Other Topics Relevant to Your Health

Other Topics

Fibromyalgia

Hypopnea

Influenza Vaccine

Osteoporosis

Sleep Apnea

Sports and Chiropractic

Sleep Apnea

Sleep Apnea is defined in The Merk Manual Seventeenth Edition Centennial Edition as:

A group of disorders in which breathing during sleep stops for more than or equal to 10 seconds, usually more than 20 times per hour, causing measurable blood deoxygenation.

Basically, sleep apnea is a sleeping disorder in which breathing stops several times an hour, for 10 seconds or more. In order for these breaks in breathing to be call sleep apnea, they also have to cause a decrease of oxygen in the blood ("blood deoxygenation") that is significant and that can be measured.

There are several different types of Sleep Apnea. The different types include central sleep apnea, obstructive sleep apnea, hypopnea, and combinations of these. Central Sleep Apnea (CSA) is due to a decrease in respiration (breathing), due to problems in the central nervous system (CNS- specifically the respiratory center has decreased output) or brain stem. Obstructive Sleep Apnea (OSA) is caused by an obstruction of the airway, usually in the upper airway or at the beginning of the airway.

The most common, and the most studied form of sleep apnea is obstructive (OSA). OSA has many causes including obesity, alcoholism, excess skin, developmental or congenital abnormalities (genetics), sleeping position, medications, and others. If the cause is obesity, weight loss can often be the cure. Likewise, if alcoholism is the cause, cessation of drinking can often be the cure.

Diagnosis is best done at a sleep clinic. If you feel that you are having trouble sleeping, if your partner says your are having trouble sleeping (i.e.-they are awake because you are snoring), or if you sleep all night and still feel un rested in the mourning, a sleep clinic is the place for you. Snoring and difficulties sleeping do not mean you have sleep apnea, but a sleep clinic could tell you what your difficulties are from, and if they are indeed from sleep apnea.

Note: snoring does not mean you have sleep apnea. You can snore and not have sleeping difficulties. However, people with sleep apnea tend to have a higher tendency to snore, than the average person.

Treatment of sleep apnea is not usually difficult. Some people get results simply from not sleeping on their backs (sleeping on your side is best), decreasing weight, having their MD change their medications, or avoiding alcohol. Sometimes a simple mouth guard will do. The most common treatment, and the treatment that works on most forms of sleep apnea is a CPAP (Continuous Positive Airway Pressure) machine. This is a machine that has a mask you wear to bed. It makes sure you have enough air going into the airway to keep it open at all times. Most people get used to it quickly, and find that they sleep better and feel more rested (this also helps their partners as well). Occasionally surgery has been used, but it is not usually recommended.

Chiropractic care as a treatment for sleep apnea has not yet been studied (I hope that changes). There are techniques used to open the airway by stimulation of the sympathetic nervous system (percussion temporarily helpful in asthma, emphysema, and some other lung diseases). We also know that chiropractic can influence the nervous system in a beneficial way. I hope that in the future, chiropractors will find a way to study the question...Can chiropractic help in the treatment of sleep apnea? I think it may be possible, but that is currently one of many questions left to be discovered by science.

Heart disease is associated with sleep apnea. People with heart disease have an increased likelihood of developing/having sleep apnea. And people with sleep apnea tend to have a higher risk of heart disease. The more sever the case of sleep apnea, the higher the risk of heart disease. These risks, however, are associated with untreated sleep apnea. It appears that treatment of sleep apnea will prevent the associated heart risks.

Resources
Javaheri, S. (2003 June). Heart failure and sleep apnea: emphasis on practical therapeutic options. Clin Chest Med. 3(2):207-22. Retrieved from Pub Med http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=PubMed in September 2003.
PMID 12800779 (PubMed-indexed for MEDLINE)
Meoli, Amy MD, et al. (2001). Hypopnea in Sleep-Disordered Breathing in Adults. Sleep, 24(4):469-470.
The Merk Manual Seventeenth Edition (Centennial Edition). (1999). West Point, PA: Merk & Co., Inc.

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Hypopnea

Hypopnea is a new term that is not yet well defined, and the definition may vary from study to study. Hypopnea is not strictly sleep apnea, it is a category made for people who exhibit mild signs and symptoms of sleep apnea, but miss the cut off of the definition for sleep apnea. For example, hypopnea is a slowing of breathing rate and a decrease in breathing volume that causes decrease of oxygen in the blood. There is not necessarily a stop in breathing. Since hypopnea is almost sleep apnea, and has the same treatments, it is included in discussions as a form of sleep apnea.

