Posts by Dr. Cremata, DC
Relief Medical Group
Your partners in restoring function, feeling more youthful, and alleviating pain
Tel: 510 796 2225
Fax: 510 792 0802
Email: [email protected]
| Edward Cremata, DC, RN Nursing and Rehabilitation Director | Edmund Kemprud, MD Emergency Medicine |
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SPINAL AND JOINT APPROACHES
Correction-focused spinal and joint rehabilitation programs with multidisciplinary input.
PAIN RELIEF AND PAIN MANAGEMENT
Conservative medication and injection procedures available. Fibrosis Relief Procedures, Including Manipulation Under Anesthesia, are provided for chronic and difficult conditions not responsive to more conservative in-office procedures.
ACOUSTIC COMPRESSION
Also known as Extracorporeal Shockwave Treatment, we are one of the few offices in the Bay Area to offer this effective and conservative option.
FEEL AND LOOK YOUNGER
Botox and other cosmetic procedures available.
HORMONE REPLACEMENT THERAPY
Hormone deficiencies common in the aging population are addressed in a safe and effective manner.
Diet and Supplementation
Botox and Fillers
BOTOX – PREVENTIVE AND REJUVENATION TREATMENT FOR FACIAL WRINKLES
The International Association for Physicians in Aesthetic Medicine (IAPAM) teaches that Botox injections have preventive uses for younger patients and rejuvenation uses for those with already established facial wrinkling (see quotation below).
“Share with the patient that the best use for Botox is preventative – NOT reparative. By starting Botox every 4 months in your late 20s or early 30s, patients effectively avoid the years for crunching and frowning which eventually lead to furrows.”
THE MOST EXPERIENCED PROVIDERS, REASONABLE PRICES
Relief Medical Group, Inc. is pleased to have one of the most experienced physicians in the Bay Area, Edmund Kemprud, MD, providing the cosmetic injections for Botox and fillers. Botox is the most commonly used wrinkle treatment and Juvederm is a popular option to fill lines that have developed on your face.
A TYPICAL USE FOR A JUVEDERM FILLER IS SEEN IN THE PICTURE BELOW:
VARIOUS USES FOR PATIENT WRINKLES WITH BOTOX
ARE SEEN IN THE EXAMPLES OF PATIENT RESPONSES BELOW:
IF YOU HAVE ANY QUESTIONS ABOUT BOTOX OR JUVEDERM PROCEDURES, EMAIL US AT [email protected]
COSTS
Relief Medical Group Inc. offers reasonable prices for Botox, based fairly on a per unit charge, and costs are very flexible to accommodate a patient’s specific needs, desires, and budget. Look for internet specials on the home page or ask about our introductory specials available for first time Botox users. A complimentary follow-up visit in one week is provided at no charge to help optimize your Botox treatment needs.
Articles
Click any article to open it as a PDF in a new window.
DC care and the heart Chap 10 7.14
Effects of lat bend original 1989
Gonstead approach-cremata etal
Jannetta Neurogenic hypertension 7.13
Lat bend and C neuropathy, Carrick 12.13
Medication – Assisted Spinal Manipulation
Pre-Post Static Pos Chg 1990 498-506
Manipulation Under Anesthesia/Fibrosis Release Procedures
Is chronic pain interfering with your life? Think you’ve tried everything? Think Again!
“The best thing about MUA/FRP is that it gives you your life back!”
When intense, chronic pain doesn’t respond to conservative or traditional treatments, surgery is not the only remaining option. There is an alternative. In fact, debilitating problems may persist even after surgery, and surgeons themselves refer patients to Relief Medical Group for Manipulation Under Anesthesia/Fibrosis Release Procedures to relieve adhesions and scarring that are common after-effects of spinal surgery.
