The Greatest Enemies of Freedom

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Election Day.  Veteran’s Day.  Pearl Harbor Day.  Do these days have anything in common?  They do — more than most of us might think.  The catastrophic attack on Pearl Harbor on December 7, 1941, shocked the nation into unprecedented action.  Millions of people who had ignored the war in Europe and Asia could no longer remain unaware or uninvolved.  Massive numbers of people rushed to enlist or pitch in on the home front to defend freedom itself.  People willingly sacrificed everything from gasoline, to meat and sugar, to fabrics and metals for the sake of the war effort.  Discipline and sacrifice were a given.

Veteran’s Day (originally called Armistice Day) honors the end of World War I. Few of us can even begin to fathom the anguish, misery, and suffering endured by the troops in Europe.  The horrors of trench warfare, malnutrition, hideous infectious disease, nerve gas, and deprivation of every sort took a terrible toll.  Nearly half of U.S. troops who died succumbed to complications of the Spanish Flu.  A hundred years ago, there were no antiviral drugs and no antibiotics to treat secondary bacterial pneumonia or meningitis.  Curiously, President Wilson never even gave a speech about the flu pandemic.

In World War I and World War II, the hardships of sacrifices endured by so many millions of people were intense.  But how does that relate to Election Day 2020?  It’s not that strange or complex.  The two greatest enemies of freedom are apathy and cowardice.  It’s been that way for thousands of years.  We are in a time of great conflict and uncertainty.  Angry, jealous, controlling people are everywhere.  Remember, if someone is trying to frighten you, he or she is trying to control you.  Don’t be intimidated.  Don’t be demoralized.  Observe, think, and vote.  Apathy and cowardice have dreadful consequences.

Deconstructing Anxiety: Finding the True Source of Fear for Profound Healing

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Pain, Psychology

By Todd E. Pressman, Ph.D.

Fear and fulfillment. These are the prime movers of our life, the two great forces that drive the human experience.

Fear is a constant companion. It whispers in our ears of lurking dangers and impending catastrophes. Fulfillment is our high purpose, that which calls us from our most secret places and compels us to discover a freedom and wholeness far beyond what we had thought possible.

These two forces engage in a constant battle. If we forgo our fulfillment and succumb to fear, we are never fully satisfied. But, fear warns us, if we venture forth, we risk the unknown; we are sure to encounter all sorts of perils and should, instead, “play it safe”.

A STRANGE PHENOMENON

Our solution, as a humanity, is to try to satisfy both drives. This results in a strange phenomenon: we convince ourselves that fear is the best strategy for finding and securing fulfillment. We have an impulse for fulfillment—a desire to connect with someone or an urge for creative expression—and immediately consult our fear to negotiate the terms. Fear becomes our provocateur, rooting out from dark corners anything that might signal danger. It becomes our warning device for taking the actions that will protect our fulfillment.

Unfortunately, the strategy backfires; it is impossible to be fulfilled while we are in fear. Not only does fear keep our attention on danger, but we know we can never truly prevent all potential threats. Our response to this is to dig in more deeply, devoting ourselves to an even greater control over danger. We fool ourselves into believing we are working toward the day when we will finally achieve the safety we seek, free to get about the business of fulfillment.  Of course, that day never comes. As the Chinese proverb states, “We are always preparing to live.”

This is the human drama that has been playing out in every culture of every age. Our first and greatest drive is for fulfillment—we know this experience whenever we watch a child filled with the joy of being—and we will not be satisfied until we reach it. Our soul rattles its cage not just for relief from anxiety but to actively create our good.

But the seduction of fear is powerful. We can’t really afford to dwell in the joy of the moment, it tells us. We must keep our eye on looming dangers or the possibility of a sneak attack. So we make the decision to take care of fear first, somehow hoping to get things under control in a complete and permanent way.

When we look around at our current state of affairs, the tragic effects of this strategy are all too evident. Security is the overwhelming goal for most of us, with fulfillment often postponed to the point of being forgotten. It has us live in ever-more-constricted ways, squeezing our once expansive, exuberant selves into a very narrow psychic territory.

