Health - Ask Dr. P - The Pain Doc

The Two Essentials for a Long, Quality Life

by Pain Doc | Jan 9, 2022 | Lifestyle Modification, Low Back Pain Exercises, Nutrition

As I transition out of mid-life, I face the inevitable things that happen at this stage of one’s life: parents, aunts and uncles aging and dying; birth of grand-nieces and nephews; and subtle changes in my body and physical ability. As someone with a professional background in healthcare, I can’t help but to analyze the health aspects of these mortal events.

The first I shall mention involves my mother and aunts (her sisters). In the gene department, I’d say they acquired good ones for longevity—mom is 88, and her sisters are in their mid-90s. However, their health status is starkly different. Yes, mom is a few years younger, but in terms of physical ability and vitality it’s as if she’s 20 years younger. One dear aunt has just weeks to live. She is barely ambulatory, and she is fading. Her body is frail, and her mind is diminishing. There were beginning signs of organ system failure during the past year – wounds not healing well; constipation, and swelling in the lower limbs.

The other aunt suffered several falls in the past year, breaking her leg each time, and is experiencing symptoms of congestive heart failure—fluid in the lungs and difficulty breathing. Both aunts require 24/7 assisted living at the time of this writing.

And mom? She still drives, speaks loudly and coherently (although her hearing is declining but not terribly); is able to vacuum and clean her home where she lives alone (dad passed in 2016), and even work in the back yard raking leaves, pulling weeds, and watering plants. She watches a lot of TV in the afternoons and, after chores and dinner, late into the night, yet is able to do all these things. She shows no signs of slowing down.

All three women fortunately did not develop dementia in their advanced age. Mom shows no signs of it at all, and I am hoping and praying I have those genes!

My dad, on the other hand, developed dementia during his last five years alive, and it played a role in his passing from an unfortunate hospital accident.

I attribute my mom’s stronger vitality, compared to her older sisters, to two things:

Give to Others. Stay Socially Connected. Avoid Isolation

She sends birthday cards to all her children (four, including me) every year, ever since we moved out of the house to go to college–without fail; on-time, every time.

For me, it’s birthday card every year for the past forty years. She does the same for her grandsons (3) and granddaughter, and now great-grandson. She’s very giving and considerate of others.

If you read authors in the Self-Improvement field, such as Brendan Burchard and Steven Covey, one of the common themes is giving. Something good happens when you give. The gesture is basically about giving out love. But to be able to give love, you must first be at peace with yourself, and have abundant love for yourself and your life. It’s like money – you can’t give others money unless you have money yourself to begin with; enough to spare.

When you love yourself, you aren’t sad; you aren’t depressed and most of all you value yourself so you take care of yourself. You don’t do things that will hurt yourself in any way and as a result, you achieve mental health, which promotes physical health. So believe me when I tell you that doing something as simple as sending someone a birthday card for 40 straight years carries a lot more meaning that it appears. It’s all about your attitude and outlook in life, which drives your actions. I do believe in the power of love. It’s one of the mysteries of being human.

My aunts, however, spent most of their lives isolated. Their spouses passed away when they were relatively still young and they never remarried. They sort of grew into living mostly solitary lives, over decades. I suspect that even with losing their spouses early on, that their isolated life was mostly due to their personality—their nature, which developed in accordance with their mindset. They are not as outgoing as my mom, and appeared to not mind being alone; at least that’s what they thought.

Do Whatever it Takes to Stay Physically Active, As Long as You are Able

The second thing that separates my mom from her sisters: she was consistently physically active all her life, and still is to this day. She is purposeful about it: she plans out her day the day before and has a set agenda– visit a friend, get some groceries, buy household things, go the bank; work in the yard, clean the house, and so on. She often mentions to me how she sweats in the back yard after doing some chores (she lives in Florida where the humidity and heat can be quite uncomfortable in the summer). She delivers food to friends who live nearby, out of the kindness of her heart. And, she goes to church regularly, where she gets most of her social interaction. Bottom line: my mother likes to stay busy and enjoys doing physical work at her age.