MUA/FRP has been Proven to be Effective for Patients Who Experience:
Recurrent Pain and Aggravation Following Injuries
Persistent Pain After Back Surgery
Fibrotic Adhesions or Internal Scarring That Limit Motion and Cause Pain
Unfragmented Herniated Disc and Chronic Disc Problems
Chronic Muscle Spasm, Myofascitis
Neuromusculoskeletal Conditions with Intractable Pain
Dr. Cremata, DC, RN is one of the few doctors of chiropractic who are certified to perform Manipulation Under Anesthesia/Fibrosis Release Procedures in California. He teaches the procedures to other doctors for four MUA/FRP accrediting agencies. He has served on various MUA/FRP committees to help determine appropriate patient selection and optimal patient protocols. His most recent publication is regarding MUA/FRP (please refer to the MUA/FRP link to read this or any of his other research publications). He has served as an expert at numerous trials before the Workers’ Compensation Appeals Board of California regarding MUA/FRP.
For more information, see Research Articles
Manipulation Under Anesthesia/Fibrosis Release Procedures is neither new nor experimental. It has actually been practiced since the late 1930’s and used by osteopathic physicians and orthopedic surgeons for many years as a proven form of treatment. During the past twenty five years, interest in MUA/FRP has greatly increased thanks to tremendous advances lately achieved in the science of anesthesiology.
What Is Manipulation Under Anesthesia/Fibrosis Release Procedures?
Manipulation Under Anesthesia/Fibrosis Release Procedures (MUA/FRP) is the use of manual manipulation of the spine combined with the use of anesthesis. The addition of anesthesia allows for the benefits of manipulation to be shared with those patients who cannot tolerate manual techniques because of pain response, spasm, muscle contractures, and guarding. It is also a proven procedure for those patients whose chronic pain has not responded satisfactorily to in-office chiropractic care and other adjunctive procedures. MUA/FRP uses a combination of specific short-level arm manipulations, passive stretches, and specific articular and postural kinesthetic integrations to obtain a desired outcome. It is a multidisciplinary procedure where a medical doctor and chiropractors work together to offer you the most benefit from these procedures. The chiropractors provide the services that they are expert in and are within their scope of practice, such as the spinal adjustments, traction, stretching, and myofascial release techniques. The medical physician, board certified in anesthesiology, provides all of the medical treatment, including medical management and the dispensing of any necessary medicines at their discretion and based on their area of expertise. This assures you the safest and most effective combination of expertise to assure that you receive optimal benefit from these very safe and effective procedures.
Who Can Benefit From MUA/FRP And Why Does MUA/FRP Work?
The goal in treatment of mechanical spine pain is to correct the aberrant spinal motion of the involved segments, thereby improving function and decreasing pain. This is achieved via a variety of techniques, most of which can be simplified into two types of forces : (1) high-velocity, short-duration and (2) low velocity, long-duration.
These two applications of force will affect different aspects of the restricted components. The former affects the osseous disrelationship or misalignment. The latter addresses the “tough soft tissue” component. These applications are used in an isolated or combined fashion, depending on the nature of the lesion. Office based SMT (spinal manipulative therapy) is rendered via specific short-lever arm-adjustive forces typically combined with traditional physiotherapeutic modalities such as ultrasound, electrical stimulation, cryotherapy, traction, and passive/active rehabilitation.
A percentage of these patients ultimately will not respond to in-office spinal manipulative therapy on the basis of one or more of the following criteria:
Chronicity of the case because of joint or soft tissue fibrosis, which has inhibited restoration of appropriate joint mechanics.
Acute myofascial rigidity and painful inhibition, which disallows conscious SMT.
Severe joint dysfunction and subluxation such that correction of evident spinal biomechanical misalignment is not achievable through conscious SMT.
Contained disc herniation (bulge) that has become refractory to conscious SMT.
Multiple recurrences during the active-resistive phase of joint rehabilitation.
What Is The MUA/FRP Procedure Like?
Before the day of the procedure, the patient is instructed regarding their nothing-by-mouth status and medications pursuant to instructions by a medical physician. The patient must be accompanied by a friend or family member to drive the patient home after the procedure. No patient will be allowed to drive themselves home after this procedure due to safety concerns. The patient then signs an informed consent affidavit and right after placed on the procedure table and hemodynamic monitoring is instituted, including electrocardiography, blood pressure, and pulse oximetry. Supplemental oxygen is given via nasal cannula. The patient is initially sedated mildly with Versed.