Influenza Vaccine

This information was reproduced with permission from Christina and Leonard Abel on Oct 17, 2004.

-Dr. Gwendolyn Kelly

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Only about 20% of all flu-like illness are actually influenza. Transcript of the Vaccines and Related Biological Products Advisory Committee, Feb. 20, 2003 U.S. FDA Center for Biologics Evaluation and Research

http://www.cdc.gov/flu/keyfacts.htm Every year in the United States, on average: 5% to 20% of the population gets the flu.

Remember good respiratory 'etiquette', cover all causes of coughs and wash your hands.
http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/cover/

Antiviral drugs used only against influenza viruses. http://www.cdc.gov/flu/protect/antiviral/index.htm

And then there are all the other non-drug, alternative treatments. Ask those health care providers that can not prescribe drugs.

What about mercury in the vaccine? from NVIC web site http://www.909shot.com

In 1999, the Environmental Protection Agency (EPA) and the Food and Drug Administration (FDA) directed the vaccine manufacturers to take mercury out of all childhood vaccines. In October 2001, the Institute of Medicine issued a report that said it is "biologically plausible" that mercury-containing vaccines could cause injury to the brain but there have been too few scientific studies conducted to prove conclusively that mercury in vaccines has caused brain damage."

Nevertheless, the Institute of Medicine recommended that drug companies take all mercury out of all vaccines and over-the-counter drugs.

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In compliance with this recommendation Fluzone, (Aventis Pasteur) a preservative-free vaccine formulated for children ages 6 to 35 months, with a trace amount of Thimerosal, is available in a limited amount (about 4.6 million doses). It is distinguished by a pink syringe plunger rod in the pre-filled syringe. (Thimerosal flu vaccine contains 25 micrograms of mercury which would be about 80 times more mercury then preservative free flu vaccines with trace amounts, about 0.3 microgram of mercury.)

Fluvirin with thimerosal and a Fluvirin reduced thimerosal-content influenza vaccines are approved for use in persons over the age of 3 years. At this time NONE of Fluvirin influenza vaccines are available.

http://www.chiron.com/investors/pressreleases/press_release100504.pdf

Trace amounts of thimerosal in vaccines are considered by the Food and Drug Administration (FDA) to be preservative-free. Manufacturers of preservative-free flu vaccine use thimerosal early in the manufacturing process. The thimerosal gets diluted as the vaccine goes through the steps in processing. By the end of the manufacturing process there is not enough thimerosal left in the vaccine to act as a preservative and the vaccine is labeled 'preservative-free'. Hence this is why we use the phrase preservative-free rather than thimerosal free.

All live vaccine have never contained thimerosal. Therefore the live influenza vaccine, FluMist is thimerosal free but only available for healthy individuals between 5 years-of-age and less then 50 years-of-age. This would exclude persons with long term health problems, weaken immune systems, pregnancy, history of Guillain-Barre Syndrome, and children on aspirin treatment.

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http://www.health.state.mn.us/divs/dpc/han/alert.html

Web site for the Revised Influenza Vaccine Recommendations from the CDC, 2004-2005 via Minnesota Department of Health 2004-2005

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http://www.909shot.com THE FLU AND THE FLU VACCINE

What is the flu?
Influenza is a respiratory infection that produces fever, chills, sore throat, muscle aches, and cough that lasts a week or more. The flu can be deadly for the elderly and those with compromised immune systems or who are suffering from diabetes, kidney dysfunction and heart disease. Each year about 36,000 Americans, mostly in these high risk groups, reportedly die from flu complications such as pneumonia. (90% of flu and pneumonia deaths occur in persons 65 years and older.)

What is the flu vaccine?
The flu vaccine is prepared from the fluids of chick embryos inoculated with a specific type(s) of influenza virus. The strains of flu virus in the vaccine are inactivated with formaldehyde and preserved with Thimerosal, which is a mercury derivative.
Every year, federal health agency officials try to guess which three flu strains are most likely to be prevalent in the U.S. the following year to determine which strains will be included in next year's flu vaccine. If they guess right, the vaccine is thought to be 70 to 90 percent effective in temporarily preventing the flu of the season in healthy persons less than 65 years old. For those over 65 years old, the efficacy rate can drop as low as 30% but the vaccine is thought to be 50 to 60% effective in preventing hospitalization and pneumonia and 80% effective in preventing death from the flu.

