Dr Davis' Back & Wrist Pain Blog

Questions & Answers With Dr. Dan Dinenberg of One Medical Group San Francisco

Daniel Dinenberg, MD                                                       

Specialty:

Family Medicine

Expertise:

Annual Physical

Birth Control Counseling

Diet and Nutrition Counseling

Diabetes and Hypertension

Healing Touch and Guided Imagery

Integrative and Functional Medicine

Lifestyle Modification

Preventative Health and Education

Skin Rash and Biopsy

Stress Management

                                      Travel Medicine and Vaccination

Daniel Dinenberg is an excellent family practice physician who has extensive training in integrative and holistic medicine.  He is focused on individualizing health care for each patient, utilizing the connection of mind/body/spirit while promoting the strengths of western medicine along with exercise, nutrition, and Healing Touch.  Daniel is Board Certified in Family Practice through the UCSF/Santa Rosa Family Medicine program. He has completed training and received Board Certification in Holistic Medicine through the American Board of Holistic Medicine.  Daniel believes strongly in the innate healing power of the human body and utilizes a functional approach to patients, specializing in helping patients to achieve more vitality and better balance in their lives.  Dr. Dinenberg recently completed a fellowship in Wilderness Medicine.

How do you incorporate your holistic training into your practice?

Well, my background is that  I’m Board Certified in Family practice and in Holistic medicine. Throughout my training, my goal has always been to figure out how to incorporate the innate healing of the body into my practice. The medical model doesn’t teach wellness, prevention, nutrition, etc. and they mainly focus on disease.   My holistic training helps me to teach my patients  the importance of a healthy mind and body as it relates to healing vs. simply treating the symptom with a drug.

What are your goals for healthcare?

I observe the big picture…using broader strokes to heal on a bigger level which includes exercise, nutrition, and life balance. I use functional medicine and try to get the body into balance. I look at the biochemical, biotransformation, detoxification, hormonal, immune, and inflammatory systems of the body, as well as try to understand the interconnectedness of symptoms...  For example, how does not getting enough  sleep affect the inflammatory reaction, natural cortisol production, and hormonal balance in the body.  I seek to treat the whole person…  and that’s when true healing happens.

Do you utilize any hands on techniques in your practice?

 I use various techniques and some are almost hands off healing such as healing touch, Reiki, energy work, etc. I mainly use it for things like stress reduction, anxiety, insomnia by using guided mediation and imagery. I use an individualized treatment program and clinical assessment for a person by figuring out what is going on with the person, and applying the appropriate healing modality specific for that person, instead of using a generalized approach.  I try not to do any test that won’t change my management of the patient and may be costly.

What would you consider to be the keys living a lifestyle of health and vitality?

1.       What you put in your body (nutrition)

2.       Exercise/movement

3.       Connection to loved ones (including yourself, friendships, family).

4.       Replenishing sleep

5.       Managing stress

Side note: Yoga is a great help making that mind/body connection

 

What is your philosophy to living a healthy lifestyle?

 Life is all about balance and allowing yourself to enjoy being in balance, and allowing it to bring happiness and fulfillment into your life at every level.  Health is our natural state.

As you can see, Dr. Dinenberg has a very special approach to health care. 

www.drdan.md

To schedule an appointment with Dr. Dinenberg at One Medical Group in downtown San Francisco call 415-291-0480

Soldiers Who Suffer Back Pain Are Unlikely To Return To Duty

San Francisco Chiropractor Comments:

I came across an interesting post on www.sciencedaily.com about soldiers who suffer back pain while on duty in places such as Iraq and Afghanistan. The name of the article is  Back Pain Permanently Sidelines Soldiers At War. Here is an excerpt from the article:  

Cohen explains that the reasons why few military personnel return to their units after leaving with back pain may simply be a reflection of the outcomes for back pain in civilian life. "Back pain has notoriously low success rates for treatment," he says. The biggest predictors of a poor outcome, he said, are psychosocial factors. People who are depressed or anxious, who cope poorly with stress, who are unhappy in their jobs, and those with other psychological issues are more likely to remain disabled by back pain. Cohen, who is also director of chronic pain research at Walter Reed Army Medical Center, said those with back pain who remain in the country where they are deployed may be more motivated to stay on the job or are more satisfied with their role in the military. 

The military needs to find a way to get soldiers with back pain back to their units wherever possible, Cohen says. He suggests that could be accomplished if there were more pain management options in Iraq or Afghanistan, following the model used for soldiers with symptoms of combat stress. When those symptoms are treated at mental health clinics on base, approximately 95 percent of service members returned to their units. When treated in a transitional unit in nearby Kuwait, the figure was around 50 percent. When sent to Germany, fewer than 10 percent returned.

