Having Orthopedic Surgery? You NEED to Know this Scary Risk

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Everyone knows that there are risks associated with any surgery. But the risks that you know about are the obvious ones.

Problems with the anesthesia such as aspiration pneumonitis or respiratory failure.  Problems with the surgery itself such as excessive blood loss, damaging the spinal cord or spinal nerves, infection or blood clots.

But what if there was something more insidious that can occur?  Something that won’t kill you today or tomorrow, but waits in the shadows until years later?

Before I tell you what this scary thing is, I do need to point out that there is a time and a place for orthopedic surgery.  But this should only be considered as an absolute last option.  All too often we THINK something is a last option.

But time and time again research proves that this is just not true.  Some examples:

• More people are having knee replacements, but NOT because of more arthritis
• Most people with a torn knee meniscus will not need surgery
• Arthritis of the spine is not directly related to pain and should NOT be a reason for surgery
• After one year, sciatic patients who have no surgery fare no better than those who do
• Chronic low back pain patients who had fusion fare no better than those who don’t

This list is much longer, but you get the idea.  There are an uncountable number of orthopedic surgeries done every year that were unnecessary.  Which would be fine if there weren’t dangerous risks associated with orthopedic surgery and the chance that you will be no better after the surgery, or worse, in more pain after the surgery.

Side note–these comments do not apply to trauma-induced orthopedic surgeries–in these cases there are usually no options for avoiding an emergency surgery after trauma.

All of this brings me to this particular study.  In it, researchers looked at a scary side effect of orthopedic surgery called myocardial necrosis.  As you may be able to tell from the name, this is a condition were the heart muscle dies as a result of the stress on the heart from the surgery.  This bad effect from surgery is well known and characterized for short term mortality after orthopedic surgery.

What is not as well-known is what happens in the long term.  To get a better idea of how often this happens, researchers looked at levels of troponin (a protein found in the heart; elevated troponin levels are a sign that damage to the heart has occurred) immediately after orthopedic surgery and whether this related to long term death in hip, knee, and spine surgery 3 years later.  Here’s the details:

• There were 3,050 surgeries with an average age of 60.8 years.
• Myocardial necrosis occurred in 179 cases (5.9%) and heart attacks in 20 (0.7%).
• In those patient who experienced myocardial necrosis, 16.8% of them did not survive in the long term (3 years).
• In those who had normal troponin levels around the time of surgery only 5.8% did not survive.
• To put it clearer, those orthopedic surgery patients who had higher levels of troponin were 233% more likely to die in the long term evaluation, while those who had a heart attack after the surgerys were 351% more likely to die.

Now certainly, if you had a heart attack just after your orthopedic surgery you’d know about it.  But myocardial necrosis may not have been fully explained to you if it had been identified.  Either way, if you DO end up having orthopedic surgery, it may makes sense to push your surgeon to run troponin levels along with everything else to get an idea about whether or not you’re going to be around in the next 3 years.

Seems simple enough.

 

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Obesity, Brown Fat and Being a Night Owl; What Glasses are YOU Wearing?

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It seems like there is a definite trend of families (both parents and kids) not getting to sleep at a decent hour.  There are lots of issues with this.

“Sure,” you say, “from the guy up at 11 PM starting to write a blog post.  I would be the first to admit that I probably don’t get enough sleep several nights a week.  (Which is why I start to blather towards the end of this article)  But the rest of my lifestyle is in line with what I recommend to my patients.

So why is lack of sleep a big deal?  For starters, there are some clear links between light maps of the United States and rates of breast cancer.  There are also links between lack of sleep and pretty much every single chronic disease.  And this includes obesity.

While the mechanism by which poor sleep contributes to chronic disease is not completely understood, there are a few things we do know:

1. By not getting enough sleep, we may not spend enough time in the deeper stages of sleep when tissue healing and memories are implanted.
2. Problems falling asleep may be due to stress and stress pretty much kills.  Enough said.
3. Melatonin is a hormone produced in the pineal gland deep in the brain when light on the blue end of the spectrum no longer strikes the retina.  Melatonin serves several purposes, but one of these is to act as an antioxidant in the brain, protecting it from damage.
4. None this even begins to address how much damage sleep apnea does to the body and brain.

