Blog - Page 13 of 15 - Michigan Spine & Pain

Let’s Get Clear on Water

We know that our body is composed of water. But not enough water that we can’t use more!

We need to remain hydrated, so that blood moves to our organs. When we are properly hydrated, we avoid kidney stones, our digestive system moves along appropriately, our skin is in its optimal condition and we can also keep hunger at bay if we are watching our weight. In addition, headache sufferers need to remain fully hydrated, as dehydration can be a trigger for migraines and other headache disorders.

It is very easy to become dehydrated. Water leaves our system through sweat, through just exhaling and when we urinate or have a bowel movement. We lose more water during the summer or during times when our breathing rate or sweating are increased such as during exercise, if we are in a hot sauna or shower, during hot or humid weather or when overlayered in clothing, or if our job or leisure activities are physically demanding.

Do we have to drink water?

No, you can also be hydrated through juices and foods that contain water (typically fruits and vegetables), but water is available for free, has no sugar added and often has fluoride, aiding oral health. In addition, water does not contain caffeine. Caffeine is not necessarily bad in smaller amounts. Contrary to popular opinion, caffeine has not been implicated in contributing to dehydration issues, especially if its use is limited (2-4 cups of coffee per day or two servings of pop).

How much water does a typical person need?

The old information is that you need to divide your weight in half (so if you weigh 150 pounds, divide that in half to get to 75). The halved number is the number of ounces that you should drink. So, under the old formula, a 200 pound person needs to drink 100 ounces of water and a 150 pound person needs to drink 75 ounces of water.

It now appears that the above formula overstates the need for water by a bit. Essentially, if you drink when you are thirsty and monitor your urinary output, you are drinking the right amount.

Signs that you are properly hydrated:

You are not overly thirsty.
Your mouth does not feel dry (and you don’t suffer from bad breath, a sign of dry mouth).
Your urine is clear or light colored (bright yellow urine or darker is a classic sign of dehydration).
Your bowel movements are relatively soft.

Depression and Pain

photo by Sander van der Well

Those of us who suffer chronic pain (pain that does not ease after 3 months’ duration) are at increased risk for developing depression.

Depression is misunderstood by many. Depression is not a character flaw or weakness. Depression is real and it can be as debilitating as the chronic pain that preceded it. We have seen with the death of Robin Williams, that depression, when treated improperly, can be life-threatening.

According to the Diagnostic and Statistical Manual of Mental Illness (DSM-V), depression is considered major or often termed clinical when it lasts for at least two weeks and when its symptoms are present daily. The symptoms include the following, five of which should be present in the case of a diagnosis of depression.

An overall feeling of sadness and hopelessness, irritability and recurrent crying spells
Significant changes in appetite resulting in either weight loss or weight gain
Major changes in sleep patterns, typically a desire to sleep all the time or an inability to either fall asleep or stay asleep
Restlessness or agitation, or complete lack of energy
Little or no energy or attention for the activities that used to entertain us or bring us joy
Decreased sex drive
Feelings or worthlessness, overwhelming guilt feelings
Inability to concentrate or remember big or little things
Thoughts of death, suicide, or wishing to be dead, fantasizing about funeral and the aftermath of our death

Dealing with chronic pain requires a team approach. There must be attention paid to the physical nature of your complaints, appropriate therapy must be administered, any medication must be prescribed and adjusted when necessary and constantly monitored for effectiveness as well as side effects. In addition, the mental aspect of pain must be addressed. Patients must avoid saying to themselves, “If I could just get rid of this pain, I’m sure my mental status would improve.” Instead, patients need to be honest with their care providers about the nature of their depression: their moods, the duration of their depression, what their thought processes are, and particularly if they are considering hurting themselves.

Depression, in and of itself, is not always easy to treat. But patients who are already receiving medical care for pain relief are at least part of the medical community and are often open to the treatments that work for depression, combined with chronic pain. These include:

Medication to alleviate severe depression.
Avoidance of triggers of chronic pain, which can in turn, increase depression.
Cognizance of lifestyle choices that contribute to depression, including alcohol and substance abuse, high stress activities, close proximity to difficult or even abusive people
Increased physical activity when possible, including endorphin-producing cardiovascular activity, stretching, and light walking.
Meditation and breathing exercises.

