5 Healthy Habits To Live Longer

healthy habitsEveryone has advice on living better and longer. Sometimes the advice is complex, sometimes someone is just trying to sell you something, and in a recent StarTribune issue, there was some simple practical advice. The information is from a study of 100,000 people published originally by the American Heart Association. It lists five habits to adopt to live better and longer. It is the straightforward approach to life.

The Five Habits

The first habit for good health is to avoid smoking. The best habit is to never smoke. The dangers of smoking have been known since the early 1960’s. Everything from vascular disease, to lung problems and cancer result from smoking. Quitting smoking does help, never starting is even better as far as the risk is concerned.

The next habit is maintaining a healthy weight. The easiest tool is based on having a body mass index (BMI) that is between 18.5 to 24.9.  The formula for is:  BMI=703x[(weight in lbs)/(height in inches)(height in inches)]. The number can be looked up in charts. Unfortunately this is a rough guide, and if you are muscular, or have a larger build with “big bone” structure, you may fall into the category of obese. For instance my BMI is 24.3, it is borderline since I have relatively more muscle than fat but I am pretty healthy from a cardiovascular standpoint due to an active lifestyle.

The third habit to increase life is to exercise moderately for 30 minutes a day. This is to walk, swim or work out in any sort of way every day if at all possible. The 30 minutes does not have to be all at once. If you take three ten-minute walks a day, that adds up to the correct amount of time. In addition to the above aerobic conditioning, most health advocates recommend a general strengthening program three times a week to maintain muscle tone. A daily stretching program to reduce muscle tightness and pain is also helpful.

The fourth habit is to drink only a moderate amount of alcoholic beverages. That is on average only 1 to 2 drinks a day. Drinking wine is often better than mixed drinks or beer due to some of the compounds from grapes that have positive health benefits. All alcohol contains carbohydrate-type calories and this needs to be remembered as part of your overall food intake. Excessive intake of alcohol, binge drinking and then averaging out the intake over time does not count. Binge drinking is dangerous.

The last healthy habit is to try to maintain a healthy diet. A healthy diet includes higher intakes of vegetables, fruits, nuts, whole grains, fibers, and stick to fats that are polyunsaturated or long-chain fatty acids. The best meats are fish and poultry as well as white meat (low fat pork). Obtaining protein from vegetable sources like beans and legumes once a week is also highly recommended. Try to reduce the intake of red meat, sugar and fructose sweetened beverages, trans fats, and high sodium salty food. Part of eating healthy is also controlling portion size and avoiding excessive snacking.

Better living is a goal in life. To reach the destination, one must take steps to change if you are not where you want to be. Setting realistic goals and changing one aspect of your life at a time is the best. Furthermore, be accountable to yourself and one another, as that will help you reach your goal. If you need help, work with appropriate experts to reach your goals. Help may be from dieticians, physicians, physical therapists, trainers to even psychologists. Change is difficult, and better health is a life long goal.

Injections and Blood Thinners

blood thinners

53793176 – render illustration of blood thinner title on pill bottle, isolated on white.

A number of patients, for a variety of reasons, are on medications that are considered blood thinners. Many patients have heart conditions that require them to be on a medication to reduce the risk of blood clots. Stopping these medications can cause multiple problems from clotting of blood vessels to pulmonary embolisms and strokes. Being on blood thinners can cause bleeding problems with or without medical procedures. The big question is whether a specific interventional procedure has more risk for a bleeding complication or whether it is safer to stop the blood thinner for the time being.

Up until recently, the decision to halt blood thinners was based strictly on the risk of bleeds in the surgical acute care settings. Many times injection procedures are done without imaging guidance and have definite risks based on the location of needle placement. Procedures for pain management are usually done with fluoroscope guidance and often are done to structures that have low risks for complications from bleeding. Until recently, risks were determined based on the rate of complications seen in the surgical procedures, and then the risks were estimated for the interventional procedures.

