Minneapolis-area Chiropractic Clinic: Kelly ChiropracticGwendolyn E. Kelly-Kohnke, DC
8421 Wayzata Blvd. Suite 220
Golden Valley, MN 55426
Phone:  (763) 231-0143
drgwen@kellychiropractic.com
Certified Chiropractic Sports Physician®

Chiropractor Dr. Gwen KellyOther Topics


SHOES!

As a woman I fall into the stereotypical group known for their love of SHOES!  I do love shoes, but as a chiropractor I see shoes not only as a fashion statement, but as a way to assess spinal health.  The shoes you wear can affect the health of the joints, muscles, and nervous system in your legs and back.  I look at factors such as how your laces are tied, how many miles your shoes have gone, how the soles on the shoes are wearing, and others, when I want to find out more about the problems causing you pain or preventing optimal sports performance.  What your old shoes look like can also give me clues as to what kind of shoes and orthotics may work best for you in the future.  If you want me to check your shoes, all it takes is a few extra minnutes during your regular appointment. Just give me a call.

Sincerely,

Dr. Gwendolyn E. Kelly-Kohnke, DC

(Blog entry from MySpace Oct. 2008)


The Sunshine State Games! 

(A sporting event in Florida with over 24 sports and 7,000 athletes.)

I recently got back form working at the sunshine state games as a medic this June.  I met a lot of decitated chiropractors down there.  It was a great experience! 

There were many athletes there needing help to continue in their sports.  I was part of a team of chiropractors, medical doctors, and students that were supplying first aid, taping, and stretching for athletes trying to heal from and prevent further injuries. 

I found that the athletes in Florida are just as dedicated as the athletes we have here in Minnesota.  They were definitely out there playing hard and doing their best.  The athletes and coaches were wonderful to work with, and made the whole experience fun, and well worth my time.

 

From June 2008 newsletter.  Written by Dr. Gwendolyn E. Kelly-Kohnke, DC

 


 Sleep Apnea

Sleep Apnea is defined in The Merk Manual Seventeenth Edition Centennial Edition as: 

A group of disorders in which breathing during sleep stops for more than or equal to 10 seconds, usually more than 20 times per hour, causing measurable blood deoxygenation.  

Basically, sleep apnea is a sleeping disorder in which breathing stops several times an hour, for 10 seconds or more.  In order for these breaks in breathing to be call sleep apnea, they also have to cause a decrease of oxygen in the blood ("blood deoxygenation") that is significant and that can be measured.  

There are several different types of  Sleep Apnea.  The different types include central sleep apnea, obstructive sleep apnea, hypopnea, and combinations of these.  Central Sleep Apnea (CSA) is due to a decrease in respiration (breathing), due to problems in the central nervous system (CNS- specifically the respiratory center has decreased output) or brain stem.  Obstructive Sleep Apnea (OSA) is caused by an obstruction of the airway, usually in the upper airway or at the beginning of the airway.  

The most common, and the most studied form of sleep apnea is obstructive (OSA).  OSA has many causes including obesity, alcoholism, excess skin, developmental or congenital abnormalities (genetics), sleeping position, medications, and others.  If the cause is obesity, weight loss can often be the cure.  Likewise, if alcoholism is the cause, cessation of drinking can often be the cure.  

Diagnosis is best done at a sleep clinic.  If you feel that you are having trouble sleeping, if your partner says your are having trouble sleeping (i.e.-they are awake because you are snoring), or if you sleep all night and still feel un rested in the mourning, a sleep clinic is the place for you.  Snoring and difficulties sleeping do not mean you have sleep apnea, but a sleep clinic could tell you what your difficulties are from, and if they are indeed from sleep apnea.

Note: snoring does not mean you have sleep apnea.  You can snore and not have sleeping difficulties.  However, people with sleep apnea tend to have a higher tendency to snore, than the average person.

Treatment of sleep apnea is not usually difficult.  Some people get results simply from not sleeping on their backs (sleeping on your side is best), decreasing weight, having their MD change their medications, or avoiding alcohol.  Sometimes a simple mouth guard will do.  The most common treatment, and the treatment that works on most forms of sleep apnea is a CPAP (Continuous Positive Airway Pressure) machine.  This is a machine that has a mask you wear to bed.  It makes sure you have enough air going into the airway to keep it open at all times.  Most people get used to it quickly, and find that they sleep better and feel more rested (this also helps their partners as well).  Occasionally surgery has been used, but it is not usually recommended.  