Headaches: Not Caused by Evil Spirits

The Centers for Disease Control and Prevention report that 28 million Americans suffer from migraines and 4.5 million people live with chronic headache pain more than once a month. We know the number is enormous, just based on how many headache patients we see on a daily basis at our three Michigan Spine and Pain clinics. We treat a lot of headache pain.

Here is something we learned once about the history of headache pain in civilized society that certainly grabbed our attention: “In times gone by, headaches were often thought to be the work of evil spirits and rituals were performed to drive them off. In the Neolithic period, circular chunks of skull were removed in order to let the spirits escape. Oddly enough, people seemed to have survived these operations as skeletons have been found that showed new bone growth around these holes”. (source: www.health24.com/Medical/Headache-and-migraine/About-headache/Interesting-facts-about-headaches-20120721)

We promise there’s no drilling going on in any of our offices, but there is a never-ending effort to understand headache pain and provide our patients with the newest proven treatment options and the best research-based clinical understandings of the causes of headache pain. If you suffer from headache pain, it is important that you are able to learn as much as you want to about your condition. The American Headache Society is a highly respected national organization and the AHS web site www.americanheadachesociety.org is a great place to turn to for education, support and other resources. The site hosts information for both medical professionals and patients alike. Especially interesting for some of our patients will be the ACHE collection of Articles covering topics including:

Our understanding of headaches and headache treatment have come a very long way. The Greeks and Romans used to use peppermint tea to treat their headaches… they also drank infusions made from chamomile, rosemary and lavender. They also applied raw potato, cabbage and onion to the head.

We promise not to tell you your pain is the fault of evil spirits and we won’t send you home with just chamomile tea and a raw potato. We will spend all the time necessary in order to understand your headache symptoms in consultation with you and our full team of doctors and therapists to design the best headache relief plan for your unique situation.

What to Do When You Disagree With Your Doctor?

Well, that’s an interesting question…What do you do? We go to our doctors because we trust that their intensive medical education and professional training puts them in the best position to help us with expert advice. That’s the way it should be and most of the time, truthfully, that’s the way it is.

Something is changing, though, about the “thickness” of the line between what doctors know and understand and what patients know and feel. Perhaps it’s the internet: we all have so much access to technical, scientific and clinical information that once was for a professional audience only. Perhaps it is a reflection of trends in our society that motivate us to want to take control of decision making and our health and health care rather than hand that responsibility to our doctors. Perhaps, also, not agreeing with your doctor is just a reflection of the natural human nature and our ability to thoughtfully agree or disagree.

Have you had an experience of disagreeing with your doctor? How did it make you feel? What did you do?

This article: What to Do When You Disagree With Your Doctor, featured recently in U.S. News & World Report offers some good advice and interesting insight on the subject.

www.health.usnews.com/health-news/patient-advice/articles/2014/07/16/what-to-do-when-you-disagree-with-your-doctor?int=98e708

From my perspective, as your doctor, I want to make sure my patients know that forming an open and communicative relationship with your doctor – indeed with your entire rehabilitation and health care team – is absolutely the best way to assure that if or when a treatment question, concern or disagreement does surface, all parties involved feel comfortable with communicating and working together. I don’t mind when a patient questions or disagrees with my medical advice.

Do you have a question? Let’s talk about it!

Dr. Marvin Bleiberg

Hey You: Take This Test Right Now!

It will only take 10 seconds or less…and it will give you almost instantaneous and invaluable info that you can bring to your next doctor’s appointment if you think you might have bad balance and are therefore possibly at risk for a fall because of weakened core muscles or any type of chronic pain.

Yes, we mean YOU: Take this simple 10-second balance assessment right now!

Stand comfortably near a wall with your arms in any position you choose.
Lift one foot an inch or two off the floor so that you are balancing on the other foot.

If you can’t hold this position for more than 10 seconds, you’re at risk for a fall!