This particular article gives us some additional insight but it takes it from a different angle.  Rather than looking at not getting enough sleep or when we go to bed, researchers asked to question about total light exposure’s effect on obesity.  In other words, how much light are you exposed to during the day.

If you think about it, we were really only designed to be exposed to light from the blue end of the spectrum during daylight hours.  Blue light tells our system that it is time to be awake and running around looking for food, shelter and a mate to club over the head and drag back to the cave.

The problem is that almost all of our electronic devices emit light at this end of the spectrum.  Cell phones, TVs, tablets, IPads, overhead lights.  They will all interfere with our sleep wake cycle.  Just in case you or your child stares at one of these devices anytime after sunset, you could consider trying one of the blue blocking glasses that can be found on Amazon by clicking here.  It’s a pretty small investment for something that could potentially make a big difference.

In the study, researchers exposed mice to a prolonged day lengths (16 and 24 hours instead of the regular 12 hours).  Here’s what happened:

• The was increased fat but not an increase in food intake or activity.
• This increased exposure to light led to a change in the activity of brown fat.  Brown fat is a literal fat-burning factory, burning calories only to make heat.

For those of you who have read some of my prior articles on brown fat, it really is something that we all want to have more of.  More brown fat = lower rates of obesity and diabetes.  Anything that is going to increase the amount of brown fat we have is generally a good thing, while anything that slows down the activity of or reduces the number of brown fat cells is a bad thing.

If you or your child are a night owl, could getting a pair of blue blocking glasses (or, better yet, shut down that IPad or TV…) actually keep you from gaining weight?  According to this study the answer may be yes.

 

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Steroids for your Disc Bulge and Sciatica-Good Science or Hoax?

Steroids for back and leg pain

When a patient goes to the ER, urgent care or a PCP before coming to our office for low back pain, I can almost always guess the drugs they were given.

Muscle relaxers, some version of opioids and either a steroid (such as a Medrol dosepak) or a strong anti-inflammatory (such as ibuprofen or naproxen) are pretty much the mainstays of treatments.  While I have a few providers in my area who will refer to our office at the slightest hint of low back pain, this still seems to be a rarity across medicine.

The approach taken is to use drugs first to see if this will help.  If the drugs don’t help, maybe some X-rays or MRIs will be ordered.  Or, if you’ve got a strong desire to develop some radiation-induced cancer, a couple of CT scans with some contrast thrown in is always good.  Then some pain management with injections which might include epidural steroid injections for localized back pain without any leg pain associated with it (this is almost always a bad scenario for epidurals).

Maybe.  Just maybe, at this point there will be a referral to a chiropractor.  Or surgeon.  Just depends on the treating physician.

Here’s the deal.  It is has been well established by one of the largest insurance companies in the US (if not the planet) that if a chiropractor is the first point of entry for any non-surgical spinal complaint there will be a cost savings and a better outcome (about 30% off the top of expenses).  But if a patient does NOT see a chiropractor first, chiropractic care is pretty rarely used and when it is it is brought in late in the game.

But this article isn’t strictly about chiropractic care.  It is more about WHY chiropractic care should be the first answer.

And this is mainly because all the other options I mentioned above just don’t seem to work well.  Even worse, they come with a long list of side effects that are likely to destroy the very tissues you are trying to protect.  Anti-inflammatories absolutely interfere with the healing process and damage a long list of other organs (if you’re really interested in finding out just how bad this class of drugs is, feel free to check out my eBook on Amazon by clicking here).

While muscle relaxers can certainly be addictive, so few patients really have bona fide muscle spasms.  What that means is that these drugs won’t fix anything, but they will make you not care in the meantime.

