Weight Loss After The New Year

/ Thomas Cohn, MD

weight loss doctorThe new year is here, and for many people, now is a time of a renewed attitude towards weight loss. For years, there have been countless pages of advice written about weight loss and dieting. There are more experts than one could believe, and everyone is willing to dish out advice. As our knowledge has grown more recently, weight gain and loss just seems to have become more complex. The advice used to be simple, calories in vs. calories out, and you could determine weight changes. If life were only so simple.

Weight Loss In Today’s Society

A recent article in the newspaper thankfully sheds more light on weight loss. The best advice may be simple – go see a doctor of medicine that specializes in weight loss. The reason for such advice is there are so many issues that can affect a person’s weight and a comprehensive analysis is often necessary. The more we try to help people with weight loss, the more factors we find that affect weight. No two people are alike. Some people will gain weight on low calorie diets, and we all know people who can eat just about anything and not gain weight. We do know that there are many factors and genes in the body that contribute to our body shape and metabolism.  

Obesity can be caused by many things, and what we eat is just part of the story. Medications from various heart drugs, to antidepressants and even some pain drugs can contribute to weight issues. Medical conditions such as diabetes, thyroid dysfunction, heart and lung disease, as well as abdominal conditions and depression all may affect our weight. Since many medical conditions directly affect our weight as well as the drugs we take, having a medical expert on obesity help design a program to control medical problems associated with obesity is often a first step.

Weight Loss Steps

The next most important step is probably taking a close look at oneself, and trying to understand personal factors that may be contributing to weight. These factors include the obvious, like our diet, especially what we eat, when we eat and how much we eat. Activity level is also a crucial factor. An inactive body does burn some calories, but being more active does increase the amount of energy used. Soft factors also contribute to weight, such as stress, anxiety, and how much we sleep.

Once we identify factors contributing to our weight, we need to make changes that are sustainable. Many diets fall into the category that are unsustainable, since they rely on one eating only packaged food from a special company. Changes do not need to all happen at once, as slow implementation fives the body time to make adjustments. Simple things like getting a good night of sleep, eating regular meals and taking a few minutes to exercise can make a big difference. Also, find a way to be accountable to either oneself or to another person. Being accountable tends to make a person more responsible.

Weight loss is extremely complex. There are many factors that contribute to a person’s weight. It takes a degree of dedication and the ability to understand what is happening in your body to facilitate weight loss. For the lucky, weight control is just a small amount of effort, while for others it often becomes a life long challenge. Seeking good medical advice is beneficial for any person looking to drop a few pounds.  

Resolutions For Keeping Chronic Pain Under Control

/ Thomas Cohn, MD

chronic pain resolutionsIt’s a new year, but that doesn’t mean you’ve left your back pain in 2016. One-third of the population battles regular pain in one form or another, so although you’re not alone, we thought the New Year was the perfect time to lay out some resolutions for pain sufferers to take back control of their bodies in 2017. Here are some resolutions to keep in mind to help control your chronic pain this year.

Pain Resolutions

The first thing is to commit to change. If you continue to do everything the same as you always have done, the results will be the same. Change is hard, but without change, there is little chance that a different outcome can be achieved. Choose to make one change at a time. It will be uncomfortable, but not all pain is bad. The first stretch in the morning always hurts, but after the initial pain, it goes away and then you feel better. Since we all are humans and not perfect, we can all benefit from change.

For many people who have pain, the next place to turn is to see a physician, especially one who specializes in Pain Management. Believe it or not, this is a small specialty of medical doctors who have expertise in diagnosing and treating all kinds of things that cause pain. Doctors who have medical boards (approved certifications by the American Board of Medical Specialties) in both Physical Medicine and Rehabilitation (P.M. and R.) and in Pain Medicine may be your best choice for an expert to help guide your treatment. Most importantly, find someone in the field who has experience, and with whom you feel comfortable. Try to find those doctors who are in the top 10 percent of the specialty, as they have extensive knowledge about diagnoses and treatment, and are continuing to educate themselves about new information.

Change Your Habits

Changes that make a difference are often those that are basic to a healthy life in general. Start simple and try to get good sleep at night. The brain needs to shut down at night and follow good sleep hygiene habits. If you’re still not sleeping, have an evaluation by a physician specializing in sleep quality.

Nutrition is the next big area, what we eat and put into our bodies has a huge effect on every part of our life. We are what we eat. For many of us, we absolutely need to change our diets. Be honest with yourself, track what you eat and change it slowly. If you have no idea what to change, get some help.

Lastly, nothing changes if you do not exercise. Exercise has to be done daily, and it will include stretching, strengthening and conditioning. Stretching should be daily, while strengthening and conditioning can be alternated. Find 30 minutes a day outside of regular activities to devote specifically to exercise.

Resolve to change in the new year. Get motivated, and be responsible to yourself. Stop feeling sorry for yourself, because a third of the world has chronic pain. Medicine knows some of the best solutions are the simplest. Exercise, nutrition, reducing stress and sleep solve many of our health problems. If you have difficulty finding the path on your own, get some help by experts.