All medical procedures, including the use of drugs, are provided by a Board Certified Medical Anesthesiologist.
The MUA/FRP procedure generally takes between fifteen and twenty-five minutes. The patient is continually monitored by the anesthesiologist. Blood pressures are obtained at least every five minutes, and a complete anesthesia record is maintained. The patient is taken to the recovery room at the completion of the procedure. He or she will then be continually monitored in the recovery room, with supplemental oxygen administered on the basis of the facility protocol, which includes stable vital signs, and a fully awake condition.
Post-Procedure care
Post-procedure care is one of the most important parts of the MUA/FRP procedure and helps to make it highly effective. The therapy begins soon after the procedure to prevent subsequent adhesion formation.
After the last MUA/FRP procedure, the patient should follow an intensive therapy program for six to eight weeks in their doctor’s office, which will consist of the same stretches and adjustments accomplished during the procedure.
Post-MUA/FRP rehabilitation includes stretching, flexibility and strengthening exercises, plus periodic adjustment as required by the doctor. This regimented post-MUA/FRP therapy will help the patient regain pre injury strength, maintain motion improvements obtained from the MUA/FRP procedures, and help prevent future pain and disability.
Diet and Supplementation
Do dietary supplements (including vitamins and minerals) really offer a significant health benefit?
Yes. Decades of scientific studies confirm that dietary supplementation can improve overall health, improve or prevent disease, and even reduce the risk of serious diseases such as cancer and heart disease.
Can supplementation make up for a poor diet?
No. Although supplements can help you to achieve appropriate intake levels of the nutrients that make up a healthy diet, supplementation cannot undo the clear and dangerous risks of a poor diet.
It is important to introduce good nutrition to your family early.
Does quality differ among supplement manufacturers?
Yes, very substantially. Supplements are evaluated for strength, bioavailability (how well they are absorbed and utilized by the body) synergism with other supplements and purity. Product quality evaluations are performed by independent laboratories, so this information is readily available. Douglas Laboratories, makers of Relief Medical Group’s supplement blend, is consistently rated among the best supplement producers.
What constitutes an optimal dietary supplement?
Although in certain cases, lower-quality and lower-dosage supplements have been shown to provide some health benefits, there is no doubt that higher-quality and more complete supplement combinations are better for achieving optimal health.
What about concentrated tea and whole fruit and vegetable supplementation?
Studies suggest that whole food supplements offer numerous advantages over individual vitamins and minerals. Several hundred vitamins, minerals, and other nutrients have been identified which seem to work better when consumed in their natural state – as part of a whole food. Furthermore, scientists believe there may be over 19,000 so-called “phytonutrients” which are only found in whole fruits and vegetables that play a crucial role in the supplements’ effectiveness. The American Cancer Society and the American Heart Association endorse the view that consumption of whole fruits and vegetables reduces the incidence of some cancers and heart disease.
What are Probiotics?
Probiotics are concentrated doses of the “friendly” bacteria that help maintain a healthy microbiological “landscape” in your digestive tract, a.k.a. your flora. Probiotic supplementation has been shown to improve immune function, as well as digestive and other disorders. It also appears to be particularly beneficial in restoring healthy flora for patients who have taken antibiotics, which can detrimentally effect microorganism populations in the body.
Are Omega-3 Fatty Acids (from fish oil and other substances) an important part of a supplementation regimen?
Numerous articles have been published in the past decade showing that fish oils can help prevent and/or treat a number of serious ailments, including cardiovascular disease, depression, bipolar disorder and inflammation. In fact, Omega-3 Fatty Acids may be one of the most beneficial supplements you can include in your daily regimen.
What is Coenzyme Q10?
Coenzyme Q10, or CoQ10 for short, has been shown in studies to be helpful as an antioxidant that increases the usefulness of Vitamins C and E. Proposed benefits include supporting the cardiovascular system, decreasing soreness following injury and decreasing fatigue during exercise.
What role does diet play in my overall health?
There are well-established connections between diet and most “western” diseases, such as cancer and heart disease. In addition to reducing your risk of disease, making good dietary choices will help you to feel happier and healthier in your daily life.
What can I do to ensure that my diet and supplementation requirements are met?