This very basic test is just a modified sample of a multi-part balance test that many doctors or physical therapists would perform in a clinical setting as part of a full stability assessment. A longer, and therefore more in depth, set of questions can be viewed on the Centers for Disease Control and Prevention National Center for Injury Prevention and Control website:

www.cdc.gov/homeandrecreationalsafety/pdf/steadi/4_stage_balance_test.pdf

Just doing two simple parts at home, though, can be an important learning tool for you and a good way to bring up the subject with your health care team if you have any questions or concerns about how your health is affecting your strength or your balance.

Even if you are not concerned about the possibility of falls for yourself, it is reasonably likely that you have a friend or relative over the age of 65 who could be at risk. Falls, especially for those who are elderly, are a huge problem! Here are some sobering facts from the CDC:

Each year, one in every three adults age 65 and older falls.
Of those adults that fall, less than half talk to their healthcare providers about it.
Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.

Harvard Health Publications, a division of the Harvard School of Medicine reminds us: “One of the best things you can do for your health is strengthen your core muscles. These muscles go far beyond your abs — your core also includes your back, sides, pelvis, and butt. Working together, these muscles let you move freely and keep you steady on your feet. Good balance is critical because it can help you keep your independence by preventing debilitating falls.”

You should always talk with your doctor before beginning any physical routine. If you are cleared for light to moderate stretching and core strengthening exercises, we recommend these three online resources. All have reliable information and clear instructions that can help remind you of different activities, stretches and exercises.

You Are so Much More Than Your Pain

Describe myself? Here is what might I say: I am a woman. I am a spouse. I am a daughter of parents who need care. I love books and swimming. I am in pain. The pain in my back and neck keeps me from swimming sometimes. I have trouble sleeping. I am a grandmother. I am depressed about living with pain. I travel in the winter to places that are warm…I understand that I am so much more than my pain, yet it is a part of my life in every way, every day. Some of these things my friends and family know. No one, though, had really ever asked me to describe myself , not in this way, until my first meeting with my Michigan Spine and Pain Social Worker.

“You are so much more than your pain”, Dr. Bleiberg told me at my first appointment. I had been in agony for weeks and, honestly, all I wanted was a muscle relaxer prescription. Right away I learned that Dr. Bleiberg and his team approach to pain medicine is about treating the whole person, not just the symptom, condition or disease. My meeting with Cory, a Michigan Spine and Pain LCSW (licensed clinical social worker) made such a difference for me in how I think about who I am and how pain modifies the parameters of my life. Before coming to Michigan Spine and Pain I could not have told you – or myself even – that I was depressed about living with chronic pain. I could not have told you that I was not alone in my emotional struggle with physical pain. It is one year – exactly – since my first MISP appointment. I’ve learned how to take control of my pain and I’ve learned how to happily live those parts of my life that are so much more than pain. Here are some resources I that helped me. Maybe that might be helpful to you too. These organizations provide information, advocacy, and support for chronic pain sufferers and families of the millions of people who live with pain:

The American Academy of Pain Management www.aapainmanage.org

The American Academy of Pain Management (AAPM) is a professional organization that provides accreditation, education and publishing opportunities. There is also a wealth of information on the AAPM web site that is easily accessible and user friendly for pain patients interested in learning more about the world of pain management and pain care.

American Chronic Pain Association www.theacpa.org

For more than 30 years the American Chronic Pain Association (ACPA) has offered support and education in pain management in the form of programs and peer to peer support groups for people living with pain, as well as to family, friends, and health care professionals working with people in pain. Simply put, the ACPA puts everyone on the same page. There are literately hundreds of ACPA support groups meeting in community centers, hospital conference rooms, schools and libraries in every city, everywhere. The ACPA’s unique take on living life to its fullest, even with pain, is important for me, and others that I have met, on my journeys with pain. As an added bonus, the information and tools on the ACPA web site are easy to access and have personally helped me live a higher quality of life.

WE are so much more than our pain. WE are not alone. We might not ever know each other’s names, but let us know how you are doing by sending Dr. Bleiberg an email. He’ll make your note anonymous and allow us to share your pain journey to help others, too.

