Michigan Spine & Pain

Mt. Pleasant, Gaylord, & West Bloomfield, MI

 

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Mt. Pleasant, MI – 989-772-1609
West Bloomfield, MI – 248-851-PAIN (7246)

Is Your Acute Pain Taken Seriously?

emergencyWhen you experience a true health care emergency, you want to feel confident that your health care providers hear what you are saying about your pain, assess your level of pain appropriately and make decisions to alleviate your pain in a timely and effective manner.

There are common barriers to communicating your pain. These include difficulties communicating the nature and severity of pain, biases in the health community regarding the aged and chronically ill and undertreatment of women’s pain.

Not speaking the same language:

This can mean a number of things. It can be as basic as poor communication with hospital personnel during a crisis due to language barriers or debilitating pain that restricts communication. It can also include crossed signals regarding how severe pain really is or an inability to describe the exact nature of the location of the pain. Patients should be honest about how much pain they are feeling. If you are asked to rate your pain in between one and ten and you are feeling pain, always say five or more. Patients should not try to be stoic or heroic about pain levels.

Furthermore, if you feel that you have been assessed inappropriately during an emergency room triage (which rank patients’ conditions from needing urgent treatment to those who can wait), ask to be reassessed. Assertively.

Girl, What You Talking About? How Women’s Pain is Undertreated

Women’s pain is notoriously undertreated in emergency rooms.

“Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing.” (Joe Fassler, Atlantic Monthly, October 2015)

Women are often conditioned not to make a scene, to follow the rules of systems and to be polite. But this behavior often means that they and their pain can be overlooked in emergency pain situations. Women need to advocate for themselves. More importantly, their companions who have brought them to the emergency room need to advocate on their behalf by saying things like, “She is really in pain like I have never seen before” or “I have never seen her like this” or “She is really in trouble.”

Two recent articles about undertreatment of women’s pain in emergency rooms can be found here:

Age and Condition:

Unfortunately, the aged and those who suffer from chronic health conditions are often the recipients of kind words, but treatment that borders on medical neglect. Doctors and nurses tend to discount “frequent flyers” at their institutions and can possibly ignore a serious incident. Again, their companions needs to advocate on their behalf and ensure that staff understands that “this time feels different”.

Appropriate timely treatment for pain requires effective two-way communication between patients and emergency room personnel.

Health Saving and Cost Savings

One of the issues that we all face in health care is the rising out of pocket or out of paycheck costs. You can’t control all aspects of your health care costs, but you can try some of these cost saving measures:

  1. Know the rules of your insurance provider. Be sure you have to up-to-date knowledge of your physicians’ and hospital networks, your out of pocket deductible, the dates of your plan and your co-pays for doctors, lab work, screening, emergency room and urgent care visits.
  2. Be sure your doctor and you are on the same page regarding costs. Make sure that your doctor understands that you are trying to save money, so that prescribed medication is not cost-prohibitive.
  3. Do your homework. If you have a large deductible to meet and you have an upcoming procedure, find out what the costs will be. If you need a surgical procedure, sometimes outpatient centers are much less costly than traditional large hospitals.
  4. Understand your options with your medication. If you take a 20 mg pill which is also available in 40 mg, it may be possible to order the larger pill and split it, saving yourself some money. Or sometimes, the reverse is true: the smaller pill is much less expensive than the larger one. You can take two pills instead of one. Discuss these possibilities with your health care providers and your pharmacists. Not all pills can be split or doubled.
  5. Find cheaper alternatives that provide similar results. Generic drugs may be a good fit (they also sometimes are not). Certain complementary practices like massage and acupuncture can substitute for other more expensive medications.
  6. Understand what a true emergency is and reserve emergency room visits for just those. Chest pain? Go to the ER. Sore throat on the weekend? This is a great reason for a trip to the nearest urgent care or convenience clinic.
  7. Utilize your employer’s health savings account to the maximum allowable, but make sure you use all of it. Add up your expected out of pocket medical costs from medication, physicians’ visits, contact lenses and glasses and dental and orthodontic care. Have your employer deduct the maximum allowable amount to get as close to your annual outlay as possible. At least, you will not be taxed on these amounts. In addition, many HSA’s are now issuing debit cards that are pre-loaded with your deducted money that can be used at pharmacies, doctors’ and dentists’ offices and hospitals and clinics.
  8. Don’t scrimp on what’s already free. Lots of screenings are now free with no copay: mammograms, PAP smears, blood sugar, cholesterol and blood pressure screenings. Ask your doctor or your health care plan administrator what is free and sign yourself up!

