'Bad' Cholesterol Not as Bad as People Think, Study Shows

ScienceDaily (May 8, 2011) — The so-called "bad cholesterol" -- low-density lipoprotein commonly called LDL -- may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise.

Steve Riechman, a researcher in the Department of Health and Kinesiology, says the study reveals that LDL is not the evil Darth Vader of health it has been made out to be in recent years and that new attitudes need to be adopted in regards to the substance. His work, with help from colleagues from the University of Pittsburgh, Kent State University, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, is published in the Journal of Gerontology.

Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, "a very unexpected result and one that surprised us.

"It shows that you do need a certain amount of LDL to gain more muscle mass. There's no doubt you need both -- the LDL and the HDL -- and the truth is, it (cholesterol) is all good. You simply can't remove all the 'bad' cholesterol from your body without serious problems occurring.

Cholesterol is found in all humans and is a type of fat around the body. A person's total cholesterol level comprises LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol.

LDL is almost always referred to as the "bad" cholesterol because it tends to build up in the walls of arteries, causing a slowing of the blood flow which often leads to heart disease and heart attacks.

HDL, usually called the "good cholesterol," often helps remove cholesterol from arteries.

"But here is where people tend to get things wrong," Riechman says.

"LDL serves a very useful purpose. It acts as a warning sign that something is wrong and it signals the body to these warning signs. It does its job the way it is supposed to.

"People often say, 'I want to get rid of all my bad (LDL) cholesterol,' but the fact is, if you did so, you would die," the Texas A&M professor adds. "Everyone needs a certain amount of both LDL and HDL in their bodies. We need to change this idea of LDL always being the evil thing -- we all need it, and we need it to do its job."

According to the American Heart Association, about 36 million American adults have high cholesterol levels.

"Our tissues need cholesterol, and LDL delivers it," he notes. "HDL, the good cholesterol, cleans up after the repair is done. And the more LDL you have in your blood, the better you are able to build muscle during resistance training."

Riechman says the study could be helpful in looking at a condition called sarcopenia, which is muscle loss due to aging. Previous studies show muscle is usually lost at a rate of 5 percent per decade after the age of 40, a huge concern since muscle mass is the major determinant of physical strength. After the age of 60, the prevalence of moderate to severe sarcopenia is found in about 65 percent of all men and about 30 percent of all women, and it accounts for more than $18 billion of health care costs in the United States.

"The bottom line is that LDL -- the bad cholesterol -- serves as a reminder that something is wrong and we need to find out what it is," Riechman says.

"It gives us warning signs. Is smoking the problem, is it diet, is it lack of exercise that a person's cholesterol is too high? It plays a very useful role, does the job it was intended to do, and we need to back off by always calling it 'bad' cholesterol because it is not totally bad."

ScienceDaily (May 8, 2011) — The so-called "bad cholesterol" -- low-density lipoprotein commonly called LDL -- may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise.

Steve Riechman, a researcher in the Department of Health and Kinesiology, says the study reveals that LDL is not the evil Darth Vader of health it has been made out to be in recent years and that new attitudes need to be adopted in regards to the substance. His work, with help from colleagues from the University of Pittsburgh, Kent State University, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, is published in the Journal of Gerontology.

Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, "a very unexpected result and one that surprised us.

"It shows that you do need a certain amount of LDL to gain more muscle mass. There's no doubt you need both -- the LDL and the HDL -- and the truth is, it (cholesterol) is all good. You simply can't remove all the 'bad' cholesterol from your body without serious problems occurring.

Cholesterol is found in all humans and is a type of fat around the body. A person's total cholesterol level comprises LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol.

LDL is almost always referred to as the "bad" cholesterol because it tends to build up in the walls of arteries, causing a slowing of the blood flow which often leads to heart disease and heart attacks.

HDL, usually called the "good cholesterol," often helps remove cholesterol from arteries.

"But here is where people tend to get things wrong," Riechman says.

"LDL serves a very useful purpose. It acts as a warning sign that something is wrong and it signals the body to these warning signs. It does its job the way it is supposed to.

"People often say, 'I want to get rid of all my bad (LDL) cholesterol,' but the fact is, if you did so, you would die," the Texas A&M professor adds. "Everyone needs a certain amount of both LDL and HDL in their bodies. We need to change this idea of LDL always being the evil thing -- we all need it, and we need it to do its job."

