Anemia may be the root cause of many chronic conditions such as headache, migraine, mood disorders, and fatigue.  Getting assessed by a functional medicine provider trained in the diagnosis and treatment of anemia may be the missing link towards optimal health.  In this blog post I will be focusing on iron deficiency anemia as it is the most prevalent in our clinical practice.  While both males and females can be affected by anemia, females are affected at a much higher rate.  

What is anemia?

Anemia is defined as a low red blood cell count (RBC), low hemoglobin (Hgb), and a low hematocrit (red blood cell concentration in whole blood). Iron deficiency anemia, or IDA, is defined as a microcytic, hypochromic anemia, where the red blood cells are small in size and pale in color due to poor hemoglobin concentration. These red blood cells do not carry oxygen as efficiently, and your tissues can become hypoxic or starved of oxygen. As a result, your heart pumps faster to try and bring more oxygen to the tissues. Additionally, your brain gets less oxygen which causes headaches and mental fatigue.  Symptoms of anemia include fatigue, cold hands/feet, rapid or irregular heart rate, headaches, dizziness and lightheadedness, pale or yellow skin, and shortness of breath. When iron status is addressed, we have seen issues like anxiety, depression, and insomnia improve drastically in our patients. 

There are many types of anemias that can affect the body. For instance, Vitamin B12 (cobalamin) and Vitamin B9 (folate) deficiencies can cause anemia.  These anemias will present as a ‘macrocytic’ anemia where red blood count is low and the red blood cells actually become larger as part of the deficiency.  When assessing your bloodwork for anemia and any other condition, make sure to consult with a physician trained in functional medicine.

How do you measure it?

To assess iron status, we order a simple test called plasma ferritin. Ferritin is your body’s storage form of iron and is in largest concentration in your liver, spleen, and bone marrow. Small amounts of ferritin circulate in your bloodstream in direct proportion to the amount of ferritin stored in tissues. Normal values for ferritin vary with age and sex, and good laboratories will provide age and sex specific reference ranges. The lab reference ranges for ferritin are typically quite large, e.g. 16-154 ng/ mL for a 40 year old female, meaning stricter ‘functional ranges’ need to be used for clinical decision making. Using functional medicine standards, we prefer to see ferritin levels above 100 ng/ mL. It’s important to note too much iron is also a problem, and can cause conditions such as iron overload or hemochromatosis.  

What to do: 

If your ferritin levels are low, look to optimize digestion of iron by taking a hydrochloric acid supplement which will help increase the acidity of your gut. Having an appropriately low stomach pH (more acidic) is necessary for the proper digestion of iron, vitamin B12, calcium, and magnesium among other vital nutrients. For more information, refer to my blog post on stomach acid and digestion here.  

To improve iron status it’s important to consume foods high in iron. Animal protein is one of the best ways to get iron. Red meat, organ meats, shellfish, and turkey are excellent ways to increase iron status when paired with optimal digestion. Cooking daily with a cast iron skillet is another easy way to improve iron status. One of my favorite iron and vitamin B12 rich meals is a grass fed ribeye steak cooked with butter or coconut oil in a cast iron skillet. Another option is to use an ‘iron fish’ which can be dropped into warm beverages and will safely release iron into your drink. Consider using an iron fish in hot water with honey and apple cider vinegar. The apple cider vinegar will help increase gut acidity and improve iron absorption.  

Take action!

If you can relate to the symptoms described above, make sure to get a ferritin and complete blood count (CBC) test as soon as possible from your doctor. It’s always better to ‘test rather than guess’ because too much iron can also be problematic. The tests are simple and inexpensive so don’t hesitate to ask your doctor to order it for you. Having healthy red blood cells is essential for optimal health, and a CBC test looking at iron levels will help determine what steps you may need to take to improve your overall well-being. 

Post written by Dr. Riley Kulm, DC.  Check out his bio here.

After a car accident your ‘to do list’ may be long – get your car fixed, find an attorney, file a claim with your insurance agent, find a rental car to get to and from work, etc. For most, the damages to your body are less of a concern in the initial stages following an accident. Unfortunately, many do not know where and how to find treatment for their injuries. Without the guidance of someone who understands the system, it’s possible to get taken advantage of as there are extensive legal businesses built around profiting from MVAs. In this post I’ll describe some of the most common injuries sustained during MVAs, as well as give you insight into the medico-legal process and how to make sure you get the care you deserve. 