The best way to control costs is to do your research and work in partnership with all of your health care providers and your insurance providers, too.

Avoiding Overuse Injuries

tennis elbowSometimes our body aches because of the presence of disease, like arthritis or fibromyalgia or various headaches, like migraines. Sometimes, we are in pain because of injuries to the bones or muscles.

There are several common injuries that are typically the result of overuse, either from athletic pursuits, work routines or regular daily life activities. Overuse kind of sneaks up on you. It may start off as a twinge that goes away and over time develops into more constant or consistent pain associated with specific activities.

Frequently occurring overuse injuries are:

  • Shin Splints (Leg pain which worsens with running or walking)
  • Tennis Elbow/Golfer’s Elbow (weakness and/or pain inside or outside the elbow)
  • Runner’s Knee (pain behind the kneecap, made worse with running, walking, jumping, cycling and ascending or descending steps)
  • Rotator cuff tendinitis (shoulder pain felt when lifting the arms straight up or in a circular motion like a swimming stroke)
  • Plantar Fascitis (usually felt in the feet and ankles upon first waking up)
  • Achilles Tendinitis (typically presents as ankle pain)

Overuse injuries are the result of too much exertion, combined with muscle weakness. The major ways to prevent the above injuries include babying yourself a little bit by not hitting the same muscles day after day. When you work out, be sure to warm up before true exertion. Most importantly, after exercising or after a long period of working, take time to stretch and cool down. Be sure you are moving appropriately. Contact a coach or trainer to check your form or consult with a physical therapist to demonstrate what hurts and learn compensating exercising to increase strength, flexibility and reduce pain.

If you are trying to increase exertion or activity, do so gradually, not all in one spurt of activity. If you’ve led a sedentary life, you can’t go from sitting on the couch to running a marathon. Start by adding 15 minutes of exertion and add a maximum of 10 minutes per day.

Being more active is a great goal. Being safe and avoiding overuse injuries should also be a concurrent objective.

It’s Apple Picking Time!

appleWhether you are a devotee of a local apple orchard or just a lover of apples, this is the best time of year. Right now, apples are at their peak, locally grown and ready to eat.

You’ve probably heard the adage, “An apple a day keeps the doctor away”. It’s not completely untrue.  Apples are a great source of vitamin C, which is found just beneath the skin (another reason to eat the skin). Apples are high in fiber, relatively low calorie and contain minimal sodium and no cholesterol. Apples have been associated with lowering LDL cholesterol (the so-called bad kind) as well as contributing to a healthy digestive tract. Apples can be a part of a diabetic diet. Consumption of apples has been shown in a variety of studies to improve cardiovascular health, improve lunch function, and keep asthma at bay. And apples contain anti-oxidants, which play a role in pain management.

Here are a few ideas to incorporate apples into your regular eating patterns:

For kids’ lunches, many kids won’t bite right into an apple (especially if they have orthodontic appliances). So, help them out, slice and peel the apples and brush the flesh with a mixture of lemon juice and water to prevent browning. Immediately put the slices into an air-tight container.

Home-made applesauce from freshly picked apples is easy and makes the house smell great. Core the apples, peel them if you want (we don’t!), cut the apples into cubes and put them into a small saucepan. Cover the apples (just barely) with water. Boil the apples and then turn down the heat to low until the water lessens. Mash up the apples to the desired consistency. Add sweetener (sugar or sugar substitute, just a few teaspoons or its equivalence) and some cinnamon to taste. Serve warm or room temperature or cold the next day.