Epidurals increase the degeneration in your discs and will increase your likelihood of getting invasive spine surgery.

Which brings us to the steroids.  The side effects of steroids are pretty well known to patients.  Bone destruction, weight gain, diabetes, adrenal gland shutdown and destruction of tendons.  But these are all with short term use, right?  Not so.  Even a single dose of steroids will change the very DNA of the cells of your soft tissues, increasing the risk of a later rupture.

But side effects can be worth it if the benefit outweighs the risks.  And this particular article nicely outlines the strong LACK of a benefit in oral steroid use for back-related leg pain.  269 Adults with radicular pain (pain down the leg that is consistent with leg pain caused by a disc bulge) for less than 3 months and a herniated disk confirmed by MRI were given a tapering 15-day course of oral prednisone (5 days @ 60 mg, then 40 mg, and then 20 mg; total dose = 600 mg) or a placebo.  Here’s what happened:

• Oswestry scores (a questionnaire gauging how much your back pain interferes with your life) dropped 19 points and placebo 13.6 in 3-weeks.
• As far as leg pain, the steroid group improved 0.3 (out of 10) points after 3 weeks compared with the placebo group (0.6 more improvement at one year).
• The prednisone group improved by 3.3-points (out of 100) in the SF-36 PCS (a survery relating to how much pain is affecting your life) at 3 weeks with no difference at the one year mark.
• There were no differences in surgery rates at the one year mark.
• As expected, side effects were more 51% common with the steroids (49.2% vs 23.9%).

In other words, the steroids provided very little benefit for either short term (3 weeks) or long term (one year) pain or function.  If we then consider the fact that these steroids are damaging the tissues surrounding the spinal, increasing the risk of long term, more severe damage, the use of steroids for back-related leg pain just doesn’t make any sense.

 

 

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Optimal Vitamin D Levels: Who’s Got the Right Answer?

optimal vitamin D levels

Anytime I try to answer a question about health, I always look back towards what we are designed for.  Our bodies are designed with a brilliance that surpasses our current knowledge.

My rationalization is that, if we can figure out what we were designed for, then living by those parameters is much more likely to produce health than disease.  We all need to face that we still have hunter-gatherer genetics.  We have spent to bulk of our existence in this model and our genetics will not catch up to today’s digital age for hundreds of thousands of years.  Heck–we still haven’t really adapted to an agricultural lifestyle very well.

The problem is that there are not many true hunter-gatherer populations left on the plan to study to help answer the pressing questions about our health.  Luckily, though, there are still some hunter-gatherer tribes left in Africa that we can study.

There has been much debate over what the “optimal” levels of vitamin D are.  The labs put deficiency as below 20 ng/ml and most doctors are happy if their patients are above that point.  But there is much debate from some very smart people that suggest that we need to have higher levels on the range of 50-100 ng/ml for disease prevention.

Personally, I think we were designed for heavy sunlight exposure at the latitude that our ancestors lived at (in other words, my Irish ancestors were not hanging out at the equator).  There was no sunscreen and no staying indoors all day long.  And the darkening of the skin (either through a tan or freckles) is a natural protectant against vitamin D toxicity.

With this rationale, it would be reasonable to estimate that the vitamin D levels in the bloodstream of hunter-gatherer societies would be closer to what we were designed for.  Which is exactly what researchers did in this particular study.  The evaulated the vitamin D levels of 35 pastoral Maasai and 25 Hadzabe hunter-gatherers living in Tanzania.  These tribes have skin type VI (deeply pigmented dark brown to black — never burns, tans very easily), have a moderate degree of clothing, spend the major part of the day outdoors, but avoid direct exposure to sunlight when possible.

Here’s what the vitamins D levels were:

• The Maasai tribe members had a average vitamin D level of 47.6 ng/ml (119 nmold/l).
• The Hadzabe had a average of 43.6 ng/ml (109 nmol/l).
• Considering both tribes together, the average vitamin D levels were 46 ng/ml (115 nmol/l)
• Vitamin D levels were not related to age, sex or BMI.