We learn to delay gratification, taking care of responsibilities and handling problems, before we can get around to what makes life really worthwhile. There seems to be always one more thing to handle, and then one more and one more. Again and again we tolerate the frustration of postponing our fulfillment until we become rigidified in a posture of waiting. When this goes on long enough, we can indeed forget our original goal.

The great irony of our approach to fulfillment, using fear as our guide, is that it is precisely the approach that will keep us from it. Over a lifetime of such practice, we see our opportunity for fulfillment slipping by. We become stunned by how hard life can be, how much we’ve lost, how far we have fallen from the dreams and high expectations of our early ideals. Because we have sought to get control over a fulfillment that never comes, the futility of the effort catches up with us and we find either that we never did have control or that it wasn’t truly fulfilling after all.

WHAT’S MISSING?

What makes fear so compelling? Why have we become so entrenched in its strategy to secure fulfillment, even when we see that it isn’t working and can make us miserable? If we consider clinical anxiety as simply an exaggerated form of the fear we all struggle with*, the problem can truly be said to be epidemic, the need universal.  How does anxiety co-opt the brain to become so maddeningly fixed and unyielding? What are we missing in our understanding?

The problem, I propose, is that we have not yet fully deconstructed anxiety. We have not yet achieved a successful analysis of precisely how it works—the exact mechanisms that create it, maintain it, give it its power, and make it so intractable. Our paradigms have been incomplete. We need a comprehensive model for understanding and working with the fear at the root of our difficulties, a Rosetta Stone for cracking its code.

Such a model would not only unravel the mystery of anxiety but would illuminate its secret gift. For, as we have said in a previous article**, finding fear’s cure reveals the path to transcending suffering in general, providing a map to deep fulfillment, healthy relationships, and a more functional world.

And why has this been so elusive? Why are we only sometimes successful in our treatments for anxiety? Simply put, whenever a therapeutic intervention fails to produce the desired results, it is because it has not yet fully deconstructed fear in these ways. Fear’s trickery depends upon its ability to convince us not to look at it deeply.  In clinical language, we say fear is hallmarked by avoidance behaviors. We seem to be reflexively wired to respond to fear with these avoidance behaviors.

THE FEAR OF LOOKING AT FEAR

Since the beginnings of psychotherapy, we have understood the importance of reversing this avoidance response, whether through insight into the unconscious, cognitive transformations, various types of exposure therapy, etc. Yet this wiring is powerful, our defenses are resistant, and we still have not explored the nature of fear in a complete enough way. Even if we think we are intimately familiar with it, many of the fast and fleeting thoughts behind the scenes will slip by unexamined. In truth, this is because we are subtly afraid to look at them and discover all they have to teach us. We don’t want to look at them because we know they will require a complete paradigmatic shift in our understanding of who we are and how we deal with life.

We have become so invested in our fear-based ways of negotiating the world that we will not easily give them up. Most of us resist looking at fear as much as possible. But even those who pursue a deeper exploration of the psyche can get lost in its meandering catacombs, missing the ways in which fear is distorting their compass. The fear of looking at fear is the first obstacle to overcome in our search for freedom and fulfillment. It is the source of our human predicament and that which preserves it as well.

Our existing strategies for dealing with fear fall short of real change in direct proportion to the extent that they do not look at and deconstruct the fear fully.  We need an approach that reliably digs up the fear at the bedrock of our suffering with insight into what gives rise to the suffering in the first place.

Those who have sought out this answer, intrepid explorers of consciousness, have demonstrated enormous courage to bring back maps of the terrain they traveled. Freud at one point thought he was going crazy as he conducted his own self-analysis. Jung had to acknowledge his “shadow” in order to deal with it effectively. The Buddha determined he would sit under the Bodhi tree until he either reached enlightenment or died trying. Their courage, and that of others, has paved a way for the rest of us, showing that we must look at and examine fear, digging it up fully, if we are to become free. The hero’s journey, the dark night of the soul, and the death-rebirth archetype all describe the same path: we must confront and move through fear all the way in order to find our higher good.