Chiropractic care as a treatment for sleep apnea has not yet been studied (I hope that changes).  There are techniques used to open the airway by stimulation of the sympathetic nervous system (percussion temporarily helpful  in asthma, emphysema, and some other lung diseases).  We also know that chiropractic can influence the nervous system in a beneficial way.  I hope that in the future, chiropractors will find a way to study the question...Can chiropractic help in the treatment of sleep apnea?  I think it may be possible, but that is currently one of many questions left to be discovered by science.

Heart disease is associated with sleep apnea.  People with heart disease have an increased likelihood of developing/having sleep apnea.  And people with sleep apnea tend to have a higher risk of heart disease.  The more severe the case of sleep apnea, the higher the risk of heart disease.  These risks, however, are associated with untreated sleep apnea. It appears that treatment of sleep apnea will prevent the associated heart risks. 

Resources
Javaheri, S. (2003 June).  Heart failure and sleep apnea: emphasis on practical therapeutic options.  Clin Chest Med.  3(2):207-22. Retrieved from Pub Med http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=PubMed in September 2003.  
PMID 12800779 (PubMed-indexed for MEDLINE) 
Meoli, Amy MD, et al. (2001).  Hypopnea in Sleep-Disordered Breathing in Adults.  Sleep, 24(4):469-470.
The Merk Manual Seventeenth Edition (Centennial Edition).  (1999).  West Point, PA: Merk & Co., Inc.

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Hypopnea

Hypopnea is a new term that is not yet well defined, and the definition may vary from study to study.  Hypopnea is not strictly sleep apnea, it is a category made for people who exhibit mild signs and symptoms of sleep apnea, but miss the cut off of the definition for sleep apnea.  For example, hypopnea is a slowing of breathing rate and a decrease in breathing volume that causes decrease of oxygen in the blood.  There is not necessarily a stop in breathing. Since hypopnea is almost sleep apnea, and has the same treatments, it is included in discussions as a form of sleep apnea.

see also Sleep Apnea

Resources
Javaheri, S. (2003 June).  Heart failure and sleep apnea: emphasis on practical therapeutic options.  Clin Chest Med.  3(2):207-22.
        Retrieved from Pub Med http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=PubMed in September 2003.  
        PMID 12800779 (PubMed-indexed for MEDLINE) 
Meoli, Amy MD, et al. (2001).  Hypopnea in Sleep-Disordered Breathing in Adults.  Sleep, 24(4): 469-470.
The Merk Manual Seventeenth Edition (Centennial Edition).  (1999).  West Point, PA: Merk & Co.,Inc.

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Osteoporosis

Osteoporosis is a loss of bone mass.  It can be seen on x-rays if the loss is 30% or more.  It is diagnosed by using a bone density test.

Facts

  • Osteoporosis affects mostly women after 65 years of age.  However, men and women of all ages can have it.

  • Bone is made of several constituents including calcium (Ca++), magnesium (Mg), Phosphorous, and protein.

  • 99% of Ca++ is stored in the bones, 1% can be found in the blood (blood plasma) and other tissues.

  • 80% of peak bone mass is completed (developed) by the 20's (20-29 years of age), the last 20% of peak bone mass is completed in the 30's (30-39 years of age).  You can increase bone density until about age 30-35, after that you can only prevent bone loss.

  • We have an average bone loss of about 1.2% per year after the age of 40 in men and women (note: this can be prevented or improved with nutrition and exercise).  Bone loss is 3.5% per year for about 5 years in women, following menopause (normal loss of  menstrual cycle due to a change in hormone levels that happens as we age, usually around 45-55 years of age) or a hysterectomy (surgical removal of the uterus).  5 years after menopause or hysterectomy,  bone loss goes back to about 1.2% per year. (see HRT below)

  • Peak bone mass tends to be higher in men due to increased body mass.  Ca++ intake, weight bearing activity, and hormones support increasing bone mass.

  • Bone mass has a hereditary component, but even if osteoporosis is in your family, it can still be prevented.

  • Heavier women tend to have a decreased chance of developing osteoporosis due to increased storage of estrogen in fat tissues...estrogen decreases osteoclast activity.  Osteoclasts are the cells that "eat" or break down bone, decreasing bone mass.