 The article talks about combat stress and the physiological component of back pain...along with the notorious poor outcomes for back pain treatment.

My Take: It is common for back pain to be the physical manifestation of psychological stress...and god knows the stress these soldiers are under. It should be a foregone conclusion that some will handle it better than others. And, I don't think we need back pain research or any kind of research to tell us that the farther a soldier is taken away from the source of stress, the less likely they are to want to return...would you?

Anyway, war is not pretty, and we need to make sure that anyone brave enough to deal with it while defending our country gets the health care they need...while they are on active duty...and after-wards...forever.

Dr. Eben Davis is clinic director of Executive Express Chiropractic in downtown San Francisco. To schedule an appointment call 415-392-2225.  

Stress, Back Pain, and Chiropractic

San Francisco Chiropractor Comments:

According to experts, there are 3 basic forms of stress...Physical, Chemical, and Mental. And...experts tell us they are all interconnected. Another-words, one can lead to the other. Lets take a look at each one of them and see how stress relates to back pain, which is one of the most common physical ailments patients present with at a chiropractors office.  

Physical stress can come from sitting all day at a desk in front of a computer with poor ergonomics.  Auto accidents. Sports injuries. Physical abuse. Slips and falls. Carrying a heavy bag all day. Knapsacks in kids. A bad mattress or pillow. Shoes that don't fit right.  Manual labor...and more. 

Chemical stress to the body can result from drugs and alcohol...even prescription drugs. In fact, there are way more deaths and addictions to prescription drugs than street drugs. Environmental and workplace pollutants like asbestos, mercury, and lead. Toxins and preservatives in our food chain and water. Chemicals in our homes in the carpet and paint...even some of the things we buy like plastics, cleaning supplies, personal care items, and rubberized (cookware and toys) items are loaded with chemicals. An often overlooked source of chemical stress is the food we eat (the typical american diet is loaded with processed foods and chemicals).  

Mental stress is what most people associate with the word Stress. Mental stress can come about from being at a job you don't like. Being in a bad relationship. Financial problems. Problems with  your children at home. An illness in the family. Harassment at home or at work. Or just feeling like you don't have enough time or energy to get through the day...or you have no control over your life.  In fact, when they study cancer in the lab with mice...the mice that are unable to exert their will to stop a spin wheel produce the highest level of cancer producing stress hormones than any other activity. It appears that not having control is the ultimate mental stress. 

So how does this tie into back pain and chiropractic?

Well...all 3 stresses can lead to a malfunctioning nervous system and are primary sources of "vertebral subluxations" which is what chiropractors treat. For instance...mental stress can cause muscle tension that can pull bones of the spine out of alignment, irritating spinal nerves, resulting in back pain, neck pain, and headaches...along with many other painful conditions.  This can lead to the chemical stress of pain medications

Physical stress can cause spinal degeneration and lead to painful back conditions such as disc herniations and spinal stenosis. Back pain can then cause mental stress from the inability to perform normal daily activities at work and home. This tends to get progressively worse as time goes on...especially if pain medications are involved (which adds chemical stress to the mix). 

When chemical stress is put on the body from poor lifestyle choices such as alcohol, drugs, and tobacco...it can actually weaken the immune system predisposing the body to all sorts of physical ailments including back pain. Things that would normally not cause physical stress, do when the body is weak. Nothing is worse for back pain than cigarette smoking. And a chemical stress dependency can lead to excessive mental stress as the patient copes with the problem.

So...as you can see...all 3 types of stress are interconnected. Heck...you can be healthy as a horse...get hit with the shell shock mental stress of a death in the family, not be paying attention and step off a curb and break your ankle. The mental stress lead to the physical stress...which could now lead to chemical stress from pain killers and most likely more mental stress from depression and loss of control. It can be a vicious cycle. 

However, for the most part, you do have control over the decisions you make day in and day out. And it's those decisions that steer you either in the direction of health or illness...it's up to you. 

Sure...there are obstacles, and STRESS, and accidents, and things that seem to be out of your control (but are they?)...and some people seem to have it easier than others...But in the end, it's the choices YOU make that mostly determine where you go (in health and wealth). In fact...you are the end product of your decisions...so make them good ones. Be the paddle...not the ball...and include chiropractic in the mix. Not only can chiropractic help remove pressure off of the nervous system (physical stress). We can help teach you about the things that cause what we treat (Vertebral Subluxations)...physical, chemical, and mental stress.