These numbers are a far cry from what the labs and most doctors view as “normal.”  Personally, I’d go with the higher numbers.

So quick tips to remember:

1. The prescription forms of vitamin D in the 25,000 and 50,000 doses just don’t seem to raise blood levels to where they should be.  For this reason I steer patients away from these forms.
2. If you’ve had your gallbladder taken out, you NEED an emulsified form.  Period.
3. In order to get your values up to the values seen in these hunter-gatherer populations, you’re most likley going to have to START at 6,000 IU / day.  This number will vary based on your skin type, BMI and how much sunlight exposure you get.

Based on this, are you taking the RIGHT amount and the RIGHT type of vitamin D for you?

 

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Coronary Stents and Reality; Did Your Cardiologist Come Clean?

Heart stents.  Coronary Stents.  Angioplasty.  Angiogram.  Percutaneous Coronary Intervention (PCI).  Regardless of what you call it, over a half MILLION of them are done per year at a cost of around $18,000 each.

Sounds great.  After all, we’re saving lives with these remarkable procedures that are far, far easier on the patient then cracking open the sternum and replumbing the coronary arteries.

Well yes.  And no.

For emergency procedures, the research is pretty positive.  The sooner you can get this procedure done in the middle of a heart attack, the better the outcomes.  That’s where the clarity ends.  In general, it is pretty well accepted (in the research, but not among cardiologists who do these procedures) that for non-emergency, elective procedures, the data on PCI crashes.  To the tune of about 50% of them being done inappropriately.

These are some serious numbers, serious dollars and serious risks to the patients.  And just in case the patient makes it through the procedure, they have usually earned a year or so on blood thinners.  In coming years, the risk of the stent closing back up again is always brewing in the background.

But all of this is ok, because before you receive ANY medical care, there is something called informed consent.  Under informed consent, it is the obligation of a physician to explain the procedure being done, the risks of the procedure, the risk of NOT getting the procedure and the alternatives.  It would make sense that, as the procedure becomes more invasive, the obligation to fully inform the patient should grow as well.

After all, how can you, as the patient, truly make a decision about a procedure this important (or not) without being fully informed??  You really can not.

Which brings us to this particular study.  In it, researchers reviewed We performed recorded 59 conversations by 23 cardiologists among adults with known or suspected stable coronary disease at outpatient cardiology practices.  These conversations were evaluated for 7 accepted elements of informed constent when it comes to helping the patient make the decision to undergo angiography and possible stenting.  Here’s what they found:

• A paltry TWO (3%) conversations included all 7 elements of informed decision making.
• Another eight conversations (14%) met a more limited definition of procedure, alternatives, and risks.

When the cardiologist was more forthcoming and honest about expectations of the procedure, the outcome of the visit was drastically different:

• If the cardiologist discussed clincially viable alternatives (i.e. medications, lifestyle changes, no treatment–the term for this in informed consent is “uncertainty “), the patient was 20.5 TIMES less likely to choose the procedure.
• If the cardiologist discussed the patient’s role in deciding about having the procedure done, they were 530% less likely to undergo PCI.
• If there was an exploration of alternatives the patient was 950% less likely to choose PCI.
• Neither the presence of chest pain (angina) nor severity of symptoms were associated with choosing angiography and possible PCI.
•  Overall, better informed patients were 320% less likely to choose angiography and possible PCI.

Granted, this was a small subset of practicing cardiologists and maybe the bulk of cardiology practices do not follow the practices seen in this study.  But, given how rushed many specialist offices tend to be, I’m afraid this is standard.

Overall, though, I think this reflects the disconnect between what patients perceive and what the reality is of the medical procedures that are performed with a high degree of regularity in modern medicine.  The list of procedures and medications that have shown little benefit in the medical research but continue to be used is quite long.

