CF 204: The Case Of The Disappearing Disc & Vitamin D And Back Pain
Today we’re going to talk about The Case Of The Disappearing Disc & Vitamin D And Back Pain. But first, here’s that sweet sweet bumper music
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
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You have found yourself smack dab in the middle of Episode #204 Now if you missed last week’s episode, we talked about Reduced Access To Chiropractic & The Ideal Diet. Make sure you don’t miss that info. Keep up with the class. On the personal end of things…..
The clinic numbers have cooled a bit. Still busy but more manageable. Since things have cooled a bit on that end of things, let’s switch focus to side gigs. I see questions about side gigs periodically in the forward-thinking chiropractic alliance group.
We chiros are doing all kinds of different things from being real estate agents and hunting guides to selling stuff on eBay and Etsy.
Here’s some of what I do and why. First, I’m very happy with my income from chiropractic but, as with anything, I don’t like my eggs being in one basket, and let’s face it, we’re in a business where if something were to happen to us, it’s game over. If we are not at work and able to perform, then we can kiss all of those years of hard work goodbye.
In our profession, we are literally on a knife’s edge and it could go good or bad in a heartbeat. Literally.
So, I like other options. Do you know what else I like? Success, freedom, achievement, and wealth. All of that gives you a better chance at happiness. People say you can’t buy happiness. Well, that’s what people with no money tell themselves so they feel better. It’s like someone saying it’s not all about looks. Well….that’s true but looks sure as hell to help land a suitable partner. Wouldn’t you agree? In the say way, wealth helps you have more security and security helps you have a better chance at happiness.
So, for all of those reasons, I do a lot of stuff. I’m an artist as many of you might know. I just finished up a series of several Charlie Chaplin watercolor paintings and a sculpture of a horse and jockey in the middle of a race. They’re flying down the track!
You can see all that stuff on Facebook at Jeff Williams Art.
I have a band and have been a traveling musician in my past. It seems like another life at this point. You can check that out on Facebook at Flying Elbows Perspective. Can you imagine another band would have the band name Flying Elbows? Well they do. It’s a fiddle band from Massachusetts. That’s not us. We’re the ones from Amarillo, TX I created evidence-based posters and brochures for you guys over at chiropracticforward.com
Then I create live edge furniture. But I like to be honest, nobody has ever bought any of the pieces but that’s not because they’re not good. It’s because they’re expensive! You can see that on Facebook at Amarillo Furniture – Live Edge and Customs. It’s fun. My office and home are full of these original pieces.
The idea is to be able to retire and still be comfortable. Still have income in retirement. How are you going to accomplish that and what is your exit number? What do you have to have at the end that allows y But here’s where things have freaking gone nuts. It’s in the land of voice-over. Holy cow, y’all. Now, my results are not normal as I’m coming to find out. But, just in the last 10 months, I’ve made about $50,000 I never planned on having in my life. I’ve done over 400 commercials in the last 10 months in about 22% of the countries throughout the world and landed talent agencies that represent California, Texas, Indiana, Ohio, Kentucky, and New Jersey/New York.
How at the age of 49 this voice over thing has just come into my life is a twisted tale but briefly, the drummer for my very first band way back in college in Natchitoches, LA became a Lieutenant Colonel in the Army and we stayed in touch. Well, he became the voice of Hand Unit in the video game called Five Nights At Freddie’s. He got to do a bunch of other really cool stuff too but when the pandemic came along, it got me thinking that I need to have options.
That’s when I hit him up about voice over. A year and a half later, here we are it’s crazy.
Now, what do we do with the extra money? Well, we put it to work. That’s what we do. I’ve also spent the last 6-12 months educating myself on real estate investing. Long-term rentals, multi-plexes, short-term rentals, vacation rentals, flipping, wholesaling, and things like that. So, you may have guessed it, voice over will be funding down payments on investment properties.
What a deal. Right?!? The problem in this market if finding a good deal but we’re on some good ones and are hoping to land them in the next week or two.