Facing fear fully, in safe and manageable ways but wholly without reservation, then, becomes the key to finding the true source of suffering and opening a path to freedom. And resolving the fear of facing fear is the first essential step in this process.  We must be willing to follow fear to its most subterranean hideout. But when finally there, standing resolutely in the face of that from which we have been running our entire life, we may at last come to know our true “enemy,” shake hands with it, and even befriend it. With this, we reveal the gift it held, discovering what it was calling for all along and satisfying its need in a new and more fulfilling way.

In traveling this path, we will come to see that the whole of humanity has been engaged in an endless cycle of fear built upon a faulty strategy for securing fulfillment. But seeing the problem clearly like this makes transformation possible.  No longer are we merely a figure caught in a play. When we take hold of the fear that has been directing from behind the scenes, we can rewrite the script in more fulfilling ways. Finding the anxiety at the root of things gives us a sort of X-ray vision where we see through our automatic assumptions about life and reveal the truth they were hiding. Like discovering the “man behind the curtain” in The Wizard of Oz, we lose our fear when we understand its source.

Our task, then, is to fully deconstruct anxiety, learning how to navigate through the subterfuges of fear and, ultimately, how to design a life lived from free choice. Rather than being twisted and distorted by the ways of fear, such a life reaches for a transcendent truth, one that has the potential for resolving suffering at its source and restoring us to our original fulfillment.

In future blog posts, we will begin to lay out exactly how the Deconstructing Anxiety model takes up this task.

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*In these blog posts, the word “fear” is considered as synonymous with “anxiety”, as per the Buddhist concept that the anxiety created by anticipating a future event has the same effect in the mind as the fear experienced by an imminent threat.

**See Deconstructing Anxiety: The Journey from Fear to Fulfillment
_______________________________________________________________________

This is an edited excerpt adapted from Todd Pressman’s Deconstructing Anxiety: The Journey from Fear to Fulfillment (2019), published with permission from Rowman and Littlefield Publishing.  All rights reserved.

Copyright 2020 by Todd Pressman

Help for the Helpers on the Frontlines of COVID-19

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Dr. Jennifer L. Abel

Many healthcare workers on the COVID-19 frontlines are overwhelmed and traumatized. In addition to putting your lives on the line, many of you are quarantined from your family and some have insufficient PPE. Many are having to make multiple difficult decisions daily and have see an unprecedented number of people suffer and die; sometimes even colleagues.

You are amazing! You are also human! So, it is crucial that you express your emotions: cry in the restroom, cry on the way home, go outside for 10 minutes to shed tears or blow off steam. Angry at a co-worker, administrator, or politician? Pay attention to your driving, but imagine they are in the passenger seat and express your feelings.

Keeping your body relaxed is very important to help with immune function and to survive emotionally.  “How can I possibly relax? I have no time and am way too stressed to relax” are common thoughts on the front lines of COVID-19. Fortunately, relaxation strategies need not take any time at all and can be done without stopping your work activity. Test it out! Because most of you are standing or walking most of the day, stand or walk now while engaging in your favorite strategy simultaneously. Now pretend. Go through the motions of a common work activity while engaging in your strategy. The exception is you can’t do breathing strategies while talking.

It’s easy to get distracted and forget to use your coping strategies. Try to get into the habit of using strategies every time a machine starts beeping, each time you switch rooms, someone calls your name, or when you change tasks. Put up sticky note reminders when possible. Change the wallpaper on your phone or change the ringtone and text-tones. Each time you experience the reminder, engage in your strategy.

No doubt you’re exhausted. When you experience one of your reminders, ask yourself “do I need all this energy” or “what’s the least amount of energy I can use while doing this procedure? Writing notes? Walking down the hall?” Follow with your favorite word, like soft, loose, or relaxed.

People in helping professions are great at taking care of others, but aren’t nearly as good at taking care of themselves. Now is the time for you to finally ask for what you need, or even want, from others. And take time to self-nurture.

I heard today that people wearing scrubs are being discriminated against out of fear they’re carrying the virus. Some have been mugged or antagonized because they are known to have a job. Please know that the majority of us, not just patients and their families, are very appreciative of your sacrifices.  Know in your heart that having a purpose is a positive predictor of happiness, even though you probably aren’t feeling particularly happy right now. Similarly remember that even when you feel helpless, you are still helping!

