We had a great session on probiotics in clinical practice on Wednesday night.
You can watch the reply here 👇️
I saw a new patient yesterday and it was such a clear case of the need to integrate, I thought I would share it with you, keeping it real, so to speak.
T is a 52 year old female with a 7-8 year history of low backpain, but it got really bad last 2-3 years.
She initially went to see another clinic in Southampton and, sadly, they have quite the reputation for doing the same thing again and again (badly).
In her case, it was twice a week for 3 months, with no changes whatsoever by the end.
I have no issue with the number of treatments per se. I do have an issue with the fact she got zero response overall, and they kept doing the same thing.
It ended up with her having an MRI and then a steroid injection, which is now wearing off.
When I see cases like this, non-responders and/or short term responders, I want to know why?
I want my patients to get the best response they can.
How do I break the vicious cycle of chronicity?
Sometimes they do need a different form of care, and I have a good level of experience in muscle testing and adjusting from a neurological POV.
But also sometimes they need metabolic care to calm their hypersensitive nervous system down and stop low grade fibrosis in the mechanical system.
Key indicators for this are poor results from previous care.
That means looking at the history very carefully and extrapolating symptoms that MAY indicate a metabolic/nutritional issue that will stop her getting better.
That is why our intake form is so comprehensive, so it screens the patient for symptoms and diagnoses that I can use to improve my diagnosis and outcomes.
Now restless leg syndrome and cramps, 25 years ago when I first qualified would’ve been of no interest to me. Potentially noted down on the forms and then discarded.
But now I recognise them as proxy markers for nutritional deficiencies which might stop my chiropractic care working as it ought to.
For restless leg syndrome, consider:
Vitamin D – over 50% reduction in this study.
Is vitamin D low this time of year, at this time of year?
And can low vitamin D cause persistent back pain?
Magnesium and vitamin B6
Nearly 50% reduction in restless symptoms and a 66% ish improvement in sleep quality.
Can low magnesium cause low back pain?
Vitamin B12
Can vitamin B12 help back pain?
But the most consistent is…….iron.
This is well established to be one cause or one part of restless leg syndrome.
One thing to be clear about, just because you are not anaemic does not mean you have enough iron.
Iron is used in many pathways as an enzyme co-factor and this will affect those pathways long before you get anaemia.
We talked about that here
Click it 👇
Without enough iron, you cannot make high enough levels of dopamine and noradrenaline. And for some reason, low dopamine makes your legs want to run off.
Iron is a cofactor for the enzymes that convert phenylalanine to tyrosine and tyosine to dopa, the precursor to dopamine, that becomes noradrenaline and then adrenaline.
They use some very strong dopamine agonist to treat this, such as Pramipexole or Ropinirole.
For restless leg syndrome get FERRITIN (iron reserves) up to 100 ng/ml, normal ranges do not apply here.
That will mean red meat and iron supplements x1 /3 times daily.
Does low iron (usually without anaemia), also affect pain levels, via lower dopamine, noradrenaline levels & also serotonin ?
Do they give drugs for chronic pain that increase levels of those neurotransmitters?
How about amitriptyline?
So is low iron associated with pain?
That to me is being a real CLINICIAN, as opposed to a therapist.
You are being paid to get results, not adjustments.
I will be getting her blood test results through next week and starting care.
These are the kind of cases that keep me in practice, where we get to change lives where others cannot by integrating the best Chiropractic has to offer with the latest science on nutrition.
