingly active, and this lifestyle shift has contributed to the rise in average age of a person experiencing a spinal cord injury.

The changing demographic calls for a better understanding of how aging impacts recovery and repair after a spinal cord injury. Researchers at University of California, San Diego School of Medicine and University of British Columbia (UBC) have now determined that, in mice, age diminishes the ability to regenerate axons, the brain’s communication wires in the spinal cord. The study was published March 31 in Cell Reports.

“Since many central nervous system diseases and disorders are age-related and are increasingly occurring in older populations, our study will likely have wide implications for both basic research and translational efforts on central nervous system dysfunction and restoration,” said senior author Binhai Zheng, associate professor of neurosciences at UC San Diego School of Medicine.

To examine how age affects regeneration, Zheng and colleagues removed the Pten gene in the neurons of both young and old mice (up to 18 months old), a molecular manipulation known to promote regeneration in young adult mammals.

The researchers found that, as in young mice, Pten deletion in neurons of older mice elicited the types of post-injury cellular responses that often indicate increased regeneration. However, axons in older mice were far less able to regenerate beyond the injury site, which would be required for any functional gains. In addition, older mice had increased signs of inflammation and other changes at injury sites, as compared to younger mice.

These changes indicate that axons in older mice face a more difficult environment for regeneration.

The researchers concluded that advancing age is associated with a further decline in the mammalian central nervous system’s ability to regenerate axons. The team studied two different types of neurons and the results were similar.

“The important implication is that in our fight against paralysis, we ought to think about how to overcome the increased challenges in promoting repair and recovery in older individuals as well,” said co-senior author Dr. Wolfram Tetzlaff, professor at UBC and director of the International Collaboration On Repair Discoveries, the spinal cord injury research centre of UBC and Vancouver Coastal Health Research Institute.

Magnetic resonance image isn’t everything. A new University of Alberta study shows that vibrating the spine may reveal more when it comes to treating back pain.

Teaming up with the University of South Denmark to study the lumbar spine of twins, chiropractor Dr. Greg Kawchuk and his team demonstrated that structural changes within the spine alter its vibration response significantly.

“Instead of using large seismic vibrations to find oil, we used gentle vibrations to find out where problems exist in the back,” explains Kawchuk, professor of physical therapy at the U of A’s faculty of rehabilitation medicine.“By studying and testing vibration responses in identical twins, we were able to demonstrate that structural changes within the spine alter its vibration response.”

Publishing online in Scientific Reports on March 11, 2016, the identical twin study design is significant and unique for biomechanical studies like this one. In the instance where twins had similar spines, the vibration responses were statistically similar. Alternatively, if one twin had a different spine, due to an accident or injury for example, the vibration responses were significantly different from each other.

“In Denmark we have the world’s largest and most comprehensive twin registry, and using this unique resource, we have been able to contribute to research that can potentially help to diagnose millions of back pain patients,” says Jan Hartvigsen, professor of clinical biomechanics and musculoskeletal research, University of South Denmark.

The findings show the viability of vibration as a diagnostic tool that could help improve MRI utilization in the short term, Kawchuk says.

“One of the biggest problems in back pain today is over utilization of MRI scans in patients that do not need them. This is a waste of health-care resources that leads to over treatment and even increased disability. By using a simple, safe and inexpensive technology like this, we can potentially decrease the use of these scans significantly,” says Hartvigsen.

The study also has implications in the long term and could provide new diagnoses not seen by current imaging tests.

“While an MRI shows us a picture of the spine, it doesn’t show how the spine is working. It’s like taking a picture of a car to see if the car is capable of starting. Vibration diagnostics shows us more than how the spine looks, it shows us how the spine is functioning,” explains Kawchuk.

“Back problems are a significant cause of disability worldwide. For 90 per cent of these patients, current diagnostic methods are not able to identify their problems,” says Cameron Schuler, president and CEO of VibeDx, who co-founded the VibeDx Diagnostic Corp, a TEC Edmonton spinoff company that has licensed the technology developed by Kawchuk.

“Our hope is VibeDx will help improve our ability to identify the cause of the patient’s back problem, which will then assist clinicians in matching a patient to the best course of treatment for their specific situation.”

“VibeDx is a TEC Edmonton client and we’re delighted to see international recognition for this innovative University of Alberta spinoff,” said Chris Lumb, CEO of TEC Edmonton, an accelerator for early stage technology companies. “VibeDx is a prime example of the outstanding research and commercialization taking place in Edmonton and at the University of Alberta.”

MIAMI – After a few weeks of working out at CrossFit, Charles Banfield says his back hurt constantly and his joints felt terrible. After feeling a searing pain during a particularly grueling exercise, the Los Angeles-based CEO of an event planning company learned he’d torn his Achilles tendon.

Though there have not yet been in-depth studies, some chiropractors, doctors and trainers say stories like Banfield’s have become more frequent with the increasing popularity of high-intensity interval training espoused by CrossFit and other similar hybrid workout gyms.

Many people who do the high-intensity workouts aren’t adequately conditioned for such rigorous workouts, or have back and spine conditions that could worsen, according to Marc Umlas, chief of orthopedic surgery at Mount Sinai Medical Center in Miami, who said his office has seen an increase in injuries from workouts at Cross- Fit and similar programs.Torn tendons and ligaments are a common result, he added.

“Every CrossFit athlete that I see as patients, they have something going on as a result of being in CrossFit,” said Dr. Tyler Kallenbach, a Los Angeles-based chiropractor who noted knee and shoulder injuries like torn rotator cuffs are common. He estimated 60 per cent of his patients at one point were seeking treatment from CrossFit workouts, where Kallenbach says overtraining is common.

A spokesman for CrossFit says its likely more doctors are seeing injured CrossFitters but only because so many people are doing CrossFit – not because it’s a more dangerous workout. The brand has over 13,000 locations worldwide.

Most CrossFit and similar high intensity workouts are not meant for average gym-goers, said Jorden Gold, who founded Stretch Zone, which has 33 locations in Florida and three other states.

“The majority have no business being there in the first place... It’s Olympic training,” said Gold. “It’s probably only (suitable for) a very, very small per cent that go.”