Opt into MedPay

In Colorado it is state law every insurance company provides their drivers with a minimum $5,000 Medical Payments Coverage (MedPay) policy in addition to their automobile liability policy¹. MedPay should be included on any insurance policy by default and is against state law for an insurance company to deny a customer MedPay.  The $5,000 policy provides coverage for the driver, as well as the passengers in the insured driver’s car, regardless of which party is at fault. MedPay even covers you when you’re in a car that isn’t your own. Unlike other medical insurance, MedPay never carries a deductible or co-pay in the policy and is available immediately following the accident².  Colorado MedPay covers payments related to bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle.  Colorado MedPay can be used to cover accident related expenses such as emergency or trauma care, ambulance rides, emergency room care, imaging services (X-rays, CT scans, or MRI’s), and conservative care treatments from chiropractors, massage therapists, and physical therapists. 

Despite being mandated by Colorado state law, some insurance companies find ways to avoid providing their customers with the required $5,000 MedPay coverage. I’ve had numerous patients tell me they unknowingly opted out of their MedPay coverage before being told what the payment meant or included. Insurance companies in Colorado are required to include MedPay by default into any new policy, however, if you’ve opted out in the past, the insurance company is not required to remind you of MedPay or to ask if you want to opt in. If you use MedPay for an accident where you were not at fault your insurance company cannot raise your premium following the accident. I highly recommend calling your insurance agent today and making sure you have not opted out of MedPay. MedPay should be of little or no extra cost to your policy, and will provide you with much needed, immediately available funds following an accident.  

Common injury patterns with MVAs

The injuries sustained in even minor MVAs can be severe. Many patients I’ve treated for a MVA report little to no pain the day of the accident, with symptoms hitting them hard the following morning. The shock involved with being in an accident is one explanation for the latency of symptoms, and oftentimes the brain is focused less on pain in the body and more on the financial and legal implications of the accident. Pain typically starts in the spine, with symptoms radiating down the extremities as the full effects of the injury are realized. I recommend waiting 2-3 days following a MVA to receive treatment. Waiting will ensure the treating physician gets the full picture of your injuries and can determine the appropriate treatment approach.  

The most common type of injury sustained during a MVA is a whiplash type injury.  Whiplash involves a sudden acceleration – deceleration force on the spine and muscles.  Cervical acceleration – deceleration injuries are very common in MVAs and the whiplash injury causes tearing of muscle and ligament fibers. The muscles damaged in a cervical acceleration – deceleration injury are typically the cervical deep neck flexors which include the longus colli, longus capitis, and also the sternocleidomastoid. These muscles are extremely important for normal biomechanical function of the cervical spine. Weakness and inhibition of these muscles due to injury can lead to instability in the cervical spine and poor healing outcomes. Exercises targeting the function of these muscles are critical following a MVA and the guidance of a trained therapist is recommended to determine which exercises will be most beneficial.  

Concussion

Concussions are another possibility after a MVA and are most often associated with a blunt force trauma to the head against the steering wheel, dash, side window, or even an airbag.  If the patient lost consciousness due to head trauma and post concussive symptoms are severe, a CT is recommended to rule out a more serious pathology such as an internal hemorrhage inside the brain. Any concussion, no matter how severe, deserves attention. Less severe cases warrant a neurologic examination by a trained therapist to assess for damage to the brain, spinal cord, or peripheral nerves. Some of the assessments used include a cranial nerve examination, ocular examination, and a high index neurologic exam that includes skin sensation, muscle testing, and deep tendon reflexes. The patient should also be taken through a verbal Sport Concussion Assessment Tool (SCAT 5) which helps determine severity of concussion and also to track treatment progress. Treatment of concussions often requires a nutritional component and an anti-inflammatory diet free of refined sugar and highly processed vegetable oils. High dose EPA/DHA from fish oil and vitamin D is also recommended to help heal brain tissue. Finally, our clinic uses a class 2 therapeutic infrared laser that can safely penetrate the skull and help to heal brain tissue via mitochondrial upregulation.  

How long will it take to get better?