However, sometimes health officials do not correctly predict which flu strains will be most prevalent and the vaccine's effectiveness is much lower for that year.

Does the flu vaccine protect against all throat, respiratory, gastrointestinal and ear infections?
The flu vaccine only protects against the three specific viral strains which are included in any given year's flu vaccine. Throat, respiratory, gastrointestinal and ear infections caused by bacteria or other kinds of viruses are not prevented by getting an annual flu shot.

Vaccination against the flu does not protect against SARS or the complications of SARS. The World Health Organization is urging a worldwide flu vaccination campaign in the belief that high vaccination coverage can decrease the possibility of misdiagnosing flu as SARS and help in the early identification of a SARS outbreak. The CDC however is not recommending the flu vaccine for this purpose since the flu vaccine is not 100 percent effective and the suggested benefits in regards to SARS cannot be reliable.

Why do doctors say I have to get a flu vaccine every year?
Like all vaccines, the flu vaccine only gives a temporary immunity to the virus strains or closely related virus strains contained in the vaccine. The only way to get natural and permanent immunity to a strain of flu is to recover naturally from the flu. Natural immunity to a particular strain of flu can be protective if that strain or closely related strains come around again in the future. However, because the vaccine only provides a 70 to 80 percent chance of temporary immunity to selected strains and those strains may or may not be prevalent each year, doctors say you have to get a flu shot every year.

Are there reactions to the flu vaccine?
The most common reactions, which begin within 12 hours of vaccination and can last several days are: fever, fatigue, painful joints and headache. (flu like symptoms ?)

The most serious reaction that has been associated with flu vaccine is Guillain-Barre Syndrome (GBS) which occurs most often within two to four weeks of vaccination. GBS is an immune mediated nerve disorder characterized by muscle weakness, unsteady gait, numbness, tingling, pain and sometimes paralysis of one or more limbs or the face. Recovery takes several months and can include residual disability. Less than 5 percent of GBS cases end in death.

Brain and nerve disorders such as encephalopathy, optic neuritis, partial facial paralysis, and brachial plexus neuropathy as well as vasculitis have also been reported following the flu vaccine, although a definite causal relationship has not been established.

What are contraindications to the flu vaccine?
Among high risk factors listed by the CDC and the vaccine manufacturers are anyone who:
(1) is sick with a fever;
(2) has an egg allergy;
(3) has a mercury allergy;
(4) has a history of Guillain-Barre syndrome.

If immunosuppressed individuals receive the flu vaccine they may not get an adequate protective antibody response.

Is the vaccine safe during pregnancy?
In years past, pregnancy was also a contraindication to flu vaccine but, today, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) recommends flu vaccine for pregnant women.

The package inserts published by the flu vaccine manufacturers state that "Animal reproduction studies have not been conducted with influenza virus vaccine. It is also not known whether influenza virus vaccine can cause fetal harm when administered to a pregnant woman. Although animal reproductive studies have not been conducted, the prescribing health care provider should be aware of the recommendations of the Advisory Committee on Immunization Practices. The ACIP states that if used during pregnancy, administration of influenza virus vaccine after 14 weeks of gestation may be preferable to avoid coincidental association of the vaccine with early pregnancy loss."

Pregnant women should be aware that the flu vaccine contains Thimerosal, which is a mercury derivative. Mercury is toxic to the brain and has been found to be associated with brain damage and developmental delays in babies whose mothers were exposed to high levels of mercury during pregnancy.

Is Flu Vaccine Recommended for Children?
One consideration with the mass use of flu vaccine in healthy children is the removal of natural antibodies to flu which are obtained from natural infection. The question of whether it is better for healthy children, who rarely suffer complications from flu, to get the flu and develop permanent immunity to that flu strain or it is better for children to get vaccinated every year to try to suppress all flu infection in early childhood is a question that has yet to be adequately answered by medical science.

Although in the past the flu vaccine has not been recommended for healthy children, today vaccination of children 6 to 23 months of age is recommended by the Advisory Committee on Immunization Practices (ACIP) of the CDC.