According to the American Heart Association, about 36 million American adults have high cholesterol levels.

"Our tissues need cholesterol, and LDL delivers it," he notes. "HDL, the good cholesterol, cleans up after the repair is done. And the more LDL you have in your blood, the better you are able to build muscle during resistance training."

Riechman says the study could be helpful in looking at a condition called sarcopenia, which is muscle loss due to aging. Previous studies show muscle is usually lost at a rate of 5 percent per decade after the age of 40, a huge concern since muscle mass is the major determinant of physical strength. After the age of 60, the prevalence of moderate to severe sarcopenia is found in about 65 percent of all men and about 30 percent of all women, and it accounts for more than $18 billion of health care costs in the United States.

"The bottom line is that LDL -- the bad cholesterol -- serves as a reminder that something is wrong and we need to find out what it is," Riechman says.

"It gives us warning signs. Is smoking the problem, is it diet, is it lack of exercise that a person's cholesterol is too high? It plays a very useful role, does the job it was intended to do, and we need to back off by always calling it 'bad' cholesterol because it is not totally bad."

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Why Wood Pulp Makes Ice Cream Creamier

What is often in shredded cheese besides cheese?

Powdered cellulose: minuscule pieces of wood pulp or other plant fibers that coat the cheese and keep it from clumping by blocking out moisture.

One of an array of factory-made additives, cellulose is increasingly used by the processed-food industry, producers say. Food-product makers use it to thicken or stabilize foods, replace fat and boost fiber content, and cut the need for ingredients like oil or flour, which are getting more expensive.

Cellulose products, gums and fibers allow food manufactures to offer white bread with high dietary fiber content, low-fat ice cream that still feels creamy on the tongue, and allow cooks to sprinkle cheese over their dinner without taking time to shred.

Cellulose additives belong to a family of substances known as hydrocolloids that act in various ways with water, such as creating gels.

The rising cost of raw materials like flour, sugar and oil is helping boost the popularity of these additives, producers of the ingredients say.

Demand for cellulose is also rising because of the growing popularity of processed food products in China, India and other countries, and because consumers are demanding low-fat or nonfat foods that still have a creamy texture.

While some food manufactures say they aren't increasing the percentage of cellulose in their products, others are boosting the amount of fiber in their foods with cellulose and other ingredients. Companies can save money by using it, even though it costs more by weight than conventional ingredients. Cellulose gives food "more water, more air, a creamy feeling in [the] mouth with less of other ingredients," and only a very small amount is needed, says Niels Thestrup, vice president of the hydrocolloids department for Danisco AS. The Copenhagen-based company makes ingredients and enzymes for food, cleaning supplies and other products.

Cellulose is especially popular because it can be used in many ways in food and is relatively inexpensive at about $2.50 to $3 a pound for one type his company makes, says Mr. Thestrup. The company's sales of hydrocolloids had been rising 3% to 5% a year over the past decade, but in the past two years, sales are up about 6% to 8%.

Even organic-food products can contain cellulose.

Organic Valley uses powdered cellulose made from wood pulp in its shredded-cheese products. The company would prefer not to use a synthetic ingredient, but cellulose is bland, white and repels moisture, making it the favored choice over products such as potato starch, says Tripp Hughes, director of product marketing for Organic Valley.

Only powdered cellulose in its least manipulated form can be used in foods labeled "organic" or "made with organic" ingredients by the U.S. Department of Agriculture.

Cellulose comes in various forms, each with a specific use. Beyond powdered cellulose, two other modified forms are common in food. Microcrystalline cellulose is either listed as such on labels, as MCC, or in some cases as cellulose gel. Carboxymethyl cellulose or cellulose gum, another modified version, is listed as such on labels. Each gives foods a slightly different texture—from gelatinous to more liquid-like—because they trap varying amounts of air or water.

Powdered cellulose is made by cooking raw plant fiber—usually wood—in various chemicals to separate the cellulose, and then purified. Modified versions go through extra processing, such as exposing them to acid to further break down the fiber.

What is often in shredded cheese besides cheese?

Powdered cellulose: minuscule pieces of wood pulp or other plant fibers that coat the cheese and keep it from clumping by blocking out moisture.

One of an array of factory-made additives, cellulose is increasingly used by the processed-food industry, producers say. Food-product makers use it to thicken or stabilize foods, replace fat and boost fiber content, and cut the need for ingredients like oil or flour, which are getting more expensive.