We can help reduce physical stress from your nervous system with our treatments, which will help the body adapt to all 3 stresses at optimum levels. And, we will do our best to educate you about vetebral subluxations and the stresses that cause them.  Our goal is to help you find that balance point where health and stress co-exists. There is no way to escape the forces of stress. All we can do is learn to manage it in the best way possible. 

Health is a spontaneous occurrence when the conditions are right. We just have to learn what the conditions are and seek to create them. They are a little bit different for all of us.

Dr. Eben Davis is clinic director of Executive Express Chiropractic in downtown San Francisco 

     

Headache Treatment San Francisco

 

Health Update: Headaches

 

 

Chiropractic Care and Headaches

“I can’t believe how much my head hurts!”  I’ve been laid off from work for the last 3 weeks and worried about making my mortgage payment this month – I think the stress is getting out of control!  Pain starts in my neck and radiates into my head eventually making my whole head hurt, especially behind my eyes.  There are times I feel like my head might explode!  I can’t stand loud noises or even normal noise.  Over the counter medications aren’t touching it and I can’t drive if I take some of the medications my doctor prescribed.  I don’t know what to do next.”

This history is classic for the diagnosis of a tension-type of headache (TTH).  As unemployment rates reach new highs and stress levels climb, it is no wonder more and more people are presenting with this condition.  Even prior to the recession, TTH was the most common type of headache experienced by adults affecting 10-65% of the population.  The impact on daily living by TTH is significant as it disrupts daily activities, quality of life, and work.  These types of headaches, according to the International Headache Society (HIS), can last from 30 minutes to 7 days, do not include nausea/vomiting but may include increased sensitivity to light or noise (rarely both at the same time).  The most common frequency is less than 15 TTH’s/month. 

Medication has been the primary medical form of treatment and some patients require the regular use of certain medications, even when headaches are not present - - as in some cases, it’s too late to start meds once the headache starts.  In these cases, Amitriptyline has been the most frequently prescribed medication and it’s considered the drug of choice for TTH.  Chiropractic spinal manipulation (CSM) has been reported to be helpful in a number of prior studies.  One reported equal benefit as Amitriptyline with 6 weeks of treatment.

A recent publication conducted a study using a new design where TTH sufferers with more than 10 headaches per month were randomly assigned to one of four groups: 1) cervical spinal manipulation (CSM) + amitriptyline, 2) CSM + placebo (fake) amitriptyline; 3) sham CSM + real amitriptyline; or 4) sham CSM + placebo amitriptyline.  That way, one can determine which of the two or, the combination of both is most beneficial.  An initial period of 4 weeks was followed by a 14 week treatment period. A headache diary was used to track headache frequency in the last 28 days of the treatment period.  Nineteen completed the study and the combined effect carried the most statistically significant result with a close second with CSM alone.  A larger sample size was recommended for a more statistically powerful evaluation.

This study is important as CSM by itself was found to be at least as (if not more) effective than Amitriptyline alone, which is the medication of choice for TTH.  Hence, if CSM or Amitriptyline alone are not found to be satisfying, the combination of the two is strongly supported by this study. 

If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future. 

To find out if you are a candidate for headache treatment at Executive Express Chiropractic in downtown San Francisco call 415-392-2225 or request an appointment online.

Altadonna Communications©

When is a Headache a Warning Sign of a Serious illness?

San Francisco Chiropractor and Former Migraine Headache Sufferer Comments:

I know first hand what it's like to suffer with migraine headaches that nobody can figure out. I suffered with headaches so bad I was on disability...which is how I discovered chiropractic.

Like most headache sufferers...I trusted my doctors to know what they were doing and to be able to figure out what was wrong with me. The first thing that was done was to rule out something really bad like a brain tumor or ruptured blood vessel. My headaches came on suddenly so this did make sense. 

Anyway...here are some of the warning signs that should lead to immediate medical attention (courtesy of www.webMD.com): 

·         A sudden, new severe headache

·         A headache that is associated with neurological (nerve) symptoms such as weakness, dizziness, sudden loss of balance or falling, numbness or tingling, paralysis, speech difficulties, mental confusion, seizures, personality changes/inappropriate behavior, or vision changes (blurry vision, double vision or blind spots)

·         Headache with a fever, shortness of breath, fever, or rash

·         Headache pain that awakens you at night

·         Headaches with severe nausea and vomiting

·         Headaches that occur after a head injury or accident

·         Getting a new type of headache after age 55

Most headaches do not require urgent care...here is a partial list of some of the most common headache signs & symptoms (chiropractic can potentially help with these):

·         Have three or more headaches per week

·         Have headaches that keep getting worse and won't go away

·         Need to take a pain reliever every day or almost every day for your headaches

·         Need more than 2-3 doses of over-the-counter medications per week to relieve headache symptoms

·         Have headaches that are triggered by exertion, coughing, bending, or strenuous activity

·         Have a history of headaches, but have noticed a recent change in your headache symptoms

So, while it makes sense to rule out serious illness when it comes to headaches...conventional medications and treatments often times fail to deliver and chiropractic should be considered.