Thanks, Cory, for asking me to share my story.

Walking Tips for Health:

Walking for health has many benefits: it is the greatest contributor to maintaining healthy weight, it staves off Type II diabetes, it improves cardiovascular health, has been proven to combat depression, contributes to overall physical functioning and also keeps dementia at bay.

While our exercise programs can get easily derailed in November and December, Michigan in July beckons us to at least get out and walk. Indeed, walking is the most popular exercise regimen for all Americans. But, not all walking is equal. For the greatest health benefit, here are some tips to “walking the line”:

Walk more. In general, in order to maintain cardiovascular health, 30 minutes of accumulated moderate exercise nearly daily is recommended, and is a very achievable goal. If you are also trying to lose weight, it may take closer to 60 minutes of sustained exercise.
Walk fast. A slow amble is better than sitting at home watching the Weather Channel. But a recent large-scale study of walkers in the National Walker’s Health Study indicated that ponderously slow walkers had a higher than average mortality. This could mean that the slow pace wasn’t aiding the poky walkers. It could also indicate that slow walking was a sign of other underlying health concerns.
Time your walking. Either time yourself on a marked track of use any kind of phone app that measures distance and time. Try to get yourself to a 16 minute mile. And be aware: if your walking is 24 minutes per mile or slower, then consider seeing a health professional.
Look at your walking shoes. If they are wearing in unpredictable places or even mildly uncomfortable, take your shoes and your feet to a reputable shoe store and find good-fitting shoes for your foot and gait.
Walk in the familiar: For lots of exercisers, the easiest walk to be motivated for is the one in the old neighborhood. Familiar terrain and no surprises make it easy to keep track of time and mileage and you never feel lost. Familiarity breeds contentment.
Take a walk on the wild side: For other walkers, the same route day after day brings boredom and saps motivation. If you want to take an adventure and see new sights, consider the variety of hiking trails all over Michigan. You can check out this site to find a huge selection of former railroad lines that have been converted to hiking trails: http://www.traillink.com/trailsearch.aspx?state=MI
Walk in good form. Walk upright, keep your arms bent at 90 degrees and your hands and arms relaxed. Avoid overstriding.

Always consult with your physician before embarking on any exercise regimen.

Taking Time with You; Using Time with Us Wisely

This story: 15-Minute Visits Take A Toll On The Doctor-Patient Relationship posted on the Kaiser Health News web site got our attention. (You can see the full story here: www.kaiserhealthnews.org/stories/2014/april/21/15-minute-doctor-visits.aspx)

Both doctors and patients are feeling the stress from the decreasing amount of minutes that physicians under pressure are able to spend in an exam room one-on-one with the patients they care for. Did you know that the average amount of time physicians spends with a patient is right around 8 minutes per patient, according to a 2013 study reported on in the New York Times?

At Michigan Spine and Pain we spend the time we need to with our patients, even if that means our time with you is ten times the “new doctor national average” reported in the NYT study. The reality, though, is that your time with the doctor is limited. Preparing a list of questions can help you make the most of the window of time you have together. You can help facilitate a truly productive visit with your doctor if you write down your symptoms prior to your appointment and you:

*Bring the name(s) and contact information for any doctor(s) you have seen in the last year.

* Bring a list, with dosage information, for all medications you are taking. This goes for over the counter medicine, vitamins and supplements too.

And ask these types of questions:

What are some of the possible causes for my symptoms?
What kinds of tests might confirm a diagnosis you suspect?
What treatments are available, and which do you recommend?
What types of side effects can I expect from treatment?
How can I best manage other health conditions I have?
Are there any restrictions that I need to follow?
Are there any alternative therapies other than the approach that you’re suggesting?
Is there a generic alternative to the medicine you’re prescribing me?
Is there educational material I can take home with me? What websites do you recommend visiting?

Digital Record Keeping and our Practice

Is your doctor going digital? Have you filled out new patient paperwork on line lately? Was there a laptop or tablet in your physicians’ hands when she saw you last? If not, be ready for these and other electronic experiences soon.