There are two things you should do:
1. To optimize your health through the foods that you eat, incorporate these three important dietary changes into your lifestyle (from The China Study, by Colin Campbell, PhD):
a. Maximize your intake of fruits and vegetables and whole grains.
b. Minimize your intake of refined carbohydrates, e.g. non-whole grain pasta, white bread, crackers and sugars; added vegetable oils, e.g. corn oil, peanut oil and olive oil; and fish containing high levels of mercury, e.g. salmon, tuna and cod.
c. Avoid as much as possible meat, dairy and eggs.
2. Take the Essential-4 Nutrition Pack
ESSENTIAL-4 Nutrition Pack
NOW AVAILABLE THROUGH RELIEF MEDICAL GROUP
NOT AVAILABLE AT THE RETAIL SITE
DIET/SUPPLEMENT INGREDIENTS
Cellulite Removal
WHAT IS CELLULITE?
It isn’t fair, but women suffer from cellulite at a much greater incidence than men and it is most commonly found in the hip and buttock regions. Up to 85% of women complain of some degree of cellulite that worsens as they age. This is due to the higher number of fat cells stored in female fatty tissue and the aging process that breaks down and loosens connective tissue that would normally contain these fat cells. This leads to an imbalance of the deposition of fat and the breakdown of fat, and causes these large fat cells to create a bulging of the skin.
(Knobloch, et.al, BMC Women’s Health, (2010) 10:29 , http//www.biomedcentral.com/1472-6874/10/29)
NEW EFFECTIVE TREATMENT AVAILABLE
Historically, treatments available have been limited to ones that provided only temporary effects (and for many were not very effective at all). Now there is a new treatment available to help reduce or eliminate your cellulite problems, using scienti cally- supported application of high energy sound waves, which is not painful and does not require either injections or surgery. This treatment is called Acoustic Compression and is commonly referred to as Extracorporeal Shockwave Treatment (ESWT).
HOW DOES IT WORK?
Consider the cause of cellulite as discussed above and how you would reverse the cause of the problem for a long-term solution. Acoustic Compression has been shown to strengthen the connective tissue in the fat layer below the skin to better contain the fat cells being deposited in this fat layer. It is the bulging of these fat cells beyond its connective tissue (restraining tissue) constraints that manifests as the skin dimpling that is commonly referred to as cellulite.
HOW WELL DOES IT WORK?
Very well! To avoid misleading anyone about the anticipated results from this procedure, let’s look at examples from the published scienti c evidence. These are results actually obtained during a research study on the effects of Acoustic Compression for Cellulite. (Dermatol Ther (Heidelb) (2013) 3:143-155). As referenced below in pictures, these results were obtained after 6 sessions of Acoustic Compression treatment followed by a 3-month period to assess the effects of the newly healed, stronger, and less dimpled tissue. More treatment may produce continued improvement, but this study was limited to studying the effects of 6 weekly sessions followed by a three-month waiting period.
CASE STUDIES
Improvement of the Cellulite Severity Score from 15 to 7 in a female patient suffering from cellulite before and 3 months after six sessions of focused extracorporeal shockwave therapy (0.35 mJ/mm2)
Improvement of the Cellulite Severity Score from 12 to 2 in a female patient suffering from cellulite before and 3 months after six sessions of focused extracorporeal shockwave therapy (0.35 mJ/mm2)
Improvement of the Cellulite Severity Score from 10 to 6 in a female patient suffering from cellulite before and 3 months after six sessions of focused extracorporeal shockwave therapy (0.35 mJ/mm2)
WHAT SHOULD I EXPECT DURING TREATMENT VISITS?
First and foremost, results are anticipated from these effective treatments, but allow three months after the seventh treatment ends before assessing your particular results. No reputable health care provider would guarantee individual results, but at Relief Medical Group, Inc., we use the same protocols and energy levels that were used in these studies, so it is reasonable to expect a similar result in patients that share similar characteristics as those in the this study. We use a seven-visit protocol instead of six visits, since the evidence on Acoustic Compression shows that the results are dose-dependent (the more the better, to a point), and other studies on this subject obtained good results with up to eight visits.