And this is heart disease.  Almost entirely preventable!  For a long time now we’ve known that lifestyle changes produce better outcomes than PCI and yet this procedure is still done on an elective hundreds of thousands of times per year.

So, if YOU had a stent put in, do you feel that your cardiologist fully educated you on the risks, benefits and alternatives?

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Probiotics and Digestion in Your Gut–Do They Even Survive?

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The use of probiotics to positively affect health (and your microbiome) and disease has expanded massively in the past decade.

Supplements, powders, probiotic drinks, juice drinks with probiotic straws–the options are almost limitless.  And, if you prefer your prefer your probiotics from the other end, you could sign up for a fecal transplant, although I have to admit that this concept still gives me the creeps.

The strains used, the method used (drink, powder, capsule, etc…) and the number of bacteria in the formulation (usually measured as CFUs, or colony-forming-units) vary widely.  VSL-3 dosages can hit a TRILLION (yes–1,000 billion CFUs for someone with an acute episode of Crohn’s or ulcerative colitis) down to a measly few hundred million in yogurt.

But what’s real?

This is not an easy question to answer, but let’s start with some thoughts on this topic:

1. Bacteria WILL be destroyed in the digestive process.  Some bacteria can handle this quite well, especially if they are in the spore form.  Others will never make it past the stomach.
2. Bacteria don’t just have to survive the stomach, they have to survive bile acids and pancreatic juices.  It’s a rough world down there.
3. Your digestive health plays a massive role in this process.  Poor digestion will lead to more bacteria surviving the digestive process.  But this also means bad bacteria as well.  This is why stressed out patients or patients on acid-blocking drugs (think Prilosec, Nexium) have bacteria growing were it is not supposed to be growing in the small intestine (small intestinal bacterial overgrowth, or SIBO).

With all of this in mind, this particular study begins to look at the answer to the question of whether or not the probiotics you are taking actually make it to the large intestine where the bulk of your microbiome resides.

In this study, researchers used simulated digestive environments to mimic stomach acid digestion, bile acid exposure and pancreatic juice exposure on bacteria commonly found in commercially available probiotic formulations.  Here are some of the basics:

• Eight different commercial products were evaluated.  Of the products tested, not all the products had bacterial strains and numbers that matched the labelling.
• 35 bacterial strains were gathered from the initial screening.
• Principal strains isolated from these commercial products were from Lactobacillus spp. and Bifidobacterium spp.

The sexy details are available by following the links to the study, but here are some details that I found interesting:

• Only 18 of the strains had half of their numbers survive stomach acid digestion.
• After determining which strains were likely to survive the bile acids and pancreatic juices, only 6 Lactobacilllus strains were felt to make it to the large intestine.  These included L. casei immunitass, L. casei shirota, L. plantarum, L. pentosus, L. reuterii, L. acidophilus subsp johnsonii and L. delbrueckii subsp bulgaricus.
• Here’s the kicker:  Despite a large number of bacteria being added to the large intestine simulator, there was little variation in the overall number of bacteria present over the course of 10 days.

So what’s the take home message here?  Supplementation with probiotics remains a good idea.  But given that so few of the bacteria are likely to make it to the large intestine and make any kind of notable change, this means that the use of prebiotics becomes even more important.  Prebiotics are food or supplements that increase the growth of the bacteria in the gut.

I have covered the effects of the addition of the amino acid glutamine and cranberry extract on the microbiome and these findings are quite interesting.  By taking food or supplements that support the growth of the bacteria that we want dominating our large intestine, we can indirectly increase these bacterial counts.

 

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Fish Oil Supplements: Buyer Beware of Dangerous Brands

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Earlier this year, the New York Attorney General charged Target, GNC, Walmart and Walgreens with removing certain supplements from the shelves.

Specifically, these stores were given cease and desist letters to stop selling ginko biloba, St. John’s Wort, ginseng, garlic, echinacea and saw palmetto.

Why?  Because quality testing demonstrated that these supplements either did not contain the labeled ingredient or contained ingredients not listed on the bottle.