Compare this lifestyle to her sisters: neither was physically active, aside from going out to run errands when needed. They spent hours sitting on the couch and watching TV much of their day, for decades — a wholly passive behavior (I don’t want to say activity) both mentally and physically.

Neither of them worked a job: one aunt lived with her adult children, and the other was supported by her spouse’s death benefits. Neither toiled in their back yard. I doubt if they walked around the neighborhood for exercise, either. Neither had a hobby that kept them engaged in something. Today, their health is in steep decline.

The Lesson Here

So, based on this real-life study, if you desire to live a long, quality life (not a long life being infirm) learn from my mother: it starts with your mindset/attitude. Your mindset drives your actions. Your actions directly determine your mental and physical health – it’s that simple.

When you have love for yourself and your life, you naturally want it to last as long as possible and as a result, your subconscious mind guides you in doing things that maintain your health and extend your life—avoiding destructive thoughts (envy, hate, anger, resentment, regret); eating healthy, getting enough sleep, and exercising regularly.

When you don’t have love yourself and your life; OR you fail to take a moment to affirm it often, you take life for granted. You become undisciplined with your actions. You don’t have purpose. You take unhealthy, dangerous risks – spending too much time on the internet and social media; developing addictions; eating too much sweets and junk food and not enough whole, natural foods; consuming alcohol excessively, and avoiding exercise. Perhaps drugs and tobacco enter the picture, too. Then, this lifestyle becomes entrenched and harder to get out of because you become overweight, have low energy, and are in a negative mood. Exercise and socializing with others are the last thing on your mind, and you avoid both. You eat food that may taste good, but doesn’t nourish your body. These actions stress your body, and payback is imminent. Unless you have good longevity genes like my mother and aunts, you can expect your lifespan to be shorter than what it could be; and/or, you can expect to live with chronic illness, severely impacting your quality of life — not a great way to spend your golden years.

I will add to this that one can make change for the better at any age. Of course, the sooner in life, the better. As a person ages, it is more difficult to change adverse behavior, due to the thought patterns that take root in the mind, which are basically the habits and rituals that give one short-term satisfaction. But, it’s not impossible. It just requires digging in deep, and having that desire and determination to change. Loving life, and wanting to experience it for as long as you can. For many people, a wakeup call has to occur before they take action, like a friend dying unexpectedly from a heart attack. Don’t wait for that to happen, because if you do, it may very well be your sudden illness or death that shakes a friend into action.

Once you change your mindset, the next challenge before you is execution. Here are a few tips:

Make small, gradual changes that are easy to accomplish. This sends a positive signal to your subconsciousness, and lays the groundwork to build upon. Examples: buy healthy foods for the week every Sunday at 6:00 PM; walk 3x around your block Mondays, Wednesdays and Fridays; etc.
If you slip and revert to an old, unhealthy habit don’t be too hard on yourself. Definitely do not throw in the towel. Get up, and keep trying. It’s all about consistency in effort.
Create simple health routines. Routines are things you do the same time of the day, every day. Stay on a routine long enough, and you won’t have to remember to do it; it will come naturally.
For your physical activity, schedule it on your calendar. Hold yourself accountable. Better yet, recruit a close friend to be your accountability partner. He or she will have the role of encouraging you to stay on track.
20 minutes of exercise a day is better than an intense, 2 hour exercise every other week. Consistency is more important than intensity.
There are exercise options for every age and ability. Exercise doesn’t necessarily require sweating gobs of sweat; getting out of breath, or pounding your joints. You need to learn what’s right for you. Stay tuned for lots of examples of physical exercise for those over 40; those who are not physically fit; are overweight; or have some form of physical disability.