HOW MUCH WILL THE CONSULTATION COST TO SEE IF I AM GOOD CANDIDATE FOR ADDRESSING MY CELLULITE THROUGH ACOUSTIC COMPRESSION?
Nothing. The initial consultation is done at no charge. If you are a good candidate, we will design an individualized treatment program consisting of seven weekly visits, and provide a follow-up visit after three months to assess the results.
Click Here to View the Brochure
Contact our office for more information
Hormone Replacement Therapy
HORMONE REPLACEMENT THERAPY
Hormone replacement therapy begins with the best available hormone testing using some blood tests and some urine tests. For simple conditions, often a blood value is all that is needed. For more complicated conditions, the 24-hour urine testing can more comprehensibly assess hormone levels and hormone utilization in the body. You can learn about this testing at www.dutchtest.com.
Hormone replacement therapy can be provided safely and effectively if managed by experienced, trained, and certified health care personnel. At Relief Medical Group, Inc., patients have this highly effective treatment available for them as provided by trained and certified doctors and nurses. All programs are supervised and approved by Edmund Kemprud, MD, the medical director.
The goal is not to provide high doses of hormones that are unnatural to the body and can carry high risks, but to determine the needed doses of hormone topical creams to bring the blood laboratory values back to more normal and optimal physiological function levels. The doctors and nurses at Relief Medical Group, Inc. strive to return your hormonal levels back to a time where you were younger and did not suffer deficiency symptoms – not to raise your blood level to high medicinal levels for a desired effect that may come with increased health risks. Blood values are monitored to assess individual effects to hormone therapy to achieve optimal safe, effective, and more youthful levels of hormones.
When testosterone deficiency is present, men and women can complain of a loss of sexual desire, loss of muscle mass, loss of energy, and a lessened ability to concentrate. We can provide testosterone for you and any other supplements or medication that may be required for your individual needs to assure that you are optimally metabolizing this hormone.
When Estrogen and Progesterone are out of balance in women, sexual dysfunction including lubrication deficiencies, cramping, irregular menstruation, mood changes, and related symptoms can take place. Symptoms related to menopause are typically caused by a sharp decrease in Estrogen production can be alleviated with hormonal balancing in patients with deficiencies or imbalances of these hormones. We assess these conditions for you using blood and urine testing as needed, and may refer you to a OB/GYN or endocrinology specialist as required for your specific needs.
If patients have an abnormally low Growth Hormone level, they feel unusually fatigued, have accelerated skin aging, and can have difficulty benefiting from exercise to develop strength and muscle tone. While few patients require this therapy when compared to the more common low testosterone findings, this is available for those with substantial deficiencies that are interfering with optimal healthful functions.
Contact our office for more information.
Feel and Look Younger
The bad news is that aging is a natural process; and let’s be honest, nobody has figured out a way to stop it!
However, there are many safe and effective procedures available to you to help you look and feel younger. The passage of time, and therefore your actual age, is not what sometimes makes us look and feel old. It is the effects of aging, including wrinkles, hormone deficiencies, and dietary deficiencies that are the culprit for many that are feeling “old”.
Acoustic Compression
Also known as Shockwave Therapy (ESWT)
The Non-Invasive Solution for an Active Lifestyle™
Acoustic Compression, also known as Extracorporeal Shockwave Therapy, is now available at Relief Medical Group!Many patients have reported excellent results with only seven in-office sessions. Anesthesia is not required! ESWT is the healing technology that ends incurable foot, shoulder, elbow, and other areas of pain without surgery!ESWT is also an effective, non-invasive treatment for Erectile Dysfunction and Cellulite Reduction!The full price for consultation, examination, any necessary x-ray, and the seven weekly sessions of ESWT is only $1175 (when paid in advance—regularly $1275) Only Seven Sessions Required! Please contact us for more information or any questions you may have! |
Download information about Therapeutic Advances in Urology
| Shockwave treatment of erectile dysfunction | Treatment of Erectile Dysfunction with Piezowave |
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| Download | Download |
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ESWT has been used effectively worldwide to treat “insertional tendinopathies,” such as:
- Heel Pain (Plantar Fasciitis)
- Tennis Elbow (Lateral Epicondylitis)
- Shoulder Calcifications (Calcific Tendonitis)
- Achilles Tendonitis
- Knees (Patellar Tendonitis)
- See our cosmetic pages to learn how this same technology is used to remove CELLULITE
Millions of people suffer from pain caused by inflammation of tendons and other soft tissues attached to bones, commonly referred to as “insertional tendinopathies” or enthesopathies”.