GNC’s corporate response?  They stated that they stand by the quality of their products.  Huh?  I’ve got a feeling that they’ve lost some corporate integrity over this entire episode by showing how disconnected they are from what was happening.

While this action by the New York Attorney General was related to a short list of supplements, it is likely that this quality control issue cuts across many other supplements that you can buy at non-physician outlets.  This problem is probably greater at retail outlets that do not focus on supplements, although the inclusion of GNC into the cease and desist order certainly questions GNC’s overall quality control process.

Each supplement has its concerns.  When it comes to fish oil supplements, the contamination with polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCs) is of concern.  The higher quality supplement companies will go through expensive and time consuming molecular distillation procedures to make sure that their fish oil supplements will be free from these contaminants.

But really—if these higher quality supplements cost more (sometimes twice as much), is it really a big deal if there’s a few extra “treats” in the fish oils?

That very question is addressed in this particular study.  In this rat study, researchers looked at the effect of contamination of fish oils with PCBs and OCs on cholesterol levels, inflammation (as measured by hsCRP) and oxidative stress.  The rats where given either “clean” fish oil, contaminated fish oil or corn oil (as a control).  Here’s what they found:

• After 9 short weeks, there was an accumulation of PCBs and OCs in the fat tissue of the group given the contaminated fish oils.
• On the plus side, as expected, both fish oil groups had higher HDL cholesterol with lower triglycerides, LDL cholesterol and C-reactive protein.
• Unfortunately, in the contaminated fish oil group there were higher levels of damage to cholesterol (as measured by lipid peroxidation).
• The contaminated fish oil group also had less antioxidant capacity.

So, while the contaminated fish oils were doing their expected job of helping lower cardiovascular disease risk factors, in the background problems were brewing.  This damage to fats (lipid peroxidation) and loss of antioxidant reserves is not a good thing and can actually do far more damage to your body in the long run.

As a physician who sells physician-level supplements in my office, this article may seem a little self-serving, but this study should certainly give you some food for thought when it comes to buying your fish oil supplements with a focus on cost rather than quality.  Always make sure that you are buying supplements that have the quality control aspects either on the bottle or readily available on the manufacturer’s website.

If your health really does matter, it pays to make sure you get good quality for your money and not just finding the cheapest fish oil you can find.  Just in case you don’t have access to a physician who sells higher quality fish oil supplements, Nordic Naturals is a brand that can be found at many health food stores or online at Amazon.

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Cranberry; And You Thought it was Just Good for UTIs

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It’s pretty much common knowledge that cranberry is good for urinary tract infections.  But, just like many other food items, the benefits extend far beyond this.

Let’s face it, though, the berries, as a group, have powerful benefits.  Blueberries, strawberries, lingonberries, cranberries.  Berries pack a pretty powerful phytonutrient (plant-based protective compound) punch.

And this benefit is across chronic conditions.  From cancer to diabetes to heart disease.  The studies are quite numerous and consistent.  And let’s face it—berries are not too painful to add into a healthy lifestyle.

Sometimes, though, with natural approaches, the way the approach is working may be far outside the realm of what we think it is doing.  As an example, when it comes to cranberries, I generally think about the antioxidant / protective compounds the are found in the berries and how they can protect against damage at the cellular level.

In addition, the sugar alcohol (d-mannose) found in cranberries is absorbed into your body but not used.  As a result, the d-mannose shows up in the urine where it helps to wash out bacteria present in the urinary tract to provide the well-known benefit for urinary tract infections.

But what if there is something more going on?  Something that may have to do with, say….the gut?

Regular readers of the blog know how much I revere any knowledge that can help me understand more about how the microbiome (gut bacterial population) affects health and how I can help patients positively affect their gut.