Cellulose products, gums and fibers allow food manufactures to offer white bread with high dietary fiber content, low-fat ice cream that still feels creamy on the tongue, and allow cooks to sprinkle cheese over their dinner without taking time to shred.

Cellulose additives belong to a family of substances known as hydrocolloids that act in various ways with water, such as creating gels.

The rising cost of raw materials like flour, sugar and oil is helping boost the popularity of these additives, producers of the ingredients say.

Demand for cellulose is also rising because of the growing popularity of processed food products in China, India and other countries, and because consumers are demanding low-fat or nonfat foods that still have a creamy texture.

While some food manufactures say they aren't increasing the percentage of cellulose in their products, others are boosting the amount of fiber in their foods with cellulose and other ingredients. Companies can save money by using it, even though it costs more by weight than conventional ingredients. Cellulose gives food "more water, more air, a creamy feeling in [the] mouth with less of other ingredients," and only a very small amount is needed, says Niels Thestrup, vice president of the hydrocolloids department for Danisco AS. The Copenhagen-based company makes ingredients and enzymes for food, cleaning supplies and other products.

Cellulose is especially popular because it can be used in many ways in food and is relatively inexpensive at about $2.50 to $3 a pound for one type his company makes, says Mr. Thestrup. The company's sales of hydrocolloids had been rising 3% to 5% a year over the past decade, but in the past two years, sales are up about 6% to 8%.

Even organic-food products can contain cellulose.

Organic Valley uses powdered cellulose made from wood pulp in its shredded-cheese products. The company would prefer not to use a synthetic ingredient, but cellulose is bland, white and repels moisture, making it the favored choice over products such as potato starch, says Tripp Hughes, director of product marketing for Organic Valley.

Only powdered cellulose in its least manipulated form can be used in foods labeled "organic" or "made with organic" ingredients by the U.S. Department of Agriculture.

Cellulose comes in various forms, each with a specific use. Beyond powdered cellulose, two other modified forms are common in food. Microcrystalline cellulose is either listed as such on labels, as MCC, or in some cases as cellulose gel. Carboxymethyl cellulose or cellulose gum, another modified version, is listed as such on labels. Each gives foods a slightly different texture—from gelatinous to more liquid-like—because they trap varying amounts of air or water.

Powdered cellulose is made by cooking raw plant fiber—usually wood—in various chemicals to separate the cellulose, and then purified. Modified versions go through extra processing, such as exposing them to acid to further break down the fiber.

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Lack of sleep found to be a new risk factor for colon cancer

An inadequate amount of sleep has been associated with higher risks of obesity, heart disease, diabetes, and death. Now colon cancer can be added to the list.

In a ground-breaking new study published in the Feb. 15, 2011 issue of the journal Cancer, researchers from University Hospitals (UH) Case Medical Center and Case Western Reserve University School of Medicine, found that individuals who averaged less than six hours of sleep at night had an almost 50 percent increase in the risk of colorectal adenomas compared with individuals sleeping at least seven hours per night. Adenomas are a precursor to cancer tumors, and left untreated, they can turn malignant.

"To our knowledge, this is the first study to report a significant association of sleep duration and colorectal adenomas," said Li Li, MD, PhD, the study's principal investigator, family medicine physician in the Department of Family Medicine at UH Case Medical Center and Associate Professor of Family Medicine, Epidemiology and Biostatistics at Case Western Reserve University School of Medicine. "A short amount of sleep can now be viewed as a new risk factor for the development of the development of colon cancer."

In the study, patients were surveyed by phone prior to coming into the hospital for scheduled colonoscopies at UH Case Medical Center. They were asked demographic information as well as questions from the Pittsburg Sleep Quality Index (PSQI), which obtains information about the patient's overall sleep quality during the past month. The PSQI asks for such information as how frequently one has trouble sleeping and how much sleep one has had per night. The study was funded by the National Cancer Institute through Case Western Reserve University School of Medicine.

Of the 1,240 patients, 338 were diagnosed with colorectal adenomas at their colonoscopy. The patients with adenomas were found in general to have reported sleeping less than six hours compared to compared to those patients without adenomas (control) patients, and the association between amount of sleep and adenomas remained even when adjusted for family history, smoking, and waist-to-hip ratio (a measurement of obesity).