Thank you very much for all the help you are providing, especially if you are putting your life at risk and/or isolating from your family to help!


Dr. Jennifer L. Abel is an expert in worry and the author of three books and two card decks including Resistant Anxiety, Worry, & Panic.

Passport to Health? Maybe not…

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Pain, Psychology

By Mary O’Brien, M.D.

“It relieves headaches, insomnia, anxiety, depression, arthritis, fibromyalgia, and pain of all kinds.” Sounds great. Unfortunately, this is merely an excerpt from an ad for CBD oil. CBD stands for cannabidiol, a non-psychoactive molecule that has some documented anti-oxidant, anti-inflammatory, and anxiolytic properties. CBD products and stores are popping up all over the country. Even the business networks are covering possible investment opportunities. CBD products now include teas, tinctures, topical creams, pills, oral solutions, sprays, candies, cookies, gummies, chocolates, and Italian ice. No kidding.

The vast majority of studies on CBD are preclinical, animal studies (mostly rats). Trying to extrapolate research findings from rats to humans is not medically sound. It can also be downright dangerous. But many people have a stunning ability to believe what they want to believe.

We live in an age of narrative. The narrative about far too many topics is carefully crafted by self-proclaimed elites in the media, the entertainment industry, the political realm, and the academic world. Money is a critical factor in forming a narrative, but equally vital is the perception of being “cool.” Being perceived as “cool” is of the utmost importance to a staggering number of people. The really “cool” people don’t even realize they’re cool because they’re too busy pursuing truth and genuine accomplishment.

When it comes to a fad like CBD, the prudent people are open-minded but cautious. Centuries of experience in numerous cultures should have taught us something about con-artists and snake oil. Some of our grandmothers were certain that a dose of castor oil every week would cure anything. Millions of people in Asia still believe the rhinoceros horn can heal everything from impotence to cancer. And despite all our science, people still spend ridiculous sums of money on ground apricot pits and crystals in place of chemotherapy.

The actual pharmacologic effects of CBD products are still being evaluated. Standardization, purity of product, dosing, absorption, bioavailability, half-life, potential contraindications, adverse effects, and drug-drug interactions need to be elucidated -– in people, not rats.

Until then, be careful. Snake oil salesmen abound, and they’ll probably seem really “cool.” Buyer beware. CBD Italian ice is likely not your passport to health.

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Calm Down, Slow Down, and Live

Posted Posted in Brain Science, Continuing Education, Pain, Seminars

By Mary O’Brien, M.D.

I witnessed a four-car accident this week.  Moments before it happened, I knew what was coming.  A driver wanting to turn left raced through a light turning red.

Another driver coming in the opposite direction jumped a light before it turned green. They collided.  Two cars following much too closely plowed into the mess.  Everyone was all right, but a major intersection was blocked and lots of people were ready to explode.

This scenario plays out all over the country every day. Impatient, rude, distracted drivers are increasingly problematic.  Drunk or sleep-deprived drivers cause a tremendous number of accidents, but 66 percent of traffic fatalities are caused by aggressive driving.

Nearly everyone is in a hurry today, even in a place like Myrtle Beach, South Carolina.  I suppose at 9 A.M. many people are still trying to get to work, but a traffic accident will really make you late.

Research has shown that aggressive, angry drivers have distorted depth perception. This is worrisome, since traffic congestion is not about to ease and most people drive much too close to the car ahead.  Add a little rain, fog, snow, or ice, and an accident is inevitable.