I cannot stress enough the importance of staying physically active to living a long, quality life. Humans, like all animals, are designed by nature to move frequently. When you don’t move enough, muscles atrophy and support to your spine and joints weakens, inviting injury and joint degeneration. Your heart, being a muscle, becomes weak so oxygen and nutrient delivery to your cells, including your brain cells, becomes sub-optimal. Your blood sugar rises because it isn’t being burned at a fast enough rate, leading to obesity and diabetes, and even Alzheimer’s disease.

Lack of physical activity even promotes gut disease, including constipation. Digestion benefits from physical activity, since your intestines are muscles themselves that require oxygen and nutrients delivered by your heart.

Bottom line, use it or lose it—being sedentary; failing to engage in consistent, moderate physical activity for years will cause a decline in your health that will be difficult if not impossible to reverse. Make it a priority in your life.

To complicate things, technological advancements have reduced our need to be physically active, and if it weren’t for advances in medicine and sanitation, human lifespan would probably be in the 40s especially with the abundance of and easy access to high-calorie, low nutrient processed food.

That’s it for now. It’s a new year, a time when people contemplate their lives and their future. If you are someone who needs to make a change, now is the best time. Stay tuned for more advice on staying healthy, vibrant, and out of pain and extending the lifespan of your body.

Stenosing Tenosynovitis

by Pain Doc | Sep 22, 2010 | Hand and Wrist Pain

Image via Wikipedia

Stenosing tenosynovitis translates to “tendon inflammation due to narrowing passageways.” It is entrapment and inflammation of the extensor pollicus longus tendon, the muscle that moves the thumb up in a “hitchhiker sign.” It is also known as DeQuervain’s Syndrome.

The passageway in question is a tunnel formed by ligaments that hold the extensor pollicus longus tendon to the distal radius (lateral wrist), one of the two bones of the forearm.

The onset is gradual over a few days. There is a very sharp, unrelenting pain at the radial styloid, the bony prominence at the lateral wrist right below the wrist crease. There is no loss of muscle strength in the thumb. Bending the affected thumb inward towards the palm while bending the wrist sideways towards the ulna (in direction away from the pain) makes the pain much worse.

Causation is believed to be related to overusing the thumbs, such as BlackBerry use, or frequent bending of the wrist while carrying weight, such as in cradling a baby several times a day. However, there are documented cases of stenosing tenosynovitis occurring with no apparent trigger (idiopathic causation).

What is known is that the synovial sheath that covers the portion of the tendon in the tunnel gets inflamed and undergoes degenerative changes. It triggers a chronic, localized inflammatory response. Pain comes from tiny nerve endings in the synovial sheath that are irritated by rubbing against the ligament holding it to the distal radius, and perhaps also by exposure to the products of inflammation.

The condition is known to be self limiting, running its course for a few months and then resolving as the body regenerates the synovial sheath. However, during its acute stage it is quite unpleasant, despite the fact that only about an inch of tendon is involved.

TREATMENT:

Wrist immobilization (wrist brace with thumb splint) to limit movement of the adductor pollicus longus is recommended for 1-3 weeks. Wear most of the day and night; remove every hour or so to do ice therapy.

Ice massage is helpful in temporarily reducing the pain by numbing the area and constricting blood vessels, which tends to suppress production of inflammatory chemicals. A wrist ice wrap can also be effective. Apply ice for 10-20 minutes directly onto the painful area.

Topical ointments may be helpful in reducing the severity of the pain. Narayan oil and products containing capsaicin (don’t use together) are worth trying. Rub into inflamed tendon gently.

Chinese herbal patches may be helpful in temporarily relieving the pain as well.

Cortisone injection into the tunnel can be effective in neutralizing the pain; however it still may take a few weeks to months for the pain to go entirely away.