What About The New Nasal-Spray Flu Vaccine?
A live-virus nasal flu vaccine, FluMist, was approved for use in June 2003. Its approved use is limited to healthy people between the ages of 5 and 49. This excludes its use in those considered at greatest risk from the disease - the very young and the elderly.

Who should not receive the FluMist vaccine?
(1) pregnant women
(2) people with asthma
(3) people with chronic lung or heart disease
(4) people with chronic underlying medical conditions such as diabetes or kidney disorders
(5) anyone allergic to any part of the vaccine including eggs
(6) children or adolescents receiving aspirin therapy
(7) those with a history of Guillain-Barre syndrome
(8) people with known or suspected immune system problems or who are immune-suppressed due to treatment with steroids, chemotherapy, radiation or other immunosuppressive therapies or their close contacts
(9) children younger than 5 and adults over 50.

Due to the possibility of spreading the virus, individuals receiving the vaccine are advised to avoid close contact with immune-compromised individuals for at least 21 days.

Is it safe to give with other vaccines?
No studies have shown the safety of giving FluMist along with other vaccines; therefore it should NOT be given along with any other vaccine. The product manufacturer's insert advises waiting at least two weeks after receiving a killed vaccine and at least one month after receiving a live-virus vaccine (MMR, Chickenpox).

How is the new vaccine administered?
Unlike the standard flu vaccine given by injection, which contains a dead virus, the vaccine is squirted up the nose and contains a diluted, live virus that could endanger people with weak immune systems. The live vaccine virus has been shown to shed for up to 3 weeks after receiving the vaccine.

What are the reactions to the vaccine?
Reported adverse effects to FluMist in children include runny nose, nasal congestion, cough, sore throat, headache, irritability, decreased activity, fever, chills, muscle aches, and vomiting.

In adults the most common side effects were runny nose, cough, sore throat, headache, muscle aches, fever, chills and tiredness or weakness.

Other adverse events that occurred in children were abdominal pain, asthma, bronchitis, conjunctivitis, viral syndrome, otitis media (middle ear infection), and wheezing or shortness of breath.

How is the vaccine made?
FluMist is prepared by introducing influenza viruses into eggs where they are allowed to multiply. Fluid from the eggs is processed and sucrose, potassium phosphate and monosodium glutamate (MSG) are added as stabilizers. The antibiotic Gentamicin is also added during the manufacturing process. FluMist does not contain any preservatives.

What should I do?
Become educated about the flu and its benefits and risks and the vaccine and its benefits and risks and make an informed decision after consulting multiple sources of information and discussing your questions with one or more health professionals.

References:
1. MMWR Recommendations and Reports "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" April 25, 2003
2. Fluzone 2003-2004 Formula, Aventis Product information as of July 2003
3. Influenza Virus Vaccine Live, Intranasal FluMist 2003-2004 Formula, Package Insert (Circular) June 16, 2003

For more information on the risks of this vaccine for those with immune deficiency please visit the Immune Deficiency Foundation.

Manufacturer's Package Insert.

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Chris Christinasabel@hotmail.com

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Osteoporosis

Osteoporosis is a loss of bone mass. It can be seen on x-rays if the loss is 30% or more. It is diagnosed by using a bone density test.

Facts

Osteoporosis affects mostly women after 65 years of age. However, men and women of all ages can have it.
Bone is made of several constituents including calcium (Ca++), magnesium (Mg), Phosphorous, and protein.
99% of Ca++ is stored in the bones, 1% can be found in the blood (blood plasma) and other tissues.
80% of peak bone mass is completed (developed) by the 20's (20-29 years of age), the last 20% of peak bone mass is completed in the 30's (30-39 years of age). You can increase bone density until about age 30-35, after that you can only prevent bone loss.
We have an average bone loss of about 1.2% per year after the age of 40 in men and women (note: this can be prevented or improved with nutrition and exercise). Bone loss is 3.5% per year for about 5 years in women, following menopause (normal loss of menstrual cycle due to a change in hormone levels that happens as we age, usually around 45-55 years of age) or a hysterectomy (surgical removal of the uterus). 5 years after menopause or hysterectomy, bone loss goes back to about 1.2% per year. (see HRT below)
Peak bone mass tends to be higher in men due to increased body mass. Ca++ intake, weight bearing activity, and hormones support increasing bone mass.
Bone mass has a hereditary component, but even if osteoporosis is in your family, it can still be prevented.
Heavier women tend to have a decreased chance of developing osteoporosis due to increased storage of estrogen in fat tissues...estrogen decreases osteoclast activity. Osteoclasts are the cells that "eat" or break down bone, decreasing bone mass.