Baked apples: This fancy looking dessert isn’t that hard to make. The hardest part is coring and scooping out the inside of the apple (a melon baller helps). The rest of the recipe can be found here:

http://www.thekitchn.com/recipe-baked-apples-stuffed-with-oatmeal-brown-sugar-75752

And we love this recipe for Apple Butternut Squash Soup, which combines Michigan apples and Michigan root vegetables, too: The recipe can be found here:

http://www.michiganapples.com/Recipes/ID/533/Michigan-Apple-and-Butternut-Squash-Soup

So, get out there and pick your apples from the orchard or the grocery store, and eat them every which way. We hope it keeps the doctors away, except for well checks, of course!

 

September is Pain Awareness Month

pain awareness monthIf you are reading this, you may already be WELL AWARE of pain.

Pain Awareness Month, truthfully, is directed at the general public and all of the health care providers, as well as family members of those who suffer from pain.

The messages of Pain Awareness Month:

The Cost of Pain:

  • Did you know that chronic pain affects 100 million Americans, more than cancer and heart disease combined?
  • Chronic pain is a leading cause of employee absenteeism.

The Impact of Pain on Quality of Life:

  • Pain can adversely impact a person, and limit their ability to work, to socialize and to form and maintain good relationships with family and friends.
  • Pain sufferers also report poor sleep, which exacerbates their pain and ability to function.
  • Pain and depression often co-exist.
  • Pain and anxiety can also co-exist.

Not Everybody Understands Pain:

  • Many health care providers “don’t get” pain, underestimating its intensity or impact.
  • Prescription pain management and proper use of prescription medication complicates the treatment of pain.

Ways to celebrate this month:

  • Share your pain story with others. Tell those who don’t understand pain how you cope, what works and what your struggles are. Your goal is to educate those around you about this seemingly invisible illness. Make it visible!
  • Take time to take care of yourself. Lead your friends and neighbors in a restorative walk. Host a healthy potluck. Get together with pain sufferers and non-pain sufferers to share how you get through tough times.
  • Take time to learn, taking advantage of resources on our website as well as with our knowledgeable staff. We can recommend lots of websites, books and magazines that we trust.

You are more than your pain. But your pain deserves to be acknowledged and treated.

Too Hip for Your Own Good? Preventing Hip Pain

quadricep stretchYour hip joint is one of the world’s greatest engineering feats: a ball and socket joint that allows for fluid movement. This joint also is surrounded by ligaments and is cushioned by cartilage. Most people’s hips can handle a lot of motion throughout their lives and a significant amount of wear and tear.

But lots of people suffer intermittent or chronic hip pain.

Hips can “wear out”. The cartilage that provides cushioning can erode. Muscles can be overused. And of course, the hip bone can be broken, a common occurrence in elderly patients, whose balance may be compromised and whose bones may be weaker due to osteoporosis.

Not all hip pain can be prevented, especially if the cause is injury or a disease process. But hip pain can be mitigated and hip injuries can also be avoided.

Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.

When you experience pain in the hip or related areas (groin, thigh, buttocks), be aware of what makes the pain feel worse or what makes it feel better. Do you experience relief when you cut back on activity or is your hip pain worse after lying down? Try to be tuned into your body so you can do more of whatever provides relief and less of whatever increases your hip pain.

Some of these suggestions may help:

  • Maintain an ideal body weight.
  • Exercise regularly, but always stretch and warm up prior to exercise and stretch and cool down afterwards.
  • If your pain flares up after exercise, particularly running, ease up a bit.
  • You can take a non-steroid anti-inflammatory drug when you experience pain or even before it comes on, if you know you are going to be using that hip joint a lot (like before shopping errands, travel, football game days, etc.)
  • When you sleep, choose a firmer mattress and sleep on the unaffected side with a pillow between your legs. Some people find side sleeping uncomfortable and enjoy more restorative sleep sleeping on their back or on their stomach.
  • Hip pain is often caused by inflammation of the joint. For this reason, applying ice for 15 minutes as many times a day as you can tolerate is often quite effective, as ice reduces swelling.
  • Elevate your hip when you lie down to recuperate, using pillows.
  • Low-impact exercises can aid in flexibility and provide relief. Some of the best choices are yoga, swimming (leisurely or vigorously) and water aerobics.
  • Resistance training, especially with body bands, can also help to strengthen weaker muscles surrounding the hips.
  • Wear good-fitting shoes all the time, but especially when exercising.
  • Runners with hip problems are advised to avoid running on hard surfaces such as concrete and asphalt.