Dr. Eben Davis is clinic director of Executive Express Chiropractic in downtown San Francisco. To schedule an appointment call 415-392-2225.

 

What Causes Migraine Headaches?

San Francisco Chiropractor Comments:

I came across an interesting article on the always informative www.medicalnewstoday.com website. The article is entitled:

What is a Migraine? What Causes Migraines?

If anyone knows anything about headaches it's me...I became a chiropractor because of my positive experience as a chiropractic patient with severe, debilitating migraine headaches.

Experts say there are not very many conditions that are as painful as a really bad migraine headache...I agree.

In my particular case, I started having headaches out of the blue when I was about 26 years old. They began to increase in frequency, duration, and intensity. The headaches got to the point where they were almost constant. I went to bed with a migraine...and woke up with one. I went to 5 or 6 different medical doctors...including a brain surgeon. I had MRIs, Cat Scans, X-rays...you name it...nobody could figure it out.

I actually developed an allergic reaction to the Percodan they gave me for pain and ended up in the Emergency Room having my stomach pumped...it was a nightmare.

At the time I was right out of school and I was working as a stockbroker which is what I thought I wanted to do. One of my clients was a chiropractor and he contacted me at home once he found out I was out with these headaches. Anyway...the rest is history. It turned out that I had pinched nerves in the neck that were triggering the migraine headaches (none of the other doctors even suggested this).

This is now considered a known cause (the article above even mentions chiropractic)...but back then my medical doctors thought it was hogwash and that chiropractic was Voodoo. Now I work hand in hand with many medical doctors to co-manage San Francisco migraine headache patients. Some patients need both.

Anyway...the results spoke for themselves and I became a chiropractic believer...so much so that I decided to change careers and become a chiropractor.

Since then I rarely have a headache and I have helped thousands of San Francisco migraine headache sufferers over the past 18 years return to more normal lives. Sure...all the mumbo-jumbo in the migraine headaches article above is true...but I would go straight to the chiropractor first if I were you...save yourself some time, stress, and aggravation. If chiropractic fails to help your migraine (and you have to give it some time)...then you can get on the migraine treatment ferris wheel  and go for a ride. 

But if your chiropractic migraine experience is anything like mine...it will be your only stop...really.

San Francisco Chiropractor Dr. Eben Davis practices in the San Francisco Financial District at the Embarcadero Center near the Ferry Building. Please call 415-392-2225 or request an appointment online. 

Giving In To Chronic Back Pain?

San Francisco Chiropractor Comments:

I have been getting emails and comments from a few of the same chronic back pain sufferers for several years now. And the thing is...some of them live right here in San Francisco. They ask for my advice over and over again...but they never seem to take action. I have offered to meet with them personally...but they never do.

Here's the deal...just like Albert Einstein said...Nothing Happens Until Something Moves.

If doing the same things is causing the same outcome than you have to do something different. Sure...it's OK to do your homework and learn about some of your options when it comes to back pain treatments...but at some point you have to make your move.

There is a school of thought that says that people actually become attached to their back pain and that having it gives them something to do...something to talk about...and something not to do...because they just can't decide. I think maybe there is some truth to this...there must be.

I also know there are those that do take action and have tried everything under the sun...and they are still in pain.  Sure, they may still be in pain, but they will never find a solution unless they keep trying...and they recognize this...so they keep moving forward...trying new things...because life is motion, and nothing happens without it. 

Even if it means changing your diet (I recommend vegan) and getting on an exercise program...or trying nonsurgical spinal decompression with the DRX9000, or chiropractic. In fact...I would put the aforementioned right at the top of the list.

And...you also have to adjust all the health variables (stress, weight loss, posture, mattress, ergonomics, smoking, drinking, etc) in the right direction before you give up.

Anyway...life is much better without chronic back pain. My favorite quote says it all:

"When health is absent, Wisdom cannot reveal itself, Art cannot become manifest, Strength cannot be exerted, Wealth is useless, and Reason is powerless."

Herophiles, 300 B.C.

To find out if you are a candidate for care at Executive Express Chiropractic in downtown San  Francisco...call 415-392-2225 or request an appointment online.

What's The Best Exercise For Back Pain?