Halloween is on October 31, with Thanksgiving and Christmas travel soon to follow.  Since an ounce of prevention really is worth a pound of cure, there are a few tips we can all use to stay safe:

  • Get in touch with reality. Many people underestimate how long it takes to go anywhere.  Stress levels ease when you routinely leave an extra 15-20 minutes to reach your destination — more if you drive in a large city.
  • Leave more space between your car and the one ahead. The laws of physics work whether we like them or not.  Sooner or later someone will have to stop unexpectedly.
  • Don’t try to run a stoplight. At some point, it will not go well for you.
  • Don’t be rude on the road. Cutting off another driver, yelling, making vulgar gestures, or otherwise being aggressive will not help.
  • Stay focused on driving. Unless you’re driving across Wyoming or west Texas, you must have your wits about you at every moment.  Even talking on the phone or sipping coffee can be dangerous.  Texting is flat out foolish.  Don’t do it.
  • Be considerate of other drivers. We’ve all struggled to get in the correct lane on a congested highway.  Unless it’s simply unsafe, let another driver merge ahead of you and never fuss at someone for being gracious to others.

Every person today is dealing with stress, and most of us have made an occasional error on the road.  Perhaps we could all calm down, slow down, and live to enjoy the holidays.

A Little Reminder

Posted Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien. M.D.

Are you a terrorist?  Are you a drug dealer?  Perhaps a criminal of some other variety?  The fact that you are reading this makes any of those possibilities quite unlikely.  And yet, our culture now assumes the worst of nearly everyone.  In an airport, we’re all treated like potential terrorists.  Hand the clerk in a grocery store a hundred dollar bill and she checks it to see if it’s counterfeit.  Anyone needing pseudoephedrine to breathe normally is treated like as if she may be running a crystal meth lab in her garage.  That’s ridiculous.  I don’t have a crystal meth lab in my garage.  It’s in the attic.  These days, too many people can’t recognize humor, much less reality.

Needing to fly somewhere does not make someone a terrorist.  Wanting to pay cash for groceries does not make someone a counterfeiter.  Trying to breathe more easily does not make someone a meth dealer.  Hoping for some pain relief does not make someone an addict.  As a society, we are making some very misguided judgments.  I recall that seven years ago I sought help from another internist when a long list of autoimmune diseases began spiraling out of control.  The “medical assistant” asked me what my main complaint was.  When I explained I had increasingly severe pain in my hands and feet, she quipped, “We don’t do pain management.”  I had to restrain myself.  I was there for a diagnosis, not a prescription.

Pain is the single most common symptom of most malignancies, autoimmune diseases, vascular diseases, and serious infections.  Renal disease, neurological disorders, metabolic diseases, and any inflammatory process can cause agonizing pain.  And we haven’t even touched on trauma.  Most patients who complain of pain are totally genuine and honest.  Some people exaggerate, some are manipulative.  Some, but not most.

Today, we have many veterans suffering constant pain from multiple amputations and other terrible conditions.  In many cases, they cannot obtain a month’s supply of pain meds.  They are forced to endure preposterous “policies” and “protocols” created by sanctimonious idiots.

If we really understood as much as we think we do about pain, pathophysiology, or pharmacology, we would ensure that patients have the pain medications they need to function.  Opioid addiction and overdoses are devastating problems.  But forcing patients with documented causes of severe pain to suffer needlessly is simply wrong.  Everyone who has had a cocktail, a beer, or a glass of wine does not become an alcoholic.  Everyone who needs chronic opioid treatment does not become an “addict.”

The whole point of health care is to relieve pain and suffering.  Perhaps we all need a little reminder.

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A Bit of Common Sense

Posted Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien, M.D.

Do you take care of patients?  Are you in a position to teach students or other caregivers?  These days, everyone in healthcare is simmering in a sea of policies, protocols, rules, regulations, and algorithms.  Some of them are reasonable.  A few even make good sense.  Unfortunately, however, many of them are downright dumb.  Often, by the time someone reaches the lofty position of creating assorted rules and policies, she has lost touch with her sector of the real world.  The results are not good.

In recent years I’ve been sidelined with a growing list of autoimmune diseases. I used to joke with audiences that with red hair, green eyes, and see-through skin, I was a walking collection of recessive genes.  It’s not a joke anymore.  Being in constant pain and steadily losing functional ability is not fun.  However, in my new role as “patient,” I have learned a few things that are not taught in most training programs.

