Learn How An Ellenville NY Chiropractic Office Alleviates Slipped Disc Pain Naturally

By Iligan Airsoft

A large portion of the country's population prefers to use alternative forms of pain relief. They want to attempt to alleviate all discomforts in the quickest, yet most natural manner possible, which means avoiding ingesting any pharmaceutical product. An Ellenville NY chiropractic office has methods that allow them to tend slipped disc issues without invasive measures.

The fact that all techniques are designed using only natural methods categorizes chiropractors as alternative medical practitioners. They seek to promote free movement and better health through an in depth knowledge of the intricate relationship between the bones, nerves and muscles. Their scope of work does not involve prescribing medications or determining whether or not surgery is necessary.

Though they are able to tend a number of different conditions such as arthritis, headaches, tension, carpal tunnel, and fatigue, their main focus is on neuromuscular disorders. These typically involve the vertebrae in the spine being misaligned and causing issue with the nerves, muscles or ligaments. Realignment of these spinal bones can relieve pain and pressure to promote natural healing.

In this field, the primary course of correction is the manual adjustment of one's spine. The basics of this technique involve the doctor using their training to apply a specific amount of pressure to a precise point on the vertebrae to push the bones back into proper placement. The procedure is quick, painless and typically immediately effective.

There are several ways in which the technique may be done, depending on the person's specific circumstances. Different methods are used for patients with herniated discs or degenerative joint syndromes than those who are receiving a standard adjustment. A individual approach will be determined after the doctor assesses information from diagnostic tests.

Most people seeking assistance through chiropractic means discover that the techniques are pain free and generally noticeably effective after the first session. Certain situations may need additional care such as repeat adjustment, massage therapy, specific exercises and dietary changes. There will be no use of pharmaceuticals or surgeries.

About the Author:

Chiropractic care alleviates spine, knee, ankle and toe pain safely and effectively. Visit this website for more info about an experienced Ellenville NY chiropractic physician at http://www.lonstein.com right now.

Discover How Whiplash Sufferers Get Relief With Kent WA Chiropractic Office

By Allan Bigarda

People often develop whiplash as the result of car collisions. The spine tends to suffer quite a bit as the result of jarring impacts. Luckily, it is often possible to gain relief by consulting with a reputable Kent chiropractor.

Unlike medical professionals in conventional health care settings, these providers do more than simply address the symptoms that are the result of this issue. Even though you may receive a prescription for pain medicine when going to the doctor, this is not how chiropractors will address this problem. These providers will instead seek to relieve the pain and pressure by resolving the issue itself.

For instance, many chiropractors look to see how a jarring event has impacted the alignment of the spine. They will also look for signs of joint dysfunction. These things can be alleviated by restoring proper spinal alignment and alleviating any muscle tension that has developed.

Chiropractors have an array of therapeutic services they can provide. They often use massage to reduce muscle stress that is caused by vertebral misalignment. This can make it a lot easier for people to move about. Being unable to turn your neck can make life extremely difficult. People tend to have a hard time operating their automobiles, performing important tasks at work and handling many of their regular obligations.

Inversion tables are often used in these settings as well. This gently reduces spinal compression which lessens the pressure and pain for pinched nerves. These tables help to increase mobility and expedite natural healing processes. When the spine is properly aligned, the body will have a better ability to heal its own injuries.

There are manual adjustments that chiropractors can also perform. This helps to realign the vertebrae after these have shifted out of their natural positions. Each of these efforts is often included in individualized and integrated care plans so that people can gain lasting relief and long-term improvements to their overall health.

About the Author:

If you are experiencing neck pain or headaches form injury in Kent, WA, Kent Chiropractor. Discover what Palmer Chiropractic can do for you, when you visit us at http://www.palmerchiropractic.com today.

How Headache Sufferers Find Relief With Ellenville Chiropractic Office

By Elinor Romig

A large number of patients affected by headaches may possess structural problems and improper nerve operation. Long term dysfunction can negatively affect health and wellness and relies on a unique approach delivered with chiropractic care for the best outcome. The Ellenville NY chiropractor delivers methods with a natural foundation to manage physical operation and decrease painful symptoms.