Try to take care of your hips and do your part to maintaining this crucial body part. Obviously, if your pain does not abate or is severe or debilitating, contact your health care team immediately.

Labor Day Lesson: How to Make Work Less of a Pain

standing deskIn honor of Labor Day, let’s talk about work and pain.

Now, we are not saying that work can’t sometimes be a pain, from the smelly leftovers your office mate is eating at lunch to the endless meetings.

We want to focus on how your body functions at work.

Standing Tall: If you stand at work a lot because you are in manufacturing or in retail or construction jobs, you may not feel that you can control your physical environment as much as you can. The major thing you can control is your posture. Check your posture. Are your legs spread around shoulder width? Are your shoulders pulled back? These questions not only make you look leaner and stronger, they also protect your back and neck. Change your position every fifteen minutes and do take seated breaks or even if they are comfortable, do occasional lunges or squats.

The Desk Jobs: The major components of most people’s work areas are a chair, a desk and a computer. You may not be able to control how much the boss spends on these items or how they are configured, but as you gain some seniority, you may be able to agitate for some better benefits.

Evaluate your seated position:

  • Does your chair give you sufficient support and padding?
  • Is your chair the right height? Your hips and knees should make 90 degree angles. Although it can be cute for young, short women to dangle their legs from their desk chairs, it’s ultimately terrible for your legs and feet.
  • Is your desk the right height? If you type at a keyboard, your elbows should be at 90 degree angles.
  • Is your keyboard the right height? The majority of the screen should be right at eye level, directly in front of you.

Make Work Less of a Pain:

Bring a weight to work and stow it under your desk. Every once in a while, grab it and do 8 repetitions of bicep curls or tricep curls or your other favorite arm exercise. Ignore the stares of your coworkers or challenge them to do the same.

Sit down/stand up desks. If your boss is Dan Gilbert, CEO of Quicken Loans, then nearly all of your employees have these wonders of ergonomics. With a push of a button, you can change the height of your desk and take a break from sitting for a while. As we looked around his busy office, we noticed that several people change their positions regularly. We also noticed a fair percentage of men and women tending to stand exclusively at the end of their day. Standing improves blood flow, burns a few more calories and prevents blood clots: all good things.

Wireless headsets are a great investment for those who spend a great deal of time on either a corded phone or cell phone. Women particularly tend to turn their necks to the side to hold the phone in place, which is a guarantor of future neck pain. A wireless headset not only frees you from neck pain but it also allows you to leave your desk while you talk, encouraging you to be less sedentary.

Work is part of life and takes up a lot of waking hours. Let’s resolve this Labor Day to treat our bodies as part of our work product, too.

Are You Too Hip for Your Own Good?

hip jointIf your hips are causing you pain and decreasing your mobility, it’s time to give your hips some attention.

Anatomically, your hips are the key to moving and walking around.  Your hips are the site where your thigh bones join with your pelvis. The actual hip is a ball and socket joint. The ball (the top of your thigh or femur) is called the femoral head. The femoral head lies within the acetabulum, which is the socket in your pelvis. Ligaments connect the femoral head to the socket.

The hip area, in addition to the ligaments, also has a thin membrane (the synovium), which lubricates the joint.

Outside the bone structure, the hip joint is surrounded by large muscles (the largest in the human body) including your “glutes”, your quadriceps, your hamstrings, muscles that connect to the inner thigh and another set of muscles that connect to your lower back.

Servicing all of these muscles and joints are an intricate network of nerves and blood vessels.

In short, your hips are essential: they are truly the core of your body.

But hips are prone to problems, particularly as we age and if we subject the joints to overuse.