Risk Factors

  • Increased risk of osteoporosis with: menopause (most in the first 5 years),  hysterectomy (most in the first 5 years), ammenorrhea (loss of normal menstruation), and lactation after 6 months.  Lactation after 6 months is only a risk factor due to the increased need for Ca++, if you are supplementing with Ca++ while breast feeding, you should have no problems.  Breast feeding is still recommended for 1-2 years after birth in the United States, and is done longer in some countries.

  • Increased risk with low calcium (Ca++) intake throughout life, but especially if low Ca++ intake after age 30, after hysterectomy, or after menopause.

  • Increased risk of osteoporosis with low body weight.

  • Smokers and alcohol users have an increased risk.

  • Some drugs such as corticosteroids, increase risk by decreasing bone density.

Prevention/treatment

As we get older, our ability to absorb nutrients from the food we eat, decreases.  In general, this makes using supplements important not just for prevention of osteoporosis, but for our general health.  Ask your doctor of chiropractic for advise on the use of and proper combination of supplements.  Supplements can cause problems if they are used improperly, they can interact with each other as well as other drugs or medications you may be taking.  They may not work properly or optimally if they are not taken correctly.  For example some vitamins work as blood thinners, if you are already on high blood pressure medications you should not take a vitamin that "thins" the blood, because it could cause problems.  In this section, I will give you some supplement recommendations.  Please do not just start taking these supplements without having your diet analyzed first. Before taking supplements, you need to know how much of that supplement you are already getting.  For example, if I am drinking 3 glasses of milk a day I will need less calcium then if I am drinking 1 glass of milk a day.  Too much of a supplement may be problematic, and too little may not be effective.  So Please consult with your Doctor of Chiropractic before using any supplements.  These recommendations are for informational purposes only.  

-Calcium can prevent and treat osteoporosis.  You (adult male or female) should be getting 1500mg/day (milligrams a day), this includes what you get from your supplements as well as your diet.  1glass/8oz. of milk or fortified orange juice has about 250mg of Ca++.  So, you need about 6 glasses a day.  Other sources of calcium are yogurt, fortified rice or soy milk, and green leafy vegetables.  Cheese is not a good source, it has a lot of calcium in it, but it is hard for your body to get the calcium from it (it isn't as bioavailable as other sources), especially if you are lactose intolerant or have food sensitivities to dairy.  If supplementing Ca++, take the citrate malate form of calcium (in the top three most bioavailable forms of Ca++).  The bicarbonate form of Ca++ is not very bioavailable, and can cause constipation.  Your body can only absorb 500mg of calcium at a time, so taking one tablet with your whole days worth of calcium is useless.  You will only absorb 500mg, so don't waste your money on a supplement with tablets that have more than 500mg each  (Note: there are instances when taking more is helpful, so if your doctor recommends more, don't tell him/her that they are crazy).  Calcium supplements are supplements that are highly likely to be contaminated, due to the source that the calcium is taken from.  It is important that you are taking a high quality supplement if you are taking Ca++ supplements.  Make sure it is a pharmaceutical grade supplement...most chiropractors can get these, as well as other health practitioners.  There are many different ways to take Ca++ in order to increase the amount your body can absorb, or the effectiveness of the supplement. Taking Ca++ at night before you go to sleep without food, is best (remember you can't take all of your calcium at once, you will need to take it other times as well).  Too much calcium can cause problems...calcium deposits in soft tissues, gall stones, etc.

-Vitamin D is necessary to help get the calcium that you absorb from your food into your bones.  We naturally make vit. D when the sun hits our skin.  If we live in a northern state, however, there are only 2-3 months in the summer when the sun is strong enough for this to happen.  Here in MN, we need to supplement vit. D  in fall, winter, and spring.  To prevent osteoporosis should take vit. D 200-800 IU/day (International Units per day).  Prevention with Vit. D should only be done in the northern states from Oct.-March, and is best done if over 50 years of age.  To treat osteoporosis vit. D should be taken 800-1600IU/day, this is for any state, time of year, or age of person who has osteoporosis.  Vit. D is fat soluble and you should not get too much...consult your doctor first.

-Magnesium (Mg) does not help prevent osteoporosis, but can be helpful if you have osteoporosis already.  350-400mg/day of Mg to treat osteoporosis.

