Time to take an X-ray?

The appropriate time for X-ray and other imaging such as MRI and CT scan is debatable. MRI and CT scan being more expensive (minimum of $800 for MRI), are a lot harder to get done. There is about a 4 months wait list in Canada to get an MRI of your knee for a suspected tear, but if you know someone that knows someone in a hospital, you might be able to get it done in about 2 weeks!

Before going into details, let’s answer a very common question regarding the differences between X-ray, MRI and CT.

For the sake of simplicity, X-ray is good to see bones (fractures), MRI is good to see soft tissues such as muscles, discs (disc herniation), nerves and CT scan is good to see structures such as lungs, sinuses, abdomen and heart. Again, it is not as simple as I explained above, your doctor will ask for a specific imaging based on what he or she would like to see!

Ankle (CT Scan)

Ankle (MRI)

Ankle (X-ray)

So when is a good time to take an X-ray? Rule #1, TRAUMA! A trauma can be a fall, a hit or any impact to your body. For example, if an object falls on your toe, depending on the object, there can be pain, swelling, bruising and potentially a fracture! Rule #2, weight bearing is hell! You cannot support the weight of your body on the injured limb. Rule #3, usually with broken bones, the pain will not get better and sometimes it will potentially get worst even with treatments. Rule #4, you are suffering from some sort of bone disease (metabolic disease) such as Osteoporosis.

Summary:

1.       Trauma

2.       Cannot stand on it

3.       Getting worst or staying the same

4.       Underlying bone diseases such as Osteoporosis

True Case at the clinic:

63 years old female comes in the clinic with rib pain after coughing. The pain is not going away. She has a history of Osteoporosis. She was diagnosed after taking x-ray with rib fracture! YES! A fracture with just coughing! So please talk to your doctor.       

Dr. Ali Masoumi

www.facebook.com/drmasoumi

Headaches Suck!

Headaches suck! For the sake of this blog, let’s start with one fact, not all headaches are Migraine Headaches. Yes, they are a common type of headaches and yes, they are very commonly diagnosed. Here are some signs and symptoms doctors use to diagnose you with a Migraine headache:

• ·         Pain in usually on one side of the head

• ·         Sensitivity to light and/or sound

• ·         Nausea and/or vomiting

• ·         May have aura (perception of a strange light, an unpleasant smell or confusing thoughts before the actual headache)

You may experience slight variations of these signs and symptoms, and you may have tried different types of medications with little or no results, which denotes to the debatable lack of understanding in the origin and cause of this disease.

Other common examples of headaches are Cluster Headaches, Frontal Headaches (usually due to sinusitis) and Suboccipital headaches. These are just few examples of headaches classified by the International Headache Society (IHS), which has a good website for more information. (Google it!)

The type of headache I really want you to be familiar with is Suboccipital headaches, which I commonly see in my practice. I have had many patients wrongfully diagnosed with Migraine whom suffer from Suboccipital headaches who got significantly better after few treatments.

Suboccipital Headache (aka Muscle Tension Headache)

This is a headache caused by a specific muscle spasm (tenderness) at the base of your skull, named Suboccipital Muscles. This is the most common type of primary headaches. The signs and symptoms of these types of headaches are outlined below:

• ·         Pain usually on two side of the head

• ·         No nausea and/or vomiting

• ·         Pain starts at the base of the skull, moves to the side of the head and behind the eye

• ·         It can co-exist with neck pain and lack of range of motion in the neck

The primary way of treating this headache is to work with your spine and the muscles surrounding your spine in the neck region by manipulation, stretches and corrective posture.

Keeping in mind the different types of headaches, the purpose of this blog is not to diagnose you over the internet; it is for you to have enough information about the differences between the Migraine and Suboccipital headaches (which are more common!), and a possible alternative treatment to pain medications.

Dr. Ali Masoumi
www.facebook.com/drmasoumi

"Arthritis" is not THAT bad!

Before going into the specifics of Arthritis, let’s break the word down into its parts! Arthro- means joints and anything with a suffix of –itis means inflammation. So YES the inflammation of tonsils are tonsillitis and the inflammation of pancreas is pancreatitis! This was a little secret into the “big medical word” dictionary!

I have recently discovered that many of patients being diagnosed by “Arthritis” don’t really know much about it. The word “Arthritis” seems to also have some effects on their mental state, preventing them from the normal activities of daily living or ADL. There are many types of arthritis, each having different signs and symptoms and different effects on your body. 