Risk Factors

Increased risk of osteoporosis with: menopause (most in the first 5 years), hysterectomy (most in the first 5 years), ammenorrhea (loss of normal menstruation), and lactation after 6 months. Lactation after 6 months is only a risk factor due to the increased need for Ca++, if you are supplementing with Ca++ while breast feeding, you should have no problems. Breast feeding is still recommended for 1-2 years after birth in the United States, and is done longer in some countries.
Increased risk with low calcium (Ca++) intake throughout life, but especially if low Ca++ intake after age 30, after hysterectomy, or after menopause.
Increased risk of osteoporosis with low body weight.
Smokers and alcohol users have an increased risk.
Some drugs such as corticosteroids, increase risk by decreasing bone density.

Prevention/treatment

As we get older, our ability to absorb nutrients from the food we eat, decreases. In general, this makes using supplements important not just for prevention of osteoporosis, but for our general health. Ask your doctor of chiropractic for advise on the use of and proper combination of supplements. Supplements can cause problems if they are used improperly, they can interact with each other as well as other drugs or medications you may be taking. They may not work properly or optimally if they are not taken correctly. For example some vitamins work as blood thinners, if you are already on high blood pressure medications you should not take a vitamin that "thins" the blood, because it could cause problems. In this section, I will give you some supplement recommendations. Please do not just start taking these supplements without having your diet analyzed first. Before taking supplements, you need to know how much of that supplement you are already getting. For example, if I am drinking 3 glasses of milk a day I will need less calcium then if I am drinking 1 glass of milk a day. Too much of a supplement may be problematic, and too little may not be effective. So Please consult with your Doctor of Chiropractic before using any supplements. These recommendations are for informational purposes only.

-Calcium can prevent and treat osteoporosis. You (adult male or female) should be getting 1500mg/day (milligrams a day), this includes what you get from your supplements as well as your diet. 1glass/8oz. of milk or fortified orange juice has about 250mg of Ca++. So, you need about 6 glasses a day. Other sources of calcium are yogurt, fortified rice or soy milk, and green leafy vegetables. Cheese is not a good source, it has a lot of calcium in it, but it is hard for your body to get the calcium from it (it isn't as bioavailable as other sources), especially if you are lactose intolerant or have food sensitivities to dairy. If supplementing Ca++, take the citrate malate form of calcium (in the top three most bioavailable forms of Ca++). The bicarbonate form of Ca++ is not very bioavailable, and can cause constipation. Your body can only absorb 500mg of calcium at a time, so taking one tablet with your whole days worth of calcium is useless. You will only absorb 500mg, so don't waste your money on a supplement with tablets that have more than 500mg each (Note: there are instances when taking more is helpful, so if your doctor recommends more, don't tell him/her that they are crazy). Calcium supplements are supplements that are highly likely to be contaminated, due to the source that the calcium is taken from. It is important that you are taking a high quality supplement if you are taking Ca++ supplements. Make sure it is a pharmaceutical grade supplement...most chiropractors can get these, as well as other health practitioners. There are many different ways to take Ca++ in order to increase the amount your body can absorb, or the effectiveness of the supplement. Taking Ca++ at night before you go to sleep without food, is best (remember you can't take all of your calcium at once, you will need to take it other times as well). Too much calcium can cause problems...calcium deposits in soft tissues, gall stones, etc.

-Vitamin D is necessary to help get the calcium that you absorb from your food into your bones. We naturally make vit. D when the sun hits our skin. If we live in a northern state, however, there are only 2-3 months in the summer when the sun is strong enough for this to happen. Here in MN, we need to supplement vit. D in fall, winter, and spring. To prevent osteoporosis should take vit. D 200-800 IU/day (International Units per day). Prevention with Vit. D should only be done in the northern states from Oct.-March, and is best done if over 50 years of age. To treat osteoporosis vit. D should be taken 800-1600IU/day, this is for any state, time of year, or age of person who has osteoporosis. Vit. D is fat soluble and you should not get too much...consult your doctor first.