New Information

Recently, several researchers have actually studied the risk of many interventional procedures on blood thinners and also studied the risk of complications from stopping blood thinners. For most experienced interventional pain doctors, they can site cases from their own experience of complications from stopping blood thinners and bleeding problems. Stopping blood thinners does cause problems with strokes and with blood clots forming in harmful places. Fortunately after over 50,000 injections, only a couple of times has a problem occurred in my practice.

The latest research has been done in Pennsylvania. One hospital system in a part of the state has enrolled virtually every person in the area, thus allowing one to study the characteristics of various problems. The first thing the researchers did was find all the people on blood thinners. Then they looked at the incidence of complications from stopping blood thinners for any medical procedure, and the number is about 0.75 people per 1,000 for a problem like stroke or blood clot of some type.

Then they looked at the risk for bleeding with typical injections that are thought to be low risk for bleeding, like joint injections, transforaminal epidural injections and medial branch blocks. The findings were that only minor bleeds occurred and the overall risk of bleeding was 1/4,000 people. That means it usually is more dangerous to stop blood thinners for most interventional procedures for the patient than it is to continue them. For a patient on blood thinners, it means they should be concerned whether the procedure they are undergoing needs to have their medication stopped.

In my practice, if I know a patient is on blood thinners and the procedure is low risk, I will not stop blood thinners. Not many physicians are comfortable with this as of yet since the research is not widely distributed. If as a patient, you are concerned about stopping a blood thinner, it is wise to ask whether it is necessary to stop the blood thinner and whether the procedure can be done in such a way that bleeding is not a significant risk. Sometimes a different approach to an injection will decrease the risk of bleeding. Lastly, a physician who is very experienced with injections will usually be able to place a needle for injection with less trauma due to their ability to overcome obstacles of the anatomy in the area. Experience does count and being specially trained in the area of interventional pain medicine helps with being up-to-date with the changing standards of care for challenging patients.

Are Corticosteroid Injections Safe?

corticosteroids safeEvery year, the majority of physicians need to attend continuing education courses. Sometimes these are online or via written materials, while others are seminars. This year I am on my second course, because unfortunately not all work qualifies for credits. The last course was extremely educational, but was sponsored by a medical corporation and therefore did not qualify for credit.

This week I am again gone from the office attending a conference. One of my goals is always to bring back some pearls to my practice. The first subject I’ve been learning more about is steroids and their role in a patient management program.

Steroids and Their Safety

The main question is whether the corticosteroids that are used in pain injections are safe for the patient. The answer of course is complicated. In a pain practice, corticosteroids are used to bring down inflammation. There are many different types of steroids, as those used for pain control are different from steroids used to build muscles or control hormones. Corticosteroids not only decrease inflammation as well as pain, but can also do many other things in the body. The problems they caused were discovered mainly due to their use for other conditions.  

Conditions like asthma, lung disease, and rheumatoid arthritis were all previously treated for years with oral, injected and IV steroids. From their use, we slowly learned some of the issues with these medications. The most obvious was the problems with blood sugars and diabetes. Steroids can make blood sugars elevated, usually for only several days when used in the spine or joints, but sometimes for several weeks. Corticosteroids can also alter the function of the balance of normal hormones in the body, causing problems with blood pressure, emotions, and female or male hormone balance.

One of the biggest worries of with the use of steroids is the cumulative effects like bone loss. Osteopenia and osteoporosis are the bone loss problems that can be increased over time with the use of corticosteroids. As people age, the natural function of bone growth changes and many people develop bone loss. The use of corticosteroids can increase the rate of bone loss. Now it is known that there is a yearly amount of steroid-type injections to try to stay below. That is between 4 and 6 shots total.

Too much steroid can increase bone loss and make osteoporosis worse. The problem with osteoporosis is that bone fractures can become more common. It can lead to problems like broken hips from a fall to spontaneous vertebral body fractures in the spine. The vertebral compression fractures can be fairly painful and cause spinal deformities.

The bottom line on the use corticosteroids in the management of pain is that they are not fully safe, but they can be used as part of an overall strategy to manage painful conditions. The total amount of steroids should be monitored, and if a person has had a number of incidents of exposure to this medication, then monitoring for side effects is necessary. If one is a diabetic, blood sugars should be watched whenever using these medications.