There is so much progress being reported about the ease and efficiency and a multitude of other benefits of entering and storing medical records as digital or electronic files. Even with all that we see happening all around us, it is clear that many questions remain yet to be explored and many more questions still need to be answered. For whom are medical records easy: the doctor, the clinic’s medical staff, the insurance companies and/or the patients? Regarding privacy issues, who gets to have access to digital records and how do we know they are secured from people who shouldn’t be peeping? How do we as the health care provider differentiate in our record-keeping among patients who utilize government-funded insurance where there are certain requirements versus those who are private insurance subscribers? What aspects of our records are required by law and the insurance companies and what aspects do we choose to utilize on our own?

Michigan Spine and Pain is considering these issues and many others as we look at the variety of ways that we can utilize electronic record keeping in the best interests of our patient community. As we research a few of the latest and some of the most trusted trends, let us know what you think about your experiences in our offices. Your feedback is valuable to us as we strive to keep up to date with important best practices in office management. If you are interested in learning more about the subject of electronic records including some insights on a few of the forces shaping the discussions, we encourage you to read either of the following articles. We found them to be well-written with unique perspective on the complex components of record keeping as it relates to medical care.

www.bostonglobe.com/lifestyle/health-wellness/2014/06/15/apps-store-personal-medical-records-growing-popularity/mh9wIhU4KdFHa1veptEUEO/story.html

www.bostonglobe.com/lifestyle/health-wellness/2014/06/15/websites-and-apps-allow-users-store-health-records-online/Q40ZT9f2PF9CSPCFYhrefP/story.html

Net Gains: Playing Tennis Safely

Tennis is a fabulous sport to watch or to play, and the temperate Michigan summer is an ideal environment for regular matches.

Tennis is terrific exercise, combining a great cardio workout along with usage of a wide variety of muscle groups.

Tennis is a relatively low-injury sport, much lower than soccer and golf. Injuries can be avoided with some smart preparation prior to playing and improved techniques.

The most common tennis injuries are:

sprained ankles
back pain or strain
tennis elbow
shoulder bursitis
calf strain

To prevent each of these, consider doing the following:

To prevent sprained ankle, first avoid playing on slippery pavement or when you are really tired. If you are prone to twisting your ankle, considering wearing an ankle brace.

Back pain prevention is that old standby: stretching prior to playing and building up your core and abdominal muscles. Yoga and Pilates, situps and crunches all improve back and core strength. The worst thing you can do for your back is to go out on the court cold with no warm-up whatsoever. Be cognizant that serving places a lot of strain on the back because of the hyperextension (bending backwards) that is involved.

The infamous tennis elbow is caused mostly from repetitive motion, and often a racquet grip that is too tight. This causes the muscles that connect from the forearm to the humerus to be inflamed. Be sure that your tennis racket handle is not too small for you. Take frequent breaks when you play to bend your wrist up (the stop sign) and to bend your wrist down. You may benefit from a tennis elbow compression strap, but only on the advice of your health professional.

Shoulder Bursitis prevention requires that the tennis player pay particular attention to the muscles of the shoulder and really maintain good strength in all of the arm muscles. Lifting weights that target biceps, triceps, trapezius and scapula muscles all will benefit the tennis player. A variety of rowing-style exercises are also helpful. Serving the ball places the greatest strain on the shoulders, so it is advisable to utilize a coach and/or a physical therapist to evaluate your serve and make corrections in your mechanics.

Calf strain occurs when you are starting your motion, pushing off to the left, right, forward or backward to return a volley. Adequate nutrition before a match helps (carbohydrates seem to make the difference, too) as does hydration and monitoring your own fatigue level.

1-800-586-7992

Let’s Get Clear on Water

Depression and Pain

Headaches: Not Caused by Evil Spirits

What to Do When You Disagree With Your Doctor?

Hey You: Take This Test Right Now!

Walking Tips for Health:

Taking Time with You; Using Time with Us Wisely

Digital Record Keeping and our Practice

Net Gains: Playing Tennis Safely

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