Tissue healing times are different for every patient and depend on age, injury history, genetics, nutrition, and lifestyle status. The severity of the accident and associated discrepancies in physical forces placed on the body are also a factor. As a general rule, the below gives the healing times for different tissue in the body which may be injured in a MVA³: 

Muscle Strain (Grade 1): 0-2 wk

Muscle Strain (Grade 2): 4d-3mo

Muscle Strain (Grade 3): 3wk-6mo

Ligament Sprain (Grade 1): 0-3d

Ligament Sprain (Grade 2): 3wk-6mo

Ligament Sprain (Grade 3): 5wk-1yr

Bone: 5wk-3mo

Many insurance companies try to fit every client into the same recovery timeline which is not realistic. If you are still in pain and someone handling your case says you need to be finished with care, advocate for yourself and demand the care you need. 

At our clinic we use passive therapies such as acupuncture/dry needling, active release technique, therapeutic laser, cupping, and instrument assisted soft tissue manipulation among others to help you heal faster. We also use a wide variety of physical rehabilitation exercises to treat the specific deficits caused by the MVA. The focus of care after a MVA is to build strength, stability, and resilience in the cervical and lumbar spine and other body regions affected by the accident. Our goal is to make the patient stronger and more functional than they were before the accident.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here

Sources and References

  1. Colorado Revised Statutes Title 10. Insurance § 10-4-636. Disclosure requirements for automobile insurance products offered–rules.
  2. Med Pay Insurance in Colorado.
  3. Potential Applications of Hyaluronans in Orthopaedics.

One of the questions I frequently ask my patients is whether or not they self adjust their spines. Self adjusting refers to cracking or popping your own joints by twisting and rotating your spine. Many patients answer yes to this question, and often say it is something they are unconsciously doing. Most people find temporary symptomatic relief when they self adjust their own necks or low backs, but what are some of the long term orthopedic consequences of self adjusting your spine? 

What is self adjusting? 

Self adjusting of the spine is when an individual twists or rotates their spine to a sufficient degree some of the joints in the area pop or what chiropractors refer to as ‘cavitate’.  The ‘cavitation’ is essentially noise made by small bubbles popping within the synovial fluid of your joints and is completely safe. Individuals who self adjust may experience temporary relief with self adjusting because the mechanical stimulation of the joint popped momentarily blocks pain, tension, and tightness signals being sent to the brain.  Muscles around the joint will temporarily relax as well.  These all sound like positive outcomes, however, they are only temporary and typically last 5 to 10 minutes.  The long term orthopedic consequences of self adjusting last much longer and are more damaging to your spinal health.  

What is the problem with self adjusting?

The problem with self adjusting is when an individual adjusts their own spine, they lack the specificity to adjust the joints actually needing to be adjusted.  Chiropractors are specifically trained to feel or ‘motion palpate’ joints and assess their ability to move in the directions they are designed to. Once a chiropractor identifies a joint is not moving properly or ‘restricted’, the chiropractor applies a high velocity low amplitude (HVLA) thrust to the specific joint in the direction it is not moving. Learning the skills of motion palpation and adjusting take years to master and should only be performed by trained professionals. 

You are not adjusting the joints needing it the most when you self adjust. In fact, the joints popping are likely ones already moving too much! We call joints moving too much ‘hypermobile joints’ and these joints lack control of movement and muscular stability. Chiropractors identify ‘hypomobile joints’ or joints not moving enough, and adjust these joints to restore normal movement. The problem with adjusting the hypermobile joints with self adjustments is when you pop these joints you make them more hypermobile. Muscles surrounding a hypermobile joint have to work harder to stabilize the joint, and patterns of muscular pain, tension and tightness often arise. Additionally, adjusting hypermobile joints will make any adjacent hypomobile joints even more restricted. Over time, self adjusting will cause severe imbalances in the spine and decrease the spine’s ability to withstand the compressive forces of life and sport.  The result is more serious conditions such as disc herniation, nerve compression, and severe instability among other serious spinal pathologies. Repetitive self adjustments in the neck can lead to chronic tension type headaches and migraines. In summary, adjusting your own spine will make the hypermobile or unstable joints move even more, and it will cause the hypomobile or restricted joints to be even tighter.

What should I do instead? 

If there is an area of your spine feeling like it constantly needs to be adjusted, I would recommend consulting with a chiropractor trained in motion palpation and functional movement assessment. This individual can determine which areas of your spine need to be adjusted, and which areas need to be stabilized. In general, hypermobile joints are moving too much and need to be stabilized with a functional exercise focused on improving muscular control around the joint. Hypomobile joints need to be adjusted by a chiropractor in the specific direction of movement they are lacking. So remember, please think twice before the next time you are about to self adjust your neck or low back!

Post written by Dr. Riley Kulm, DC.  Check out his bio here.