The researchers also found a slightly stronger association of sleep duration with adenomas with women compared to men, but the difference was not statistically significant.

Dr Li said the magnitude of the increase in risk due to less hours of sleep is comparable to the risk associated with having a first-degree relative (parent or sibling) with colon cancer, as well as with high, red meat intake. "Short sleep duration is a public health hazard leading not only to obesity, diabetes and coronary heart disease, but also, as we now have shown in this study, colon adenomas," he said. "Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for prevention of colorectal cancer."

Although why fewer hours of sleep may lead to colon cancer is unknown, Dr. Li said some of theories include that less sleep may mean less production of melatonin, a natural hormone that in animals has been linked to DNA repair, or that insulin resistance may underlie the link between sleep disturbance and cancer development.

An inadequate amount of sleep has been associated with higher risks of obesity, heart disease, diabetes, and death. Now colon cancer can be added to the list.

In a ground-breaking new study published in the Feb. 15, 2011 issue of the journal Cancer, researchers from University Hospitals (UH) Case Medical Center and Case Western Reserve University School of Medicine, found that individuals who averaged less than six hours of sleep at night had an almost 50 percent increase in the risk of colorectal adenomas compared with individuals sleeping at least seven hours per night. Adenomas are a precursor to cancer tumors, and left untreated, they can turn malignant.

"To our knowledge, this is the first study to report a significant association of sleep duration and colorectal adenomas," said Li Li, MD, PhD, the study's principal investigator, family medicine physician in the Department of Family Medicine at UH Case Medical Center and Associate Professor of Family Medicine, Epidemiology and Biostatistics at Case Western Reserve University School of Medicine. "A short amount of sleep can now be viewed as a new risk factor for the development of the development of colon cancer."

In the study, patients were surveyed by phone prior to coming into the hospital for scheduled colonoscopies at UH Case Medical Center. They were asked demographic information as well as questions from the Pittsburg Sleep Quality Index (PSQI), which obtains information about the patient's overall sleep quality during the past month. The PSQI asks for such information as how frequently one has trouble sleeping and how much sleep one has had per night. The study was funded by the National Cancer Institute through Case Western Reserve University School of Medicine.

Of the 1,240 patients, 338 were diagnosed with colorectal adenomas at their colonoscopy. The patients with adenomas were found in general to have reported sleeping less than six hours compared to compared to those patients without adenomas (control) patients, and the association between amount of sleep and adenomas remained even when adjusted for family history, smoking, and waist-to-hip ratio (a measurement of obesity).

The researchers also found a slightly stronger association of sleep duration with adenomas with women compared to men, but the difference was not statistically significant.

Dr Li said the magnitude of the increase in risk due to less hours of sleep is comparable to the risk associated with having a first-degree relative (parent or sibling) with colon cancer, as well as with high, red meat intake. "Short sleep duration is a public health hazard leading not only to obesity, diabetes and coronary heart disease, but also, as we now have shown in this study, colon adenomas," he said. "Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for prevention of colorectal cancer."

Although why fewer hours of sleep may lead to colon cancer is unknown, Dr. Li said some of theories include that less sleep may mean less production of melatonin, a natural hormone that in animals has been linked to DNA repair, or that insulin resistance may underlie the link between sleep disturbance and cancer development.

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Does Soda Cause Gout?

Sugary sodas have recently been implicated in everything from obesity to high blood pressure. But if you’re worried about gout, it may be especially important to steer clear of the sweet stuff.

Ongoing research has examined the relationship between rising soft drink consumption and an increase in gout. Consider this: The number of people with gout back in the 1970s was 20 per 100,000. By the mid-1990s, that number had more than doubled to 45.9 per 100,000. Likewise, soda consumption among adults rose by 61 percent from 1977 to 1997.

This link between soda intake and gout makes sense since the "source of almost all of the sweetness in sugary drinks comes from fructose — and fructose elevates uric acid levels, [leading to] gout," explains Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine. Dr. Choi also points out that fructose is used to make high-fructose corn syrup, a substance commonly used to sweeten many foods and beverages besides soda.

Soda and Gout: The Link

Uric acid is usually filtered by the kidneys and excreted from your body in your urine. Gout occurs when uric acid builds up in the blood, causing uric acid crystals to form in one or more joints and leading to intense pain and swelling. There are a number of factors that can cause elevated uric acid levels, including heavy fructose consumption.

