OUR APPROACH
This is the real deal.
Dr. Cancel combines current research, best practices and guidelines, and direct evidence with innovative thinking to develop creative solutions to effectively achieve your healthcare goals.
We do not do contracts. We do not require long-term commitments, and we don’t play games. Results are what matter most. And we don’t push supplements or do upsells, either. Our mission is to achieve lasting outcomes, not endless treatments.
And from a practical point of view, effective treatment results in lower overall cost when all factors are considered.
Get your life back on track.
You don’t have to live with chronic pain. If you want results rather than endless treatments, then schedule a free initial phone consultation by clicking “Help me, Dr. Doug!” and filling out our brief questionnaire.
patient reviews
facebook feed
Recently, I shared the findings of a recent large scale analytic study linking testosterone replacement therapy (TRT) and the incidence of rotator cuff tears. Among my comments, I made a passing reference to reports of increased heart attack and stroke risk among some men receiving TRT. ![]()
![]()
I thought that my Facebook friends and patients might find the findings of a recently published long-term TRT safety study to be rather interesting. (N Engl J Med. Published online June 16, 2023)![]()
![]()
**It is important for readers to clearly understand that the following findings apply ONLY to: 1) men receiving TRT in the form of TOPICAL testosterone gel, and 2) men with BONA FIDE, clinically demonstrable low testosterone levels (not men who somehow finagled TRT because they reported feeling "run down" or lacking in energy)![]()
![]()
A) Among over 5000 men, age 45-80 years, followed for an average of 22 months, there was NO increased risk of death from cardiovascular causes, non-fatal myocardial infarction, or non-fatal stroke.![]()
![]()
B) There was NO increased risk for prostate cancer observed over a 33 month follow-up period.![]()
![]()
C) There WAS increased rates of atrial fibrillation, acute kidney injury and pulmonary embolism.![]()
![]()
D) There WAS lower rates of anemia among men who were anemic at the beginning of the study.![]()
![]()
E) TRT was associated with improved sexual function over 2 years of treatment.![]()
![]()
F) A significant and unexplained 43% INCREASE in fractures with TRT.![]()
![]()
One can make of this recently published study what one wishes, but it was a big trial trial that does offer some reassurance for men on the heart safety of TRT.
There is a relationship between testosterone therapy (TRT) and rotator cuff tears, rotator cuff repair surgery and rotator cuff revision surgery according to an analysis of almost 674,000 patients with rotator cuff tears, recently published in the Journal of the American Academy of Orthopedic Surgeons (J Am Acad Orthop Surg. 2023;31(11):581-588).![]()
![]()
The analysis revealed that those receiving testosterone replacement therapy (TRT) had a greater risk of sustaining a rotator cuff tear, a greater likelihood of undergoing rotator cuff repair surgery and a greater likelihood of undergoing a subsequent rotator cuff repair surgery. ![]()
![]()
The analysis did not reveal a specific cause for this association, but there are number of facts to consider. Rotator cuff tears, whether full-thickness or partial, have been estimated to be present in up to 34% of asymptomatic individuals, with high rates of progression to symptomatic tears. We know that tear development and progression are strongly associated with age, as well as smoking and family history, along with posture, repetitive activities and a number of other factors.![]()
![]()
In sports, we know that the administration of testosterone in doses exceeding normal body production can cause increases in the size and strength of muscles that can exceed the load bearing capabilities of tendons thereby resulting in tendon tears. The question is whether the administration of testosterone in “normal” / “replacement” amounts (a.k.a. TRT) produces the exact same profound physiological effects on muscles as supraphysiologic amounts do and whether, alone, this explains the increased tendon tear risks reported in this analysis.![]()
![]()
Based upon my 40 years of clinical experience in treating more high-level weightlifters and strength athletes in my community than anyone else, I believe that there are additional considerations at play in these TRT associated rotator cuff tears. To be sure, TRT has become increasingly popular among older men and “hypogonadic” younger men because it does, for the most part, restore energy, vigor, and quality of life (despite recently reported risk factors for heart attack and stroke in some men). In my experience, many patients being prescribed TRT have more active lifestyles and perform a higher degree of activities that stress the rotator cuff.![]()
![]()
But there is more to it than just that, I have observed. Because TRT does generally restore energy and vigor many men think that they can do just about any exercise activity with impunity and exhibit a casual disregard for proper training volume/intensity and recovery. They follow poorly designed exercise programs. When it comes to weight training, they use improper weight selection and demonstrate poor exercise form. They often workout too often, for too long, and generally do not get sufficient rest. Many simply train like some of the more knuckle-headed younger men that they strangely seek to emulate. Therefore, it should come as no surprise that many of these guys are destroying their tendons at higher rates than their fellow “non-enhanced” men. ![]()
![]()
My office is the leading fitness focused Sports Chiropractic facility in Walnut Creek. We draw patients from all over Northern California seeking prevention, relief and rehabilitation of rotator cuff as well as other shoulder related dysfunctions. We provide expert exercise program design and individual exercise instruction in an environment like no other in our profession. If you have concerns about your shoulders and wish to avoid surgery, give us a call at (925) 945-1155.
USAIN BOLT HAS A SCOLIOSIS AND IS ASYMMETRICAL.![]()
One leg is almost 2cm shorter than the other.![]()
He has a spinal curvature of about 40 degrees from “normal”.![]()
When he runs he imparts 13% more force with his right leg than his left, and 14% more time on his left than his right.![]()
He also has 8 Olympic Gold Medals and is the fastest human of all time.![]()
For many years people have contacted me, asking me to treat and "correct" all the misalignments and “imbalances” reported to them by other Chiropractors on static, non-moving, X-ray pictures.![]()
But what about the functioning of the person? Has the person developed adaptations that now provide a competitive advantage? Should "corrections" be done in the pursuit of perfect looking x-rays irrespective of performance? Is it possible that some asymmetries serve a purpose that provides an advantage in some circumstances?![]()
In a human there can be adaptive as well as genetic asymmetries. Each case is contextual to the person and the tasks they perform.![]()
In my office, performance is key. What matters most is that patients feel and perform better as soon as possible. If this is what matters most to you, consider giving us a call.