Individuals debilitated by headaches are advised on seeking alternative therapy for relief rather than cover the expense associated with medication. Unfortunately a number of side effects are associated with heavy reliance on prescriptions that may place a limit on normal healing. Chiropractic incorporates natural methods to alleviate limitations and improve physical operation.

Studies have shown that agitated nervous tissue can prove responsible for headaches. Tense and tight muscles often compress surrounding nerves in the neck and shoulder regions. Symptoms attributed to dysfunctional soft tissue require massages for relaxation and exercise methods to alleviate stress and irregular operation.

Spinal misalignment caused by force or sudden injuries can cause nerve compression between the misplaced spinal discs. Upper cervical problems including whiplash are often responsible for headaches and limitations in general operation. A chiropractor can apply spinal adjustment methods to restore the normal positioning of the affected joints for healthy function and full range of mobility.

Identifying the possible cause for symptoms with a chiropractic examination can aid in determining structural deficiencies. X-rays may be advised to aid in identifying injuries such as misalignment of the spine that has a negative impact on the ability to function normally. Should the joints in the upper spine become compromised, it requires manual intervention to restore balance and overall wellness.

Chiropractic care has proven best for headaches involving tension, allergies, and migraine pain that restrict the ability to engage in healthy activities. Therapy can aid in reducing muscle tension and nerve irritation responsible for the formation of discomfort. Natural remedies are determined according to individual needs for long term wellness and relief from physiological difficulties.

About the Author:

Chiropractic care alleviates migraine headache and neck pain safely, naturally and quickly. Click here for information about an experienced Ellenville NY chiropractor at http://www.lonstein.com now.

How A Norwalk CT Chiropractic Office Helps Relieve Whiplash

By Bertulda Zerna

The injury called whiplash is hard to identify and controversy may arise concerning its validity. Most often it is associated with the rapid jerking of the head that occurs in a car accident. It takes only a second to happen. However, it takes much longer to assess. A Norwalk CT Chiropractor can facilitate pain relief, but only after a full evaluation has been conducted.

During the crash the vertebrae, nerves, discs, muscles and ligaments may be damaged. The accident most often associated with whiplash is the rear-end collision. The effects on the crash victim are like what the infant suffers when roughly shaken by someone.

A full evaluation will be done during your first appointment with the chiropractor. A medical history is taken. An x-ray and physical exam will be conducted. Your head, neck, upper back and shoulders may be hurting. In some cases the lumbar spine can be affected as well.

Damage to muscles and ligaments is the main factor causing pain. What is called facet joint pain cannot be detected on an x-ray. Detection is by physical palpation of the neck and shoulder area. This exam, plus your description of what you feel, helps the chiropractor to form a professional opinion.

This care might be spinal adjustments or muscle relaxation along with a mild exercise regimen. The exercises are tailored to meet a clients individual requirements. The same routine is not applied to another client even if his or her symptoms appear to be the same. No type of care can be generalized as each client is unique.

The goal of manual adjustments is to move any misaligned vertebrae back into their customary position. A short thrust is used in some cases and a slow movement in others. When the muscles are damaged, finger pressure applied to trigger points may be the optimal way to help in the recovery.

Consider the fact that two clients experiencing the same level of pain may require different care plans. It depends on each ones age, health status and how severe the injury is. A different method may be appropriate for one, but not the other.

About the Author:

Chiropractic care alleviates neck, shoulder, back and groin pain safely, naturally and quickly. Click here for more info about an experienced Norwalk CT chiropractor at http://www.DrSlovin.com right now.

Oraya IRay In office Stereotactic X ray Treatment for AMD A First Report

Another new company with a treatment for wet AMD has come out of “stealth mode”, and presented information on how it’s system works and the results of it’s initial clinical trials. Here is an in-depth presentation of the Oraya IRay radiotherapy system.

Introduction

Over the past few years, several drug-based treatments have been suggested and tried to prevent visual loss due to neovascular age-related macular degeneration. Two anti-VEGF drugs, Avastin and Lucentis are now available to prevent significant vision loss in a majority of wet-AMD patients who are treated. However, it appears that repeated intravascular injections over an indefinite time period are required to keep the disease at bay.