The most common type of arthritis (and I mean THE most common type) is Osteoarthritis. Osteoarthritis (and now known as Degenerative Joint Disease) is a type of arthritis mostly associated with aging. What I mean by aging is not someone over 90, but anyone after the age 25 can have potentially some sings of Osteoarthritis. This is caused by “wear and tear” of bones and the increased friction between them causing pain. You can have osteoarthritic changes in your bone without knowing it. Sometimes I send a patient to get an x-ray for a potential fracture and I find out that they have some osteoarthritic changes!

There are different types of medications that help with OA (Osteoarthritis) and usually supplements such as Glucosamine Sulfate, Chondroitin Sulfate and MSM (which needs about 6-8 weeks to get absorbed and for you to feel the effects) help with symptoms. (Talk to your doc for specific doses!)

Although there are many types of arthritis such as Rheumatoid , Psoriatic and many more (which you can ask me if you like), with varying degrees of disability, it seems wrong to me that a patient would allow this to limit their horseback riding, hiking, snowboarding and running!

So, the reason for this blog was for you to realize there are MANY types of arthritis and the most common type being Osteoarthritis COULD have minimal effects on your life and you should NEVER stop being active and do things you like since you have been diagnosed with “arthritis”.

Please ask your doctor to clarify the type of arthritis you may have for you!      

Dr. Ali Masoumi
www.facebook.com/drmasoumi

Sciatica!

I have had many patients walking into my clinic being diagnosed by Sciatica! Sciatica is not a diagnosis, it’s simply a symptom. All Sciatica means is “leg pain”. So imagine walking into your doctor’s office telling him you have shooting leg pain and he “diagnoses” you with “leg pain”! I am not trying to disrespect any doctors or practitioners, but simply Sciatica as a diagnosis is not correct.

Sciatica = Leg Pain

What you need to know is: where this leg pain or sciatica is coming from? There are many reasons for shooting pain down the legs. In rare cases, it could be a sign of spinal tumour/cancer. I said in RARE cases, so don’t panic. Other causes can be spinal osteoarthritis which is usually a wear and tear of the spine due to age. But in many cases, the shooting pain can be from Disc Herniation, Muscle Spasm and your spine not moving the way it should, or spinal joint dysfunction. These conditions can be diagnosed by your chiropractic physician and require some orthopaedic and neurological exams.  

Piriformis Syndrome

The picture above, is an example of commonly seen disorder, called Piriformis Syndrome (go ahead, Wikipedia it!) The muscle shown, called Piriformis, when in spasm, will irritate the Sciatic nerve which causes shooting pain down the legs.

Again, please don’t diagnose yourself and don’t get diagnosed by your neighbour!

Dr. Ali Masoumi

Plantar Faciitis and Heel Pain!

Are you getting up in the morning with lots of heel pain? If so, you might be suffering from a condition called plantar fasciitis. The reason I said might, is because there are other conditions that can closely resemble plantar fasciitis, but are completely different. I will go over some of these conditions throughout this blog! So grab a beer and follow through!

Plantar Fascia

Plantar fasciitis can be felt usually within the first couple of steps from bed. As you move around it gets better, yet to “attack” again at the end of the day! It is due to inflammation/irritation of the fascia (the “blanket”) around the bottom of your foot. It could be due to faulty biomechanics of foot and your gait cycle (your walking). There are many types of treatments for plantar fasciitis with the main one being ORTHOTICS. Yes I said Orthotics! There has always been controversy surrounding the miss use of prescribing custom made Orthotics by doctors and practitioners for their financial benefits. That being said, I’ve had many success stories with the use of Orthotics for my patients.

In my opinion, there are other forms of treatments before Orthotics, which can be as beneficial. For example; you can stretch your calf muscles, use a golf ball in a sock and role the bottom of your foot on top of it, use low light laser therapy, Shockwave therapy, Active Release Technique (my favourite) and proper shoes with good support.

Golf ball for plantar fascia

With all these little advices I’m giving you; make sure you consult with your doctor since every case is different. Your heel pain could be the result of some systemic disease/disorder which is more important than heel pain.

One other disorder that very closely resembles Plantar Fasciitis is Fat Pad Syndrome. At the bottom of your heel, there are usually some “fat” which is used as a cushion every time you hit your heels to the ground. With degenerative joint disease, increase in age and worn out shoes, you can potentially loose these cushions used to absorb weight as you heel strike (hit your hill to the ground in walking). With such condition, a quick run to the drug store, looking for some heel gel/lift (should be soft) will do the trick!

Again don’t diagnose yourself and don’t get diagnosed by your neighbour!

Dr. Ali Masoumi
www.facebook.com/drmasoumi