Fat Belly? Your bigger concern should be Fatty Liver.

Fat Belly?  Your bigger concern should be Fatty Liver.

Alan Himmel, DC.

The next time you look in the mirror and look at your gut, you should be more concerned about what's happening on the inside, particularly to you liver.  The condition I am talking about is called Fatty Liver Disease, or Hepatic Steatosis.

What is normal?  

There is always a small amount of fat surrounding your liver.  A small amount (5-10%) of fat in the liver is considered normal.

Who is at risk?

If you drink alcohol (alcoholic liver disease), you are at risk, and this condition is clinically significant, because this may lead to cirrhosis, over time.

In pregnancy, fatty liver can be common.  If you are obese or even overweight, you are at risk.  These two causes are (NAFLD) or Non-alcoholic Fatty Liver Disease, and are clinically less significant and considered by some sources to be benign, although there is a causative link between fatty liver and type two diabetes, hepatitis, and advanced liver disease, such as cirrhosis as well.

What are the symptoms of fatty liver?

Generally, there are no symptoms.  It is one of those silent diseases.  If you carry a large amount of fat around your midsection, there is a good chance you have fatty liver.  In extreme cases, you may feel some fatigue, abdominal discomfort, enlargement of the liver, weakness, poor appetite, or weight loss.

What are the long term consequences?

In most cases of NAFLD, the long term clinical outcome is minimal with not much evidence of increased mortality.  However, there is a group of the population with with NAFLD that progresses to a more inflammatory liver disease called nonalcoholic steatohepatitis (NASH) which leads to hepatitis, end stage liver disease, and a lower chance of survival.

How is fatty liver diagnosed? 

Liver enzymes (transaminases) can be checked, but in many cases, the levels appear normal. Clinically, the signs of Fatty Liver would include high triglycerides, high cholesterol levels. Another way to check would be the use of  ultrasound.  Lastly, MRI or CAT scan can be used.

What can I do to prevent it fatty liver, and is it reversible?

 Fatty liver is one of those diseases which is preventable and often times reversible.  It is highly advised to stay away from a diet high in sugars, and in particular, high fructose corn syrup sweeteners which are found in many foods we eat, from soft drinks to tomato sauce.  Within the liver, these sugars undergo a process called lipogenesis, and much of that fat is stored in the liver and the viscera.  In order to reverse fatty liver, a diet devoid of high sugars and high fructose corn syrup, along with exercise, can lead to weight loss, and ultimately a reduction of fat in the liver.

Do you need some advice or counseling on effective ways to reduce or prevent fatty liver disease?  I have been in practice since 1996.  You can contact my office and make an appointment: 954-659-8600

Will Florida PIP Cover Me if I am Traveling out of Florida?

Will Florida PIP Cover Me if I am Traveling out of Florida?

Alan Himmel, DC PA

In your own car: YES.
In a car that is not yours, including a rental: NO
In Mexico:  NO
In Canada:  YES

Here is a scenario:  You are a Florida resident and have a Florida registered and insured car and travel north to go skiing in the Smoky Mountains.   You decide to pile your family into the family SUV, and make a trip. You manage to get through Florida and Georgia safely, but when you get into Tennessee, someone runs a red light and smashes into your car causing injuries. In this scenario, you were in your own car, so there IS coverage for you and your family.

Let's say you find that there is no snow in North Carolina and decide to travel into Canada?  Yes, there is PIP coverage for injuries to you and your family if you have an accident in Canada.

HOWEVER, lets say you decide to FLY to North Carolina, and rent a car.  You have an accident in North Carolina while occupying a rental car.  NO, there is no coverage under your Florida PIP policy. Same is true if you are in a friend's car in NC, It's not your car, so no PIP. 

Let's say you are in your relative's car in NC, providing that the relative is a NC resident, No Florida PIP here either.  How about if you are in a relative's car in NC and the relative is a Florida resident with car insurance coming from Florida?  No coverage here either unless you and the relative LIVE together.

In Mexico in your own car and there is NO coverage.

In regard to resident relatives:  There are some companies that will deny a claim if they determine that the policyholder did not disclose all people in the household when the policy was purchased.  They will deny the claim based on "material misrepresentation."    So, always let the company know all people living in the house, no matter if the addition of these extra people in the house will increase the cost of the policy.  If you hide this information from them, they will find out and may deny your claim.

I'm not a lawyer.  I am a chiropractor with 26 years experience treating auto accident patients, and I have been exposed to many different coverage scenarios.  Get all legal opinions from a licensed attorney.

Nursemaid's Elbow in a Young Child. Cause, signs, and reduction.

                                       Nursemaid's Elbow

Dr. Alan Himmel

It is never a good idea to pull or tug a young child by the arm.  This action may create what is called a nursemaid's elbow. 

What essentially happens is that a person, who is trying to control an uncooperative child, grabs the child by the arm.  The child of course, still is not cooperative, and fights back, by pulling.  The resulting injury is that the head of the radius, subluxates at the elbow causing a lot of pain, guarding, and the inability of the child to want to use the arm or hand.

Often times, the radial head pops back in by itself and the pain and guarding will disappear on its own, allowing for almost instantaneous pain relief.  But, sometimes, the joint will not "go back in" without a little help.

I don't recommend doing trying to fix this at home, because without knowing for sure whether it is truly a radial head subluxation or a fracture, it is possible to cause more pain and injury.  However, if you are confident the child has a nursemaid's elbow, or if it has happened before (children who have had this injury, may tend to have it again) then this is what you can do to fix it.

Carefully supinate the hand in front of the child. Then, while palpating the radial head with your fingertip and just a little bit of pressure, use your other hand to slowly flex the arm at the elbow.  You may have to go past 90 degrees of flexion, but you will feel, with very little effort, the radial head click, and pop back into the correct position.  The child may cry a little, but the relief is instantaneous, and within a few minutes, the child should be acting normal again and giving high fives with the injured hand.