-Protein is helpful, 1-2 servings of protein drink a day, or 30-60 g. (grams) protein a day.  Too much animal protein can increase calcium loss in the urine.  In the United States most of us get too much protein as it is and most of it is animal. protein.  So if supplementing protein for osteoporosis I recommend Soy protein drinks.  Make sure it has Soy isoflavones. Soy isoflavones are helpful in osteoporosis, and menopause.  Soy isoflavones can be found in other foods and supplements as well.

-Hormone Replacement Therapy (HRT) is a popular treatment and prevention for osteoporosis.  HRT can prevent osteoporosis after menopause/hysterectomy.  It only brings you back to a normal level of bone loss (i.e. from 3.5% loss per year to 1.2% loss per year).  This means that for the first 5 years after menopause it is extremely helpful in treatment/prevention of osteoporosis, but after that, it doesn't help much. (see Facts above). So HRT is only helpful in osteoporosis for the first 5-7 years after menopause.  HRT does not prevent heart disease as previously thought.  Estrogen based HRT does increase your risk for estrogen based cancer i.e. breast cancer.

-Vit K is helpful, but there are only a few studies,  too much is bad, and the wrong kind of vit. K can cause jaundice.

-We need 25g. (grams) of fiber a day.  But too much fiber will decrease calcium absorption.  

-Too much salt, animal protein, or caffeine will increase calcium loss in the urine.

-Phosphorus will increase fecal calcium loss, but decrease calcium loss in urine.

-Exercise is important.  You need weight bearing exercise (exercise with resistance) in order to get the absorbed calcium into your bones.  If you have severe osteoporosis (2 STD's or standard deviations, from the mean) exercise could be problematic and you should consult your doctor before starting an exercise program. 

Chiropractic Care

Chiropractic care is beneficial for everyone.  In treatment of people with osteoporosis, there are several adjusting techniques that can be used.  These techniques are more gentle then other adjustment techniques, and are used to avoid putting too much pressure on the bones so that risk of  fracture is decreased.  This allows chiropractors to treat people with osteoporosis.  

Chiropractors are also well trained in nutrition.  Your chiropractor can analyze your diet and recommend the supplements you need to prevent and treat osteoporosis.  Your chiropractor can also help you get on an exercise program that is necessary to build and maintain strong bones.  Exercise and nutrition are extremely important in the prevention and treatment of osteoporosis.  Remember prevention starts with moms getting enough nutrients to us as babies, and needs to be done throughout our whole lives, but it is never too late to start now.

References
Lecture notes Joel J. Pins, MPH, LN.  Clinical Nutrition II, fall 2000.

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Sports and Chiropractic

Here is a video about sports and chiropractic which I have posted at YouTube.  Please ignore any advertising or additional links which may appear from YouTube after my video is over.  Anything after the video is material from them, and I have no control over it.

 

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Runners and Chiropractic

Here is a video about runners and chiropractic which I have posted at YouTube.  Please ignore any advertising or additional links which may appear from YouTube after my video is over.  Anything after the video is material from them, and I have no control over it.





Gymnasts and Chiropractic

Here is a video about gymnasts and chiropractic which I have posted at YouTube.  Please ignore any advertising or additional links which may appear from YouTube after my video is over.  Anything after the video is material from them, and I have no control over it.


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Fibromyalgia

Here is a video about Fibromyalgia and chiropractic which I have posted at YouTube.  Please ignore any advertising or additional links which may appear from YouTube after my video is over.  Anything after the video is material from them, and I have no control over it.

 

From Chiro Corner, a Kelly Chiropractic, P.A. Blog 3/1/2010

Hi Everyone,

I see a fair number of fibromyalgia patients in my office.  One patient has been bugging me for a couple of years to put some of this information on the internet.  Well, here it is. 

Since fibromyalgia is a symptom based diagnosis, the treatment plan can vary a bit from person to person.  Fibromyalgia is not diagnosed based on the cause of the symptoms, but rather on the symptoms themselves.  This means that there could be several treatments that work for different people because the cause might not be the same.  The cause is still debated in the health care world, but several sound theories are being looked into.  Until the cause of fibromyalgia is defined more clearly, the treatment needs to be based on each individual. 

I have read many studies on this problem, and today I found two studies I hadn’t read before.  I was unable to find links to some of the other information I have come across in the past.  Before I share the studies today, I’d like to share some more information.

Some possible causes of Fibromyalgia syndrome (FMS) or Fibromyalgia (FM) include stress, lack of certain vitamins and minerals, and a lack of or imbalance in some neurotransmitters (such as norepinephrine and serotonin).  There are other ideas out there, these are just a few.

