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July 24, 2000 Newsletter

Hi from Dr. Lamb! www.drlamb.com

***If this newsletter helps you - forward it to your friends & family***

In this issue:

Answers to questions sent to Dr. Lamb...
*Loss of Normal Curvature
*Chiropractic and Fibromyalgia
*Post Surgical Spinal Pain
*Prescription renewals on-line

Loss of Normal Curvature

Many of our readers have asked for my opinion about straightening of the neck on X-ray.

There are four segments to the spine, the sacrum, or pelvic section, the lumbar spine or lower back, the thoracic spine, or upper back, and the cervical spine or neck. Each section of the spine has normal curvatures to form a fluent curve to that specific section. The neck or cervical spine curves by lordosis or curving forward much like a pot belly sticking forward. This is normal in most people. 

It is very common that in whiplash accidents, repetitive work or even over time, the deep and superficial muscles of the neck shorten, causing a loss of normal curvature or straightening of the neck. This is generally not good or normal and will typically contribute to abnormal compression forces within the neck, causing pain, limb numbness or tingling, tennis elbow, golfer’s elbow, thoracic outlet, carpal tunnel, ulnar neuritis and a whole host of other problems. 

The treatment is a little tricky, and can involve many disciplines including traction, chiropractic, physiotherapy, personal stretching, a mix of medications and possibly a form of deep spinal needling or injections performed by a therapist who is experienced in deep myofascial spinal release. 

The recovery is gradual and takes commitment from the therapist and patient.

Chiropractic and Fibromyalgia

Many of our readers have asked about chiropractic therapy and it’s use in fibromyalgia.

I am generally in favor of chiropractic therapy. I believe it is well documented that spinal subluxation does occur, and that chiropractic
manipulation can be very effective for spinal relocation in all areas of the spine and pain reduction in most areas. 

My first point is that not all fibromyalgics are created equal, and therefore some will respond more to one therapy versus another. What I
find more important, however, is that fibromyalgics, like many other severe pain disorders, will respond better to different therapies at different stages of their condition. 

Mild to moderate spinal or limb pain disorders seem to respond well to chiropractic and physiotherapy. As the condition worsens, more intensive or aggressive or invasive therapies may be needed such as paraspinal injection or acupuncture. 

But as the condition improves, I move patients from my care of injection medicine to chiropractic, massage and physiotherapy. 

As such, Fibromyalgia may be improved by an experienced chiropractor that has time to work with these complicated patients. Very often it takes a
combination of treatments to be successful. Fibromyalgia is best treated by prevention; that is early and consistent spinal and limb therapy early
in an injury. 

Post Surgical Spinal Pain

Many of our readers asked my opinion about post-surgical spinal pain.

Spinal surgery to the low back and neck have been performed successfully for decades. I find most of the surgeons I have been exposed to for my
patients and other doctor’s patient’s, both orthopaedic and neurosurgical, to be excellent. 

However, the reality is that many people who have spinal surgery have problems later. These problems can be immediate or delayed. The reason’s for pain syndromes after surgery are complex, as every patient is a little bit different that the next. 

There has been a definite trend in Canada to perform less spinal surgery, and more rehabilitative medicine, and I think that this is good for several reasons. One reason is that spinal surgery comes with some risk, including paralysis and death from anaesthetic or complication. 

Although these are quite rare, they have occurred. 

Another reason is that spinal surgery may not be successful, as in the low back they often have to cut through ligaments and muscles to get to the
surgical site. These muscles often scar quite significantly contributing to a compression syndrome, and often disk herniation recurrence or
arthritis of the facet joints. 

This is one of the reasons why it is difficult to rehabilitate a failed back surgical patient. Surgery to the neck is a little different, as the spine is usually approached from the front of the neck avoiding neck muscles and ligaments. Some surgeons do approach the back from the front,
but it too is complicated, as there are a few organs that can get in the way. 

Another surgical point is whether to fuse, or not to fuse the spine. 

It is my general opinion that a fusion should be performed where possible if the spine is to be opened. A fused section of the spine is generally
very solid, and will generally not cause any more pain. However, the levels above and below that fused segment may come under more stress, and
are possibly more prone to arthritis and herniation. 

One way to potentially reduce this risk is to ensure all spinal surgical patients undergo long-term physiotherapy and intense personal instruction
for self-stretching.

Unfortunately, some people must have spinal surgery as the spinal segment can become so degenerated that the only solution is to try to clean up the fragmented disk and bone within the spinal canal and spaces. 

Some can be relieved with a less traumatic spinal scoping procedure, also called microsurgery. Others will require clear access to the spinal
segment for repair, and therefore must be opened. 

As a patient, carefully explore your avenues before deciding to undergo spinal surgery. 

As always, keep long and strong.

Prescription renewals on-line

Coming to Canada August 1, 2000 you will be able to request your prescription renewals from your physician on-line.  YOUR doctor will receive a fax from your on-line request for a renewal of your
prescription.  (These are for non-narcotic, non-emergency, standard prescriptions.)  The doctor reviews your request.  If they approve - it is
faxed to YOUR pharmacy for you to pick-up.  If the doctor wants to see you before the renewal, then you will have a call from their office asking you
to come in.  

What a great way to avoid the delays in making an appointment and the time off work to see the doctor for routine renewals.  

The cost of the renewal service is C$30 per request (up to three medications per request.) If your the doctor asks you to come in - you receive a refund of C$15.)  

To use this service, you also have to be a member of the Iasis Safeguard health system that authenticates and protects those using any of the many services Iasis services.  

The annual cost of this program is C$25.

For more information, go to www.drugsanddocs.com/prescriptions.htm or
contact us at -

info@drugsanddocs.com.  

If your physician is not on the system, give her or him this newsletter or have them contact-

 Iasis Corporation 905-608-2349.  

ASK DR. LAMB

Thanks to all who have sent in questions.  I read every question and we try to pick ones that would be of general interest to cover in the newsletters.  

If you have other questions - please write me at-

 pain@drlamb.com

The information contained in this newsletter is the opinion of Dr. G..Blair Lamb M.D. C.C.F.P. and should not be used as personal medical advice. 

Everyone is encouraged to see their own healthcare professional to review what is best for them.  

For further details, please visit
http://www.drlamb.com/legal.htm

Thanks for reading!  

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