In the hope that it might help a few other folks, here’s some of what I’ve learned:

  • Sunshine is our friend.  Over the years, I’ve spent far too little time outdoors.  I was a sickly little kid and a natural-born bookworm.  From the mid-1980s on, I was afraid of “skin damage.”  Swell.  Now I have decent-looking skin but my musculoskeletal system is so badly compromised I struggle to get in or out of a chair.  Please encourage patients to get some fresh air and sunshine on a regular basis — especially if these patients suffer from any chronic illness.  Vitamin D supplements are fine, but they can’t undo the damage of decades of deficiency.
  • Small comforts matter.  The point of health care is to relieve pain and suffering.  Many of our colleagues have apparently forgotten that.  Computers can provide information.  They cannot provide comfort and consolation.  There is a true art to easing another person’s misery, and it usually involves small, simple measures.  “Hugging” a king-size pillow while lying on your side can ease pressure and strain on shoulders, elbows, and knees.  Massaging a nicely-fragranced body butter into hands, arms, legs, and feet before bed can help ease the achiness that accompanies chronic illness.  It’s not a substitute for proper medication, but these measures can provide a few moments of respite.
  • Being squeaky clean feels good.  I was obsessed with hygiene even as a little kid.  But chronic pain and illness can make taking a shower, washing your hair, and brushing your teeth feel like a triathlon.  Nearly anyone who has had the flu can relate.  The most simple measures can make a difference:
    • Change pillow cases every 12–24 hours.  I did this for patients when I was a nurse’s aide 45 years ago.  I do it for myself now.  If feels nice.
    • Step up oral and dental care after meals and before bed.  This feels nice, too.  And, there are discernible medical benefits.
    • Try a shower in the morning and a warm bath at night (as long as it’s safe).  Baby wipes, facial wipes, and dry shampoo are essential for travel and chronic illness.
  • Never wake a sleeping patient for vital signs.  I can hear nursing instructors screaming right now.  However, if a patient is sound asleep, her vital signs are probably fine.  Despite all of our impressive technology and sophisticated medications, we have found nothing more restorative than good, deep sleep.

If policies and protocols eased misery, everyone would feel fine by now.  Sometimes what we need is a bit of common sense.

Little Charlie

Posted Posted in Brain Science, Continuing Education, Pain, Psychology

By Mary O’Brien, M.D.

Do you know what “Mitochondrial Deficiency Syndrome” is?  Most people don’t.  Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard.  Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria.  Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate).  In essence, ATP represents energy at the cellular level.  Without ATP, cells, especially brain and muscle cells, cannot function.  The most sensitive and vulnerable cells in the body are those of the cerebral cortex.  Little Charlie cannot see or hear or move or swallow or vocalize or think.  No one can know with absolute certainty, but he probably cannot “feel” anything at this point.  The word tragic is utterly inadequate.

The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing.  Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become.  Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation.  Some timeless principles are useful:

  • Embrace humility.  Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
  • Exercise the intellectual discipline to learn the facts involved.  In medicine, every patient is unique.  Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
  • Resist the temptation to become emotional.  Unbridled emotions cause far more problems than they solve.  Try to be the voice of reason.
  • Try not to confuse or conflate the issues.  People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology.  The case of Charles Gard is about medical ethics.
  • Focus on principles, not personalities.  There is a colossal difference between saving life and prolonging death.  Remember, there is never a moral imperative to render futile care.

Primum non nocere.  (First, do no harm.)  There’s a reason that Solomon prayed for wisdom.

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Arthritis and Diet

Posted Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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Neck Pain: An Introduction

Posted Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

Rear view of a young man holding her neck in pain, isolated on white background, monochrome photo with red as a symbol for the hardening

By Raj Hullon, MD

Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason.  One of the most common causes of such pain is poor posture.  Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain.  Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low.  The key is always to maintain the neck as close to a neutral position as possible.

The best medical care, however, begins with a crucial question:  What is the most serious problem this could be?  Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage.  Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.

Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time.  People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain.  It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling.  Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.

The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent.  Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs.  When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.

The natural healing processes result in improvement in almost all cases.  In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months.  There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.

Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments.  Whiplash injuries can be serious in certain situations.  Severe damage to the spinal cord can be fatal.

Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.

Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.

 

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