Choi's research has shown that study participants who consumed two or more servings of sugar- or fructose-sweetened soda each day had an 85 percent increased risk of developing gout, compared with participants who consumed less than one serving of sugary soda per month. Even sugary fruit juice, such as orange juice, raises the risk.

If diet soda is your vice, you may not have to worry as much about developing gout. "With diet soda, we did not find the association," Choi says.

Choi and his colleagues did find a slight increase in gout risk with consuming high-fructose fruits, such as apples and oranges. However, Choi emphasizes, artificially added fructose found in soda is linked to a higher risk of gout than naturally occurring sources of fructose like fruit.

Soda and Gout: What This Means for You

Traditionally, gout prevention strategies have focused on limiting protein-rich foods and alcohol, which can encourage uric acid accumulation in the body. This new research, however, suggests that cutting back on soda consumption may be just as important in preventing future gout attacks.

Also keep in mind that in the United States, the biggest single source of calories is soda sweetened with sugar or fructose. This means that beyond reducing your risk of developing gout, avoiding the empty calories in soda may also help you shed excess weight and keep your blood sugar levels in check. So instead of reaching for another soda or sugar-sweetened drink at your next meal, opt for water instead — your joints will thank you.

Sugary sodas have recently been implicated in everything from obesity to high blood pressure. But if you’re worried about gout, it may be especially important to steer clear of the sweet stuff.

Ongoing research has examined the relationship between rising soft drink consumption and an increase in gout. Consider this: The number of people with gout back in the 1970s was 20 per 100,000. By the mid-1990s, that number had more than doubled to 45.9 per 100,000. Likewise, soda consumption among adults rose by 61 percent from 1977 to 1997.

This link between soda intake and gout makes sense since the "source of almost all of the sweetness in sugary drinks comes from fructose — and fructose elevates uric acid levels, [leading to] gout," explains Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine. Dr. Choi also points out that fructose is used to make high-fructose corn syrup, a substance commonly used to sweeten many foods and beverages besides soda.

Soda and Gout: The Link

Uric acid is usually filtered by the kidneys and excreted from your body in your urine. Gout occurs when uric acid builds up in the blood, causing uric acid crystals to form in one or more joints and leading to intense pain and swelling. There are a number of factors that can cause elevated uric acid levels, including heavy fructose consumption.

Choi's research has shown that study participants who consumed two or more servings of sugar- or fructose-sweetened soda each day had an 85 percent increased risk of developing gout, compared with participants who consumed less than one serving of sugary soda per month. Even sugary fruit juice, such as orange juice, raises the risk.

If diet soda is your vice, you may not have to worry as much about developing gout. "With diet soda, we did not find the association," Choi says.

Choi and his colleagues did find a slight increase in gout risk with consuming high-fructose fruits, such as apples and oranges. However, Choi emphasizes, artificially added fructose found in soda is linked to a higher risk of gout than naturally occurring sources of fructose like fruit.

Soda and Gout: What This Means for You

Traditionally, gout prevention strategies have focused on limiting protein-rich foods and alcohol, which can encourage uric acid accumulation in the body. This new research, however, suggests that cutting back on soda consumption may be just as important in preventing future gout attacks.

Also keep in mind that in the United States, the biggest single source of calories is soda sweetened with sugar or fructose. This means that beyond reducing your risk of developing gout, avoiding the empty calories in soda may also help you shed excess weight and keep your blood sugar levels in check. So instead of reaching for another soda or sugar-sweetened drink at your next meal, opt for water instead — your joints will thank you.

Read More

Pain Assessment in Cats

Brondani JT, Luna SPL, Padovani CR: Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats, Am J Vet Res 72:174, 2011

The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

Hellyer P, Rodan I, Brunt J et al: AAHA/AAFP pain management guidelines for dogs and cats, J Feline Med Surg 9:466, 2007.

More on cat health: Winn Feline Foundation Library

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Brondani JT, Luna SPL, Padovani CR: Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats, Am J Vet Res 72:174, 2011

The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

Hellyer P, Rodan I, Brunt J et al: AAHA/AAFP pain management guidelines for dogs and cats, J Feline Med Surg 9:466, 2007.

