Short Sleep Linked to Body Mass, Waist Size

An August 2017 Medscape article linked short sleep to larger waist size, increased body mass index, increased hunger, and increased food intake. This is significant when obesity is tied to increased risk for heart disease, high blood pressure, diabetes, arthritis-related disability and some cancers, according to the National Center for Health Statistics.

Dr. Samuel Klein, director of Center for Human Nutrition at Washington University School of Medicine in St. Louis recommends two bits of advice for patients: Get more sleep for the hours spent in bed and increase the time allocated for sleeping. Keep the room cool and dark, do not spend a lot of time in bright light or in front of the TV, before bed.

Recorded Office Visits – What providers should know

Did you know that patients can record their office visits? Patients may choose to do so to help them remember important details about their visit or to share the information with their family.  The legality of recorded visits depends on the state where you practice. Oregon and Washington states are “All Party consent” states which means that all parties must consent to being recorded. Idaho, Utah and Colorado are “Single Party consent” states which means the patient can record their visit without your knowledge. An August 2017 JAMA article provides further information.

Outdoor time may prevent nearsightedness

A Medscape article from July 11, 2017 highlights information from British Journal of Opthamology showing young children who play outdoors are less likely to be nearsighted. This research looked at a large sampling (5,711) of children from Rotterdam, participating in a long-term study, participating from birth to age 6. At age 6, a full medical exam was done, showing 2.4% were myopic. In addition, children who did not play outdoors had lower Vitamin D levels and higher body mass index, than the group who played outdoors. Differences in myopic presentation, once thought to be genetic, may in fact be due to lifestyle differences between ethnic groups. This study highlights the importance of all medical providers to advice minor patients and their parents to spend less time in front of computers, TVs and hobbies requiring close up work, and more time at far-sighted activities outdoors. This practice is showing promise to prevent myopia in later years.

Mindfulness-Based Stress Reduction (MBSR) Shown to be Cost Effective for Chronic Low Back Pain (LBP)

Researchers from RAND Corporation, Kaiser Permanente Washington Health Research Institute & the University of Washington, Seattle, completed a study with 342 adults with chronic LBP that suggests substantial cost savings compared to ‘usual care’ when adding MBSR to care plans. This study designed a 1X/week, 2 hour group session for 8 weeks. The study results demonstrate group-based, MBSR and to a lesser extent, group based, Cognitive Behavioral Therapy (CBT) may provide cost-effective treatment for both health care system payers and society. It would be wise for providers to educate themselves on ways to introduce these plans, and add them to existing protocols,  for better patient outcomes

Attending one of our Continuing Education presentations on pain management may offer a good start! This course helps providers understand new research that describes the anatomy of pain, and offers clinical plans that can be immediately incorporated into your practice. There will be live mind-body exercises demonstrated, with providers encouraged to participate.  This will allow providers to see how much time it may take to add this valuable tool to improve patient outcomes. These tools can be used with patients or for personal use to avoid the consequences of high stress. Check out our events schedule at

Patient Request For Information – Template Forms

HIPAA requires covered entities (health plans and most healthcare providers) to provide patients, upon request, access to their protected health information (PHI) within 60 days.  There is no standardized form; however, there are several sources that provide a template such as through a newly released sample form available from (search Patient Request) or within this book (also an excellent HIPAA resource!): HIPAA: Plain & Simple.

Higher Coffee Intake Tied to Lower Mortality Rates

In a July 2017 Medscape article, coffee intake has been tied to lower mortality rates in two large studies of European subjects. There is mounting evidence that three or more cups of coffee per day may reduce risk of death from circulatory/vascular and digestive cancers. The European Prospective Investigation (EPIC) into Cancer, Lyon France completed a study of 451,743 subjects from 10 European countries. Results suggest that higher levels of coffee drinking are associated with lower risk of death from both circulatory and digestive diseases. Men appeared to have a 59% lower mortality risk, while women were 40% lower than those who did not drink coffee at all. The risk was the same whether the coffee was caffeinated or decaffeinated!

In another multi-ethnic (MEC) study with 185,855 African Americans, native Hawaiians, Japanese Americans, Latinos and Whites, the University of Hawaii investigated coffee associations to mortality and found the same to be true – higher coffee consumption, whether decaf of caffeinated, was associated with lower risk for death for heart disease, cancer, respiratory disease stroke, diabetes and kidney disease at one cup per day.

Coffee in the waiting room? You decide.

Backpack Safety Tips for New School Year

In July 2017, the Oregon Depart of Education website showcased an article from the Oregon Chiropractic Association (OCA) citing Consumer Product Safety Commission’s concerns. Over 7,000 ER visits each year are due to backpack injuries. The OCA adds, “The vast majority of students carry backpacks that weigh a quarter or more of the student’s body weight.”

The following advice is offered to avoid injury from back packs:

  • Always wear both straps.
  • Choose packs with wide padded straps.
  • Backpack weight shouldn’t exceed 10% of student body weight.
  • Packs shouldn’t hang more than 4 inches below the student’s waist.
  • Leave what you don’t need in the locker.
  • Consider rolling bags.

September is Pain Awareness Month

There are a variety of definitions of chronic pain, for example pain lasting 3-6 months, however it’s most important to recognize that chronic pain is a very common problem. The 2012 National Health Interview Survey demonstrated that about 25.3 million US adults (11.2%) had pain every day for the previous three months. According to a recent article in the Journal of the American Medical Association, chronic pain in the US costs an estimated $560-635 billion annually.

The National Center for Complementary and Integrative Health highlights some of the complementary health approaches to help manage chronic pain. Their highlights for low-back pain treatment include acupuncture, massage, spinal manipulation, yoga, and several herbal products such as devil’s claw and white willow bark. These approaches provide a generally safe alternatives for chronic pain treatment when performed by experienced, well-trained practitioners.

Oregon-California $5.7 Million Dollar 3-Year Study To Include Non-drug Therapies For Low Back Pain in Medicaid Population

The State of Oregon has included nondrug treatments such as chiropractic, acupuncture, yoga, massage, cognitive behavioral therapy, etc. for Medicaid patients with low back pain (LBP) starting in July of 2016.  A newly announced study through Patient-Centered Outcomes Research Outcomes Institute (pcori) will be evaluating physicians’ opioid prescribing practices and other outcomes in Oregon in comparison to matched patients in comparable clinics in California where services for LBP are restricted to more conventional care.  This $5.7 million dollar project is set to begin August 2017 and end July 2020.

For additional details:

Creatine Dosing: Symptoms and Safety

Medline Plus (a service of the US National Library of Medicine) offers a compilation of several research projects on the safety and efficacy of creatine supplementation dosing with patients. Creatine has been used as an athletic performance enhancing supplement for years, and is approved for use by the International Olympic Committee, National Collegiate Athletic Association (NCAA), and many professional sports. The NCAA no longer allows colleges and universities to supply creatine to students with school funds. Students are permitted to buy and use creatine on their own. This article answers the following questions:

• What is creatine?
• How effective is it? (Citing several disease states and performance enhancing scenarios.)
• What are the food, herb and drug interactions?
• What are the safe and most effective doses?
• What are the most important safety concerns when recommending creatine?

There are many new findings for integrative providers to consider before using this supplement on either healthy athletes, or patients with disease states.