-Magnesium (Mg) does not help prevent osteoporosis, but can be helpful if you have osteoporosis already. 350-400mg/day of Mg to treat osteoporosis.

-Protein is helpful, 1-2 servings of protein drink a day, or 30-60 g. (grams) protein a day. Too much animal protein can increase calcium loss in the urine. In the United States most of us get too much protein as it is and most of it is animal. protein. So if supplementing protein for osteoporosis I recommend Soy protein drinks. Make sure it has Soy isoflavones. Soy isoflavones are helpful in osteoporosis, and menopause. Soy isoflavones can be found in other foods and supplements as well.

-Hormone Replacement Therapy (HRT) is a popular treatment and prevention for osteoporosis. HRT can prevent osteoporosis after menopause/hysterectomy. It only brings you back to a normal level of bone loss (i.e. from 3.5% loss per year to 1.2% loss per year). This means that for the first 5 years after menopause it is extremely helpful in treatment/prevention of osteoporosis, but after that, it doesn't help much. (see Facts above). So HRT is only helpful in osteoporosis for the first 5-7 years after menopause. HRT does not prevent heart disease as previously thought. Estrogen based HRT does increase your risk for estrogen based cancer i.e. breast cancer.

-Vit K is helpful, but there are only a few studies, too much is bad, and the wrong kind of vit. K can cause jaundice.

-We need 25g. (grams) of fiber a day. But too much fiber will decrease calcium absorption.

-Too much salt, animal protein, or caffeine will increase calcium loss in the urine.

-Phosphorus will increase fecal calcium loss, but decrease calcium loss in urine.

-Exercise is important. You need weight bearing exercise (exercise with resistance) in order to get the absorbed calcium into your bones. If you have sever osteoporosis (2 STD's or standard deviations, from the mean) exercise could be problematic and you should consult your doctor before starting an exercise program.

Chiropractic Care

Chiropractic care is beneficial for everyone. In treatment of people with osteoporosis, there are several adjusting techniques that can be used. These techniques are more gentle then other adjustment techniques, and are used to avoid putting too much pressure on the bones so that risk of fracture is decreased. This allows chiropractors to treat people with osteoporosis.

Chiropractors are also well trained in nutrition. Your chiropractor can analyze your diet and recommend the supplements you need to prevent and treat osteoporosis. Your chiropractor can also help you get on an exercise program that is necessary to build and maintain strong bones. Exercise and nutrition are extremely important in the prevention and treatment of osteoporosis. Remember prevention starts with moms getting enough nutrients to us as babies, and needs to be done throughout our whole lives, but it is never too late to start now.

References
Lecture notes Dr. Joel J. Pins, PhD, MPH, LN. Clinical Nutrition II, fall 2000.

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Sports and Chiropractic

Here is a video about sports and chiropractic which I have posted at YouTube. Please ignore any advertising or additional links which may appear from YouTube after my video is over. Anything after the video is material from them, not from me, and I am not responsible for it:

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Fibromyalgia

Here is a video about Fibromyalgia and chiropractic which I have posted at YouTube. Please ignore any advertising or additional links which may appear from YouTube after my video is over. Anything after the video is material from them, not from me, and I am not responsible for it:

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Kelly Chiropractic serves patients from the Twin Cities - Minneapolis area including Bloomington, Edina, Minnetonka, Eden Prairie, St. Louis Park, Wayzata, Plymouth, Maple Grove, Brooklyn Park, St. Paul, Anoka, Shakopee, Hastings, Eagan, Burnsville, Crystal, Golden Valley, New Hope, Robbinsdale, Hennepin County, Anoka County, Ramsey County, Dakota County, and Wright County.

Thank you for visiting the Kelly Chiropractic, P. A. web page. Please note that the information located on our site is not intended to provide specific chiropractic advice. You should consult with a chiropractic doctor and not rely on any information contained herein regarding your specific condition. We welcome the receipt of electronic mail. Please be advised, however, that the act of sending electronic mail to this office or to Dr. Gwendolyn E. Kelly, DC does not alone create a physician-patient relationship. We will neither accept requests for chiropractic advice or treatment nor offer specific chiropractic advice over the internet. The information here is presented for general information purposes only and is not intended to be used as a substitute for medical advice.