More on cat health: Winn Feline Foundation Library

Join us on Facebook

Follow us on Twitter

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Chiropractic Management of Pain in a Young Scoliosis Patient

By Nancy Martin-Molina, DC, QME, MBA

Case History

The patient is a 14-year-old girl with a recent diagnosis of scoliosis received on medical referral.

She reports her actual pain onset started at menarche around 11-12 years of age, worsening in the past 6-9 months, during which time she underwent a growth spurt.  Written parental consent is obtained and an initial evaluation is provided with radiographic spinal record review performed. She hand-carried her medical radiograph report, dated six months prior.

The patient's complaint on pain drawing is neck / mid-back / low back / midline; the pain level was rated as a 6-7/10; severe on a scale of 1-10 with 10 being severe pain with moderate interference in activities of daily living. The quality of the pain is as follows: aches at suboccipital to upper dorsal, stabbing intrascapular, aches low back. Provocative: daily ADL. Palliative: nothing; mother has tried administering Tylenol. Source: oral history and pain.

Evaluation & Findings

Clinical evaluation showed a tall, thin female with significant right convex kyphoscoliosis, left convex lumbar with hyperlordosis, and generalized weakness, especially around the pelvic and shoulder girdles. Spinal listings detected at vertebral levels C2/3, T4/T5, L3 and PSI. Allis testing was negative for femoral shortening. Measurements: Umbilicus to medial knee: L 23," R 23." Sensation is normal on light touch and to vibration and light prick. Negative Romberg. Tandem gait intact. Coordination is normal on heel-shin, finger-nose and rapid alternating.

Radiological views submitted from outside imaging included posterior and lateral projected views of thoracolumbar; revealed 12-degree dextroscoliosis with apex at T10-11, Levoscoliosis of lumbar spine with apex at L3-L4.

Treatment Plan

I discussed my findings in detail with the patient and parent utilizing charts and diagrams. I recommended that the mother purchase a gym ball; they are available in most retail outlets for home use and assist in maintaining normal flexibility in a scoliotic spine.

The frequency of radiographic monitoring is also important for achieving maximal correction. We are now recommending routine radiographs every six months to monitor for any curvature progression beyond its current degrees. Should a rapid increase in curvature or decrease in flexibility occur, a neurological referral may be indicated. (Most often, curvatures of this type do not involve the viscera, but may in the event of any growth spurts; it may progress before full skeletal maturation occurs.)

I also discussed the importance of good posture and continuity of exercises designed for curve flexibility. As the patient is a typical young female teenager overtly concerned with body image, I warned against performing any abdominal exercises whereby both the psoas muscle and the back arching come into play. I also instructed on a particular order of abdominal muscle sequencing: lower abdominal work before upper abdominal work, and oblique abdominal work before straight abdominal work.

Medical IPA authorization from the medical director approved chiropractic manipulation at a frequency of 2-3 times/week for 4-6 weeks since spinal manipulation was not felt to be contraindicated. The patient reported a subjective pain reduction of 75 percent. This is a recognized and common response to chiropractic in that like any other joint, the motor segment may become locked. This is usually associated with pain. The patient was discharged after 18 sessions with good response and scheduled for follow-up in six months.

By Nancy Martin-Molina, DC, QME, MBA

Case History

The patient is a 14-year-old girl with a recent diagnosis of scoliosis received on medical referral.

She reports her actual pain onset started at menarche around 11-12 years of age, worsening in the past 6-9 months, during which time she underwent a growth spurt.  Written parental consent is obtained and an initial evaluation is provided with radiographic spinal record review performed. She hand-carried her medical radiograph report, dated six months prior.

The patient's complaint on pain drawing is neck / mid-back / low back / midline; the pain level was rated as a 6-7/10; severe on a scale of 1-10 with 10 being severe pain with moderate interference in activities of daily living. The quality of the pain is as follows: aches at suboccipital to upper dorsal, stabbing intrascapular, aches low back. Provocative: daily ADL. Palliative: nothing; mother has tried administering Tylenol. Source: oral history and pain.

Evaluation & Findings

Clinical evaluation showed a tall, thin female with significant right convex kyphoscoliosis, left convex lumbar with hyperlordosis, and generalized weakness, especially around the pelvic and shoulder girdles. Spinal listings detected at vertebral levels C2/3, T4/T5, L3 and PSI. Allis testing was negative for femoral shortening. Measurements: Umbilicus to medial knee: L 23," R 23." Sensation is normal on light touch and to vibration and light prick. Negative Romberg. Tandem gait intact. Coordination is normal on heel-shin, finger-nose and rapid alternating.