San Francisco Chiropractor Comments:

We treat hundreds of new cases of low back pain and sciatica every year at Executive Express Chiropractic in downtown SF. The conditions vary from simple sprains to degenerative disc disease and lumbar disc herniations. Some patients are new and acute...some are chronic. Some patients can still function normally...some are debilitated.

We incorporate chiropractic adjustments, Active Release Techniques (ART), Graston Technique, Massage, and Exercise into our treatment protocols. We are also the only clinic in the SF Financial District to offer nonsurgical spinal decompression with the DRX9000.

I spend a lot of time staying current on trends in health care...especially in regards to back pain. One thing for sure...there is an overwhelming amount of research that has been done lately in the area of back pain and exercise. I wrote a few weeks ago about how exercise is underutilized as a potential treatment for back and neck pain.

Only 14.4% of physicians prescribe exercise. I was really shocked to learn that only 33% of all chiropractors prescribe exercise...that's really low. Roughly 64% of physical therapist prescribe exercise...but then again...that's what they do...and they do it well. 

This new research seems to be telling us what I already knew...exercise is one of the best therapies for back pain prevention (and treatment)...we do it with ALL patients at Executive Express.

But here's the crazy thing about exercise and back pain...It appears that there is no particular exercise that is better than the other. Studies show that exercise programs with varied goals and methods achieve the same favorable outcomes (Back Letter, Volume 24, Number 3, 2009) if the patient sticks with the program.

Can this mean that maybe it's not the exercise itself...but the fact that exercising increases self-confidence in movement and activities...and reduces fears of injuries (you look better too)?  

These studies suggests that clearly there is more to exercise than increased strength, endurance, and flexibility. A lot of the benefit is in the head...are we underestimating the psychological component of chronic back pain?

I Think We Are.

To find out if you are a candidate for care at Executive Express Chiropractic at the San Francisco Embarcadero Center...please call 415-392-2225 or request an appointment online.

Taking Care Of Your Back with Chiropractic

San Francisco Chiropractor Comments:

Life is not much fun when you have chronic back or neck pain. When you are in pain your body makes natural pain killers which effect your moods, energy levels, and immune response. When you have chronic back pain it's often times hard to sleep, so you don't get enough rest, further suppressing your energy levels and immune system, making you even more prone to getting the flu, allergies, musculoskeletal injuries, and all kinds of other stuff.

Often,  your back or neck is so sore all the time it makes it hard to sit or stand for long periods, so you are miserable at work...forget about exercising as this is often times impossible. And I haven't even mentioned the effect that pain medication can have on the body for those that take them.

Sometimes the side effects from pain medications can interfere with life more than the back or neck pain.

Back and neck pain can also be very depressing.

Anyway...not everyone that has chronic back or neck pain is living life like this...some are worse...some are better.

And here's the deal...most of the time, help is near...help is cheap...help is painless...and help is drugless. What kind of help?...Chiropractic.

I'm serious...every day around the world, thousands of chiropractors help millions of chronic back and neck pain sufferers return to more normal lives.

It's just not worth it. Life is not fun when you have chronic pain...and not only that...

YOU CAN'T AFFORD TO BE IN PAIN!

You need to be on top of your game. Pain can interfere with your earning potential, your health and your life. So do the smart thing and visit a chiropractor.  Chances are you will feel like a genius after a few sessions. Let me know how it goes by commenting below.

To find out if you are a candidate for care at Executive Express Chiropractic at the SF Embarcadero Center...call 415-392-2225 or request an appointment online.  

Stress Management with Yoga

San Francisco Chiropractor Comments:

Here we are in the middle of one the worst economic crisis' in history. And in my opinion...it's far from over.  This crisis is effecting everyone...and not in a good way. One thing for sure...it's very stressful...and stress is not healthy.

However, there are ways to counter the negative effects of stress...and one of my favorites is Yoga. What I like about Yoga is...you can dive in...hook, line, and sinker...or, you can just do the parts of it you like...even at home...or at work.

Sure...going to a Yoga studio...especially here in San Francisco, is probably the best way to learn...under the tutelage of a master...even then you don't have to do all of it... you probably couldn't anyway.

Heck, even buying a book or a video and learning some of the poses and breathing techniques on your own will most likely work wonders managing your stress. That's what I do.

Anyway, I looked around and found an excellent article about Yoga and stress on www.mayoclinic.com entitled:

Yoga: Improve your stress management and relaxation skills

Check it out and tell me what you think.

To find out if you are a candidate for care at Executive Express Chiropractic in the SF Financial District...call 415-392-2225 or request an appointment online.