I like to start with lifestyle changes.  Are you getting enough water, vitamins, and minerals?  Are you exercising on a daily basis?  Are you doing something everyday to relax?  All of these things can decrease symptoms of FM.

Heart and cardiovascular issues as well as sleep issues can also be a problem in people with FM.    Dealing with these issues can also help symptoms.  For some people a visit with a cardiologist or a sleep study might be helpful to rule out heart problems, sleep apnea, or hypopnea.

Digestive issues like IBS (irritable bowel syndrome) and other digestive problems are common in people who have FM. Allergies and food sensitivities can contribute to symptoms of FM. It is important to rule out any digestive abnormalities.  Managing digestive problems will help with the FM symptoms.

Depression, anxiety, and other psychological issues are common in fibromyalgia patients.  These issues, like cardiovascular, digestive, and sleep disorders, should be dealt with.  Getting help from a psychologist is not something to be embarrassed about.  Many people try to avoid the possibility that stress and other psychological influences could be affecting their physical pain.  Finding out if some of the physical pain can be helped with stress reduction and counseling is an important part of care.  There are very real physical results that manifest due to what we are thinking.   

Chiropractic treatment, aerobic exercise, strength training, acupuncture, Qi Gong, and nutritional supplements (especially Magnesium, EPA, and DHA) can all be helpful in treating fibromyalgia.  The difficulty is in finding the right combination of treatments to help each individual with fibromyalgia to feel better.  Patients I have worked with have found that chiropractic care as well as massage, acupuncture, Pilates, yoga, tai chi/qi gong, ball rolling, aerobic exercise, relaxation, meditation, diet changes, and nutritional supplements all to be helpful.  Not every patient does all of the above, but different combinations of the above.  FM patients need to give their doctors enough time to run through trial treatments of various combinations of things that we know will help.  Too often a patient gives up on care without trying all of the different combinations of treatments available, or don’t follow doctor’s instructions.  Find a doctor you trust, and stick with it.  It takes time to find a treatment plan that works for any given person with FM. 

There are also medications that can be helpful, but as a chiropractor those are out of my legal scope of practice.  

http://www.chiroindex.org/?search_page=articles&action=&articleId=16610 –This study finds that chiropractic care can be helpful for fibromyalgia patients.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779399/?tool=pmcentrez –This study is a medical study, and so it is heavy on the drug treatments.  It didn’t look like it mentioned chiropractic.  It did, however, find that exercise, acupuncture, nutrition, and Qi gong can be helpful. 

            In the past I have read that 20 min. of aerobic exercise (huff and puff you could talk but you don’t feel like it exercise) daily, can significantly decrease symptoms of FM.  The above study says 20 min. two times a week will do.  The above study also mentions strength exercise is helpful as well.  

Clearly, the best treatment for Fibromyalgia is a multi-level plan of care.  It is my opinion that the best results come when the different health care specialties can work together to manage the problems that come with FM.   Chiropractors usually have great results in treating FM symptoms.

Hope you all have a wonderful day!

Sincerely,

Dr. Gwen

(Gwendolyn E. Kelly-Kohnke, D.C.)

 

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Kelly Chiropractic, P.A. in Golden Valley, Minnesota, serves patients from the Twin Cities - Minneapolis West Metro area including Bloomington, Edina, Minnetonka, Eden Prairie, St. Louis Park, Wayzata, Plymouth, Maple Grove, Brooklyn Park, St. Paul, Anoka, Shakopee, Hastings, Eagan, Burnsville, Crystal, Golden Valley, New Hope, Robbinsdale, Hennepin County, Anoka County, Ramsey County, Dakota County, and Wright County.

Thank you for visiting the Kelly Chiropractic, P. A. web page. Please note that the information located on our site is not intended to provide specific chiropractic advice. You should consult with a chiropractic doctor and not rely on any information contained herein regarding your specific condition. We welcome the receipt of electronic mail. Please be advised, however, that the act of sending electronic mail to this office or to Dr. Gwendolyn E. Kelly-Kohnke, DC does not alone create a physician-patient relationship. We will neither accept requests for chiropractic advice or treatment nor offer specific chiropractic advice over the internet.  The information here is presented for general information purposes only and is not intended to be used as a substitute for medical advice.