Whey Protein – Great Supplement for Healthy Tissue Healing

by Pain Doc | Sep 16, 2010 | Uncategorized

Image via Wikipedia

Whenever you suffer an injury to the musculoskeletal system, there is some degree of tissue damage. In minor sprains and strains, it is microscopic tears to the fascia, muscle fibers, tendons and ligaments; in major sprains and strains it is complete rupture or tearing of large groups of muscle, ligament and/or tendon fibers.

The first thing the body does at the onset of the injury is initiate the inflammatory response. Various biochemicals constitute inflammation; each having an important role. Inflammation confines the injury to the injury site and is actually the first step in tissue repair. It is only when it is overproduced that it becomes a problem in itself (which is why you should use ice therapy to mediate swelling the first few days after an injury).

At some point, the body sends special cells called fibroblasts to the injury site. These cells synthesize connective tissue comprised of collagen to close the tears of the injury.

Collagen is the main protein of connective tissue in animals, making up 25%-35% of the total protein content . It forms as elongated fibrils (long chain of amino acids in a strand formation) and is mostly found in fibrous tissues such as tendon, ligament and skin, as well as other places in the body.

Therefore, after sustaining an injury, the body needs a ready supply of protein in order to properly heal itself. If you recently sustained a soft tissue injury such as a sports injury to a joint, whiplash car accident, or sprained your lower back from heavy lifting, make sure you are eating enough protein. I recommend whey protein due to its ability to be digested very rapidly, making it available for use shortly after consumption. Whey is a protein-rich byproduct that is formed during cheese formation, usually from cow’s milk.

Body builders and athletes drink whey protein shakes after workouts to help increase amino acid levels in the blood, which are taken up by the muscles to ultimately increase mass. During exercise, whey helps improve blood flow by inhibiting an enzyme that constricts blood vessels; this allows better flow of nutrients to needed areas to help repair and rebuild muscle tissues.

Leucine is an amino acid found in whey protein shakes. When leucine is ingested in high amounts it stimulates protein synthesis, which may speed recovery and adaptation to the stress that occurs from heavy exercise and injuries.

Another good source of protein is eggs. Eggs are a complete source of protein, especially the yolk. Cook them at low heat; and if you have the stomach for it, eat them raw.

What Can Be Done About Meniscal Tear?

by Pain Doc | Sep 11, 2010 | Knee Pain

Capsule of right knee-joint (distended). Poste...

Image via Wikipedia

The meniscus is a shallow bowl shaped piece of cartilage that is attached to the lower leg bone, or tibia. There is a medial meniscus (inner half of knee) and a lateral meniscus (outer half of knee).

The end of the femur (upper leg) bone has two protuberances called the femoral condyles, which rest on top of the meniscii (plural). In the standing position, the meniscii bear the full weight of the body above the knee. They serve as a cushion and shock absorber and protect both of the ends of the tibia and the femur. The meniscus also guide the action of the femoral condyles as you bend and extend your knee.

The knee is obviously a highly utilized, weight bearing joint. It has the largest suface contact area of any joint in the body as it has to bear most of the body’s weight and on top of that, absorb shock from walking, running and jumping. It is held together by several strong ligaments, the primary being the anterior and posterior cruciate ligaments (ACL, PCL), the medial and lateral collateral ligaments (MCL, LCL), and the patellar tendons. It is a synovial joint, which means it is totally encapsulated and lined with synovium, a specialized tissue that secretes synovial fluid to lubricate the joint.

The slightest alteration in the inner workings of the knee will lead to problems. A common one is a meniscal tear. The two basic types are a radial meniscal tear and a vertical meniscal tear. A radial tear that expands forms what is called a “bucket handle” tear (3rd set in the below image- top and bottom).

types of meniscal tears

Meniscal tears are caused by excessive pounding forces to the knee, which weaken the meniscii over time. Eventually a tiny tear forms, which grows in length as the individual continues to engage in the offensive activity (running on hard pavement, weight lifting, playing basketball, etc.), much like how a tiny crack in a car windshield grows into a long crack over time . If a small piece breaks free, it floats inside the knee space, suspended in the synovial fluid. Like a grain of sand in a watch, it interferes with the moving parts and can cause the knee to swell and become stiff.. Pain is felt deep inside the knee and is worse with prolonged standing and transitioning from sitting to standing.