Most people may need to be watched for bone loss, and then bone density monitoring is necessary. Osteoporosis is a silent disease with only 25 percent of those who have it being aware of the problem and seeking treatment. Since pain physicians often use the medication in their injections, it should be a routine concern to monitor patients who are receiving shots. If you are at risk for bone loss, make sure that your doctors test you for it, it can even happen to young and seemingly healthy individuals.

That’s all for now, off to another conference lecture!

Dr. Cohn

5 Things Patients With Chronic Pain Should Do Every Day

As anyone with chronic pain will tell you, it is a daily battle against their pain condition. Some days are good, some days are not. You have to take it one day at a time when it comes to managing your chronic pain and focus on winning small battles. While it’s easier said than done, we’ve found that if chronic pain patients perform some or all of the following activities on a daily basis, they put themselves in a better position to have more good days than bad.

Daily Habits For Chronic Pain Patients

If you deal with chronic pain on a regular basis, strive to do a couple or all of the following activities on this list every day.

1. Eat Healthy – Now, you don’t need to eat a perfect balance of fruits, vegetables and whole grains at every single meal, but you should strive to hit all the important food groups throughout the day. Getting a wide range of vitamins and nutrients from our diet can help to strengthen structures and keep muscle groups healthy. On the flip side, fatty or sugary foods can contribute to the onset of inflammation, which can compress structures and make chronic pain worse.

2. Exercise – We don’t expect you to go to the gym every day, but if you want to fight back against your chronic pain, activity is your friend. Even if it’s just in the form of a 30-minute walk around the neighborhood, mild and moderate intensity exercise helps to promote healthy blood flow throughout the body, strengthen muscles and wards off inflammation. More intense exercise can also lead to the release of endorphins, which can mask pain sensations.

3. Challenge Your Mind – While it’s important to exercise your physical body, it is just as important to challenge our minds each and every day. Not only can brain stimulation enhance our mood, but it can also take our mind away from the pain. Don’t just lay in bed watching Netflix, challenge your brain by reading, doing crossword puzzles or playing along with Jeopardy. If your mind is focused on a task it won’t be as focused on your chronic pain.

4. Laugh – Speaking of enhancing your mood, few things are better for your mindset than a good laugh. Whether you find humor in a conversation with a friend or in a book or a movie, let some laughter into your life. Being able to change your psychological state for the positive can go a long way with helping you manage and deal with the annoyances of chronic pain.

5. One Active Treatment – Finally, take time each day to do one active treatment to manage your chronic pain. Painkillers and rest are passive treatment options, but physical therapy, aqua therapy, yoga, cycling, cognitive behavioral therapy or meditation are all ways we can actively confront our chronic pain issues. Your active treatment may differ depending on your specific pain condition, but if you can end the day saying you did at least one active treatment to fight back against pain, you’re going to have a lot more good days than bad.

Have Chronic Pain? There’s An App For That

Each day, millions of Americans battle a chronic pain condition or rehab a previous injury. If you’re one of them, you’ve probably done your research online and listened to your doctor’s instructions about caring for the injury. Those are great ways to manage your condition, but technology is making it easier for us to stay connected with our care plan when we’re on the go.

If you have a smartphone, you’re only a couple of clicks away from being able to access thousands of different apps that are designed to help you control and treat your pain condition. But how can you sort the good apps from the ones that aren’t worth your time?

The Best Chronic Pain Apps

To answer that question, we turn to our friends at Burning Nights CRPS. We’ve shared some of their stuff on our blog in the past, and they always share useful information for chronic pain sufferers. Their latest infographic is no different. In this infographic, they take a look at six of the most useful apps for chronic pain sufferers.

From helping to coordinate a physical therapy plan to helping you track your progress with a pain journal, the apps highlighted in this infographic can be very useful to anyone who is trying to put a chronic pain condition behind them. Give it a look, and don’t forget to check out Burning Nights CRPS for more information on all things chronic pain!

chronic pain apps