Here is a little real estate tip for you. Two tips actually. First, money has always been in real estate and it always will be. Through ups and downs, the money is still there. Secondly, losses in your real estate business can offset gains in your chiropractic business come tax time. That’s if you can qualify as a real estate expert. Well…..they made it really hard to qualify so basically, if you have a job like we all have, you can’t. Your loophole, however, is this; short-term rentals don’t count.
Short-term rentals can offset tax gains without you having to qualify as a real estate expert. So, if you’re a chiropractor, short-term rentals probably make a lot of sense so that real estate losses and depreciation can offset the money you make in your chiropractic business so that you can reduce or eliminate taxes.
As a disclaimer, I am not a lawyer nor a CPA so make sure you run that by them.
OK, just some tips from you Ol’ Uncle Jeffro.
Now to the good stuff. Item #1
This first one is called “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers”’
by Xu et al
(Xu HW 2021) and published in Pain Physician in November of 2021 and that’s a steamy as a sizzling sirloin.
I believe I got this one from my esteemed colleague, Dr. David Graber who always always posts great research findings. He’s a fountain of knowledge nuggets so go search him up on Facebook and follow his page. One of the smartest guys you’ll find out there. Why They Did It
To explore the mediating effects of inflammatory markers on the relationship between vitamin D levels and pain outcomes. How They Did It
What They Found
- This study was done at the Department of Spinal Surgery of a hospital affiliated to a medical university.
- It was a cross-sectional study
- They selected patients with non-specific acute low back pain and non-specific chronic low back pain,
- The study included 60 people without Ns-LBP as controls,
- The study was done from January 2018 to January 2019.
- Serum 25(OH)D and inflammatory marker levels were examined.
- Regression and causal mediation analysis were used to evaluate the mediating effects of inflammatory markers on the association between vitamin D and pain.
Wrap It Up
- After adjustment for clinical factors, vitamin D deficiency was associated with Ns-LBP
- however, when the interleukin 6 (IL-6) level was added to the multivariable models, the association was no longer significant in Ns-CLBP patients
Patients with Ns-LBP had lower vitamin D and higher inflammatory marker levels. This association between hypovitaminosis D and Ns-CLBP may be mediated by IL-6.
Very interesting findings. They do say there are some limitations to the study. They say a retrospective study may include inevitable bias. More sensitive biomarkers were not investigated in this study. Pain intensity evaluation using the visual analog scale is inevitably subjective. Item #2
Alright, item 2 is called “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study”
by Sucuoglu et. al. (Sucuoğlu H 2021) and published in Medical Principles and Practice in February of 2021 and that’s got my glasses fogged up! Why They Did It
The authors wanted to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them. How They Did It
What They Found
- Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated.
- Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline and 1st , 3rd, and 6th-month visits were used.
- Radiological evaluation was performed by measuring the sequestered herniation level and herniation volume using 2 MRIs spaced out between 1st and 4th months
- After the second MRI, patients in the nonoperated group were divided into 3 groups: non-regression, partial regression, and complete resolution
Wrap It Up
- cant improvements were observed in VAS and Oswestry scores at month 2 and month 3 in all groups and at month 4 in partial regression and complete resolution groups.
- VAS and Oswestry score improvements at months 2 and 3 were significantly higher in the operated group than in other groups.
- At month 4, there were no significant differences in VAS and ODI scores between the operated group and partial regression and complete resolution groups.
If you remember, I did a whole episode on disappearing discs. Here’s the deal. You have to know this. The more a disc herniates, protrudes, or extrudes into the spinal canal and migrates either cephalad or caudal, the more likely the body is to recognize it as foreign and gobble it up like the cookie monster. What I thought was instant surgery several years ago, I now know may be a waiting game that ends up being non-surgical. Here’s the thing that episode taught me though; the disc material can be dissolved but the symptoms remain. At least for a while while the nerve tissue in the region undergoes the healing process.
- Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered herniation patients with conservative treatment.
- Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store
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Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact
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Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Sucuoğlu H, B. A. (2021). “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study.” Med Princ Pract 30
(3): 244-252. Xu HW, Z. S., Yi YY, Chen H, Hu T, Wang SJ, Wu DS, (2021). “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers.” Pain Physician 24