One promising approach to reducing the number of injections needed is the synergistic use of radiation in conjunction with intravascular injections, to prevent the proliferation of vascular tissue and to induce visual acuity gains.

The idea of using radiation as a treatment modality for wet AMD has been around for years, but its use has been limited due to the potential damage that can be done to sensitive tissue within the eye without localization of the radiation beam and treatment area. Two companies now claim to have systems that achieve that aim.

The NeoVista Epi-Rad 90 System

The first of the two new therapy systems is the NeoVista Epi-Rad 90, which involves delivery of a target dose of 24 Gy of beta radiation to the center of the choroid neovascularization (CNV) following a partial vitrectomy for placing the strontium 90 tip close to the choroid. Several controlled clinical trials with this system are currently underway to determine if the combined use of radiation therapy and anti-VEGF injections can result in AMD control with fewer injections, compared to drug use alone.

(For more on the NeoVista Epi-Rad 90 system and the clinical trials underway, please see my four reports already posted on this site – links noted at the end of this writeup.)

The Oraya IRay System

Now, a second, office-based system has been proposed and is in early stages of testing. This is the Oraya IRay system, that uses a table-top source of low-energy X-ray beams, directed through the sclera onto the macula to treat CNV secondary to AMD. Unlike the NeoVista system, the Oraya IRay system delivers three doses of highly localized low energy X-ray radiation to the macula non-invasively, using a robotic positioning system, targeting algorithm and a device, I-Guide, for eye stabilization and motion detection. This office-based procedure can be performed in about 10-20 minutes, under a topical anesthetic. The IRay device delivers three beams of up to 8 Gy each through three different locations on the sclera (roughly at 7 o’clock, 6 o’clock and 5 o’clock), delivering up to 24 Gy to a single spot on the macula.

The unique method of delivering the three beams of radiation to the macula was chosen to avoid other sensitive eye structures such as the lens and optic nerve. In addition, the angle of the beam path minimizes collateral damage to radiosensitive structures, while enabling the delivery of the appropriate dosage of radiation (24 Gy) to the choroidal neovascularization that was found clinically useful in the NeoVista studies.

Details of the System

The IRay system consists of three parts: the robotically-controlled X-ray generation and eye imaging workstation (Figs. 1-3); the I-Guide, which is coupled to the patient’s eye via suction, and aligns and optically connects the eye to the X-ray generator (Figs. 5, 6); and the adjoining shielded operator workstation (Figs.3, 4).

To minimize the effects of eye motion during therapy, the I-Guide is used, which consists of a contact lens coupled to the eye with syringe-generated suction, and attached to a central post. The post is mounted to a stabilizer bar via a ball joint. The purpose of the I-Guide is to steady the eye and act as a target for the imaging system to monitor the eye’s position and gaze angle. During treatment, the automated positioning software continuously evaluates the deviation of the eye from nominal. Motion of the eye already is substantially reduced by the I-Guide and is monitored in real-time using a two-camera imaging system. When necessary, the beam is automatically gated off by an algorithm that incorporates time as well as displacement, allowing brief eye excursions while still maintaining effective targeting. The I-Guide is designed with a breakaway feature that allows emergency exit of the patient from the system.

Targeting is achieved on the basis of a calculated position of the fovea, as determined by the simple geometric relationship of the center of the I-Guide lens to the back of the eye. Oraya determined its targeting algorithm based on extensive pre-clinical studies, mathematical modeling of the eye, and subsequent developmental work. Pre-procedure fundus imaging, obtained via spectral-domain OCT, is used to verify targeting and ensure that patients with “outlier” fundus anatomy are identified.

In performing the procedure, the operator, after protecting the lower lid with a specially designed self-retaining retractor, places the I-Guide on the anesthetized eye. The patient’s head is secured in a chin rest/head restraint, which incorporates a radiation shield.

The operator at the shielded operator workstation obtains a visual lock on the eye and applies the appropriate X-ray dose to the three designated spots on the sclera. The three 3.5 mm collimated X-ray beams are sequentially and automatically delivered to converge onto a single 4 mm target spot on the fovea (Figs. 7-11).