Opioids – Understanding Dependence Vs. Addiction

/ Thomas Cohn, MD

addiction dependenceAnother misleading article appeared in the paper again last week, this time it is again about the opioid crisis. The headline gets the story wrong, and is truly misleading. It says in the headline “Third of long-term opioid users addicted”. The story is from the Washington Post-Kaiser Family Foundation survey of 622 users of opioids for over two months. In the article it states one third of users are either addicted or dependent on these powerful painkillers. The critical information is in one word that was left out headline and it was the word “or”. Addiction and dependence are two very different things, and two-thirds of the people had neither of the problems. Deaths from opioids are indeed a crisis, as the yearly total of opioid deaths are in the region of 30,000 in the United States – about the same as the number killed by either auto accidents or gun violence.

Chronic Pain

Chronic pain is an extremely difficult medical problem. Pain is caused by hundreds of issues and there is no simple solution to many of the problems related to pain. It is not a glamorous condition, and despite the deaths related to opioids, not much is being done to find better treatments for pain. There has been little government support for finding treatments to pain while billions are being spent to treat addicts. There are no moonshots or big government programs to fund research into better treatments for pain. With a third of the population in the world dealing with pain, it is a wonder why so little is spent on finding solutions.

Addiction Vs. Dependence

To understand the article noted above, knowing addiction and dependence are two different things is incredibly important. Dependence is a condition where the body becomes adapted to a chemical, and if the compound is stopped, then the body goes through withdrawals from that compound. There are a number of compounds like this that are medicines including anxiety drugs and many others. Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. In addiction there is an inability to abstain from behaviors that are detrimental to one’s physical and emotional health.

People who have chronic pain may use opioids to control symptoms and allow for increased daily functions. If they have been on the medications for a long time, then they may or may not be dependent on them physically. If they are suddenly stopped, and you are dependent, the body would go through withdrawals. Understanding pain and dependence is a medical problem and treated best by experts in Physiatry and Pain Medicine.

Addicts use a medicine like opioids for pain relief, but mostly they are used for the pleasure it creates in the brain. They crave the reward it gives and will do whatever it takes to obtain pleasure even if it is causing physical, legal, behavioral, or emotional destruction. Addicts are unable to control their cravings and will continue the activity despite the harm it is causing. The number of pain patients that are truly addicts alone range from estimates at about 5-7% to about 17%. The addicts are usually those who are using pain medicines illegally and are dying. Understanding addicts and treatment is a Psychiatry and Addiction Medicine problem.

Finding a Solution to the Pain

Chronic pain affects a third of the world population. There are not enough good treatments available and the research in this field is poorly funded. Opioids can be a very effective treatment for some people, but they have many drawbacks. Most people can use these medications safely if needed. Addiction is a separate disease, and opioids have now become a tempting drug for many to satisfy their needs. Possibly the best solution to the opioid crisis is finding a solution to pain versus treating another cause of addiction.

Managing Chronic Pain During The Holidays

/ Thomas Cohn, MD

Chronic Pain HolidaysThe holidays can be a wonderful time of year, but they can also be a time of stress, especially if you have to deal with chronic pain. Whether your pain is in the form of low back pain, arthritis or pulsing headaches, pain can make the holidays nearly unbearable. However, you can make the pain a little more manageable if you keep a few tips in mind. Today, we’re going to share four tips for keeping chronic pain under control during the holiday season.

Chronic Pain and The Holidays

Here are a few tips to keep in mind as the holidays approach.

1. Share Duties – No matter what you’re doing, be it wrapping presents, shoveling the driveway or cooking a Christmas feast, always recruit some helpers to take the burden off your body. Standing on your feet or over stressing your back can all cause inflammation to flare up, making pain worse. Always see if some friends or family are willing to lend a hand when you have a lot on your plate.

2. Travel Comfort – Whether you’re driving home from college or flying across the country to meet up with loved ones, if you aren’t prepared to travel, chronic pain can be exacerbated by the extended period in one spot. Consider these tips when attempting to keep chronic pain at bay when traveling:

  • Stand up and stretch during stops or when allowed to move about the cabin.
  • Pack a pillow to help you get comfortable in your seat.
  • Request a seat that will give you the best chance to get comfortable (aisle, captain seat, etc.).
  • Leave early so you can hit rest stops if need be.

3. Exercise – Exercise can not only help us relieve stress during the holiday season, but it can also prevent chronic pain from bubbling to the surface. Exercise helps oxygenated blood circulate through our bodies, which helps keep them in good working order, and exercise can release endorphins in your brain, which can impact our mindset and push away chronic pain triggers. If you’re feeling overwhelmed by the holidays, jump on the treadmill for a quick run.

4. Eat Right – This is one especially difficult to do during the holidays when gingerbread cookies and candy canes are bountiful. As we’ve stated on the blog before, junk foods, especially foods that are high in saturated fat and sugar, can trigger inflammation in our joints. Coupled with the cold weather, these inflammatory flare ups can trigger the onset of chronic pain. We’re not saying you can’t indulge here and there, but work in some fruits and vegetables between snacks to ensure your body is getting the right amount of vitamins and nutrients.