How Does Extracorporeal Shockwave Treatment Work?
The widely accepted theory is that Extracorporeal Shockwave Treatment (ESWT) causes micro-trauma and controlled injury at the affected area, thereby leading to the formation of blood vessels (revascularization) which triggers the body’s natural healing process and repair mechanisms. The sound waves are also thought to release adhesions and scarring to help increase mobility and optimize healing. Studies have shown a 60-80% success rate in significantly reducing or eliminating pain.
What Happens Before, During and After ESWT Treatment?
BEFORE: Patients will be instructed to discontinue medication containing aspirin or non-steroidal anti-inflammatory medications (e.g. Motrin) for several days before treatment (and most likely for up to 10 days following treatment) unless otherwise instructed by the treating doctor.
DURING: Treatment typically lasts 10 to 30 minutes and is performed in the office without the need for anesthetic. We use a high quality, low-medium energy ESWT unit.
AFTER: Patients may experience discomfort in the treated area after the effects of anesthesia have subsided. Some bruising, swelling, and temporary numbness is normal and expected. In the days immediately following treatment, many doctors will recommend stretching exercises to maintain mobility.
Patients can then typically resume normal activity. Heel pain patients are recommended to use custom orthotics when they have hyperpronation (flat feet) to optimize healing of the planter fascia and prevent recurrences.
Healing is generally near complete at about twelve weeks after the completion of the treatment visits, although patients may continue to experience additional reduction in pain and increased capacities thereafter.
What are Alternative Treatments?
Most doctors will first pursue conservative treatment options to reduce or eliminate pain. Conservative treatment may include such measures as rest, non-steroidal anti-inflammatory medications (NSAIDs), over-the-counter pain relievers, physical therapy, and orthotics (for heel pain). ESWT should be tried before cortisone injections, since injections increase the chances of tendon ruptures. Doctors will usually recommend ice, physiotherapy, exercises, and orthotics (heel lifts) prior to considering more aggressive approaches. However, when conservative treatments have failed, ESWT is increasingly being used to avoid traditional invasive surgery. Acoustic Compression is a more aggressive, more effective, and yet still conservative management for the conditions shown above.
Is This Treatment Right for Everyone?
You should speak to Dr. Cremata DC about your specific needs to see if Extracorporeal Shockwave Treatment is right for you. ESWT is not recommended for use on pregnant women, children, anyone with a pacemaker, or anyone on anti-coagulant therapy, or who has a history of bleeding problems.
How Do You Get Treatment?
Call Dr. Cremata, DC about your specific medical condition to see if Extracorporeal Shockwave Treatment (ESWT) is right for you.
The full price for consultation, examination, any necessary x-ray, and the weekly sessions of Acoustic Compression (Shockwave) is $995.00 (reg. $1195.00) when paid in advance. ONLY SEVEN VISITS REQUIRED!
Dr. Cremata, DC can provide additional complimentary medical treatments as needed. Informatios
Pain Relief and Pain Management
Control of your pain is very important for your comfort, ability to sleep well, take care of yourself and your family, perform your job duties, etc.
At Relief Medical Group, we can provide you with prescription and non-prescription options to relieve your pain while you are undergoing treatment to improve the cause of your pain. We can dispense or prescribe various topical creams, anti-inflammatory agents, muscle relaxants, and other appropriate medications. When necessary for acute and severe pain, we can deliver these medications to you by injection for a rapid effect.
The ultimate goal is to improve your underlying condition enough so that you don’t need prescription medication for very long. The more conservative options of a topical medication cream as opposed to oral medication helps to prevent the dangerous and sometimes avoidable adverse effects from medications, such as stomach problems like ulcers, liver problems, or kidney toxicity.