This office-based, low-voltage (100 keV) X-ray radiation therapy is a 10-20 minute procedure with no appreciable external shielding required. For patients, the exposure is comparable to the radiation received in getting an X-ray of the head and neck. For operators, the radiation exposure would be equivalent to ~0.14 mrem/hour or one-quarter of the radiation from a transcontinental airline flight. Each patient would get just one lifetime dose, not repeated exposures. Even though doctors might experiment, after FDA approval, with pulse or repeat dosing at some interval, Oraya is not studying repeat dosing at this time.


The following illustrations show the elements of the system:


Figure 1. The Table-top X-ray Generator System




Figure 2. The 3-Part System Platform




Figure 3. The I-Ray System



Figure 4. The I-Ray System (showing operator station and shielding)




Figure 5. The I-Guide Assembly




Figure 6. The I-Guide in Position




Figure 7. The Robotic System and Spot Distribution




Figure 8. Spot Positioning on the Sclera




Figure 9. The X-Ray Beam Size on Sclera and Macula




Figure 10. X-Ray Beam Distribution within the Eye and Brain




Figure 11. X-Ray Beam Intensity on Fovea

Clinical Trials

Phase I (CLH001)

There are three clinical trials planned. The Phase I Trial (CLH001) has been initiated and is fully recruited with over 60 patients to having been treated at either 16 or 24 Gy.

The Phase I trial is a pilot study to evaluate the safety and tolerability of the IRay stereotactic, radiosurgery system in patients with Choroidal Neovascularization (CNV) secondary to AMD. The study aims to determine safety, preliminary efficacy, and dose evaluation.

The study includes two cohorts: those without previous treatment and those previously treated with anti-VEGF therapy requiring additional treatment due to persistent or recurring disease activity.

Monthly retreatment with additional anti-VEGF drug, if needed, is based on any of the following criteria:

– Increase of >100 microns central subfield thickness using SD-OCT
– Evidence of new macula hemorrhage on clinical exam
– New area of classic CNV on FA
– ≥10 EDTRS letter decrease in BCVA vs. previous visual acuity score, with associated fluid on SD-OCT

The initial results, on 28 patients with up to a year followup, treated in Mexico City, were presented by Dr. Peter Kaiser of the Cleveland Clinic Foundation at the Retina Sub-Specialty pre-meeting held prior to the main 2009 AAO Meeting. Dr. Kaiser reported on patients treated with 16 Gy of radiation plus Lucentis (following two monthly injections) in 15 anti-VEGF-naïve patients and in 13 prior Avastin or Lucentis patients (who had had on average 2.9 injections prior to entry into the study).

There were no device-related serious adverse events and no evidence of radiation-related abnormalities, but there were a few device related adverse events, all superficial keratopathy − which Dr. Kaiser attributed mostly to placement of the I-Guide. These superficial events required no intervention by the physician.

The efficacy results are shown in Figures 12, 13 and 14 below:

Figure 12. CLH001 Efficacy Results after 12 months



Figure 13. CLH001 Efficacy Results for Treatment Naive and Previously Treated Patients


Figure 14. Loss or Gain in Letters


The results of this feasibility study, while meant to evaluate primarily safety and tolerability of the IRay therapy, demonstrated a number of encouraging efficacy signals, including substantial preservation and gain of vision in both the treatment-naïve and previously treated cohorts, as well as low numbers of required anti-VEGF retreatment injections. The rate of the anti-VEGF retreatment injections (following the two mandatory “baseline” doses) was found to be only 0.9 per patient over 10 months, and ~56% of patients needed no additional anti-VEGF injections, while still demonstrating visual acuity preservation and gain at least comparable to that seen in other studies, such as MARINA and PrONTO, with much greater injection burdens.

(For a refresher on the MARINA, PrONTO – and ANCHOR studies, please see my NeoVista Update report of July 11, 2007, linked at the end of this report.)

Anti-VEGF retreatments, as described by Dr. Kaiser, are shown in the following graph:


Figure 15. Anti-VEGF Retreatments

Dr. Kaiser concluded that IRay extends the durability of Lucentis, reduces the number of injections, and appears safe and effective.