Meniscal tears increase the chances of accelerated knee osteoarthritis, as “bone on bone” contact occurs between the ends of the femur and tibia.

TREATMENT: Diagnosis is made with a knee MRI and arthroscopy. Meniscal tears will most likely require arthroscopic surgery involving repair to the tear. If you have a gradual onset of deep, focal knee pain accompanied by knee stiffness that doesn’t go away, see your doctor.

Prevention, as always, is the key. I advise against sports that involve consistent and prolonged pounding forces to the knee. This includes long distance running and frequent hard court basketball that involves jumping. Consider doing functional exercises that combine cardio and strength instead.

Most leg exercises will strengthen the knee. Do mostly closed kinetic chain exercises where the foot is immobilized. This includes squats and lunges.

Intermittent jumping exercises are ok as long as they are controlled and are not the focus of an exercise session. Power jumps and related plyometric exercises fall into this category.

Most meniscal tears grow too large to heal on their own by the time the patient seeks medical help. This is why surgery is the only option. The surgeon stitches together the tear, but thanks to the forces the knee has to endure, the tear often returns.

Some patients do not get surgery, and let the tear become chronic. When it’s chronic, there is less acute pain, and more of a broad, dull pain in the knee. In this scenario, the knee joint will experience accelerated degeneration, leading to knee osteoarthritis. Eventually in the later years, knee replacement surgery is needed.

I made a general Knee Pain Rehab instruction video that includes things one can do to help deal with early stage knee pain.

How to manage lower back strain

by Pain Doc | Sep 9, 2010 | Low Back Pain

Low back pain is said to be the most common cause of lost work days, after the common cold. Most everyone has experienced an episode of lower back pain at some point in their life; millions suffer from chronic (ongoing; unending) lower back pain of some form.

The low back, or lumbar spine, is comprised of the last five (5) vertebrae in the spine. These vertebrae are the largest as they support most of the body’s torso weight. Like the cervical spine; i.e. neck (the first 7 bones of the spine), there are no rib attachments in the lumbar spine to limit movement, making the lumbar spine more moveable than the thoracic spine (torso), but less flexible than the cervical spine due to its larger, heavier vertebrae.

This unique lumbar spine design offers advantages and disadvantges. The obvious advantage is flexibility–you can bend (flex) your low back forward, backward, sideways, and can rotate it a few degrees to either side. The disadvantage is that with more movement, there are more opportunities to stress the joints of the lumbar spine (more moving parts) and therefore more chance of injury and pain. This includes potential injury/ trauma to the surrounding ligaments, joint capsules, cartilage lining the small joint surfaces; small facet joints, intervertebral discs, and the lumbar vertebrae themselves.

Therefore, low back pain can originate in one of several structures in the lower back:

the discs (strong fibro-cartilage ligaments that hold vertebrae together)
the facet joints (the “rear” joints of a vertebra, opposite the vertebral
Image via Wikipedia

bodies)
the pars– the small extensions of bone to either side of the vertebrae that form the upper and lower borders of the intervertebral foramen, and end in the lumbar facet joints
the surrounding muscles
the surrounding fascia (muscle covering)
the nerve roots inside the spinal canal
the vertebrae itself (compression fractures; vertebral end-plate fractures)

Today we’ll address lower back pain due to muscle and fascia strain. I’ll refer to this a low back or lumbar strain. This is a common cause of lower back pain and is more manageable than pain due to deeper spinal structures.

In the many cases of lower back strain that I’ve treated over the years, the patient describes a sudden onset of pain after bending at the waist reaching for something. In other cases, the pain starts a day after doing something like weight lifting, running or rock climbing.