Some of the causes and related symptoms of hip pain are:

  • Osteoarthritis (pain and stiffness, often worse after periods of inactivity)
  • Rheumatoid arthritis (pain and swelling at the hip joints)
  • Ankylosing spondylitis (very commonly affects the hip joints)
  • Lupus (inflammation of the joints as well as organ systems)
  • Lyme disease (caused by a tick bite)
  • Sciatica (a sharp, shooting pain down the lower back, hip and leg to the foot, often caused by a compression in the vertebrae)

Hip pain can be addressed in multiple ways:

  • Physical Therapy to help build strength and endurance in order to maintain the flexibility and stability of your spine
  • Medication, including anti-inflammatory drugs
  • Steroids (oral or injected)
  • Chiropractic adjustment and treatment
  • Massage therapy
  • Pain psychology to deal with other issues that can worsen pain like life stressors, anxiety and depression
  • Transcutaneous Electrical Nerve Stimulation (TENS), which utilizes electrical stimulation of muscle tissue to relieve pain
  • Acupuncture
  • Surgical intervention, including total joint replacement (indicated when the joint is severely degraded, typically from arthritis or injury)
  • Walking aids like a cane or walker.

Hips are a crucial working component of our bodies. It’s important to understand how they function, what can cause pain in the hips as well as some non-surgical and surgical methods of relieving hip pain.

Next week: How to prevent hip pain

The Balancing Act

balanceHaving good balance is critical. You need good balance to function efficiently and safely. Sometimes injury and disease processes can impair balance.

There are two kinds of balance: static balance and dynamic balance. Static balance is your ability to stay upright and in good position while staying still. Dynamic balance is your ability to maintain proper balance and form while moving around (walking, exercising, transitioning from sitting to standing).

All adults, young and old, can benefit from exercises that work on strengthening and improving balance.  Older adults, in particular, should tackle balance-increasing activities as they can help to prevent falls, which can be harmful or even fatal for seniors, and can lead to loss of independence and mobility. Balance issues can also impair athletic performance and daily living skills for all people, regardless of age.

Consider incorporating exercises into your routine that address endurance, strength, balance and coordination. Here are a few suggestions:

  • Sitting down and standing up without using your hands for support
  • Standing on one foot (you can do this holding on to something or not)
  • Walking on a line (or if advanced, a balance beam). To do this, you need to walk with one foot directly in front of another. You can hold on to a friend or a wall for support, if necessary, but try to progress to doing it unaided.
  • Leg Raises: Stand alone or behind a chair. Lift one leg at a time, first to the side and then to the back. Switch legs. (You can even do this while standing in line…ignore the stares of the other people, they are imbalanced.)
  • Tai chi is a slow, deliberate series of movies that emphasizes balance and gentle stretching.
  • Certain beginning yoga and Pilates moves also incorporate balance, but they often require strength. Your pain level may or may not allow these more involved calisthenics.

Please check with your health care team before embarking on any exercise program.

Not Tonight, I Have a Headache

headache radiatingYour headache is truly a pain. Perhaps your head is throbbing, or maybe there is a sharp pain. Maybe your headache improves when you lie down

Knowing what kind of headache you have matters.

Different headaches respond to different treatments.

The first question about your headache is, “Do I have a primary or a secondary headache?”

Secondary headaches are headaches that are caused by other disease processes, some relatively minor (dehydration, sinus infection, ear infection, flu); some quite serious (encephalitis, aneurysm, stroke). Your health care provider would need to evaluate your symptoms and examine you in person to rule out more serious ailments.

Primary headaches are headaches where the major illness is the headache. For some reason, there is overstimulation of the pain-sensitive structures in your head.

The most common primary headaches are:

  •  Cluster Headaches (can involve any part of the head, usually consists of sharp, stabbing pain, can be debilitating)
  • Migraine Headaches (typically starts as a dull pain, but then worsens, can involve any part of the head, often includes light sensitivity and nausea)
  • Tension Headaches (typically a dull ache or pain, most often in the front of the head)

Primary headaches can be caused or exacerbated by the following:

  • Poor or insufficient sleep
  • Insufficient hydration
  • Hunger
  • Eating certain trigger foods
  • Alcohol use or abuse
  • Extended periods of discomfort, including poor positioning, strain, excessive work or exercise
  • Stress

Primary headaches can be treated with over the counter medications, a variety of prescription medications, biofeedback, physical therapy, complementary medicine, and relaxation techniques.

In order to get relief from your headache, it is critical to narrow down the type of headache you are experiencing.

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