The company concluded that its non-invasively delivered, ionizing radiation in combination with Lucentis appears to:

– Extend the durability effect
– Limit the number of anti-VEGF injections
– Work in both treatment n ive and previously treated patients, and,
– Be safe and well tolerated

Phase II Clinical Trial (CLH002)

Oraya expects to enroll the first patients in a multi-center, randomized, masked, sham-controlled European trial before the end of the year, using a 16 Gy dose. (The company continues to evaluate the possibility of adding a higher-dose treatment arm.) It is expected that 8-10 sites in Europe will participate.

Phase III Pivotal (CLH003)

This larger randomized, masked, sham-controlled study is expected to initiate in mid-2010 and plans to enroll approximately 450 patients in 15-20 sites in both the U.S. and Europe


Questions and Answers

During the recent 2009 AAO Meeting in San Francisco, CEO of Oraya, Jim Taylor, was interviewed by Lynne Peterson of Trends-in-Medicine. She asked him the following questions:

Asked about the long-term safety of IRay, Taylor said, “I’d be the last person to say we have absolute certainty we know the outcome (with IRay). The comfort comes from the ample data and research from ocular oncology and from some early work done in radiotherapy for AMD that suggest the incidence of radiation retinopathy is low. Years of study in ocular oncology have given comfort that the doses here (are safe). We know that AMD has an inflammatory component to it, and we know that AMD causes scarring and building of lesions in the eye that don’t respond to anti-VEGF therapy. We also know that radiation is anti-vascularization and antifibrotic as well. Lastly, we know that if you combine an anti-VEGF agent with radiation, you get a synergistic effect”.

Taylor explained that radiation works best on concentrated lesions in an atmosphere of oxygenation. So, stopping leaking capillaries with an anti-VEGF, tends to make the center of the lesion more robust, and a better target for radiotherapy. Oraya has worked with radiation and oncology researchers and experts around the world to determine the dose and the approach. The science looks good. And the radiation is not delivered through the cornea but through the sclera. Taylor said one advantage of IRay over NeoVista’s therapy is that IRay is robotically delivered while NeoVista has a hand-held system. “We have a robot that is a wonderfully designed sniper, shooting low energy in tightly collimated beams with 3 beams going through the sclera at separate points, all converging at the same point on the fovea”. The IRay goal is to deliver either 16 Gy or 24 Gy to a spot centered on the fovea covering approximately 6 mm in diameter.

The three elements of IRay that Taylor highlighted were:

1. Robotic positioning.

2. Continuous tracking and management of eye motion with the I-Guide.

3. Collimation of the beam.

Does IRay make financial sense for retina specialists? Probably, if CMS reimburses for it. There would be an initial machine cost plus a per-procedure disposable cost. Taylor believes the procedure will be cost-effective because it should reduce both diagnostic testing and anti-VEGF injections. IRay is not currently being tested in dry AMD, but that might be an area for research in the future, as drusen formation has been demonstrated to have an inflammatory component which may be amenable to radiotherapy.



References:

1. Office-based External Beam Radiation Therapy for Age-related Macula Degeneration; Hsu, Jason and Regillo, Carl; Retinal Physician, September 2009.

2. Stereotactic Radiotherapy for AMD; Taylor, James; Ophthalmology Innovation Summit, October 2009.

3. Motion Management for a Novel Ophthalmic Stereotactic Radiosurgical Device; Chell, E. et al; AAPM, July 2009.

4. 2009 AAO Meeting; Peterson, Lynne and Woods, Diane; Trends-in-Medicine, November 2009. (Subscribers, only, contact Trends-in-Medicine)


Links to the NeoVista Writeups:

NeoVista Epi-retinal Strontium 90 Treatment for Wet AMD (2-14-07)

NeoVista Epi-retinal Strontium 90 Treatment for AMD Update (7-11-07)

NeoVista Epi-Retinal Strontium 90 Treatment for AMD: Update 2 (11-19-07)

NeoVista Epi-Retinal Strontium 90 Treatment for AMD: Update 3 (10-1-08)