Medically speaking, a muscle sprain-strain occurs when muscle fibers tear during contraction and subsequently release inflammation.

The convention for naming soft tissue injuries is that strain refers to injury to a muscle and tendon while sprain refers to injury to ligaments, which connect bone to bone. Since muscles, ligaments and tendons typically get injured all at once in a typical injury due to their anatomical proximity to one another, doctors refer to these types of injuries as sprain-strain injuries.

Sprain-strain severity is described as Grade I, Grade II and Grade III, with Grade III being the most severe and refers to complete rupture of a tendon or ligament. Most lumbar strains are Grade I and II.

Inflammation is meant to contain/ quarantine an injury and is actually an important process in the healing phase (tissue regeneration). The problem is that it releases chemicals that irritate nerves and surrounding tissues, and stiffens adjacent muscles and joints. The inflammatory response can “overshoot” causing the patient to needlessly suffer.

If you go to your doctor complaining of lower back strain, and tests do not indicate damage to deeper structures (discs, facet joints, nerve roots, bone) then you will most likely be prescribed pain blockers (usually NSAIDs- non-steroidal anti-inflammatories), rest, and ice. Your doctor will likely put you on “temporary disability” which means no heavy lifting, bending at the waist, and other activities that put stress on the lower back. Sometimes muscle relaxants are prescribed, if there are complaints of spasm and stiffness. You will be told that it should resolve on its own, and most cases do.

TREATMENT:

At first onset of straining your back, apply ice for 20 minutes every two hours of the waking day. The easiest way in my opinion is to get a large freezer ziplock back, fill a third of it with ice cubes, put about a cup of water in the back and zip it closed (get as much air out as possible before closing shut).

Lie down so that your exposed (no clothing) lower back is directly on top of the bag. Bend your knees or put a pillow under them for comfort. This flattens the lower back and allows it to make good contact with the icepack. (Optional: put a neck roll under your neck for comfort). Do this for 1-2 days.

On the second day, you can introduce gentle stretches while you ice. After your 20 minutes of icing, try lifting your knees to your chest, pulling them gently towards you with your hands. Hold for 5 seconds; repeat five times. Then, keeping your feet together (you are still lying on your back), knees bent, let the knees fall to the right side, gently twisting the lower back; reverse sides. Do five times to each side. What these movements do is orient any scar tissue that develops, in the direction of contraction.

On the third day, assuming pain is still present, you can try using heat. I recommend an infrared lamp. This is radiant heat that penetrates deeper than a hotpack.

If you need to get pain free even sooner, I suggest using the 120 LED (Light Emitting Diode) wrap. This popular home therapy device used red light therapy + infrared heat, which goes beyond simply blood circulation increase. The red light diodes inhibit inflammation and increase cellular metabolism (energy production, waste removal) which means speedier tissue healing.

After a week, your lower back strain should be 60-90% better. If it is only 25% or so improved after a week, the injury is likely worse than originally thought; and deeper soft tissues may be involved. In this case, consider using Pulsed EMF to further enhance tissue healing.

Last thought: I believe that if someone strains his lower back by simply bending forward, it indicates that the back muscles, and probably core/abdominal muscles need better conditioning. It’s not all about strength, it’s also muscle coordination in response to varying loads; for example, picking up a piece of heavy luggage. Those with excellent muscle coordination (there are five major muscle groups that have to work together to move the lower back) are less likely to injure their backs like this. Interestingly, research shows that osteoarthritis, or degenerative joint disease in the lumbar spine, is related to poor lower back muscle coordination. And it makes sense– your muscles move and support your lumbar spine. Poor support and coordination between muscles (erector spinae group, abdominals, etc.) can cause your spinal joints to bear more stress than normal during every day movements.

So, the best strategy is to prevent getting lower back strain by strengthening AND conditioning (improve coordination of) your lower back muscles by doing functional exercises.