Radiological views submitted from outside imaging included posterior and lateral projected views of thoracolumbar; revealed 12-degree dextroscoliosis with apex at T10-11, Levoscoliosis of lumbar spine with apex at L3-L4.

Treatment Plan

I discussed my findings in detail with the patient and parent utilizing charts and diagrams. I recommended that the mother purchase a gym ball; they are available in most retail outlets for home use and assist in maintaining normal flexibility in a scoliotic spine.

The frequency of radiographic monitoring is also important for achieving maximal correction. We are now recommending routine radiographs every six months to monitor for any curvature progression beyond its current degrees. Should a rapid increase in curvature or decrease in flexibility occur, a neurological referral may be indicated. (Most often, curvatures of this type do not involve the viscera, but may in the event of any growth spurts; it may progress before full skeletal maturation occurs.)

I also discussed the importance of good posture and continuity of exercises designed for curve flexibility. As the patient is a typical young female teenager overtly concerned with body image, I warned against performing any abdominal exercises whereby both the psoas muscle and the back arching come into play. I also instructed on a particular order of abdominal muscle sequencing: lower abdominal work before upper abdominal work, and oblique abdominal work before straight abdominal work.

Medical IPA authorization from the medical director approved chiropractic manipulation at a frequency of 2-3 times/week for 4-6 weeks since spinal manipulation was not felt to be contraindicated. The patient reported a subjective pain reduction of 75 percent. This is a recognized and common response to chiropractic in that like any other joint, the motor segment may become locked. This is usually associated with pain. The patient was discharged after 18 sessions with good response and scheduled for follow-up in six months.

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Scoliosis Prevalence Increases With Age

The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

THURSDAY, April 28 (HealthDay News) -- The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

Khaled M. Kebaish, M.D., from Johns Hopkins University in Baltimore, and colleagues examined the prevalence of lumbar scoliosis in adults aged 40 years or older; the association between prevalence of lumbar scoliosis and age, race, and gender; and whether these factors affect curve severity. The presence of scoliosis, defined by a curvature greater than or equal to 11.0 degrees, was ascertained by digitally measuring Cobb angles using dual-energy X-ray absorptiometry lumbar spine images of 2,973 patients without a history of previous lumbar spinal surgery.

The investigators identified scoliosis in 263 individuals. A higher prevalence of scoliosis was related to age (40 to 50 years old, 3.14 percent; ≥90 years old, 50 percent), and varied among races (11.11 percent in whites, 6.49 percent in African-Americans). There was no association between the prevalence of scoliosis and gender. Curve severity was mild in most patients (80.6 percent), with no variation due to gender or age. African-Americans were more likely than other races to have mild curves (94.3 percent).

"The prevalence of scoliosis in our patients ≥40 years old was 8.85 percent and was associated with age and race, but not with gender. Most curves in our population were mild; curve severity was associated with race but not with age or gender," the authors write.

The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

THURSDAY, April 28 (HealthDay News) -- The prevalence of scoliosis increases with advancing age, with a higher prevalence in whites, according to a study published in the April 20 issue of Spine.

Khaled M. Kebaish, M.D., from Johns Hopkins University in Baltimore, and colleagues examined the prevalence of lumbar scoliosis in adults aged 40 years or older; the association between prevalence of lumbar scoliosis and age, race, and gender; and whether these factors affect curve severity. The presence of scoliosis, defined by a curvature greater than or equal to 11.0 degrees, was ascertained by digitally measuring Cobb angles using dual-energy X-ray absorptiometry lumbar spine images of 2,973 patients without a history of previous lumbar spinal surgery.

The investigators identified scoliosis in 263 individuals. A higher prevalence of scoliosis was related to age (40 to 50 years old, 3.14 percent; ≥90 years old, 50 percent), and varied among races (11.11 percent in whites, 6.49 percent in African-Americans). There was no association between the prevalence of scoliosis and gender. Curve severity was mild in most patients (80.6 percent), with no variation due to gender or age. African-Americans were more likely than other races to have mild curves (94.3 percent).

"The prevalence of scoliosis in our patients ≥40 years old was 8.85 percent and was associated with age and race, but not with gender. Most curves in our population were mild; curve severity was associated with race but not with age or gender," the authors write.

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