Core Strengthening And Back Pain

/ Thomas Cohn, MD

Core StrengtheningIf you have had low back pain and have done physical therapy, you’ve probably been told about the benefits of core strengthening. The muscles that keep the spine stable are those known as the core muscles. These include the hip musculature, the large and small muscle along the spine, and the abdominal and pelvic muscles. When a person normally does strength training, the core muscles are often not included in an exercise program. Without specifically focusing on these muscles, they are often weak. Working the core muscles often is hard because it takes special exercises, they are boring to do, and sometimes it is hard to tell if you are working the correct muscles. Further, when going to physical therapy, many people are given fifty exercises, they all seem to be the same, and they take too long to get done in a reasonable amount of time.

A good core strengthening program can be done by just about anyone in about 15 to 20 minutes. If you have had low back pain, doing core strengthening combined with general muscle strength training should be done three times a week. This will be necessary to build and maintain the muscle function, and should decrease the overall pain level felt by a person. The nice thing about core strengthening is that it does not require expensive or significant amounts of equipment. For many people core strengthening can be done with no equipment. Helpful equipment would include 1.5 pound each ankle weights, 3-lb. hand weights, an exercise ball, a balance board, and rubber tubing with handles and a door loop to secure it in a doorway.

Core Strengthening Exercises

The first set of exercises does not require any equipment. Weight can be added to the ankles and the 3-lb. hand weight when it becomes too easy. Planks engage the whole body and especially the core muscles. A plank is done like a push-up, but one holds the body stiff like a straight board, instead of the arms straight, lean on bent elbows, and hold the position for 30-45 seconds, take a break then repeat. Making it harder, try holding the plank on a balance board, as this will make you engage the muscles to keep you from falling to the side. One level higher includes side planks, keeping the position on one elbow and leg on your side, hold on each side again for 30 seconds. Adding side leg lifts increases the challenge as does adding in ankle weights.

Superman

The next exercise that is easy to add is the “superman”.  In this exercise, you are on the floor on your hands and knees. From this position, stretch out one arm and the opposite leg, get them fully extended, reach as far as possible, and hold it for 5-10 seconds, keeping the back level. Switch and do the other arm and leg, and do a series of seven to eight of these. This exercise is good at working the small muscles along the spine and leg as well as arm muscles. When it becomes easy, strap on ankle weights and use the 3-lb. hand weight.  

Crunches & Leg Lifts

The next group of exercises is the one many people hate. Abdominal crunches and leg lifts. Abdominal crunches are like the old fashioned sit-ups, but one does not sit up at all. Lying on your back with your legs bent and feet flat on the ground, place your hands behind your head and start to bend forward at the waist tightening up the abdomen. There is no rule on how many crunches to do, but do as many as needed to make the stomach feel like it is working. Combine straight crunches with twisting to each side, as this allows one to make sure that you work more of the abdominal muscles, especially the obliques. The other good abdominal exercise is doing leg lifts. Again, lying on the back, but with the legs straight out, lift them off the ground 6-12 inches and hold them there for 10 seconds.  Making it tougher, spread the legs apart and hold them after having them together.  If it’s still not hard enough, add the ankle weights and do the exercise. Do a series of seven of them.

Working the small paraspinal muscles that connect level to level in the spine seems one of the hardest areas. Rubber tubing and bands seem to be an easy way to activate these, and to be able to feel them when you are engaging the correct muscles. Rubber tubing of different strengths with handles for each end and a doorway anchor (a nylon loop to thread the tubing through and an enlarged end, when placed between a closed door, this is a secured hold for the tubing) is great for these exercises. There are only a few exercises to with the tubing, but it is easy to feel you are working the back muscles. First, place the anchor in the top of the door, face the door, grab the handles, step back slightly and pull the handles down and hold for several seconds at your waist then slowly release the tension, and do seven of these. Turn around with your back to the door, take a small step out, hold the tubing with the elbows bent to the chest and slowly bend forward, hold the position and then slowly return to standing upright. The forward bending puts traction on the lower spine as well as makes one activate the muscles. Also with your back to the door, you can have your arms fully extended forward and bring the arms down in front of you, also activating lower spine muscles as well as arm muscles. Once those exercises are mastered, you can add in placing the anchor in the side of door frame at mid to lower chest level, and do arm exercises facing the door and away. These will work the arms, chest, mid and low back muscles. Doing a series of seven of each exercise often will only take between 5-10 minutes and does a very good core and upper body workout. Tubing is extremely portable and can be easily taken with you and used when traveling to keep up the exercise program.

Core body strengthening is relatively easy and does not require a lot of time or equipment.  A physical therapist often will give you too many exercises, but just choose some and do them. A rounded program hitting the major areas often can be done in a very short amount of time, three times a week. It does not need expensive equipment and can be done at home or when travelling. Feeling better takes the commitment to do the work. The simple stuff like exercise works the best to control pain, but it is up to you whether you will succeed.