Which brings us to this particular study.  In it, researchers evaluated the effect of a cranberry extract on the gut bacterial flora in a group of mice who were fed a high-fat, high-sugar, pro-diabetic diet.  Here’s what they found:

• The cranberry extract slowed down the expected weight gain and abdominal obesity.
• Cranberry treatment, led to less triglyceride accumulation.
• The extract protected against liver oxidative stress and inflammation (the liver weight was less).
• Insulin action was improved (improved insulin tolerance, lower HOMA of insulin resistance and decreased glucose-induced hyperinsulinaemia during an oral glucose tolerance test).
• There was less intestinal inflammation and oxidative stress.
• But, despite all of this, the most interesting finding was that there was a marked increase in the bacterium Akkermansia.

Akkermansia?

Isn’t that just south of Istanbul?

Akkermansia muciniphila is a relatively newly-discovered bacteria present in the gut that has a unique ability to break down mucin.  Mucin is a mucous-like compound that lines the entire gastrointestinal tract.  Mucin can provide protection to the cells lining the gut, but it can also protect nasty bacteria in your gut that hide behind a layer of mucin from protection.

More importantly, as we see in this study, A. muciniphila seems to have a pretty potent anti-diabetic effect on the organism that it thrives in.  So, based on this study, it would seem that cranberry, as both the fruit and the extract, may give you the ability to fight off weight gain and diabetes.  Pretty cool.

One quick note:  If you choose to use real cranberries, absolutely avoid the sugared-up, sunflower coated variety.  See if you can find straight-up cranberries.  If this isn’t your speed, you can always check out what your local chiropractic-nutritionist or Amazon has to offer.

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Narcotics and Your Baby; Not a Good Combo

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You’re reading the title of this thinking that this is pretty stupid.  Who on Earth would think that this is a good idea??  Opioids during pregnancy.

I’m sure that if I gave you the true / false question, “Morphine is ok to take while pregnant,” there’d be no hesitation to check the “false” box.  And it wouldn’t surprise you at all to know that the use of morphine and morphine derivatives during pregnancy can lead to scary things like withdrawal symptoms into the newborn.  The technical term for this is Neonatal Abstinence Syndrome (NES).

If you agree that it’s absolutely crazy to take opioids during pregnancy, then you will likely be as shocked at the results from this particular study as I was.  In it, researchers looked at the use of opioids during pregnancy to evaluate just how common it was.  Here’s what they found when they looked at group of 112,029 pregnant women:

• A shocking 28% (31,354) filled at least one opioid prescription during pregnancy.

How is this possible?  There are probably few people out there who would think that opioid use during pregnancy is ok.  I think I may know why; at least in my office.

From what I’ve seen, not enough of the population understand the drugs that they take.  Top culprits are Percocet and Vicodin.  It seems like a good chunk of my patients do not realize that these drugs are opioids.  Sure, most know that OxyContin and Oxycodone contain morphine derivatives.  But a surprising number of my patients over the years have not been aware that common pain medications that are handed out like candy also contain opioids.

So maybe a good chunk of the 31,000+ pregnant women in this study were written a prescription for hydrocodone-containing drugs like Percocet and Vicodin and just didn’t realize it.

Of course, the real question is how they got the prescription in the first place.  The prescribing physician should darn well know that opioids should not be prescribed in pregnant women.

The researchers then looked at what factors played a role in these pregnant women receiving a prescription for an opioid.  Here are the factors they found:

1. They were more likely to have depression (5.3% vs 2.7%).
2. Anxiety disorder (4.3% vs 1.6%)
3. Smokers (41.8% vs 25.8%)

Looking at the list of these 3 factors, I just can’t understand how these patient-related factors should affect whether or not these women got a prescription for an opioid from her physician.

Overall, I don’t really have a take home message.  I’ve provided this article more for educational purposes rather than providing answers because I can’t understand how these prescriptions are written at this frequency.

In my biased opinion, the best and easiest answer to this prescribing problem is chiropractic care during pregnancy for any pain-related complaints instead of these prescriptions.  Maybe the answer is education for these pregnancy-related-opioid-prescribing physicians on the benefits of chiropractic care for pregnant women…??

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